Stent-assisted coiling of intracranial carotid ophthalmic segment aneurysm segment aneurysms: Long-term follow-up from a single center.

Background: To evaluate the efficacy of stent-assisted coiling (SAC) for the treatment of carotid ophthalmic segment aneurysm segment aneurysms (OSAs) of the internal carotid artery (ICA) through detailed long-term follow-up of a large patient cohort. Methods: We retrospectively analyzed 88 consecutive patients with OSAs between January 2009 and January 2020 â€‹at our center. Angiographic results were evaluated using the modified Raymond grading system and clinical outcomes were evaluated using the mRS scale. The primary endpoints were major aneurysm recurrence and poor clinical outcomes for at least 18 months of follow-up. The patients were asked to attend clinical follow-up assessments and possibly undergo DSA or MR via telephone. Results: We enrolled 88 patients with 99 OSAs treated with coiling, of whom 76 were treated with SAC. The coiling procedures were successful in all 88 patients. Overall, complications occurred in 8 patients (9.1%). No procedure-related mortality was observed. 67 (76.1%) experienced immediate aneurysm occlusion at the end of the procedure. Long-term angiographic follow-up (18 months) was available in 45/88 aneurysms (51%) (average 18.7 â€‹± â€‹5.2 months). Four patients continued their follow-up for 5 years after initial aneurysm treatment. After a clinical follow-up time of 28.7 months (range, 12-51 months), 85 patients (95.5%) achieved favorable clinical outcomes (mRS scores of 0-2). Conclusions: This study indicates that SAC treatment is a safe and effective therapeutic alternative for ruptured and unruptured OSAs. The procedural risks are low with relatively long-term effectiveness.

Analysis of Risk Factors for Anterior Communicating Artery Aneurysm Rupture: A Single-Center Study.

BACKGROUND: Congenital hypoplasia or aplasia of the A1 segment of the anterior cerebral artery is associated with an increased incidence of berry aneurysms at the anterior communicating artery (ACoA) complex. We analyzed the factors contributing to ACoA aneurysm rupture. METHODS: We retrospectively analyzed the data of patients with ACoA aneurysms who had undergone cerebral angiography from July 2008 to January 2020. The risk factors for rupture were identified using univariate and multivariate logistic regression models. We used the imaging data of patients without intracranial aneurysms as the control population. RESULTS: We confirmed 253 aneurysms in 253 patients, including 137 men (54.2%) and 116 women (45.8%), with a mean age of 54.6 ± 12.7 years. Of the 253 aneurysms, 218 (86.2%) were ruptured and 35 (13.8%) were unruptured, with a mean diameter of 4.56 ± 1.96 mm and 3.24 ± 1.79 mm, respectively. Of the 253 aneurysms, 176 (69.6%) were <5 mm in diameter, 146 (83%) of which were ruptured. Of the 253 patients, 141 (55.7%) exhibited A1 segment hypoplasia or aplasia: 106 (41.9%) on the right side of the circle of Willis and 35 (13.8%) on the left. Multivariate logistic regression analysis identified the aneurysm diameter (odds ratio, 4.11; 95% confidence interval, 1.601-16.07; P = 0.003) and age <65 years (odds ratio, 0.17; 95% confidence interval, 0.062-0.48; P < 0.001) as independent predictors of rupture. CONCLUSIONS: ACoA aneurysms are small (<5 mm) and have a high risk of rupture. A1 segment hypoplasia or aplasia is a risk factor for ACoA aneurysm formation; however, it was uncorrelated with aneurysm diameter or rupture risk. The strongest independent risk factors for rupture were age <65 years and aneurysm diameter.

Gastric fundus splenosis with hemangioma masquerading as a gastrointestinal stromal tumor in a patient with schistosomiasis and cirrhosis who underwent splenectomy: A case report and literature review.

