bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracranial Arterial Dissection Related to HIV Infection
Authors: Lefeuvre D. , Liebenberg L. , Taylor A.
Published: January 2017

There are many reasons for patients infected with human immunodeficiency virus (HIV) to develop cerebrovascular disease. The HIV virus itself however may be a cause of vessel wall pathology. We present a clinical and pathological study of a patient who was HIV positive and presented with a subarachnoid haemorrhage. Cerebral angiography and later histology confirm that there was extensive vessel wall injury with dissection and a false aneurysm of the right middle cerebral artery.
Electrical Models in the Analysis of Hemodynamic Characteristics of Arteriovenous Malformations
Authors: Guglielmi G.
Published: January 2017

This paper describes the creation of two electric arteriovenous malformation (AVM) models where electric resistors simulate AVM vessels. The flow of electrons simulates the flow of blood. Using the models, it was possible to analyze the pressure and flow patterns in the nidus of a small, low-flow AVM and in the nidus of a large, high-flow AVM. “Normal” hemodynamic “physiologic” conditions of the two AVMs were studied, including the autoregulation of normal brain surrounding the AVMs. It is the first time that the hemodynamics within the different parts of the nidus (arterious, arteriolar, venular, venous) can be determined. The models will be utilized to assess AVM hemodynamic changes when different parameters (systemic blood pressure, embolization of arterial feeders, embolization of nidus, embolization of draining veins, surgical by-pass of the AVM) are changed. This will be the subject of part 2 of this paper.
An Experimental Aneurysm Model: A Training Model for Neurointerventionalists
Authors: Grunwald I.Q. , Romeike B. , Eymann R. , Roth C. , Struffert T. , Reith W.
Published: January 2017

Reproducible animal models not only facilitate the pre-clinical assessment of aneurysm therapy but can also help in training for interventional procedures. The objective of this study was to find an animal model that can be used to test different endovascular occlusion techniques.

Aneurysms in the right common carotid artery were created in 35 NZW rabbits by distal ligation and intraluminal elastase infusion. A total of 27 aneurysms were occluded by endovascular embolization with GDC-Coils. The time needed for placement of the microcatheter into the aneurysm by a professional interventionalist, a semi-professional interventionalist and a trainee was measured. The percentage of occlusion (occlusion rate) of the aneurysms was determined angiographically after embolization and again three months later, followed by a histological examination.

Aneurysms of 2–6 mm size were reliably created in all 35 animals; mean size was 3.0 mm in height and 5.5 mm in diameter. Occlusion was achieved in 27 animals. Five animals from the group of 35 were initially planned as a control group with no embolization. We added to the control group one animal whose aneurysm could not be occluded endovascularly because of partial thrombosis and small size of the aneurysm. The angiographically determined mean occlusion rate was 89.5% ± 11.3% standard deviation. Histological evaluation of the six aneurysms of the control group showed that they remained patent. Aneurysms that underwent embolization showed organized thrombus formation with no signs of recanalization. Two animals died from anaesthesia related or embolic complications. The time needed by the professional did not significantly decrease, after a little practice the trainee was nearly as quick as the professional. The beginner showed extensive progress, reducing the time for catheter placement by more than 50%.

This paper describes the angiographic and histopathologic findings and also demonstrates possible methods for training in interventional procedures. Animal models will play a vital part in the training of future interventionalists. This model has the capability of testing different embolization devices (GDC, Onyx®) and methods. Histologic long-term prognosis and the physical effect of the coils can be evaluated with this model.
Cerebral Aneurysm Perforations during Treatment with Detachable Coils
Authors: Layton K.F. , Cloft H.J. , Kallmes D.F.
Published: January 2017

Perforation of intracranial aneurysms during endovascular treatment with platinum micro-coils is a well-known and serious complication reported to occur in 2–4% of patients.

Inflation of a remodelling balloon across the aneurysm neck or within the proximal parent vessel is an additional technique that theoretically might be useful to reduce flow within the aneurysm and achieve hemostasis.

In the case reports that follow, we present our experience using this technique for managing intraprocedural aneurysm rupture.
Bilateral Acute Subdural Hematoma from Ruptured Posterior Communicating Artery Aneurysm
Authors: Boujemâa H. , Góngora-Rivera F. , Barragán-Campos H. , Karachi K. , Chiras J. , Sourour N.
Published: January 2017

Brain tumors, hematological diseases and vascular malformations like fistulas or arteriovenous malformations are the most well known causes of non-traumatic subdural hematoma (SDH)1 Although spontaneous subdural hematoma from ruptured intracranial aneurysm has been reported2, SDH with non radiographic evidence of subarachnoid hemorrhage is very rare3,4. Moreover, a patient with acute and bilateral spontaneous subdural hematoma secondary to ruptured left posterior communicating artery aneurysm has not been reported to date. The clinical findings and etiologic mechanisms are discussed.
Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment
Authors: Yagci A.B. , Ardiç F.N. , Oran I. , Bir F. , Karabulut N.
Published: January 2017

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.
Trapped Microcatheter from Vessel Spasm: Safe Removal after Double Microcatheter Technique and Local Papaverine Infusion
Authors: Celedin S. , Song J.K. , Valavanis A.
Published: January 2017

