bluuebunny/crossref_metadata_2025 huggingface dataset:
External Manual Carotid Compression is Effective in Patients with Cavernous Sinus Dural Arteriovenous Fistulae
Authors: Kai Y. , Morioka M. , Yano S. , Nakamura H. , Makino K. , Takeshima H. , Hamada J. , Kuratsu J.
Published: January 2017

External manual carotid compression is a non-invasive method to treat patients with cavernous sinus dural arteriovenous fistulae (CS-DAVF). We studied a group of patients with CS-DAVF to identify factors that made cure by compression therapy possible.

We treated 23 patients with CS-DAVF without cortical venous drainage or a recent decline in visual acuity by compression therapy. All were followed up by magnetic resonance angiography (MRA) at one, three, six, and 12 months after treatment and the characteristics of the imaging findings, their neurological symptoms, and the patterns of symptom improvement were examined.

In group A (n=8), cure was achieved by manual carotid compression; in the other 15 patients (group B), cure was not obtained. Group B manifested significantly higher ocular pressure and a significantly longer interval between symptom onset and treatment by manual carotid compression. In group A, venous drainage was via the superior orbital vein (SOV) with/without involvement of the inferior petrosal sinus (IPS); closure of the CS-DAVF occurred within 4.1 months after the start of treatment. In three patients symptom improvement progressed steadily and gradually. The other five cured patients experienced transient worsening of their symptoms at two to four months after the start of treatment, these resolved within four to seven months

Manual carotid compression was effective in patients without retrograde venous CS-DAVF drainage or a severe decline in visual acuity. The factors that rendered cure by compression therapy possible were lower ocular pressure and a shorter interval between symptom onset and the start of treatment. Venous drainage in those patients was exclusively via the SOV without involvement of the IPS.
Four Cases of Thrombotic Events Associated with Neuro-Endovascular Therapy: Heparin Resistance and Aspirin Resistance
Authors: Naito K. , Nagashima H. , Oya F. , Koyama J.
Published: January 2017

Thrombotic events are caused by insufficient antithrombotic treatment in endovascular surgery. We experienced four cases of thrombotic events and consider the factors from the point of view of heparin resistance and aspirin resistance. The proportion of these features is quite high and appropriate management is important.
Correlation of Head Trauma and Traumatic Aneurysms
Authors: Nakstad P. HJ. , Gjertsen Ø. , Pedersen H. KR.
Published: January 2017

Subarachnoid hemorrhage following severe trauma to the head is relatively common. In most cases the bleed originates from superficial veins and occasionally from arteries. Following the replacement of cerebral angiography with CT in the diagnostic evaluation of head traumas fewer traumatic aneurysms have been observed. This may indicate that some traumatic aneurysms are missed if angiographic procedures are not performed in patients with severe head injury.

Trauma patients admitted to our institution are submitted to CT including a bone algorithm. In case of subarachnoid hemorrhage, especially in the basal cisterns, CT- angiography is performed. Digital subtraction angiography is performed as well in cases with uncertain interpretations.

During one year 81 patients were admitted with subarachnoid hemorrhage following head trauma. Thirteen (16%) of them underwent CT-angiography and in five (6.2%) with SAH in the basal cistern traumatic aneurysms were found. Four of these cases had a skull base fracture including fractures through the clivus. Four cases were embolized and one very small extradural aneurysm is still not treated. One small pericallosal aneurysm was operated.

A traumatic aneurysm should always be suspected n patients with skull base fractures and subarachnoid hemorrhage in the basal cisterns.
Imaging Findings of a Patient with Incomplete Phenotypical Expression of the PHACES Syndrome
Authors: Sarikaya B. , Altugan F.S. , Firat M. , Lasjaunias P.L.
Published: January 2017

We present imaging findings of a patient with an incomplete form of the PHACES syndrome with dolichosegmental intracranial arteries as the predominant component, and discuss the etiopathological and clinical significance of this finding.
Endovascular Treatment of Middle Cerebral Artery Aneurysms
Authors: Guglielmi G. , Viñuela F. , Duckwiler G. , Jahan R. , Cotroneo E. , Gigli R.
Published: January 2017

The endovascular approach is described in 113 middle cerebral artery (MCA) aneurysms. The treatment failed in six cases with no adverse clinical consequences. Out of the 107 treated cases, it was possible to obtain a complete occlusion in 50 aneurysms (47%), whereas a residual aneurysm neck was observed in 54 cases (50%). Follow-up angiograms were performed in 60 cases, showing a 22% rate of further thrombosis of the aneurysm. Recanalization of the aneurysm was observed in 8% of cases, which required retreatment.

