The Silk Vista Baby - The UK experience.

BACKGROUND: The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB. MATERIALS AND METHODS: We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected. RESULTS: We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30-72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1-36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm).An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%).Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) - one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up. CONCLUSION: The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.

An efficacy and safety comparison between different stentriever designs in acute ischaemic stroke: a systematic review and meta-analysis.

AIM: To assess the recanalisation rates and long-term functional outcomes of the Solitaire and Trevo devices; to compare these results to those from the Solitaire With the Intention For Thrombectomy (SWIFT) trial and TREVO 2 studies; and to assess for statistical differences in the outcomes between the two devices. MATERIALS AND METHODS: A systematic review and meta-analysis of studies that utilised stentrievers in the treatment of acute ischaemic stroke was conducted. The results were compared to those of the SWIFT and TREVO 2 trials and outcome differences between Trevo (Stryker, Kalamazoo, Michigan, USA) and Solitaire (ev3/Covidien, Irvine, California, USA) were analysed statistically. RESULTS: Solitaire had a lower mortality rate compared to Trevo (16.2% [95% confidence interval {CI}: 13.1%, 19.8%] versus 22.2% [95% CI: 10.8%, 40.2%]) and achieved a higher rate of functional independence (52.1% [95% CI: 46.3%, 57.8%] versus 47.6% [95% CI: 36.7%, 58.8%]). Statistical tests, however, failed to demonstrate significant differences in either functional outcomes or 3-month mortality rates. No significant differences were noted in weighted mean recanalisation rates between the Solitaire and Trevo groups. CONCLUSION: Stentrievers achieve a high rate of recanalisation and functional independence in acute ischaemic stroke and have a relatively good safety profile. No significant differences in functional outcomes, mortality, and symptomatic intra-cranial haemorrhage could be demonstrated between two popular stentrievers designs, namely Trevo and Solitaire.

Decision-making in the scheduling of endovascular treatment after brain arteriovenous malformation haemorrhage: a retrospective single centre study.

The appropriate timing for endovascular intervention after brain arteriovenous malformation (bAVM) rupture is not known. This paper aims to determine factors that lead to early endovascular intervention and to investigate whether early intervention has the same complication rate as late intervention in a single centre. All patients who underwent endovascular treatment for a ruptured bAVM at our institution in the period January 2007 and July 2010 were included in this retrospective observational study. Of 50 patients, 33 had early endovascular intervention, defined as within 30 days of haemorrhage and the remaining 17 patients had endovascular treatment at day 30 or beyond. A greater proportion of patients treated within the first 30 days were in neuro-intensive care preoperatively (51.5% vs. 23.5%, p=0.07). A 'high-risk' angioarchitectural feature was identified in more patients who had acute intervention (78.8% vs. 11.8%, p<0.0001) and targeted embolization was also more frequent in this group (48.5% vs. 5.9%, p=0.004). Nidal aneurysms, venous varices and impaired venous outflow (venous stenosis) were the principal 'high risk' features. Clinically apparent complications occurred in 10.8% of procedures with permanent neurological deficit in 3.6%. There was no directly procedure-related mortality. There was no statistically significant difference in the complication rate of early procedures compared with delayed interventions (12.5% vs. 7.4%, p=0.71). Greater initial injury severity and the presence of high-risk lesion characteristics are the factors that lead to early endovascular intervention. Early intervention is associated with a higher complication rate, but this difference is not statistically significant.

Symmetry in computed tomography of the brain: the pitfalls.

Computed tomography (CT) studies of the brain are one of the most frequent examinations interpreted by radiologists out of hours. Apparently normal appearances in patients with significant neurological morbidity can be perplexing. As the contents of the cranium are normally remarkably symmetrical on axial CT, disease entities that result in symmetrical appearances are the most difficult to detect. In this review we highlight a spectrum of important acute neurological conditions that result in abnormal but symmetrical appearances on CT.

Percutaneous retrograde tibial access in the endovascular treatment of acute limb ischaemia: a case report.

The utilization of a retrograde tibial approach in lower limb endovascular therapy has been described in the published literature. In this article we report our recent experience in order to highlight this valuable and under-utilised technique, which was successful in a difficult case where a conventional approach failed.

Sclerotinia Petiole and Crown Rot of Celery Caused by Sclerotinia minor in California.