In a child undergoing combined transarterial and direct percutaneous puncture embolization of an extensive and complex facial arteriovenous malformation, severe arterial spasm fixed a flow-directed microcatheter in an ethmoidal branch of the left ophthalmic artery. Multiple traction attempts failed to remove the microcatheter. After catheterization of the distal, post central retinal artery part of the same ophthalmic artery, with a second flow-directed microcatheter and following intraarterial papaverine injection through this second microcatheter, the fixed microcatheter could be removed without complication. This case demonstrates a technique that can be attempted before deciding to leave the microcatheter in the patient or to remove it surgically.
Polyurethane Stent Obstruction as a Cause of Recurrent Epiphora
Authors: Doganay S. , Sarac K. , Miman M.C. , Karadag N. , Cokkeser Y.
Published: January 2017

A Song's nasolacrimal duct stent was placed in a patient with epiphora due to primary nasolacrimal duct obstruction and the stent was kept for 32 months. Mitomycin C 0.02% eye drops four times a day were prescribed for four weeks following polyurethane stent placement procedure. No epiphora-related complaints occurred for thirty months after then the epiphora started. Nasolacrimal stent was removed from nasal cavity endoscopially and the tissues within the extruded stent were examined histopathologically. The patient's complaints were relieved following stent removal. Dacryocystogram revealed normal passage and a filling defect within the lacrimal sac. Macroscopic evaluation of the stent revealed a firm mass in the stent mushroom, causing complete obstruction. Pathological examination of the mass revealed chronic inflammation, increased connective tissue and vascular proliferation.

Nasolacrimal polyurethane stents can be removed easily by nasal approach. Nasolacrimal passage may be left open temporarily after stent removal. The use of Mitomycin C drop is a novel approach in nasolacrimal stent placement cases. However, when the long-term results of endoscopic and external dacryocystorhinostomy are considered, further research is needed on the biocompatibility of stent material.
Spontaneous Mirror Dissections of Cervicocephalic Arteries
Authors: Zhao W.Y. , Krings T. , Alvarez H. , Ozanne A. , Holmin S. , Lasjaunias P.L.
Published: January 2017

While so-called twin or mirror aneurysms constitute an established subgroup of multiple aneurysms, simultaneous spontaneous mirror dissections of cervicocephalic artery have not yet been reported as a particular entity. Among the patients treated at our institution since 1989, we identified 74 patients with spontaneous, non-traumatic dissections. Six of these cases presented with simultaneous bilateral dissections and four of the six patients had mirror dissections. Acute or chronic headache was present in all four cases. Additional clinical presentations consisted of impaired consciousness, cranial nerve palsy, and tinnitus. Angiography revealed irregular stenosis, dilatation or aneurysms located in the cervical ICA (internal carotid artery), VA (vertebral artery), or MCA (middle cerebral artery) without evident location bias. Although mirror dissections seems to be an exceptional finding, they may shed light on the vulnerability of different arterial segments to specific diseases. Similar to arterial aneurysm formation, pathogenesis of mirror dissection may involve an underlying “shared defect” in the endothelial cells, since these cells demonstrate a bilateral distribution during embryological development. This particular distribution therefore also provides a chronicle trail of the first trigger striking during embryonic development and demonstrates the segmental vulnerability to highly specific triggers.
Radial Approach in the Treatment of Supraaortic Arterial Lesions
Authors: Théron J. , Guimaraens L. , Casasco A. , Sola T. , Saleme S. , Courtheoux P. , Hamon M.
Published: January 2017

Radial approach (mainly right) has been used in the treatment of 67 supraaortic lesions including 56 carotid, nine vertebral and two subclavian artery stenoses. This approach offers new possibilities and solves most of the remaining technical difficulties or impossibilities encountered in the endovascular treatment of supraaortic lesions. The current technique is described. The results of this first series have been very satisfactory without complication. MR angiography allows selection of patients suitable for radial approach.
Pseudotumor Cerebri: A New Door Opens for Treatment
Authors: Crosa R. , Marabotto O. , Meehroff G. , Legnani C. , Boschi J. , Negrotto A. , Terbrugge K.G. , Lasjaunias P.
Published: January 2017

Pseudotumor cerebri remains a scarcely known pathology. We present the experience of a multidisciplinary working group which studied this disorder focusing on the venous alterations of the dural sinuses.

Seventeen cases were studied, diagnosed, controlled and treated by our team. In one of the cases, we placed a stent in the left lateral sinus with good result.

In all the patients we observed various degrees of stenosis in the brain venous sinuses quantified by pressure measurement. Nevertheless, to determine the exact cause of this pathology, more studies are necessary.
Minimally Invasive Approach for Drainage of a Sacral Epidural Abscess
Authors: Kostanian V.J. , Mathews M.S.
Published: January 2017

Sacral epidural abscesses are rare infections, often managed with open surgery, especially in the presence of acute neurological symptoms. We report a novel approach for minimally invasive drainage of sacral epidural abscesses.