The technique-related permanent morbidity rate was 9% while the mortality rate was 2%. A review of the surgical and endovascular literature is presented. The endovascular approach is particularly indicated when normal MCA branches do not arise from the aneurysm base. It must be meticulously planned in all other cases. Endovascular coil treatment of MCA aneurysms is feasible, with acceptable morbi-mortality rates.
Anatomic Results and Complications of Stent-Assisted Coil Embolization of Intracranial Aneurysms
Authors: Kim S.-R. , Vora N. , Jovin T.G. , Gupta R. , Thomas A. , Kassam A. , Lee K. , Gologorsky Y. , Jankowitz B. , Panapitiya N. , Aleu A. , Sandhu E. , Crago E. , Hricik A. , Gallek M. , Horowitz M.B.
Published: January 2017

The purpose of this study was to evaluate and report our anatomic results and complications associated with stent-assisted coil embolization of intracranial aneurysms using the Neuroform stent. From September 2003 to August 2007, 127 consecutive patients (ruptured 50, 39.4%; unruptured 77, 60.6%) underwent 129 stent-assisted coil embolization procedures to treat 136 aneurysms at our institution. Anatomic results at follow-up, procedure-related complications, and morbidity/mortality were retrospectively reviewed.

Stent deployment was successful in 128 out of 129 procedures (99.2%). Forty-seven patients presented with 53 procedure-related complications (37.0%, 47/127). Thromboembolic events (n = 17, 13.4%) were the most common complications, followed by intraoperative rupture (n = 8, 6.3%), coil herniation (n = 5, 3.9%), and postoperative rupture (n = 4, 3.1%). For thromboembolic events, acute intra-procedural in-stent thromboses were observed in two patients and subacute or delayed in-stent thromboses in three patients. Overall mortality rate was 16.5% (21/127) and procedure-related morbidity and mortality rates were 5.5% (7/127) and 8.7% (11/127) retrospectively. Patients with poor grade subarachnoid hemorrhage (Hunt and Hess grade IV or V; 25/127, 19.7%) exhibited 56% (14/25) overall mortality rate and 24% (6/25) procedure-related mortality rate. Immediate angiographic results showed complete occlusion in 31.7% of aneurysms, near-complete occlusion in 45.5%, and partial occlusion in 22.8%. Sixty nine patients in 70 procedures with 77 aneurysms underwent angiographic follow-up at six months or later. Mean follow-up period was 13.7 months (6 to 45 months). Complete occlusion was observed in 57 aneurysms (74.0%) and significant in-stent stenosis was not found.

Thromboembolism and intra/postoperative aneurysm ruptures were the most common complications and the main causes of procedure-related morbidity and mortality. Patients with poor grade subarachnoid hemorrhage showed poor clinical outcomes. Since most complications were induced by stent manipulation and deployment, it is mandatory to utilize these devices selectively and cautiously. While the follow-up angiographic results are promising, further studies are essential to evaluate safety, efficacy, and durability of the Neuroform stent.
Ophthalmic Rete Mirabile: The First Angiographic Documentation of Embryonic Ophthalmic Collaterals in a Patient with Moyamoya Disease
Authors: Chung J.-I. , Weon Y.C.
Published: January 2017

Plexiform vascular networks of the rete mirabile in humans are rare but can be observed in some vertebrates such as cobaye, cat, cow and sheep. Each set of embryonic arteries can be a potential source of these vascular networks which reconstitute the distal flows in segmental agenesis of internal carotid or vertebral arteries especially in patients with PHACE (posterior fossa malformation of the brain, facial hemangiomas, arterial anomalies, cardiac anomalies with coarctation of aorta, and eye abnormalities) syndrome. Ophthalmic rete mirabile has been found in some mammals such as camel, deer and avian species of pigeon, Hawaiian seabirds and deep-water fish of the cod other than human.

We describe the first human case of ophthalmic rete mirabile confirmed on angiography in a patient with moyamoya disease. These findings are the first description in the English literature as far as we know. The clinical implications with moyamoya disease will be briefly discussed according to the embryologic development of cranial arteries.
Coil Knotting during Endovascular Coil Embolization for Ruptured MCA Aneurysm
Authors: Kwon S.C. , Lyo I.U. , Shin S.H. , Park J.B. , Kim Y.
Published: January 2017

Complications during coil embolization of cerebral aneurysms include thromboembolic events, hemorrhagic complications related to procedural aneurysmal rupture and parent vessel perforation, and coil-related complications. The present report describes a rare coil-related complication involving spontaneous coil knotting.
Intraarterial and Intravenous Treatment of Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas
Authors: Lv X. , Jiang C. , Li Y. , Yang X. , Wu Z.
Published: January 2017

Transverse/sigmoid sinus (TS) is the most common location for cerebral dural arteriovenous fistulas (DAVFs). Most of them are cured by venous embolization or a combination of arterial embolization and surgery/radiosurgery. Our goal was to reconsider the endovascular treatment strategy of TSDAVFs according to the new possibilities of arterial embolization using Onyx-18.

