Tratamiento endovascular exitoso de aneurisma del arco aórtico en un paciente pediátrico / Successful endovascular treatment of aortic arch aneurysm in a pediatric patient

Resumen Antecedentes: Los aneurismas de la aorta ascendente son patologías poco frecuentes en la infancia, sobre todo en ausencia de enfermedades previas como el síndrome de Marfan. Objetivo: Dar a conocer la posibilidad del manejo endovascular exitoso de los aneurismas de grandes vasos, usando stent y micro catéter con embolización del saco aneurismático. Método: Presentamos el caso de una paciente de 10 años y 2 meses, previamente sana, en quien se documentó un pseudoaneurisma entre el origen de la arteria carótida común izquierda y la arteria subclavia izquierda, que logró manejarse de forma endovascular, inicialmente con un stent cubriendo el cuello del aneurisma con el fin de remodelarlo y posteriormente por medio de microcatéter se realizó embolización del saco del aneurisma con coils, con resultado exitoso. Resultados: Los aneurismas de los grandes vasos, como la arteria carótida común y la arteria subclavia, tienen riesgo de ruptura con complicaciones devastadoras; el manejo endovascular se plantea como una opción poco invasiva de manejo, con resultados favorables. Conclusión: El manejo de aneurismas de grandes vasos, por vía endovascular usando stent y microcatéter con embolización del saco aneurismático, es una opción novedosa de manejo que logra resultados exitosos.

Abstract Background: Ascending aortic aneurysms are rare pathologies in childhood, especially in the absence of previous diseases such as Marfan syndrome. Objective: Present the possibility of successful endovascular management of large vessel aneurysms, using stents and microcatheters with embolization of the aneurysm sac. Method: We present the case of a previously healthy ten-year-old patient, in whom a pseudoaneurysm was documented between the origin of the left common carotid artery and left subclavian artery, successfully managed endovascularly, initially with a stent covering the neck of the aneurysm to remodel it and later with embolization of the aneurysm sac using a microcatheter. Results: Aneurysms of large vessels, such common carotid artery and subclavian artery, are at risk of rupture with devastating complications; endovascular management is considered a minimally invasive management option, with favorable results. Conclusion: The endovascular management of large vessel aneurysms using stents and microcatheters with embolization of the aneurysmal sac is a novel management option that achieves successful results.

Hongos formadores de micorrizas aislados a partir de raíces de la orquídea Rodriguezia granadensis (LINDL.) RCHB. F / Mycorrhizal forming fungi isolated from roots of the orchid Rodriguezia granadensis (LINDL.) RCHB. F

RESUMEN Rodriguezia granadensis (Lindl.) Rchb. f. es una orquídea epífita que crece sobre árboles, en zonas poco intervenidas. Para la germinación de sus semillas y en los estadios iniciales de su desarrollo forma relaciones simbióticas con hongos micorrícicos, los cuales, brindan los nutrientes que necesita. En el municipio de Fusagasugá esta especie crece en condiciones naturales y debido a la belleza de sus flores es promisoria para su producción comercial, pero hay poca información sobre los microorganismos asociados a esta planta; por lo tanto, el presente trabajo tuvo como propósito identificar, a nivel de género, los hongos asociados a las raíces de R. granadensis, en el agroecosistema Hacienda Betania. Se tomaron muestras de raíz, anotando el forofito donde se encontraban las plantas. En laboratorio, se dividieron en tres extremos: proximal, medio y distal y se realizaron cortes transversales, para identificar enrollamientos hifales. Adicionalmente, se sembraron explantes en agar papa dextrosa, agar Sabouraud y medio de Ko y Hora. Se identificó al género Rhizoctonia, con una frecuencia del 95 %. Se encontró que el 70 % de las plantas muestreadas crecían sobre árboles de guayabo y el 30 % sobre cítricos. Los resultados indican que R. granadensis pueden tener interacciones con hongos del género Rhizoctonia.