A 51-year-old man presented to the emergency department complaining of low back pain, generalized muscle pain, pain across several large joints, low-grade fever, and weakness of both legs for ten days. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as anterior and posterior epidural abscesses extending from L5-S1 disc space to the S2 vertebral level. Under CT fluoroscopic guidance a 20-gauge spinal needle was inserted into the sacral hiatus, parallel to the pelvic surface of the sacral canal, and directed cranially. A 0.18-gauge microwire was then advanced through the 20-gauge needle. The 20-gauge needle was exchanged over the guidewire for an 18-gauge blunt tipped needle which was curved to approximate the contours of the sacral canal. The curved needle was inserted through the sacral hiatus with its concavity initially facing upwards, and then rotated 180° to gain access to epidural abscess.

Once anatomic access was established 5cc of thick purulent material was evacuated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure.

Image guided aspiration of sacral epidural abscesses can be carried out in a safe and effective manner using CT fluoroscopy. Aspiration of these abscesses combined with intravenous antibiotics may be an alternative to open surgery in select patients.
Multiple Cerebral Aneurysms Caused by Cardiac Myxoma
Authors: Sedat J. , Chau Y. , Dunac A. , Gomez N. , Suissa L. , Mahagne M.H.
Published: January 2017

A case of multiple cerebral aneurysms caused by left atrial myxoma is reported. We present the details of this case and discuss the hypothetical pathogenesis, radiological aspects and treatment of these neoplastic aneurysms.
Delayed Medullar Syndrome after Aneurysmal Subarachnoid Haemorrhage
Authors: Silva N. , Januel A.C. , Sabatier J. , Demonet J.-F. , Tall P. , Cognard C.
Published: January 2017

We described a case of chronic spinal cystic arachnoiditis after subarachnoid haemorrhage in a 54-year-old woman with a ruptured vertebral artery aneurysm treated by coils. At three months she complained of lumbar pain. At twelve months she presented lower limbs paresthesia then a rapidly bilateral motor deficit. MR showed a spinal arachnoiditis with two compressive cysts. Surgical decompression was inefficient and after three months spinal compression symptoms worsened and MR signs were unchanged.
Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms
Authors: Pyysalo L.M. , Keski-Nisula L.H. , Niskakangas T.T. , Kähärä V.J. , Öhman J.E.
Published: January 2017

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess the long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms. The clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment.

Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. The occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment.

Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, the annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1,3%.
Triple Coaxial Catheter Technique for Transfacial Superior Ophthalmic Vein Approach for Embolization of Dural Carotid-Cavernous Fistula
Authors: Yuen M-H. , Cheng K-M. , Cheung Y-L. , Chan C-M. , Yu S.C.H. , Wong G.K.C. , Poon W-S.
Published: January 2017

We report a triple coaxial catheter technique to facilitate the venous access to the superior ophthalmic vein during transvenous embolization of dural carotid-cavernous fistula (DCCF) via the transfacial venous route. Two patients with transvenous embolization of DCCFs by coils were treated with transfacial superior ophthalmic vein (SOV) approach by the triple coaxial catheter technique. The triple coaxial catheter system consisted of a 6F guiding catheter as the outer catheter and a 4F guiding catheter as the middle catheter and a microcatheter as the inner catheter to help navigation and manipulation.

The DCCFs were completely obliterated in both cases. There were no complications associated with the procedure. The ophthalmic symptoms of the patients had totally resolved at two-month follow-up.

The triple coaxial catheter technique can be used with the transfacial SOV approach in embolization of DCCF. This technique has two advantages over the double coaxial catheter technique because it offers additional length and support for the distal navigation of microcatheter into the SOV.
Isolated Hypoglossal Nerve Palsy Due to Endovascular Treatment of a Dural Arteriovenous Fistula with Onyx-18
Authors: Pei W. , Huai-Zhang S. , Shan-Cai X. , Cheng G. , Di Z.
Published: January 2017

We describe a patient with dural arteriovenous fistula (DAVF) treated with Onyx-18 who developed isolated hypoglossal nerve palsy. This is the first case of isolated hypoglossal nerve palsy caused by Onyx-18 embolization. This complication suggests that over embolization with Onyx-18 in the treatment of hypoglossal canal DAVFs should be avoided, and transvenous embolization may be safer. Furthermore, prednisolone therapy should be carried out in the prophase of nerve palsy.
Hemorrhage Rates and Outcomes When Using up to 100 mg Intra-Arterial t-PA for Thrombolysis in Acute Ischemic Stroke
Authors: Christoforidis G.A. , Slivka A.P. , Karakasis C. , Mohammad Y. , Avutu B. , Yang M. , Bourekas E.C. , Chakeres D.W. , Slone H.W. , Yuk W.T.
Published: January 2017

This work presents a unique single center experience with intra-arterial delivery of tissue plasminogen activator (t-PA) doses as high as 100mg for thrombolysis. Hemorrhage volumes, hemorrhage rates, clinical outcomes and radiographic outcomes were assessed.

Prospectively collected angiographic, clinical and laboratory information on 67 consecutive patients with acute ischemic stroke involving either the m1 segment of the middle cerebral artery, the intracranial internal carotid artery or the basilar artery were retrospectively analyzed. Patients who received more than 50 mg t-PA were compared with those patients receiving 50 mg or less. Outcome measures included: symptomatic hemorrhage, significant hemorrhage volume (greater than 25 ml), hemorrhage rate, change in National Institutes of Health stroke scale score at 24 hours and at hospital discharge, modified Rankin score at 90 days, in-hospital deaths, death within 90 days, reperfusion rate, and infarct volume.