RATIONALE: Splenosis is the heterotopic auto-transplantation of the splenic tissues. Gastric splenosis in a rare location mimics a gastrointestinal stromal tumor (GIST). Gastric splenosis with hemangioma has not been reported throughout the literature. PATIENT CONCERNS: We report a case of a 74-year-old schistosomiasis cirrhosis splenectomy woman diagnosed with gastric fundus mass. Preoperative computed tomography and endoscopic ultrasonography revealed findings suggestive of a GIST. DIAGNOSES: The mass located in the gastric fundus muscularis propria, measuring 3.9 × 2.8 × 2.4 cm with a dark red color, was removed by surgery. In the mass, a 1 × 1-cm red-purple nodule was also found. On microscopic examination, a well-formed splenic tissue divided into two compartments-white pulp and red pulp-separated by an ill-defined interphase known as the marginal zone. However, a nodule in the heterotopic spleen was mainly composed of larger thin-walled muscular vessels. The final diagnosis was gastric splenosis with hemangioma. INTERVENTIONS: After discussion in a multidisciplinary conference, the patient was considered for a GIST resection under gastroscopy. In the process of peeling, the surface of the mucosal, submucosal, muscle layers and the tumor surface were diffusely oozing. The effect of electrocoagulation and hemostasis was extremely poor. Therefore, endoscopic surgery was arrested. After dealing with the patient's family, a combination of laparoscopic-gastroscope double-mirror surgery was decided in accordance with the principle of minimally invasive surgery to preserve the stomach. Owing to several adhesions and concealed the location of tumor, we stopped the double-mirror combination surgery plan. Considering the great possibility of a malignant GIST, we still decided to continue the traditional surgical resection. The tumor was then removed via surgery OUTCOMES:: The patient was favorable with healing and discharged on postoperative day 10. LESSONS: Gastric splenosis with an associated hemangioma is the first well-documented case. Its pathogenesis may be direct implantation. Appropriate medical history taking and Tc-99 m heat-denatured RBC spleen scintigraphy (Tc-99MHDRS) are valuable for its diagnosis; however, pathology is the gold standard. Surgery is a reasonable treatment for gastric splenosis with hemangioma.

The curative effect analysis and nursing measures of the transvaginal myomectomy and transabdominal myomectomy.

To analyze the curative effects of the transvaginal myomectomy (TVM) and the traditional transabdominal myomectomy (TAM). The group with traditional TAM received routine preoperative nursing guidance and postoperative care. While the group with TVM received preoperative strengthened psychological care, vaginal preparation and postoperative strengthened vagina nursing, paying attention to the prevention and treatment of complications, and maintaining effective pelvic draining and other nursing measures. After that, the statistical processing and analysis were used to compared the intraoperative blood loss, operating time, postoperative infusion time, hospitalization time, postoperative eating, postoperative ambulation, the usage rate of postoperative analgesic, postoperative morbidity and postoperative complications between the two groups Comparison between TVM group and TAM group showed that the difference of the operating time, postoperative infusion time, hospitalization time, postoperative eating, postoperative ambulation, the usage rate of postoperative analgesic, postoperative morbidity and postoperative complications between the two groups were statistically significant (P<0.05). While the difference of intraoperative blood loss between the two groups were not statistically significant (P>0.05). The operating time in TVM group was shorter than TAM group; the postoperative eating, postoperative ambulation were earlier than the TAM group; the duration of postoperative transfusion and hospitalization in TVM were shorter than the TVM group; and the usage rate of postoperative analgesic and postoperative morbidity and complications in TVM group were less than the TAM group. TVM have the advantages of minimal invasion, quick recovery, less pain, shorter hospitalization duration and notable curative effect etc. Strengthening nursing care is the key to the success of treatment.

Viability assessment of magnetic resonance spectroscopy for the detection of minimal hepatic encephalopathy severity.