ABSTRACT Rodriguezia granadensis (Lindl.) Rchb. f. is an epiphytic orchid that grows on trees in areas with little intervention. For seed germination and the initial stages of development, it forms symbiotic relationships with mycorrhizal fungi, which provide the necessary nutrients. In the municipality of Fusagasugá, this species grows in natural conditions and, due to the beauty of its flowers is a promissory specie to commercial production, but there is little information about the microorganisms associated with this plant; therefore, the purpose of this work was to identify, at the genus level, the fungi associated with the roots of R. granadensis in Betania farm. Root samples were taken, noting the phorophyte where the plants grew. In the laboratory, they were divided into three sections: proximal, middle, and distal, and made cross-sections to identify hyphal curls. Additionally, explants were put in potato dextrose agar, Sabouraud agar, and Ko and Hora media. The genus Rhizoctonia was identified, with a frequency of 95 %. It was found that 70 % of the sampled plants grew on guava trees and 30 % on citrus. The results indicate that R. granadensis may have interactions with fungi of Rhizoctonia genus.

Pseudoaneurisma de la arteria femoral profunda secundario a trauma penetrante: reporte de caso / Deep femoral artery pseudoaneurysm secondary to penetrating trauma: case report

Resumen Objetivo: El objetivo del trabajo es presentar una opción terapéutica adecuada para los pseudoaneurismas de la femoral profunda secundarios a trauma penetrante, así como realizar una revisión de la literatura sobre el manejo en estas patologías. Caso clínico: Paciente masculino de 21 años quien 5 meses previos a su valoración sufre una herida por arma punzocortante en el muslo izquierdo, desarrollando aumento de volumen el sitio de la lesión, dolor y limitación al movimiento. Se diagnostica un pseudoaneurisma de la arteria femoral profunda de 2,3 cm x 2,1 cm x 2,7 cm y un hematoma adyacente de 13,5 cm x 12,6 cm x 23 cm. Se realiza exclusión del pseudoaneurisma mediante cirugía endovascular con coils, posteriormente se evacúa el hematoma adyacente. Resultados: El paciente egresa al tercer día posoperatorio con mejoría de la sintomatología, antibioticoterapia y analgesia. Discusión y Conclusión: En el caso presentado la exclusión del pseudoaneurisma mediante coils facilitó el control de éste y la evacuación del hematoma adyacente, disminuyendo el riesgo de sangrado. Por lo que consideramos adecuada esta conducta terapéutica en pseudoaneurismas de la femoral profunda.

Aim: The aim of this paper is to present a case of a deep femoral artery pseudoaneurysm secondary to a penetrating trauma in the left thigh, its management and a literature review. Clinical Case: 21-year-old male referred to the emergency department of our institution 5 months after he was injured with a knife on his left thigh, with severe local swelling, local pain, and difficulty to the mobilization of the left leg. A 2.3 cm x 2.1 cm x 2.7 cm deep femoral artery pseudoaneurysm was diagnosed with a 13.5 cm x 12.6 cm x 23 cm adjacent hematoma. Endovascular exclusion was made with coils and evacuation of the hematoma with open surgery. Results: The patient was discharged on the third day postop without pain and walking with antibiotics and follow-up to a month did not reveal any complications. Discusion and Conclusion: Exclusion with coils is an adequate management in deep femoral pseudoaneurysms that facilitates the evacuation of the hematoma lowering the risk of bleeding.

Improvement of semen parameters after coil embolization of varicoceles: a systematic review / Melhora dos parâmetros seminais após embolização com molas de varicocele: uma revisão sistemática

Abstract This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.

Resumo Trata-se de uma revisão sistemática conduzida de acordo com o PRISMA 2009 (Principais Itens para Relatar Revisões Sistemáticas e Metanálises) que incluiu estudos em que a melhora dos parâmetros seminais tenha sido um dos desfechos. Esta revisão foi realizada com o objetivo de avaliar as evidências sobre o papel da embolização com uso apenas de molas na melhora de parâmetros seminais em homens com varicocele, uma vez que a embolização apenas com molas é o método com melhor custo-benefício para o reparo de varicoceles. A qualidade dos estudos foi analisada com o índice MINORS. Em seis estudos clínicos retrospectivos e em outros dois prospectivos observacionais ou comparativos, a concentração seminal melhorou significativamente em todos os cinco estudos que avaliaram esse parâmetro. A motilidade seminal melhorou significativamente em sete estudos. Não foi possível analisar o impacto da embolização com molas na densidade seminal.