Nineteen patients with TSDAVFs were included in a prospective study between 2004 and 2007. Three of them had type I, four had type IIa, six had type IIa+b, three had type III, and three had type IV fistulas. Three presented with subarachnoid hemorrhage. The approach routes, angiographic results, complications, and clinical outcome were assessed. The mean clinical follow-up period was 32.5 months.

In one patient, the DAVF had been obliterated spontaneously at ten month follow-up. Complete angiographic cure was obtained in nine cases with one case of progressive thrombosis. Of these ten cures were achieved after a single procedure in seven out of ten patients who had not been embolized previously. Three patients were cured with sinus packing with prior arterial embolization. Among these 19 patients, 15 underwent follow-up angiography which confirmed the complete cure. Partial occlusion was obtained in nine patients, one was cured after additional surgery, and one underwent radiosurgery. Hallucination occurred in one completely cured patient on day one.

Based on this experience, we believe that intraarterial Onyx may be the primary treatment of choice for patients with TSDAVFs. The applicability of this new embolic agent indicates the need for reconsideration of the treatment strategy for such fistulas.
Parent Artery Occlusion for Intracranial Aneurysms
Authors: Cui Lishan , Peng Qiang , Ha Wenbo , Zhou Dexiang , Xu Yang
Published: January 2017

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally.

In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two.

Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits.

Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.
Reversible Aggravation of Neurological Deficits after Steroid Medication in Patients with Venous Congestive Myelopathy Caused by Spinal Arteriovenous Malformation
Authors: Lee C-S. , Pyun H.W. , Chae E.Y. , Kim K-K , Rhim S.C. , Suh D.C.
Published: January 2017

Steroids are empirically used to medicate patients with myelopathy of unknown etiology. We report the reversible aggravation of neurological status after steroid administration in a patient with venous congestive myelopathy (VCM). We retrospectively evaluated 36 patients with angio-graphically confirmed spinal arteriovenous malformation (SAVM) from a prospectively collected neurointerventional database. We evaluated steroid medication and neurological aggravation using Aminoff grading and analyzed using Fisher's exact test whether steroid medication is related to neurological aggravation and spinal cord edema as demonstrated on MR T2-WI. Among 26 patients who had been treated with steroids, ten had aggravated neurological deficits. The aggravation in these ten patients was related to the steroid medication (P = 0.039 in all patients) and only marginally to VCM with spinal cord edema as seen on T2-WI (P = 0.074). Aggravation caused by using a high intravenous dose (250–1000 mg) of methylprednisolone or dexamethasone at 8–20 mg/day slowly decreased after stopping the steroid medication. Steroids were reversibly detrimental in patients with VCM caused by SAVM. A history of neurological aggravation after the use of steroids may suggest the diagnosis of SAVM associated with VCM.
Endovascular Management for P2 Aneurysms of the Posterior Cerebral Artery
Authors: Lv X. , Li Y. , Jiang C. , Wu Z.
Published: January 2017

This study evaluated the outcomes of endovascular management for P2-segment aneurysms. From 2003 to 2008, 14 consecutive patients with P2 aneurysms were treated endovascularly by proximal P2 segment occlusion at our institution. The aneurysms included 12 P2a and two P2p aneurysms. Presenting symptoms were caused by subarachnoid hemorrhage (SAH) in six patients, stroke in five, and isolated headaches in three. Mean follow-up was 14 months. Twelve aneurysms were treated with proximal P2 segment occlusion without parent artery revascularization. Twelve aneurysms were at the P2a and two aneurysms at the P2p. Two patients developed hemianopsia after the procedure and one recovered completely within six months follow-up with one still persistent at 22-month follow-up. Proximal parent vessel occlusion was a relatively safe, effective treatment for P2 aneurysms that posed low risk for early or delayed ischemia or infarction.
Posterior Cerebral Artery Aneurysm with Posteromedial Choroidal Artery-P3 Segment Anastomosis
Authors: Majoie C.B. , Van Den Berg R.
Published: January 2017

We describe the case of a patient with an aneurysm of the P2 segment of the PCA with a persistent anastomosis between the posteromedial choroidal artery and the P3 segment of the posterior cerebral artery.
Fenestrations of the Basilar Artery Demonstrated on Magnetic Resonance Angiograms: An Analysis of 212 Cases
Authors: Sogawa Keiji , Kikuchi Yoichi , O'Uchi Toshihiro , Tanaka Michihiro , Inoue Tomio
Published: January 2017

Fenestration of the basilar artery (BA) is a rare variant of the intracranial artery, well demonstrated in autopsy and angiographic studies. Some angiographic series show a high incidence of associated aneurysms at the basilar fenestration site. The purpose of this study is to report the incidence of BA fenestration, its configurations, associated aneurysms, and arterial anomalies in a large series of intracranial MR angiograms (MRAs).