Multivariate logistic regression analysis demonstrated that t-PA dose over 50 mg was associated with higher rates of hemorrhage and larger hemorrhages. Poor pial collateral formation, poor reperfusion (less than 50% of the territory involved), and platelet count below 200 K/μL influenced hemorrhage. Limiting t-PA dose to 100mg rather than 50mg improved documented reperfusion rates from 37% to 61%.

Restricting intra-arterial t-PA administration to 100mg rather than 50mg, is associated with higher overall reperfusion rates and improves overall outcomes, however, the hemorrhage rate is also elevated. Poor pial collateral formation and platelet count less than 200 K/μL may be reasons to curtail the use of higher t-PA dose to reduce hemorrhage rate.
A Novel Device for the Revascularization in Acute Ischemic Stroke Patients
Authors: Shrivastava S. , Cam A. , Slee E.
Published: January 2017

This article provides insights into how the authors developed the Solitaire™ FR revascularization device and associated procedure including commentary on the mechanism of revascularization and future of device development in this area. The article is intended to give research-minded physicians a view into the device development world by sighting examples of this novel device for revascularizing patients with acute ischemic stroke.
A Case of Non-Traumatic Subgaleal Hematoma Effectively Treated with Endovascular Surgery
Authors: Koizumi H. , Suzuki S. , Utsuki S. , Nakahara K. , Niki J. , Mabuchi I. , Kurata A. , Fujii K.
Published: January 2017

Non-traumatic subgaleal hematoma is very rare. We present a case of refractory non-traumatic subgaleal hematoma occurring in a 15-year-old male patient. The patient was successfully treated by embolization of the superficial temporal artery. This therapeutic approach to refractory non-traumatic subgaleal hematoma is discussed.
Aneurysmal Malformations of the Vein of Galen
Authors: Lasjaunias P.L. , Alvarez H. , Rodesch G. , Garcia-Monaco R. , terBrugge K. , Burrows P. , Taylor W.
Published: January 2017

The Vein of Galen Aneurysmal Malformation (VGAM) is regarded as a lesion with high morbidity and mortality, both spontaneously and under treatment, in part due to an incomplete appreciation of the effects of the lesion on the specific physiology of young children. In addition, various techniques have been applied over a short period of time to treat the lesion rather than the disorders it creates.

We report experience with 120 consecutive cases of VGAM managed over the past ten years: 24 were diagnosed antenatally; 50 presented in the neonatal period with haemodynamic disturbance; 35 in infants presented with secondary hydrovenous disorders (macrocrania, subependymal atrophy and ventricular dilatation); 12 were seen in children.

We were unable to follow 10% of the patients because the referring teams decided not to follow our therapeutic advice. Treatment was contra-indicated in 17% of cases (with early brain damage and a rapidly fatal outcome).

There were five (4%) which thrombosed spontaneously (but only two of these were neurologically normal). Embolisation was performed in 78 patients via a transarterial femoral approach using glue. Anatomical cure has already been achieved in 53%.

Of the treated patients, even when treatment has not been completed, 80% are growing neurologically normal.

Permanent neurological deficit or irreversible neurocognitive delay related to the natural history of the lesion were evident in 8.5%. Overall mortality was 9%.

These figures confirm that previous views on the prognosis of VGAM should be revised. Endoarterial embolisation, is the preferred treatment to date.
Medical Treatment of Congestive Cardiac Failure from Cerebral Arteriovenous Fistulas at Bicêtre Hospital
Authors: de Victor D. , Le Pommelet C.
Published: January 2017

Arteriovenous fistulas create an increase in venous return and subsequent right heart overload. The result is right heart dilatation, pulmonary arterial hypertension, and increased pulmonary blood flow. Reduction in arterial diastolic pressure (as observed in arteriovenous shunt), an increase in end diastolic pressure (due to increased preload), a reduction in diastolic period (due to tachycardia) are all detrimental to myocardial perfusion and hence oxygen delivery and may precipitate left ventricular failure.

Furthermore, the transition from a foetal circulatory pattern to an adult circulatory pattern is complex and both pulmonary and systemic circulations remain highly unstable during the first week after birth. This can explain a persistent transitional circulation with shunts through the ductus arteriosus, the foramen ovale and a pulmonary hypertension which worsen the systolic and diastolic wall stress.

The clinical presentation depends on the size of the left-to-right shunt and its tolerance. The aims of symptomatic therapy are to improve oxygen delivery to the tissues and decrease tissue oxygen consumption. Measures that improve the patient's effective ventilation, arterial oxygen saturation, and hematocrit need to be the first steps. Diuretics are the first step for reducing preload. Cardiac output can be improved by increasing cardiac contractility with inotropic agents. Digoxin is the main agent used to increase myocardial contractility.

However, its use in a hyperkinetic state due to arteriovenous fistulas remains controversial: pretreatment myocardial function indices may already be above normal, and there is no clear evidence that their further increase produces clinical benefit. Vasodilators are obviously contraindicated if systemic arterial pressure is low. If the failure cannot be controlled, embolisation of the lesion should be considered.