Celery (Apium graveolens) is grown extensively in the coastal counties (Ventura, Santa Barbara, San Luis Obispo, Monterey, and Santa Cruz) of California. In 2004 and 2005, field plantings of celery in Ventura and Monterey counties showed symptoms of a petiole and crown rot. Initial symptoms consisted of a light tan discoloration at the crowns and on outer petioles that were in contact with soil. These discolored areas developed a soft, brown, watery rot. Affected petioles wilted and later collapsed. White mycelium and small (0.5 to 3.0 mm in diameter), irregularly shaped, black sclerotia formed on diseased tissues. Isolations from symptomatic petioles, crowns, mycelium, and sclerotia produced colonies of Sclerotinia minor. Eight-week-old celery transplants (cv. Conquistador) grown in a peat-moss based rooting medium in 10-cm2 pots were used to test pathogenicity. Colonized agar plugs (one plug per plant) from eight celery isolates were inserted into slots made in the potting mix adjacent to the crowns and lower petioles of the transplants. Noncolonized plugs were placed in slots for control celery plants. Twenty plants were used for each isolate and control, and all test plants were incubated in a greenhouse at 21 to 23°C. Disease development was rapid, and after 4 days, inoculated celery plants exhibited brown necrosis at inoculation points. After 9 days, celery crowns were decayed and petioles collapsed. S. minor was reisolated from necrotic crown and petiole tissues. Noninoculated plants were asymptomatic. The experiment was repeated and results were similar. To our knowledge, this is the first report of celery as a host of S. minor in California (2). In the United States, S. minor has been reported on celery in Florida (1). Celery in California is only occasionally infected by S. minor and is more often infected by S. sclerotiorum. Reference: (1) D. F. Farr et al. Fungi on Plants and Plant Products in the United States. The American Phytopathological Society. St. Paul, MN, 1989. (2) M. S. Melzer et al. Can. J. Plant Pathol. 19:272, 1997.

Left lateral vs. supine, wedged position for development of block after combined spinal-epidural anaesthesia for Caesarean section.

This prospective, randomised controlled trial compared a spinal block developing in the left lateral position (LL), after sitting a combined spinal-epidural for Caesarean section with the woman sitting -- using intrathecal hyperbaric bupivacaine and fentanyl -- with a block developing in the supine, wedged position (SW). The median (IQR) block onset times for loss of cold sensation to T4 bilaterally for LL and SW women were 15 (13-19) and 12 (10.8-14) min, respectively (p = 0.004). Unilateral blocks did not occur in the left lateral group. There were no other significant differences between groups, except the median [range] 1-min Apgar scores, which were 9 [8-10] and 9 [6-9] in the LL and SW groups, respectively (p = 0.04). In summary, the LL position is associated with a relatively slower block onset, but produces a spinal block with similar characteristics to that obtained in the SW position.

Comparison of animal models for the evaluation of radiolabeled androgens.

Biodistribution of two 18F-labeled androgens and an 124I/125I-labeled androgen were studied in five androgen receptor (prostate) animal models with or lacking sex hormone binding globulin (SHBG). As models for androgen-receptor positive ovarian cancer, xenografts of three human ovarian cancer cell lines were tested in SCID mice. SHBG in the prostate model systems significantly affects the metabolism, clearance, and distribution of the radiolabeled androgens in several tissues, but ovarian cancer animal models were disappointing.

Effect of administration route on FES uptake into MCF-7 tumors.

We have observed that intraperitoneal administration of [(18)F]fluoroestradiol (FES), a radiolabeled estrogen receptor ligand, results in higher abdominal organ uptake and slower blood clearance than intravenous administration in female mice. In SCID mice bearing MCF-7 human tumors SC, IP administration resulted in tumor uptake that was only about one third that obtained with IV administration. Thus, the route of administration of a radiopharmaceutical for imaging or radiotherapy of a tumor in the abdomen, an ovarian tumor, for example, could have a profound effect on the efficiency and selectivity of delivery of the agent to the tumor.

Reactivity of p-[18F]fluorophenacyl bromide for radiolabeling of proteins and peptides.

Radiolabeling of the somatostatin analog octreotide was attempted with p-[18F]fluorophenacyl bromide ([18F]FPB). Following these unsuccessful trials, the reactivity of FPB was studied using benzyl mercaptan, phenyl acetic acid, benzyl alcohol, and benzyl amine as model compounds for amino acid functional groups. Structure and purity of products, relative reactivity of FPB in competition reactions, and radiolabeling experiments are described. In addition, improvement in labeling efficiency of HSA using [18F]FPB was achieved by pretreatment with 2-iminothiolane.