A total of 16,416 MRAs were retrospectively reviewed to identify the location, size and associated intracranial arterial anomalies of BA fenestrations. All images were obtained with the time-of-flight (TOF) technique. Of the 16,416 MRAs, 215 fenestrations were found in 212 cases (1.29%). Most fenestrations were located in the proximal BA. The average length of the fenestration was 4.6 mm; the largest was 15.6 mm. No aneurysm was found at the site of the fenestration. Thirteen aneurysms were found in nine cases at locations other than the BA: seven in the middle cerebral artery (MCA), one in the anterior cerebral artery (ACA), one in the anterior communicating artery (Acom), one in the vertebral artery (VA), one at the carotid siphon, and two at the internal carotid-posterior communicating artery (IC-PC). Arterial anomalies in other locations were found in 26 cases.

BA fenestrations were found in 1.29% of the 16,416 cases studied. There were no aneurysms at the BA fenestration site. Aneurysms at the BA fenestration site may be an exceedingly rare phenomenon.
Endovascular Exclusion of the Anterior Communicating Artery with Flow-Diverter Stents as an Emergency Treatment for Blister-Like Intracranial Aneurysms
Authors: Rouchaud Aymeric , Saleme Suzana , Gory Benjamin , Ayoub David , Mounayer Charbel
Published: January 2017

Blood blister-like aneurysms (BLAs) are rare lesions, associated with diffuse subarachnoid hemorrhage (SAH). BLAs tend to rebleed quickly after first bleeding and must be treated as an emergency. Acute treatment is challenging using surgical and endovascular approaches due to the fragile aneurysm wall and small sac. Flow-diverter stents (FDSs) may offer a new option for the treatment of difficult small aneurysms. We describe a case of a ruptured BLA on the anterior communicating artery (AComA) treated in the acute phase of SAH by endovascular exclusion of the AComA with deployment of two FDSs in the A1/A2 junctions of both anterior cerebral arteries (ACAs). A 61-year-old man was admitted for diffuse SAH with a focal interhemispheric hematoma. Angiography revealed multiple arterial wall irregularities on the AComA and both ACAs. We performed an endovascular shunt of the AComA by deploying two FDSs in both A1/A2 junctions. Immediate control injections confirmed flow diversion in the A1/A2 segments of the ACAs with decreased blood flow in the AComA. The patient's course in hospital was uneventful. A three-month follow-up angiogram confirmed complete exclusion of the aneurysms, complete exclusion of the AComA, and patency of the two ACAs without any persistent arterial wall irregularity. Endovascular bypass using an FDS for a ruptured BLA has never been described. It establishes a new therapeutic option despite the need for antiplatelet therapy. Endovascular AComA exclusion using an FDS may be a solution when no other treatment is available for a ruptured BLA.
Anatomoclinical Aspects of Dural Arteriovenous Shunts in Children
Authors: Lasjaunias P. , Magufis G. , Goulao A. , Piske R. , Suthipongchai S. , Rodesch R. , Alvarez H.
Published: January 2017

We review 29 children (presenting between 1985–1996) with dural arteriovenous shunts. By analysing the anatomical features from axial and angiographic imaging and examining the clinical history and pathophysiological characteristics, we hypothesize that different diseases can be distinguished and divided into three groups: dural sinus malformation (DSM), infantile type of dural arteriovenous shunts (IDAVS) and adult type of dural arteriovenous shunts (ADAVS). It was helpful to classify these diseases when assessing the treatment options and long-term prognosis.

Our group of 29 children comprised 19 DSM, 7 IDAVS, 3 ADAVS. A slight male preponderance was noted in the DSM group.

The range of symptoms encountered included mild cardiac failure and coagulopathies, macro-crania, developmental delay, mental retardation, seizures and focal neurological deficits (in the neonates and early infancy age group) with or without haemorrhagic venous infarctions secondary to venous outlet restriction.

We found all types of lesion in the neonatal age group, but in general the different types of lesion correspond to the paediatric subgroups with DSM occurring in the neonatal age group, IDAVS in infancy and ADAVS in children.

DSMs are revealed in the first few months of live and the prognosis is good if the torcular is not involved. Two types can be seen:

1) DSM involving the posterior sinus with or without the confluens sinusum, with giant dural lakes and slow flow mural AV shunting. Spontaneous thrombosis may further restrict cerebral venous drainage and subsequently lead to intraparenchymatous haemorrhagic infarction.

2) DSM involving the jugular bulb with otherwise normal sinuses but associated with a high flow sigmoïd sinus AVF. The prognosis is excellent with embolisation treament.