Embolización venosa transcatéter de várices gástricas con coils / Transcatheter venous coil embolization of gastric varices

Resumen Los espirales de embolización (coils o microcoils) son los agentes más comúnmente usados, con un éxito técnico reportado en aproximadamente el 81-100 % de los casos. Los espirales o coils se encuentran disponibles en una amplia variedad de configuraciones y tamaños, lo que permite acomodarse a vasos de distintos calibres; además, por su buena radiopacidad, tienen la ventaja de ser liberados con precisión. Los espirales o coils son el análogo de una ligadura arterial quirúrgica, debido a que producen una oclusión mecánica por su posicionamiento en el lumen vascular, lo que disminuye el flujo sanguíneo, y sus fibras sintéticas tienen un efecto trombogénico adicional. Caso: presentamos cuatro casos del Hospital Universitario Fundación Santa Fe de pacientes con várices gástricas tratadas satisfactoriamente con embolización transcatéter con coils, los cuales tuvieron un buen resultado técnico; además presentamos una revisión de la literatura.

Abstract Coils and microcoils, the most commonly used embolization agents, have reported technical success rates ranging from 81% to 100% of cases. The spirals or coils are available in a wide variety of configurations and sizes which fit into vessels of different calibers. They have good radiopacity allowing for accurate release. Coils are the analogue of a surgical arterial ligation, because they produce mechanical occlusion due to their positioning in the vascular lumen. This decreases blood flow while their synthetic fibers have an additional thrombogenic effect. Case: We present four cases of coil embolization treatment of gastric varicose veins at our institution. All procedures were successful and had good technical results. We also present a review of the literature.

Ensayo pictórico: control imagenológico de aneurismas tratados ¿qué examen elegir? / Pictorial essay: imaging control of treated aneurysms. which exam to choose?

Resumen: El tratamiento de aneurismas intracraneanos rotos y no rotos incluye opciones quirúrgicas (clips vasculares) y endovasculares. Existen varios dispositivos y técnicas de manejo endovascular (coils, stents, diversores de flujo), cuyo conocimiento permite elegir e interpretar adecuadamente las técnicas de imágenes para el seguimiento no invasivo. Mediante una revisión pictográfica del control de aneurismas intracraneanos tratados quirúrgicamente y vía endovascular, se muestran las diferencias en la capacidad de caracterización en el seguimiento con angio TC, angio RM sin contraste (con técnica de "tiempo de vuelo" o "TOF" por sus siglas en inglés), angio RM con gadolinio endovenoso (C+) y angiografía por sustracción digital (ASD). Adicionalmente se entregan recomendaciones para el seguimiento de aneurismas según modalidad y dispositivo de tratamiento.

Abstract: Treatment of intracranial ruptured and unruptured aneurysms can be performed with surgical (vascular clips) or endovascular procedures (coils, stents, flw diverters). There are several devices and techniques for endovascular treatment. Knowledge of this techniques allows physicians to choose and interpret accurately imaging modalities for non-invasive follow-up. Through a pictorial essay of imaging follow-up of treated intracranial aneurysms we show the differences in characterization with computed tomography angiography, magnetic resonance angiography without contrast (time of flght or "TOF" technique), contrast enhanced MR angiography (C+) and digital subtraction angiography (DSA). Additionally we recommend imaging modalities for each treatment device.

Recurrence of Small Cerebral Aneurysms (< 4 mm) Treated Endovascularly Using Target® Nano™ Coils