Dose titration of sustained-release recombinant bovine somatotropin in lactating dairy cows.

Lactating dairy cows (n = 264) were used in seven dose titration experiments at four geographic locations in the United States. A sustained-release formulation of recombinant bST was evaluated for a 30-wk treatment period that began 14 wk postpartum. The first series of four experiments evaluated doses of 0, 140, 350, or 700 mg of bST/14 d (series A); the second series evaluated doses of 0, 56, 140, or 350 mg of bST/14 d (series B). Milk yield, DMI, milk composition, body condition, health, and reproductive parameters were measured. Multiparous cows in series A that were administered 700 mg of bST/14 d yielded 3.0 kg/d more milk and 3.5% FCM than control cows. When all seven experiments were combined, multiparous cows that were administered 350 mg of bST/14 d yielded 2.7 and 2.6 kg/d more milk and 3.5% FCM than control cows. Dry matter intake was not significantly affected by bST administration. In series A, an increase in milk yield with no increase in DMI resulted in lower adequacy of dietary NEL and CP to meet maintenance and yield requirements among multiparous cows administered 700 mg of bST/14 d. Primiparous cows that were administered bST in series A and both parity groups in the combined seven experiments were not different from control cows in the adequacy of dietary NEL or CP to meet maintenance and yield requirements. No adverse effects of bST on health parameters were significant, and doses of 350 mg of bST/14 d or less caused no changes in reproductive parameters. Conception rate was decreased by administration of 700 mg of bST/14 d. These data suggest that 350 mg of bST/14 d increased yields of milk and FCM with no adverse effects on DMI, health, or reproduction in dairy cows.

Correlation of the oxygen cost of breathing and length of weaning from mechanical ventilation.

We studied 20 patients (ages 43 to 84 yr), whose forced vital capacity, peak negative inspiratory pressure and alveolar-arterial gradient indicated that they were unlikely to be withdrawn rapidly from mechanical ventilation. Their mean oxygen consumption (VO2) during controlled ventilation (CV) was 292 +/- 21 (SEM) ml/min. During spontaneous ventilation (SV) through endotracheal tube and ventilator circuit, the VO2 rose significantly (p less than .001) to 323 +/- 20 ml/min. The oxygen cost of breathing (OCB) (the difference in VO2 between CV and SV) and the OCB as a fraction of the oxygen consumed during SV (OCB/VO2 SV) both correlated significantly by linear regression analysis with the total time to wean in days (-11.6 + 0.93 for OCB, r = .79; and -12.6 + 293.1 for OCB/VO2 SV, r = .84, p less than .001 for both). As the OCB was correlated with the total wean time, this variable may be a useful index of the effect of many influences on the weaning process.

Effect of dietary iodine on tissue iodine content in the bovine.

Twelve yearling Holstein steers were blocked by weight and assigned to receive one of three dietary I levels (0, 50 or 400 mg ethylenediamine dihydriodide [EDDI]/head/day) for 4 weeks. Average daily gain, body temperature and respiration rate were measured before and during the I feeding period, and no significant differences among treatment groups were found. Serum total I showed a significant increase with each increment of I. When animals were slaughtered, five muscle samples and liver and thyroid samples were dissected for I analysis. Mean total muscle I levels for the 0-, 50- and 400-mg treatment groups were .092, .127 and .406 micrograms/g wet tissue, respectively, each being different (P less than .05) from the other two. I concentrations did not differ statistically between individual muscles within the 0- and 50-mg treatment groups, but in the 400-mg EDDI group, the trapezius (.469 micrograms/g) and biceps brachii (.569 micrograms/g) muscles had higher (P less than .05) I concentrations than the semimembranous (.316 micrograms/g), psoas major (.365 micrograms/g) and longissimus (.307 micrograms/g). Dietary I increased (P less than .05) liver and thyroid I concentrations in the 400-mg treatment group over those observed for the 0- and 50-mg treatment groups.

Traumatic production of an intracranial berry-like aneurysm in a monkey.

A berry-like dissecting intracranial aneurysm resulted from inadvertent puncture of the internal carotid artery during trans-palatal section of a monkey's optic nerve. The light and ultrastructural features are rather similar to those of human berry aneurysms supporting the notion that the latter are degenerative rather than congenital in origin.