IDAVS are high flow and low pressure. The sinuses are large and patent with no lakes. Clinical onset is seen in the first few years of life and the shunts are initially well tolerated. Progressive symptoms (symptoms of raised ICP and venous ischaemia) develop at a later age and initially respond to partial embolisation. The long term prognosis is poor with neurological deterioration in early adulthood.

ADAVS present in all age groups and almost all of them are located in the cavernous venous plexus. Post embolisation outcome is excellent.
The Marginal Sinus Normal Anatomy and Involvement with Arteriovenous Fistulae
Authors: Evans A.J. , Kallmes D.F. , Jensen M.E. , Dion J.E.
Published: January 2017

Rationale and Objectives

The marginal sinus is an infrequently recognized dural venous sinus at the rim of the foramen magnum. Recognition of this sinus and knowledge of its anatomy will enable the neurointerventionalist to treat dural arteriovenous fistulae (AVF) involving the marginal sinus.

Methods

We present a report of the signs, symptoms, angiographic appearance, and treatment results of two patients with marginal sinus dural AVF. In addition, we review the literature concerning the marginal sinus and describe the anatomy of this region. Angiograms depicting normal variants are presented to illustrate the various patterns that may be encountered when the marginal sinus participates in the venous drainage of the cranium.

Results

In two patients with dural arteriovenous fistulae (AVF) the marginal sinus was found to be the venous receptacle. The marginal sinuses are dural venous sinuses located at the lateral margins of the foramen magnum. Superiorly, the marginal sinus connects to the occipital sinus, a single or paired midline venous channel arising at the torcular Herophili or the medial transverse sinus. The marginal sinus typically drains into the sigmoid sinus, and may connect to the condylar veins, the superior aspect of the internal venous plexus, or the occipital plexus. Occasionally, the occipital-marginal sinus system represents the primary drainage pathway of the cranium, completely replacing the transverse sinus. In the two patients we treated with dural AVF in this location, simple transvenous packing of the sinus effectively cured the lesion.

Conclusions

The marginal sinus is a dural venous sinus that can rarely be involved with a dural AVF. Recognition that a dural AVF involves the marginal sinus can facilitate safe, effective therapy.
A Case of Vertebrovertebral Arteriovenous Fistula Presenting with Subarachnoid Haemorrhage
Authors: Kominami S. , Liu Y. , Alvarez H. , Rodesch G. , Coubes P. , Lasjaunias P.
Published: January 2017

A rare paediatric case of vertebrovertebral arteriovenous fistula presented with a subarachnoid haemorrhage.

A 12 year-old boy, who fell on his back at school, presented with a one week history of headache, vomiting, and double vision. Computed tomography (CT) scan revealed subarachnoid haemorrhage.

Magnetic resonance imaging (MRI) demonstrated a tortuous vessel on the anterior surface of the spinal cord. Selective angiography showed an arteriovenous fistula of the left vertebral artery at the level of C1.

The venous drainage of the fistula refluxed into the medullary vein at the level of C6-7, and drained upwards into the posterior fossa veins. An endovascular detachable balloon technique was employed and complete occlusion of the fistula was achieved.
Volume Determination of Intracranial Arteriovenous Malformations Prior to Stereotactic Radiosurgical Treatment
Authors: Ericson K. , Söderman M. , Karlsson B. , Lindquist C.
Published: January 2017

Exact dose planning for stereotactic radiosurgery was enabled in connection with diagnostic angiography or at the end of an endovascular procedure by simply placing a stereotactic localizing box onto the head of the patient while acquiring PA and lateral angiographic views.

The fiducials engraved on the localizing box enabled the appropriate images to be scaled to the stereotactic space. Regular dose planning was then performed after estimating the size of the patient's head. A prediction of the chances of obliteration and the risks of complication could then be made immediately after the endovascular or diagnostic procedure, and further therapy could be selected much more confidently.

This technique may also be used at centres without facilities for radiosurgical treatment if only the localizing box is available. The images may then be sent for evaluation to a unit with dose planning equipment.

The technique is simple and involves little risk, significantly improving patient management. Digital subtraction angiography was used in this study. A correction algorithm was used to minimize the geometric distortion inherent to the digital technique.
Post-Procedure CT Follow-up after Percutaneous Automated Lumbar Nucleotomy
Authors: Dullerud R. , Johansen J.G.
Published: January 2017

In order to evaluate the incidence of soft tissue changes after automated lumbar nucleotomy, a prospective cohort study was performed with follow-up CT within four to six hours after treatment of 97 discs in 88 patients.