OBJECTIVE: In our series, endovascular coiling with Target® Nano™ coils (Stryker Neurovascular, Fremont, CA, USA) with diameters of 1 or 1.5 mm exhibited favorable technical feasibility in the treatment of small cerebral aneurysms (< 4 mm). However, little is known about the recurrence of small cerebral aneurysms treated using Target® Nano™ coils. We investigated recurrence following the treatment of small cerebral aneurysms using Target® Nano™ coils. MATERIALS AND METHODS: Between January 2012 and November 2013, 143 patients with 148 small cerebral aneurysms (< 4 mm) were included our study. A total of 135 cerebral aneurysms (91.2%) were unruptured; 45 cerebral aneurysms (30.4%) were treated by endovascular coiling using Target® Nano™ coils. Follow-up radiological images were obtained for 132 cerebral aneurysms (89.2%) over a range of 3 to 58 months (mean, 34.3 months; standard deviation, 14.2). RESULTS: In the group treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 33 (73.3%), residual necks in eight (17.8%), and residual sacs in four (8.9%) cases. Follow-up radiological outcomes revealed complete occlusion in 35 (77.8%) and residual necks in four (8.9%) cases that exhibited stable coil masses. In the group that was not treated with Target® Nano™ coils, radiological outcomes revealed complete occlusion in 69 (67%), residual necks in 18 (17.5%), and residual sacs in 16 (15.5%) cases. Follow-up radiological outcomes revealed complete occlusion in 87 (84.5%) and residual necks (5.8%) in six cases that exhibited stable coil masses. No significant differences were observed in the radiological outcomes or follow-up radiological outcomes between the two groups. No recurrences or retreatments occurred in our series. CONCLUSION: Endovascular treatment using Target® Nano™ coils may be a robust treatment option for small cerebral aneurysms (< 4 mm).

Initial practice on quality control tests and action limits setting of birdcage head coils / 中国医学影像技术

Objective To establish clinical quality control method with testing the birdcage head coils and setting up the action limits.Methods Three different MR devices (GE 1.5T HDi,GE 3.0T HD and GE 3.0T 750W) and corresponding birdcage coils were tested.Axial T1WI was performed to scan ACR phantom.SNR,percent image uniformity (PIU) and percent signal ghosting (PSG) were measured for six times,and the mean values and standard deviations (SD) were calculated.Based on the results,the action limits for each parameter were set.Results The mean value of SNR for the three devices was 262.14,280.47 and 474.24,and SD was 18.43,29.67 and 29.95,respectively;the action limits were ≥225.28,≥221.13 and ≥414.34,respectively;the mean value of PIU for the three devices was 95.00％,83.17％ and 84.33％,SD was 0.63％,1.17％ and 0.82％,respectively;the action limits were ≥93.74％,≥82.00％ (corrected) and ≥82.69％,respectively.The mean value of PSG for the three devices was 0.11％,0.07％ and 0.14％,SD was 0.12％,0.03％ and 0.11％,respectively;the action limits were ≤0.35％,≤0.13％ and ≤0.36％,respectively.Conclusion All of SNR,PIU and PSG for three MR devices were consistent with the action limits in this study.

Efficacy evaluation of embolization with Scepter balloon-assisted coils and Onyx glue for traumatic carotid cavernous fistula / 中华创伤杂志

Objective To evaluate the efficacy and safety of embolization with Scepter balloonassisted coils and Onyx glue in treatment of traumatic carotid cavernous fistula (TCCF).Methods A retrospective case series study was conducted on the clinical data of 24 patients with TCCF managed with embolization with Scepter balloon-assisted coils and Onyx glue from February 2012 to February 2017.There were 20 males and 4 females,aged 21-65 years [(42.6 ± 6.8) years],with Glasgow coma scale (GCS) of 15 points.All patients were with unilateral lesions,with 13 on the right and 11 on the left.Among TCCF patients,23 patients were with cranial bruit,22 with pulsating exophthalmos and bulbar conjunctiva congestion edema,19 with orbital symptoms,and 9 with visual impairment.A micro-catheter was sent into the cavernous sinus of lesion side,and the location of traumatic carotid cavernous fistula and draining characteristics were identified by micro catheter contrast.With a balloon inflated to cover the fistula and protect the interual carotid artery,Onyx was injected into the cavernous sinus after several coils were deployed adjacent to the fistula until the complete occlusion of fistula.Cranial bruit,pulsating exophthalmos,visual impairment,and orbital symptoms before operation and 2 weeks after operation were observed.Six months after operation,digital subtraction angiography (DSA) was reviewed to evaluate the carotid artery patency and TCCF recurrence.Results The cranial bruit,pulsating exophthalmos,and bulbar conjunctiva congestion edema in all TCCF patients disappeared 2 weeks after operation.No obvious improvement was seen in 2 out of 9 patients with visual impairments and 2 out of 19 patients with orbital symptoms,but there was significant improvement after operation (P ＜ 0.05).Onyx glue adhering to the surface of the protective balloon occurred in one patient.The balloon and catheter were delivered to the external carotid artery and then removed,with no complication seen.Follow-up found no recurrence or operative complications in 6-12 months.Complete occlusion of fistula was seen in all patients,and the internal carotid artery showed good patency.Conclusion Embolization with Scepter balloon-assisted coils and Onyx glue can occlude fistula,eliminate ocular symptoms,and maintain internal carotid artery patency and hence is an effective and safe treatment option for TCCF.