The goal of this paper is to provide a rational approach to the treatment of circulatory failure due to cerebral arteriovenous shunts.
Interventional Neuroradiology in Thailand: 1989–1997
Authors: Suthipongchai S. , Pongpech S. , Siriwimonmas S. , Chawalparit O. , Churojana A. , Chiewvit P.
Published: January 2017

In 1979 the Siriraj team in Bangkok began exploring a field that was then new in Thailand, i. e. interventional neuroradiology. This first phase consisted mostly in self-training and foreign exposure.

It included experimental work with animal models, as well as early clinical trials designed to assess our skills in particle embolisation and the ligated and detachable balloon techniques. In 1990 a new phase started.

Essential techniques were acquired in collaboration with the neurovascular unit of Bicêtre Hospital in France during a three year training programme. Throughout this period, the support of the Association Médicale Franco-Asiatique (AMFA) and the French foreign affairs department proved vital. Our department progressively became a referral centre for the different techniques used in embolisation (balloons, glue…) and for various vascular lesions of the brain, the head and neck region, and spinal cord diseases.

Within Mahidol University, the Ramathibodi and Prasat Hospital centres started the same interventional neuroradiology training program in 1995; they benefited from the same tutors and connections as Siriraj. In 1996, the newly acquired biplane DSA machines in both centres enabled us to improve the treatment of arteriovenous malformations - using the glue technique –, intracranial aneurysm - using GDC-coils -, clot lysis, angioplasty… etc.

According to international recommendations, the critical mass we reached in 1997 in terms of number of patients and interventions, allows us to offer training in endovascular techniques to junior neuroradiologists at Mahidol university.
How to Avoid Bias: Methodological Vigilance
Authors: Mansmann U.
Published: January 2017

One of the main purposes of choosing and developing a strategy for clinical research is to attempt to reduce bias.

The avoidance of bias is build on methodological vigilance: The researcher should be familiar with the most common sources of bias. This vigilance is supported by guidelines and the development of methodological standards.

Where sources of bias cannot be eliminated, it is important to identify them so that they may be considered when conclusions are drawn from a study.

Randomized controlled trials (RCT) have the greatest potential to reduce bias, but conducted without methodological vigilance the trial's guarantee of lack of bias is lost. Methodological vigilance has also to be applied when results of different RCT's are combined and used for clinical or research purposes.
Endovascular Management of Paediatric Intracranial Aneurysms
Authors: Laughlin S. , TerBrugge K.G. , Willinsky R.A. , Armstrong D.C. , Montanera W.J. , Humphreys R.P.
Published: January 2017

The purpose of this paper is to discuss the radiological and clinical features of paediatric intracranial aneurysms including endovascular techniques currently being used for their therapy. Paediatric patients who presented with the diagnosis of intracranial aneurysm between August 1982 and February 1997 were included. The data were collected retrospectively.

Clinical features included patient's age, sex, presentation, treatment and outcome. Radiologic features included location, size and number of aneurysms present.

21 patients (13 females and 8 males) ranging in age from 9 months to 16 years had intracranial aneurysms. Seventy six percent of the aneurysms were located in the anterior circulation and 24% in the posterior circulation. Seven patients (33%) had giant aneurysms and three patients (14%) had multiple aneurysms. Endovascular treatment was performed in six patients (29%) and neurosurgical treatment in eight patients (38%). Endovascular treatment included the use of coils and/or balloon occlusion.

Of the remaining patients, two (9.5%) died prior to any surgical or radiological intervention. A further five patients (24%) were treated conservatively. Intracranial aneurysms in children demonstrate clinical and radiologic features that differ significantly from those seen in adults. There is a higher percentage of ICA termination aneurysms, giant aneurysms and post-traumatic aneurysms.

However, aneurysms in children, like those in adults, can and have been successfully treated utilizing endovascular as well as neurosurgical techniques.
Technical Aspects of Intra-Arterial Electroencephalogram Recording
Authors: García-Asensio S. , Guelbenzu S. , Barrena R. , Valero P.
Published: January 2017

The purpose of this prospective study is to show a technique for recording electroencephalographic activity via an endovascular approach in presurgical evaluation of epileptic patients. Technical aspects and insertion strategy are outlined. Advantages of intra-arterial electroencephalography have been demonstrated. It is a semi-invasive procedure that provides information in temporal lobe and extratemporal epilepsy. It allows a dynamic electroencephalographic recording and patient tolerance is excellent. Risks are practically absent. Disadvantages are: in comparison to ovale electrodes, chronic and multicontact recording is not possible and the recording is only intercritical.
Embolisation of a Persistent Primitive Trigeminal Artery for a Large Cavernous Aneurysm
Authors: Iizuka Y. , Maehara T. , Nakanishi H. , Arai H.
Published: January 2017

We report a case of large cavernous aneurysm associated with persistent primitive trigeminal artery (PPTA). Thrombosis of the aneurysm was obtained only by occlusion of the PPTA. Aneurysms associated with PPTA have not previously been treated only by the occlusion of PPTA with GDC, and this report presents the first such intervention. A radiological follow-up study with MRI and angiography demonstrated marked shrinkage of the thrombosed aneurysm 17 months later, although clinical symptoms were not improved. From our experience, we suggest that the occlusion of the PPTA can be the first step in the therapeutic protocol for aneurysms associated with PPTA.
Spontaneous Thrombosis of an Intracranial Giant Aneurysm
Authors: Warschewske G. , Benndorf G. , Lehmann Th. , Lanksch W.
Published: January 2017