The CT scans were normal at 47 levels and abnormal at 50. At 11 levels traces of blood were seen along the trajectory, of which nine were located in the subcutaneous fat, one in the extensor and one in the psoas muscle. Small gas collections were observed at 42 levels. Twenty-one of them were located in the extensor and two in the psoas muscle, seven in the subcutaneous fat, two in the epidural space and ten in multiple locations. The abnormal scans were not associated with clinical symptoms different from those with normal scans.

The results support previous reports indicating that this procedure is associated with low morbidity and complication rates.
A Revised Concept of the Congenital Nature of Cerebral Arteriovenous Malformations
Authors: Lasjaunias P.
Published: January 2017

Cerebral arteriovenous lesions are in general considered to be congenital in nature despite the fact that there is no evidence that the AV shunts diagnosed in adults are present at birth in a similar format.

Construction of a vascular structure is the result of complex biological influences starting in the embryo, and continuing in the foetus, the neonate and the young infant. This vascular tree has to be maintained, repaired and modified according to metabolic demands, requiring over time the renewal of the entire structure. This is also genetically programmed and controlled.

Both construction and maintenance involve repetitive steps and feedback towards the vascular tree according to the demands. Alterations in the programme or in the cellular logistics to achieve it, will create a different construction of the blood vessel wall.

Analysis of the origin of the cerebrofacial endothelial cell would suggest that, the earlier a causative event occurs the larger the area of impact, and the higher the chances of apparent multifocality will be. The later the trigger occurs the more focal the defect and the smaller the lesion. If so, growth of an AVM as such should not occur; large nidi will not result from the growth of smaller ones.

The impact of Rendu-Osler-Weber (ROW) disease on the venous endothelial cells and the polymorphism observed in cerebral arteriovenous shunts in ROW patients may outline the role played by the veins as the primary target in the development of cerebral AVMs.

The venous and arterial angiopathy related to chronic high flow (or flow changes beyond normal equilibrium) impact a normally reacting vasculature which has been “abnormally” triggered by an AVM. This intraluminal trigger represents a “stress trigger” which can be flow, pressure or “other” related factors.

This interpretation identifies the so-called AVMs to be the expression of various diseases rather than the disease itself. They are the result and negative impact of biological dysfunction of the remodelling process at the capillarovenous junction.
Making Evidence Available: Prognostic Classification Systems
Authors: Mansmann U.
Published: January 2017

Claims of treatment selectivity can represent an important therapeutic advance: however, most such claims cannot be confirmed with independent data.

This implies a management dilemma when confronted with ambiguous information on the risks of therapies and, most of all, insufficient criteria for identifying patients at risk. An accurate assessment of prognosis can help overcome the uncertainties facing the patients. But the identification of prognostic factors is subject to certain caveats.

An essential part of prognostic factor analysis is standardization, a fact that is often overlooked. Thus, two different studies identifying the prognostic value of a factor may not be truly comparable, making a meaningful comparison difficult.

Therefore, the development of an accurate prognostic system provides a method of conveying clinical experience to others without ambiguity.
Gene Expression Profiling Associated with the Progression of Classic Kaposi's Sarcoma
Authors: Guttman-Yassky E. , Chiricozzi A. , Jacob-Hirsch J. , Tintle S. , Khatcherian A. , Amariglio N. , Rechavi G. , Krueger J.G. , Nisticò S.P. , Bergman R. , Sarid R.
Published: January 2017

Although Kaposi's sarcoma (KS) gene expression profile is closer to lymphatic (LEC) rather than blood vascular endothelial cells (BEC), uncertainty still surrounds the cellular origin of KS. To follow KS progression from early to late (nodular) stage, and characterize the molecular fingerprinting associated with each stage, gene arrays were used to compare gene expression profile of 9 skin samples of classic KS (4 Early, 2 Mixed, and 3 Nodular CKS samples) to 4 normal samples. Results for selected genes were validated by Real-time (RT) PCR and immunohistochemistry. Genes regulating immune and defense responses, angiogenesis, apoptosis and proliferation were differentially expressed in different KS stages compared to normal skin. Hierarchical clustering separated normal skin from KS with a clear gradient from early to nodular KS lesions. The gene expression level of endothelium markers, metalloproteinases, angiogenic factors and chemokines, gradually increased from normal through all KS stages. The expression of LEC genes highly increased from early to nodular KS. In the initiation phase we noticed a higher expression of growth factors, as compared to progressive stages. LEC and BEC markers co-exist in “KS expression signature”, although the LEC signature prevailed. Our results also show a complex environment of inflammatory cells and chemokines during KS evolution. A pathogenic hypothesis where cellular hyperproliferation is driven by local expression of chemokines and growth factors without clonal expansion of cells is suggested.
Influence of Polymorphism −308 G/A of the Tnf-α Gene on High Mobility Group Box-1 Protein in Rheumatoid and Spondylo-Arthritis Patients
Authors: Bitto A. , Polito F. , Bagnato G. , Talotta R. , Atteritano M. , Irrera N. , Ientile R. , Ferlazzo N. , Caccamo D. , Bagnato G. , Caliri A. , Squadrito F. , Altavilla D.
Published: January 2017