Growth rates of dynamic dermal model exposed to laminar flow and magnetic fields

Abstract Introduction Ongoing research in the use of electromagnetic stimulation as coadjuvant in fracture healing has led the authors to begin generating computer models in order to predict cellular growth changes when cells are electromagnetically stimulated. By generating these models, scientists will be able to better understand how electromagnetic fields affect cellular development. The experimental design integrated a cellular culture bioreactor along with an external magnetic stimulation system, which allowed for dermal models to be exposed to controlled magnetic fields. Methods Initially, it was necessary to analyze the static growth of Normal Human Skin Fibroblast (NHSF) cells when they were exposed to Extremely Low Frequency – Electromagnetic Fields (ELF-EMFs). Using optimal conditions for the NHSF culture, from stimulation signal to scaffolding material, we were able to perform the dynamic flow stimulation experiments. Results The following systems were developed: (1) a bioreactor aimed at cellular tissue culture, and (2) Helmholtz coils capable of generating stimulation signals for the cultured tissue. The authors were able to appreciate the quantified values of cellular density diluted in all the experiment samples that were taken and overall, the irradiated samples displayed an average increase of 53% higher cellular density for the same amount of initial cellular seeding when the cells were exposed to a 1 mT, 60 Hz magnetic field signal. Conclusion ELF-EMF’s indeed alter NHSF cell growth rates and it is the challenge of the authors to continue investigating what cellular mechanisms are altered when cells are exposed to ELF-EMF’s.

Efficacy analysis of endovascular treatment of vertebral basilar artery dissecting aneurysms / 中国脑血管病杂志

Objective To investigate the effect of endovascular treatment of vertebral basilar artery dissecting aneurysms. Methods The clinical data of 40 patients with vertebral basilar artery dissecting aneurysm admitted to Beijing Xuanwu Hospital and Haidian hospital,Capital Medical University from August 2013 to September 2014 were analyzed retrospectively. Their clinical symptoms and imaging were followed up. According to the treatment methods,they were divided into either a stent-assisted coil emboliza-tion group (group A;n = 34)or a parent artery occlusion (group B;n = 6),and according to the clinical symptoms and imaging followed-up,the efficacy was assessed at 1 year after procedure. Results The patients were followed up for 1 year after procedure,29 patients (85. 3%)were improved in group A, 1 (2.9%)was stable,and 4 (11. 8%)deteriorated. All the 4 deteriorated patients died of cerebral infarction complications (at 1 week to 6 months after procedure). The 6 patients in group B were improved compared with before procedure. No intracranial hemorrhage and ischemic events occurred. Conclusion Using the stent-assisted coil embolization technique and the parent artery occlusion technique for the treatment of the vertebral basilar artery dissecting aneurysms are relatively safe and effective.

The use of coils in endovascular repair of aortic diseases / 中华普通外科杂志

Objective To summarize the experience and efficiency of coils in endovascular aortic repair.Methods From September 2008 to December 2013,48 patients received endovascular aortic repair in combination of coil embolization including abdominal aortic aneurysm in 32 patients, and aortic dissection in 16.Results Coils were successfully implanted in all cases.One patient with ruptured abdominal aortic aneurism (AAA) underwent emergency endovascular aortic repair and died of multiple organ failure the day after surgery.One patient died of pulmonary artery embolization 3 hours after TEVAR.44 patients were followed up ranging from 7 to 60 months.In AAA group, 25 patients received endovascular exclusion in combination with internal iliac artery embolization, four of them had claudication due to gluteal ischemia but without other severe complications.Post-operative CTA found endovascular thrombosis in aneurysm.In the aortic dissection group, one patient died of pulmonary infection.During the follow up, there was no AAA dissection, and AAA rupture.Post-operative CT confirmed thrombus in cavity.There were no scaffold and coil translocation and surrounding tissue injury.Conclusions Endovascular aortic repair in combination with coil embolization is a complementary treatment to aortic diseases.