Spontaneous thrombosis in giant aneurysms is known, whereas complete occlusion of such aneurysms in a short period of time is rarely reported. We present the case of a 50-year-old man with a giant anuersym arising from the anterior communicating artery (ACA) producing significant mass effect with clinical consequences. The digital subtraction arteriogram (DSA) showed a patent lumen of about 20 mm and a very small neck leading to extremely slow blood flow inside the sac and stagnation of contrast. During catheterization for endovascular occlusion four weeks later, the arteriogram revealed complete disappearance of the aneurysm, while the patient remained clinically stable. The patient was operated upon and the thrombosed sac was removed with no complications. He was discharged one week later and recovered completely from his symptoms within three months.
The Vessel Wall Remodelling Technique Using a Coronary Angioplasty Balloon and a Single Guide Catheter
Authors: Halpin S.F.S.
Published: January 2017

The vessel wall remodelling technique was created by Moret to enable endovascular therapy of relatively wide-necked cerebral aneurysms. As originally described, two guide catheters are placed in the relevant vertebral or carotid artery, and a Solstice balloon (Micro Interventional Systems, Ca, USA) inflated across the neck of the aneurysm while coils are placed inside. I describe a modification of this technique, using a single guide catheter, and a “monorail” coronary artery angioplasty catheter.
Dietary Supplements for Arthritis and other Inflammatory Conditions: Key Role of Mast Cells and Benefit of Combining Anti-Inflammatory and Proteoglycan Products
Authors: Theoharides T. C.
Published: January 2017

Arthritis is estimated to affect over 30% of all adults and all the available drugs add considerable morbidity and mortality of their own. A recent therapeutic approach targets the mast cells that are currently considered critical in a variety of inflammatory diseases, especially arthritis. Mast cells could be activated by many immune and neural triggers, as well as by many food substances and drugs leading to secretion of numerous vasoactive and inflammatory molecules. Recent studies have shown that mast cells can be inhibited by certain naturally occurring flavonoids, such as quercetin, and the sulfated proteoglycan chondroitin sulfate. Glucosamine and chondroitin are present in many dietary supplements, but neither the source nor the purity of the active substances is listed; moreover, these formulations do not permit sufficient absorption, due to the high molecular weight and negative charge. Moreover, a common source of chondroitin sulfate is cow trachea with the risk of spongioform encephalopathy (mad cow disease). A new series of dietary supplements (Algonot-Plus®) are based on published scientific evidence and combine quercetin, glucosamine sulfate and chondroitin sulfate of high purity in formulations that include kernel olive oil to increase absorption of the inhibitory substances.
Remodelling and Inflammation in Bronchial Asthma
Authors: Riccioni G. , D'Orazio N. , Della Vecchia R. , Iezzi T. , Di Ilio C.
Published: January 2017

Chronic stable asthma is characterized by inflammation of the airway wall, with abnormal accumulation of basophils, eosinophils, lymphocytes, mast cells, macrophages, dendritic cells and myofibroblasts. The airway inflammation is not confined to severe asthma, but is also found in mild and moderate asthma. This inflammation results in a peculiar type of lymphocytic infiltration whereby Th2 lymphocytes secrete cytokines that orchestrate cellular inflammation and promote airway hyperresponsiveness.

The term “airway remodelling” in bronchial asthma refers to structural changes that occurr in conjunction with, or because of, chronic airway inflammation. Airway remodelling results in alterations in the airway epithelium, lamina propria, and submucosa, leading to thickening of airway wall. The consequences of airway remodelling in asthma include incompletely reversible airway narrowing, bronchial hyperresponsiveness (BHR), smooth muscle contraction, airway edema, and mucus hypersecretion which may predispose persons with asthma to exacerbations and even death from airway obstruction.
Keratoderma Hereditarium Mutilans (Vohwinkel's Syndrome) Associated with Sensorineural Deafness in an HIV Positive Man: A Case Report
Authors: Boccia L. , Perrella M. , Donofrio P.
Published: January 2017

Keratoderma hereditarium mutilans (KHM) or Vohwinkel's syndrome is a rare cutaneous disorder, characterized by thickening of palms and soles and by ainhum-like constrictions of the fingers and toes. KHM is usually inherited as an autosomal dominant disease, but a recessive type has occasionally been described.
A Multicenter Open Study on the Tolerability and Efficacy of a Cosmetic Treatment in Mild Acne Vulgaris during the Summer Months
Authors: Cassano N. , Carbonara M. , Grandolfo M. , Calabretta S. , Castellana C. , Coviello C. , Curia S. , Dattola S. , De Caro C. , Favero G. , Felice G. , Ferrari A. , Fiorentino D. , Liguori G. , Lopreiato R. , Ottomano L. , Provenzano E. , Salamina F. , Vernaci R. , Vena G.A.
Published: January 2017