Single nucleotide polymorphism (SNP) in the human Tumor Necrosis Factor-α(TNF-α) gene promoter, the −308 G/A variant, has been associated with increased TNF-α levels that may amplify the severity of rheumatoid arthritis (RA) and a poor responsiveness to TNF-α blockade therapy. High mobility group box protein (HMGB-1) is a pro-inflammatory cytokine that plays a pivotal role in the pathogenesis of RA and may be an original target of therapy. The aim of this study is to investigate whether the −308 G/A variant of the TNF-α gene is associated with altered expression of HMBG-1. A total of 110 consecutive patients with rheumatoid arthritis and spondylo-arthritis (ankylosing spondylitis, psoriatic arthritis and spondylitis associated with inflammatory bowel disease) referring to the Rheumatology Unit of Messina University Hospital were enrolled. Patients were genotyped for the −308 TNF-α gene promoter polymorphism. Clinical status was also assessed. HMGB-1 and TNF-α mRNA(Real Time PCR) from total blood and plasmatic HMGB-1 (Western Blot analysis) and TNF-α (ELISA) protein were also evaluated. Irrespective of the underlying disease, patients carrying the G/A genotype showed enhanced HMGB-1 and TNF-α mRNA levels and increased circulating concentration of the inflammatory cytokines when compared to patients with G/G genotype. The data suggest that subjects carrying the TNF-α −308G/A genotype have enhanced expression of HMGB-1 protein that may explain, at least in part, the increased severity of the disease.
Post-Extractive Implants: Outcome of 40 Cases
Authors: Lopez M. A. , Bassi M. Andreasi , Confalone L. , Fanali S. , Candotto V. , Oliveira D. Pedreirade , Carinci F.
Published: January 2017

In the last two decades, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results with a two-stage surgical procedure. Recently immediate loading has become an emerging technique as it has been documented to be a successful and time saving procedure. As regard the possibility of immediate/early loading of implants placed in fresh extraction sockets few reports are available. In addition they are based on limited series with short follow-up. Thus we decided to perform a retrospective study on a series of post-extractive implants. A total of 40 two-piece implants (FMD srl, Rome, Italy) were inserted in post extractive sockets, 22 in females and 18 in males. The median age was 52 ± 11 (min-max 24–69 years). Twenty-one implants were inserted in upper jaw and 19 in mandible. Fixtures replaced 7 incisors, 3 cuspids, 12 premolars and 18 molars. Implant' length was x ≤ 10 mm, 10,30 ≤ x ≤ 12.30, equal to 13 mm and x ≥14 mm in 6,14,9, and 11 cases, respectively. Implant' diameter was narrower than 3.5 mm, equal to 3.8 mm and wider than 4.0 mm in 1,7, and 32 cases, respectively. There were 28, 2 and 10 Elisir, I-fix, and Shiner implant types, respectively. No implant on single tooth rehabilitations, was lost, survival rate = 100%. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Seven fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 82.5%). Statistical analysis demonstrated that there was a difference between surgeons (p= 0.005). In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.
Gene Expression Study in Dental Pulp Stem Cells Cultivated on Titanium Alloys
Authors: Lopez M. , Bassi M. Andreasi , Confalone L. , Fanali S. , Candotto V. , Cura F. , Carinci F.
Published: January 2017

Nowadays, research on orthopedic and dental implants is focused on titanium alloys due to their appropriated mechanical properties and corrosion resistance in the body environment. Another important aspect to be investigated is their surface topography, which is very important to osseointegration. The aim of this study was to assess dental pulp stem cells response to different titanium surface topography modified. Mesenchymal stem cell marker ENG was significantly decreased in stem cells cultivated in modified titanium surface respect to machined titanium surface, indicating the differentiation effect of this biomaterial on stem cells. The obtained results can be relevant to better understand the molecular mechanism of bone regeneration and as a model for comparing other materials with similar clinical effects.
Oral Manifestations in Children with Acute Lymphoblastic Leukemia
Authors: Lauritano D. , Petruzzi M. , Fumagalli T. , Giacomello M.S. , Caccianiga G.
Published: January 2017