Cierre percutáneo de fístulas coronario-pulmonares en el adulto / Percutaneous closure of coronary-pulmonary fistula in the adult

El cierre percutáneo de las fístulas coronario-pulmonares con implante de "coils" es eficaz y pueden realizarlo los cardiólogos intervencionistas de adultos. Se presentan tres casos clínicos de cierre percutáneo exitoso de fístulas coronario-pulmonares con implante de "coils".

Percutaneous closure of coronary-pulmonary fistula with "coils" implant is effective and may be accomplished by adult interventional cardiologists. We present three cases of successful percutaneous closure of coronary-pulmonary fistula with implant of "coils".

MRI features of different sizes of small coil using a water phantom / 中华放射学杂志

Objective To explore the imaging characteristics of different sizes of MR small surface coil.Methods A water phantom with NiSO4· 6H2O for Siemens was scanned with 4 cm,7 cm and 11 cm small surface coils in Siemens 3.0 T MR system.T1WI,T2WI,three dimensional reversed fast imaging with steady state precession with diffusion-weighted(3D-PSIF-DWI) and three dimensional fast imaging with steady state precession and fat suppression(3D-FISP-FS) images were obtained.The imaging area,signal intensity (SI),standard deviation (SD) and signal-to-noise ratio (SNR) variations of different depths (from the near to the distant) were measured and compared.Curves according to the SI and SNR data were draw.SI and SNR characteristics of images obtained by L11 separately and used together with spine matrix coil were compared by using signed rank sum test.Results The signal intensity of images scanned by 4 cm,7 cm small surface coil decreased gradually in the depth of 0.2 to 2.2 cm,maintain good signal uniformity in the depth of 2.2 to 4.2 cm,and the signal intensity obtained by 11 cm coil maintain good signal uniformity in the depth of 5.2 cm.The optimum imaging widths of 4 cm,7 cm and 11 cm coil were about 7.0,8.5 and 11.0 cm.As the diameter of the coil increased,the imaging width and depth increased,but the received noise also increased.The SNR gradually reduced from the center to the edge of the coils.The imaging area increased but the local SNR decreased when using L11 coil combine with spine matrix coil,which showed a statistically significant difference (Z=-2.354,P=0.019).Conclusions A suitable size of small surface coil should be chosen according to the location and size of the organ or lesion before clinical MR examination.Other coils should be turned off to improve the SNR.

Accuracy of Preoperative MRI with Microscopy Coil in Evaluation of Primary Tumor Thickness of Malignant Melanoma of the Skin with Histopathologic Correlation

OBJECTIVE: The purpose of this study was to evaluate the accuracy of a preoperative MRI with microscopy coils in determining the primary tumor thickness of malignant melanoma with histopathologic correlation. MATERIALS AND METHODS: Eleven patients with histopathologically confirmed malignant melanoma were included in this study. MR images of the tumors were obtained with a 47-mm microscopy coil on 1.5T MR scanners and were evaluated by two radiologists, who assessed the thickness of the primary tumor on T2-weighted images (T2WI) and gadolinium-enhanced T1-weighted images with fat suppression (Gd-T1WI) and compared the results with the histopathologic findings as the reference standard. Correlations between tumor thickness on MRI and histopathologic examination were assessed using concordance correlation coefficients (CCCs). Inter- and intraobserver variabilities of tumor measurements were also assessed by intraclass correlation coefficient (ICC). RESULTS: Among the 11 cases included in the study, 10 cases from the same number of patients were managed with surgical excision and one case was confirmed with punch biopsy. The primary tumor thickness measured on T2WI showed better correlation with histopathologic results, as compared with measurements taken on Gd-T1WI: the CCC of measurements on T2WI ranged from 0.64 to 0.78, indicating a substantial agreement, whereas the CCC of measurements on Gd-T1WI ranged from 0.50 to 0.61, indicating a moderate to substantial agreement. Inter- and intraobserver agreements of readers 1 and 2 were excellent for both T2WI and Gd-T1WI, with ICC ranging from 0.86 to 0.99. CONCLUSION: MR imaging with microscopy coils may be an accurate technique in the preoperative assessment of tumor thickness in malignant melanoma, especially on T2-weighted images.

