Introduction of endovascular embolization for intracranial aneurysms in a low-volume institution.

BACKGROUND: Studies indicate a relationship between hospital caseload and health outcomes after both surgical and endovascular repair of intracranial aneurysms. PURPOSE: To evaluate outcomes after introduction of endovascular embolization for intracranial aneurysms in a low-volume regional university hospital. MATERIAL AND METHODS: Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome Scale (GOS) was used for assessment of outcome. RESULTS: The mean annual number of procedures was 39 (microsurgery 23, embolization 16). Seventy-four percent of patients with ruptured aneurysms and all patients with unruptured aneurysms had a favorable outcome (GOS 4 or 5) at 1 year follow-up. Patients with subarachnoid hemorrhage were more likely to experience postoperative complications than patients treated for unruptured aneurysms (42% versus 8% of the patients, P<0.01). The immediate incomplete occlusion rate (Raymond II-III) in the initial embolization procedure was 29%. Ten endovascularly treated patients and one surgically treated patient required retreatments due to residual aneurysm or neck remnants. CONCLUSION: The present study indicates that acceptable outcome from aneurysm treatment, both endovascular and microsurgical, is possible in a low-volume institution.

The main epidemiological, clinical and morphological features of moyamoya disease in Yugoslavia.

Over a period of 22 years, 31 Moyamoya cases have been recorded in Yugoslavia. In this group of the patients comprising four children and 27 adults, peak age incidence is in the third and fourth decades of life. Males and females have been almost equally affected. Familial cases or territorial clustering of the patients have not been noted. In most cases leading symptoms on admission were motor disturbances. In four patients unilateral involvement was observed while in 27 patients bilateral changes of the internal carotid artery were seen.

Intracranial aneurysms associated with moyamoya disease.

The authors examined 31 patients with moyamoya disease in Yugoslavia. Among them four intracranial aneurysms were disclosed, two in males and two others in females. The aneurysms, which were present in adult patients only, were diagnosed angiographically. Three of four patients died several days or weeks after onset of hemorrhage. The aneurysms were located within the basal abnormal vascular network, on a distal branch of the posterior cerebral artery, on the top of the basilar artery, and on the posterior branch of the middle meningeal artery. The moyamoya disease on the side of the individual aneurysms was most often stage III or IV.

Moyamoya disease in Yugoslavia: angiographic study.

The angiographic findings in 31 Yugoslav moyamoya patients, 16 males and 15 females, including four children, were studied by conventional or digital subtraction angiography. The angiographic findings were reviewed for stenoocclusive lesions, form of the main cerebral arteries, transdural anastomoses, and basal vascular networks. There were 27 patients with bilaterally symmetrical or asymmetrical lesions and four with unilateral lesions. In two of these latter four patients, follow-up studies showed progression of the disease to the opposite side. Of 58 sides investigated, stenoocclusive lesions were localized above the origin of the anterior choroidal artery in 33 internal carotid arteries. Occlusions of the anterior and middle cerebral arteries were noted more frequently than stenoses: 89 vs. 27. The majority of the nests of abnormally dilated vessels (73 of 102) were localized in the ethmoidal region and basal ganglia. Analysis of distribution of the transdural collateral pathways to the brain discovered predominant participation of the middle meningeal and occipital arteries (43 of 55). Moyamoya disease in Yugoslavia predominantly affects the adult population, males and females equally, with the slowly progressive course typical for adults, and is mainly confined to the carotid fork and rarely extends to the posterior circulation.

Intra- and interobserver variability in the measurements of abdominal aortic and common iliac artery diameter with computed tomography. The Tromsø study.

OBJECTIVES: to assess intra- and interobserver variability in the measurement of aortic and common iliac artery diameter by means of computed tomography (CT). DESIGN: reproducibility study. MATERIAL AND METHODS: three radiologists performed measurements of aortic diameter at five different levels and of both common iliac arteries with CT. Fifty-nine subjects were examined, 29 with and 30 without abdominal aortic aneurysms (AAA) as assessed by ultrasound. RESULTS: intraobserver variability varied between radiologists, measurement plane (anterior-posterior vs transverse) and measurement level. The interobserver variability was markedly higher at the bifurcation than at the suprarenal level and higher than intraobserver variability for measurements at all levels. Both intraobserver and interobserver variability increased with increasing vessel diameter and were largest in patients with AAA. The absolute intraobserver difference of the maximal infrarenal aortic diameter was 2mm or less in 94% of intraobserver pairs. The corresponding interobserver difference was 82%. CONCLUSIONS: interobserver variability of CT measurements of aortic and common iliac artery diameter is not negligible and should be taken into account when making clinical decisions. When assessing change in aortic diameter, previous CT-scans should be reviewed simultaneously as a routine to exclude interobserver variability.

[Anemia and neutropenia in primary empty sella syndrome]. / Anemi og nøytropeni ved primaert tom sella-syndrom.

BACKGROUND: A 64-year-old man was admitted to our hospital with significant weight loss and symptoms of fatigue. He had normocytic anaemia and absolute neutropenia in peripheral blood. MATERIAL AND METHODS: Further haematological and endocrinological investigations were performed. RESULTS: Bone marrow aspiration and biopsy showed dysplastic signs. Immunophenotyping and cytogenetics did not provide evidence of primary haematological disease. Endocrinological testing demonstrated secondary adrenal insufficiency. Magnetic resonance imaging of the sella turcica showed an empty sella. Cortisol substitution eliminated the symptoms of the patient and normalised his peripheral blood values. The disturbed maturity and hypoplasia of the bone marrow were also normalised. INTERPRETATION: Normalisation of haematopoiesis after cortisol substitution indicates that cortisol plays an important role in the regulation of haematopoiesis. Primary empty sella syndrome with isolated ACTH cortisol deficiency is a very rare cause of disturbed haematopoiesis.