The improvement of acne vulgaris (AV) during summer months is a general opinion which is not universally accepted as some patients experience no change or even an aggravation of their AV during hot months. Therapeutic management of AV in summer is often difficult; in fact, most traditional anti-acne treatments are contraindicated or poorly tolerated during summer months. In this study we evaluated the tolerability and effectiveness of a cosmetic anti-acne treatment performed for 12 summer weeks in 347 patients (mean age, 19.4 yrs) with mild AV of the face. The study product (Exfoliac®) contained a mixture of alpha hydroxy acids and substances with moisturizing and/or lenitive effects. In the first 4 weeks, Exfoliac® 10 cream was applied twice a day (b.i.d.). The treatment in the following 8 weeks was decided on the basis of dermatologist's assessment of the clinical response and could consist in Exfoliac® 10 cream or Exfoliac® 15 cream, once daily (o.d.) or b.i.d. During the study period, patients used Exfoliac® cleansing gel. The cumulative results indicate a significant improvement of AV lesions and seborrhoea, irrespectively of sun exposure, and a good tolerability, even in sunbathed patients. Adverse reactions, mostly of mild severity, appeared to be independent of sunbathing or use of sunscreens and were observed in a small proportion of cases (6.8% in the first 4 weeks and 5.6% in the last 8 weeks).

Our results suggest that this type of treatment is an effective and safe approach to patients with mild AV who require treatment in the summertime.
Treatment of Seborrhoeic Dermatitis of the Scalp with Desonide 0.05% Solution
Authors: Cassano N. , Alessandrini G. , Fai D. , Gabbellone M. , Gravante M. , Ligori P. , Malvindi C. , Mancino A. , Martina G. , Natalizi A. , Sodo M. R. , Serratì E. , Stasi R. , Vena G. A.
Published: January 2017

Topical corticosteroids are commonly used for the short-term management of seborrhoeic dermatitis (SD) of the scalp. The aim of this study was to evaluate the effectiveness, tolerance and cosmetic acceptability of desonide 0.05% solution, whose alcohol-free formulation is innovative with respect to traditional corticosteroid lotions, in the treatment of SD of the scalp.

For this purpose, 155 adult subjects applied on scalp lesions desonide once daily for 1 week, on alternate days for 3 weeks, and two times a week for 4 weeks. A significant reduction of the severity of erythema, scaling and pruritus was observed (P<0.001). Interestingly, during the phase of gradual reduction of weekly applications, results were frequently maintained or improved further. Twenty patients (13%) at 4 weeks and 85 patients (58%) at 8 weeks had their scalp SD cleared. Most patients regarded the overall effectiveness, tolerability and acceptability as satisfactory; patients who had previously used common steroid lotions expressed a positive judgment on desonide solution compared to the other lotions in terms of efficacy, acceptability, rapidity of action, tolerability and persistence of effects.

In conclusion, our preliminary findings indicate that desonide 0.05% solution is suitable for the short-term management of scalp SD.
Procalcitonin and Inflammatory Cytokines in Children with Asthma
Authors: Emporiadou M. , Hatzistilianou M. , Haidopoulou K. , Aggouridaki C. , Reklity A. , Magnisali C. , Karamperis S.T.
Published: January 2017

Asthma is currently defined as a chronic inflammatory disorder of the airway mucosa. The resulting inflammation of the airway mucosa shows signs of an acute as well as a more chronic type of inflammation. Cytokine-mediated interactions among the inflammatory cells may play a role in the pathogenesis of bronchial asthma. The aim of this study is to assess inflammatory agents as markers of chronic inflammation in childhood asthma and as indicators for determining the state of the disease. This study included 3 groups of children. Group A consisted of 35 children with asthma and FEV1<80% of predicted values, 24 boys, 11 girls, aged (mean age ± SE) 9.3 ± 0.4 years, Group B of 70 children with asthma and FEV1≥80% of predicted values, 44 boys, 26 girls, aged 8.65 ± 0.36 years and Group C of 48 healthy children, 33 boys, 15 girls, aged 10.73 ± 0.4 years. In serum, levels of PCT were determined by immunoluminescence, CRP by nephelometry and cytokines IL-1β, IL-6, IL-4 and IL-5 by ELISA. Our results show that the mean concentration of CRP and PCT were not significantly different between groups A, B and C. The mean values of IL-1β were significantly different between groups A, B and C. The mean values of IL-6 were higher in group A than those of Groups B and C, although the difference between the groups was not statistically significant. The mean values of Th2 cytokines IL-4 and IL-5 were significantly different between groups A, B and C. In conclusion, CRP and PCT levels did not play any role in airway allergic inflammation, while strong indications were found that sera levels of inflammatory cytokines associated mainly with Th2 responses play a key role in airway allergic inflammation.
Comparison of Two Different Dosing Regimens with Lymecycline, in Association with Adapalene, in Inflammatory Acne
Authors: Vena G.A. , Cassano N. , Alessandrini G. , Carrieri G. , Fai D. , Gabellone M. , Ligori P. , Maietta G. , Malvindi C. , Mancino A. , Martina G. , Pellè S. , Ricciuti F. , Ruggiero A. , Serratì E. , Sodo M.R. , Stasi R.
Published: January 2017