Number of coils necessary to treat cerebral aneurysms according to each size group: a study based on a series of 952 embolized aneurysms / Quantidade de molas necessárias para o tratamento endovascular dos aneurismas cerebrais de acordo com seu tamanho: estudo baseado em uma série de 952 aneurismas embolizados

OBJECTIVE: The Brazilian public health system determines a quantity of coils allowed to treat a cerebral aneurysm. The goal of this paper was to determine the number of coils necessary to treat an aneurysm based on size. METHODS: All patients harboring an aneurysm treated by endovascular approach between 1999 and 2003 were reviewed. RESULTS: There were 952 aneurysms included. Mean diameter sac was 8.2 mm with 7.9 coils per aneurysm. Out of 462 small aneurysms, mean size was 4.8 mm, with 4.6 coils/aneurysm used. A total of 315 medium aneurysms were treated, mean size was 8.6 mm, with 8.2 coils. Out of 135 large, mean size was 17 mm, with 16.1 coils. Forty giant aneurysms were treated with a mean size of 32 mm and 28.7 coils. CONCLUSIONS: We propose size as a reference to predict the number of coils necessary to treat each aneurysm: one coil for each millimeter of diameter.

OBJETIVO: O sistema público brasileiro determina uma quantidade limitada de molas permitida para o tratamento endovascular dos aneurismas cerebrais. O objetivo deste trabalho foi determinar a quantidade de molas necessária para tratar um aneurisma usando tamanho como referência. MÉTODO: Foram revisados todos os pacientes com aneurismas embolizados entre 1999 e 2003. RESULTADOS: No total, 952 aneurismas foram analisados. O diâmetro médio foi de 8,2 mm, com 7,9 molas usadas por aneurisma. Do total, 462 aneurismas eram pequenos, com tamanho médio de 4,8 mm e 4,6 molas/aneurisma. Foram tratados 315 aneurismas médios, com tamanho médio de 8,6 mm e 8,2 molas/aneurisma. Dentre os 135 aneurismas grandes, o tamanho foi de 17 mm, com 16,1 molas/aneurisma. Foram tratados 40 aneurismas gigantes, com média de 32 mm e 28,7 molas/aneurisma. CONCLUSÃO: Propomos que se utilize o tamanho do aneurisma como referência para prever o número de molas necessário para embolização: uma mola para cada milímetro de tamanho do saco aneurismático.

Affection of embolism on rat aneurysm model with new platinum coils modified by VEGF / 中华神经医学杂志

Objective To explore the embolization effect of new platinum coils coated with [4COOH-P (DLLA-co-TMC)] biodegradable polymer and released vascular endothelial growth factor (VEGF) into intracranial aneurysms on rat intracranial aneurysms. Methods A total of 54 adult healthy female SD rats were randomly divided into Group Ⅰ with general platinum coils, Group Ⅱ with polymer-coated platinum coils and Group Ⅲ with platinum coils modified with VEGF (n=18).The right common carotid arteries (CCA) of rats in each group were exposed; and the 8 mm lengths of platinum coil segments were inserted into the ligated right CCA of rats. The distal right CCA was performed ligation and restored the blood flow; 6 rats each time at 15,30 and 90 d after the surgery were chosen;and the distal right CCA was used as aneurysm models,and the left CCA without the coil placement or surgical disruption in Group I with general platinum coil was chosen as normal control.The proliferation and fibrosis of endothelial cells were observed by HE staining; von Willebrand Factor (vWF) expression was detected by immunohistochemical staining; and VEGF expression was examined by Western blotting. Results Cellular proliferation and fibrosis in Group Ⅲ with platinum coils modified with VEGF enjoyed significantly higher grade than those in Group Ⅰ with general platinum coils 10,60 and 90d after the surgery (P＜0.05); Cellular proliferation and fibrosis in Group Ⅲ with platinum coils modified with VEGF enjoyed significantly higher grades than those in Group Ⅱ with polymer-coated platinum coils 30 d after the surgery (P＜0.05).Pathological observations showed that the massive intimal hyperplasia and substantial clot completely occluded the aneurysm lumen in Group Ⅲ with platinum coils modified with VEGF; New small blood vessels having vwf-positive expression were noted in the fiberized tissues;the thrombosis in Group Ⅰ with general platinum coils and Group Ⅱ with polymer-coat platinum coils were not fully organized and showed loose hyperplasia structure with a large number of internal spaces.Western blotting indicated that the VEGF level in Group Ⅲ with platinum coils modified with VEGF were significantly higher than that in other groups 15 and 30 d after the operation,however,the VEGF level in Group Ⅲ with platinum coils modified with VEGF 90 d after the surgery was decreased because the lumen completed fibration and degradation of 4COOH-P (DLLA-co-TMC). Conclusion The VEGF-eontaining biodegradable polymer,by slowly releasing VEGF to modify the surface of platinum coils, could enhance the cellular proliferation, thrombosis and formation of dense fibrous tissue in aneurysm lumen; as compared with general platinum coils,these new platinum coils could occlude the rat aneurysm faster and more completely.