OBJECTIVE: To evaluate regional cerebral metabolic changes in minimal hepatic encephalopathy (MHE) patients using magnetic resonance spectroscopy (MRS) in 3T scanner. MATERIALS AND METHODS: This study comprised 30 cirrhotic patients with MHE, 29 cirrhotic patients without MHE and 30 healthy volunteers. Single-voxel proton MRS data in the anterior cingulate cortex (ACC) and basal ganglia were acquired using a 3-T scanner. The concentrations of N-acetylaspartate (NAA), mI (myo-inositol), glutamate (Glu), glutamine (Gln) and creatine (Cr) were obtained by LC-model software. Statistical analysis was performed to evaluate the differences between the three groups. RESULTS: There was a significant increase in Glu for the cirrhotic patients, particularly the MHE patients. There was an elevation of Gln in the cirrhotic patients, but not in all cirrhotic patients or controls. There was a significant decrease in mI for the cirrhotic patients, but no significant difference between the two cirrhosis groups. There was no significant difference in NAA between the three groups. CONCLUSIONS: MRS using a 3-T MR scanner could detect cerebral metabolic changes in cirrhotic patients with MHE. Glu levels were elevated in cirrhotic patients with MHE; Glu levels could be used as a sensitive indicator to evaluate the severity of MHE in patients with cirrhosis.

Pseudolesions on clinical imaging caused by Sappey veins: a dynamic contrast magnetic resonance and Doppler study.

AIM: This study aimed to investigate the anatomy and mechanism of pseudolesions around falciform ligament, which appeared on dynamic contrast magnetic resonance (MR) imaging. METHODS: A total of 30 cases were included in the normal control group (group 1), and 30 cases were enrolled into the liver cirrhosis group (group 2). All cases underwent MR examination including in-phase and out-phase T1-weighted image, T2-weighted fat-suppressed image, and dynamic MR imaging enhancement scanning. The MR images were analyzed to detect pseudolesions, and results from the 2 groups were compared. An ultrasound examination was also performed in all cases to assess the abdominal umbilical vein blood flow. RESULTS: In group 1, MR images detected pseudolesions in 13 cases, and signal reduction did not appear in out-phase MR images compared with in-phase MR images. In 5 of these cases, the umbilical vein was observed to be connected with the hepatic IV segment, and direction flow was toward hepatic during Doppler ultrasound examination. In the 30 patients with liver cirrhosis, pseudolesions were not detected in any of the cases, dilation of the vena epigastricas was observed in 12 cases, and flow direction was from liver. The difference in the incidence of falciform ligament pseudolesions between group 1 and group 2 was statistically significant (P > 0.01). CONCLUSIONS: Pseudolesions around the falciform ligament are associated with the Sappey vein, and there is no significant relationship with fatty infiltration.

[Relationship between adiponectin and beta-cell function in abdominal visceral obesity women].

OBJECTIVE: To investigate the relationship between adiponectin and beta-cell function in abdominal visceral obesity women. METHODS: Nine abdominal visceral obesity women (VO), 9 normal subjects (C) and 7 patients with type 2 diabetes mellitus (T2DM) were enrolled in the study. Beta-cell function and insulin sensitivity were determined by hyperglycemic clamp, fasting serum adiponectin was assayed by ELISA and regional body fat was measured by MRI. RESULT: The levels of first phase insulin release (FPIR), glucose disposal rates (GDR), insulin sensitivity index (ISI) and adiponectin were significantly elevated in control group compared with VO group and T2DM group. As compared with T2DM group, the levels of adiponectin, FPIR, second phase insulin release (SPIR) and maximum insulin release (INS(max)) increased significantly in VO group. Multiple stepwise regression analysis showed that age, FPIR and GDR were positively correlated to adiponectin (B=0.145, 0.194, 0.277 respectively, all P<0.05), while waist-hip ratio was negatively correlated with adiponectin (B=-7.424, P<0.05). CONCLUSION: The visceral obesity women have lower adiponectin levels, and hyperadiponectinemia may be the link with insulin secretion.