Combined treatment with oral lymecycline and topical adapalene has been shown to induce greater and faster improvement of acne than monotherapy with lymecycline. We wanted to evaluate the effects of combined therapy with topical adapalene (cream or gel) plus oral lymecycline used at different dosages (group A: 300mg/day for 2 weeks and then 150mg/day for 14 weeks; group B: 300mg/day for 16 weeks) in 242 patients with inflammatory acne. Both dosage regimens were well tolerated in the majority of patients and significantly improved both the acne lesion count and seborrhoea. There was a trend towards a greater reduction of seborrhoea and nodules in patients of group B. After the initial 16-week phase, patients entered an 8-week follow-up phase, consisting of the use of adapalene monotherapy. The results obtained after this phase confirm the therapeutic value and the favourable tolerability of adapalene as maintenance treatment after successful treatment of inflammatory acne. At the same time, a significantly reduced count of comedones was observed in patients of group B as compared with group A, suggesting that prolonged use of high-dose lymecycline may have a more pronounced influence on comedogenesis.
Saliva: Its Value as a Biological Matrix and Current Methods of Sampling
Authors: Campisi G. , Di Fede O. , Roccia P. , Di Nicola F. , Falaschini S. , Muzio L. Lo
Published: January 2017

Saliva is a non-invasive medium, its analysis is useful to measure a wide range of hormones, drugs, narcotics, antibodies, host, microbial, fungal and viral DNA up to salivary mRNA; hence, it has been suggested to be an easy and reliable biomarker in disease diagnostics, such as inflammatory mouth infections/diseases, and in normal health surveillance. In light of this potential, our primary endpoint is to review the current knowledge on saliva analyses and its recent methods of sampling.
Ticlopidine-Induced Cholestatic Inflammatory Hepatitis: New Insights into Pathogenetic Mechanisms of Drug-Related Hepatotoxicity
Authors: Kraslova I. , Muchova L. , Vitek L. , Novotny A. , Svestka T. , Bruha R.
Published: January 2017

In immune-induced liver damage the reactive metabolites may covalently bind or alter liver proteins such as cytochrome P450 enzymes, which leads to activation of the immune system. Ticlopidine is an inhibitor of CYP2C19 human liver cytochrome. We attempted to analyse the role of cytochrome CYP2C19 genetic polymorphism in the development of ticlopidine-induced cholestatic hepatitis and relate it with the specific immune reactivity to ticlopidine, different cytokine profiles and induction of necrosis and apoptosis within the liver tissue. Three patients with cholestatic hepatitis with ticlopidine-related liver injury, 3 patients with obstructive jaundice due to choledocholithiasis, 3 patients treated with ticlopidine without liver damage and 10 healthy individuals were studied. Genotyping for the following genotypes CYP2C19 (CYP2C19*1–3) were tested after polymerase chain reaction (PCR) by restriction fragment length polymorphism (RFLP) with Sma I and BamH I enzymes. The T cell reactivity to ticlopidine was analysed by T cell proliferation assay in PBMC against ticlopidine, tetanus toxoid antigen and phytohemagglutinin on days 0, 90, 150 and 210 after therapy withdrawal. The serum levels of INF-γ, IL-2, IL-4, IL-10, TNF-α, sFas and sFasL were measured by ELISA at the same time points. Apoptosis was analysed by TUNEL assay. All patients with cholestatic hepatitis had “slow metabolizers” genotypes in contrast to other groups. The T cell reactivity to ticlopidine was present only in all the cholestatic hepatitis patients together with substantial decrease in levels of INF-γ, IL-2 and TNF-α during all of the follow-up period. Cholestatic hepatitis patients had high apoptotic index in TUNEL assay. The genetic polymorphism of the cytochrome CYP2C19 gene is directly responsible for the susceptibility to the ticlopidine-induced liver damage. Th1 type of immune reactivity plays the key role in the pathogenesis of drug-induced hepatotoxicity.
Travelling through Time with Aspirin, a Healing Companion
Authors: Tsoucalas G. , Karamanou M. , Androutsos G.
Published: January 2017

Four thousand years ago the willow tree was known for its palliative effects. Ancient Greeks used the extract from the cortex and leaves to treat pain, fever, calluses and to enhance semen quality. Bayer Company and Felix Hoffmann claimed discovery of aspirin, and chemists all over Europe dealt with the synthesis of the drug. During 1988 the use of Aspirin was extended from an analgesic, antipyretic to a life-saving drug as it was suggested that it reduced the danger of cardiovascular accidents. Aspirin is still a drug that can offer much to medicine.
Tumor Necrosis Factor-Alpha and Mast Cells: Revisited Study
Authors: Saggini A. , Tripodi D. , Maccauro G. , Castellani M.L. , Anogeianaki A. , Teté S. , Felaco P. , De Luths M.A. , Galzio R. , Fulcheri M. , Theoharides T.C. , Caraffa A. , Antinolfi P. , Felaco M. , Conti F. , Neri G. , Pandolfi F. , Tomato E. , Shaik-Dasthagirisaheb Y.B.
Published: January 2017

Mast cells reside in connective tissues and are widely recognized as effector cells important in innate and acquired immunity. These cells are the only ones capable of storing preformed TNFα in their cytoplasmatic granules and release upon activation. TNF-alpha is a potent multifunctional cytokine involved in autoimmune diseases, cancer, allergy, and acute and chronic inflammation. In this study, we revisit the interrelationship between TNFα and mast cells.