A Case of Pial Arteriovenous Fistula with Giant Venous Aneurysm and Multiple Varices Treated with Coil Embolization

Intracranial pial arteriovenous fistulas (AVFs) are rare vascular lesions of the brain. These lesions consist of one or more arterial connection to a single venous channel without true intervening nidus. A 24-year-old woman visited to our hospital because of headache, vomiting, dizziness and memory disturbance that persisted for three days. She complained several times of drop attack because of sudden weakness on both leg. Cerebral angiograms demonstrated a giant venous aneurysm on right frontal lobe beyond the genu of corpus callosum, multiple varices on both frontal lobes fed by azygos anterior cerebral artery, and markedly dilated draining vein into superior sagittal sinus, suggesting single channel pial AVF with multiple varices. Transarterial coil embolization of giant aneurysm and fistulous portion resulted in complete disappearance of pial AVF without complication.

Complete Visual Recovery after Mycotic Aneurysm Embolization Complicated by Cavernous Sinus Thrombophlebitis

A 62-year-old woman has been suffered from cavernous sinus thrombophlebitis which was confirmed by four-vessel angiography, orbit magnetic resonance imaging, and blood culture. Three weeks after recovery of cavernous sinus thrombophlebitis, right eye proptosis and complete third, fourth, and sixth cranial nerve palsies developed. Best-corrected visual acuity decreased to 20/70 in the right eye. Repeat magnetic resonance imaging demonstrated a 1.5-cm-sized mass in the right cavernous sinus, suspicious for mycotic aneurysm. Amphotericin B supplementation was begun and was followed by successful transarterial Guglielmi detachable coil embolization. Four months later, extraocular movement was normalized, and visual acuity improved to 20/25 in the right eye.

A clinical study of NexusTM coils for endovascular occlusion of intracranial aneurysms / 中华神经医学杂志

Objective To analyze the effect of NexusTM coils for endovascular occlusion of intracranial aneurysms. Methods In 41 patients with intracranial aneurysms, endovascular occlusion of 43 aneurysms was performed using NexusTM coils. The follow-up data of the patients for 6 to 12 months were reviewed, and the imaging data from digital subtraction angiography (DSA), CT angiography (CTA) or magnetic resonance arthrography (MRA) alter the treatment were analyzed. Results In the 41 patients, 1 died, 1 had aneurysm recurrence, 3 had cerebral infarction, 1 showed ocular paralysis, and 2 developed hydrocephalus after the surgery. Evaluation with modified Rankin Scale showed grade 0 in 8 cases, grade 1 in 19 cases, grade 2 in 7 cases, grade 3 in 3 cases, grade 4 in 1 case, grade 5 in 1 ease and grade 6 in 1 case. Conclusion Endovascular embolization with NexusTM coils is effective for treatment of intracranial aneurysms especially in cases of small aneurysms and parent artery occlusion. Caution should be taken with the coil for endovascular occlusion of the neck of anterior and middle cerebral artery aneurysms with thin parent arteries, as the fibers in the coil may cause thrombosis and potential cerebral infarction.