Leukaemia, a form of abnormal and atypical proliferation of undeveloped white cells, is the most common form of malignant neoplasia in childhood. The different forms of leukaemia are characterized by a high incidence of oral complications. Moreover, oral injuries may be the first predictor of the illness helping to diagnose leukaemia, even if the histologic examination of the marrow is required for a certain diagnosis. Actually the early diagnosis of oral injuries is really important for prevention and treatment of the complications that may arise during the therapy: a better prognosis and lower morbidity and mortality for this illness ensue. Furthermore, even after remission, the young patient increasingly needs a constant monitoring of the oral cavity because of the delayed effects of the illness and the therapy. Therefore a dental treatment programme for paediatric haemato-oncological patients is very important to improve quality of life of leukemic children.
Periodontal Lesions and Gingival Problems in Children with Acute Lymphoblastic Leukemia
Authors: Lauritano D. , Petruzzi M. , Giacomello M.S. , Ordesi P. , Caccianiga G.
Published: January 2017

Dentists both as clinical practice and research increased progressively their interest in leukemia, because the oral complications are common during the outcome of the disease, dental management is complex, and the mouth is a potential source of morbidity. The aim of this review is analyzing the most important periodontal problems due to childhood Leukaemia. Infact only with an appropriate periodontal treatment oral health could be mantained and restored before development of irreversible periodontal damage. Our experience suggests that even if detrimental impact of antineoplastic therapy on oral cavity is unavoidable, it could be diminished with an adequate and correct preventive or curative therapy contributing to a better quality of life of children treated for cancer.
The Stomatognathic System's Role in the Postural Stabilization in Subjects Suffering from Whiplash Injury Part 1: Patients with Physiological Occlusion
Authors: Giacomello M.S. , Bertella L. , Perego S. , Zorzella P. , Caccianiga G.
Published: January 2017

Aim of this study is analyze the effects of dental occlusion on postural stability in patients with previous whiplash and normal occlusion. Materials and methods: 36 adult patients with previous whiplash and normal occlusion (good alignment, 1st class or mild 2nd class deep bite for mandibular retrusion) were selected. The patients were suffering from masticatory muscles pain caused by clenching during sleep. Exclusion criteria: use of psych drugs. To simulate the conditions of sleep (with a reduction of proprio-and esteroceptive inputs for postural management performed by CNS), we used postural Romberg analysis (feet together, closed eyes)on stabilometric platform changing occlusal parameters only, under the following conditions: 1) in occlusal rest position, 2) in centric occlusion, 3) in clenching, 4) with occlusal disengage with cotton rolls and 5) in clenching on cotton rolls. Time of each test: 15 seconds. It was performed a statistical analysis with T-test comparing between them the mean of all tests. Results: stabilometry data (postural ball and ellipse) show better postural performances in centric occlusion and clenching in centric occlusion, and a worsening in all tests with occlusal disengage (with statistically significant difference - p<0.05). Conclusions: postural instability caused by whiplash increases muscles tone and dental clenching as compensatory effects, with onset of facial pain. An occlusal disengage (like an occlusal splint to reduce clenching)induces a postural worsening in patients with normal occlusion, while centricocclusion increases the stability. These results suggest that stomatognathic organ has a new physiological function: the posture stabilization.
Safety and Tolerability of Intra-Articular Hyaluronic Acid Injection (Sinovial®) in Experimental and Clinical Practice
Authors: Chevalier X. , Migliore A.
Published: January 2017

Osteoarthritis (OA) requires long-term treatment, therefore, tolerability is a key factor in treatment choice. Hyaluronic acid (HA), a glycosaminoglycan with viscoelastic properties, a major component of synovial fluid and the extracellular matrix of the joint cartilage, plays key roles in synovial fluid viscosity and maintaining normal cartilage. Viscosupplementation is an intra-articular (IA) injection of exogenous HA in an effort to delay joint mobility loss. Commercially available viscosupplementation includes HA of different average molecular weight (MW), concentration and origins, with varying tolerability. This review describes the tolerability and safety profile of Sinovial® in knee and hip OA. A literature search of PubMed using the search queries [Sinovial® OR hyaluronic acid OR hyaluronan] and [intra-articular OR osteoarthritis] was performed using terms as medical subject headings and free text searches. Studies were selected manually for inclusion in this review. Sinovial® is a low-medium MW HA of non-avian origin, produced by biofermentation to ensure the product is pure and free of allergenic animal proteins. We analyzed data regarding the tolerability of Sinovial® in OA patients. This formulation has a favorable tolerability profile; no systemic reactions have been reported and most adverse events (AEs) are mild, transient and easily managed local injection site reactions. Reactions — pain and burning at the injection site - are typical of IA injections. AEs with Sinovial® used in the hip are similar to knee OA.
Impact of Age and Autoantibody Status on the Gene Expression of Scleroderma Fibroblasts in Response to Silica Stimulation
Authors: Yang Y. , Wei P. , Guo X.J. , Zhou D. , Zhang W.Z. , Assassi S. , Zhou X.D.
Published: January 2017

Environmental factors are believed to play an important role in the pathogenesis of systemic sclerosis (SSc). Silica exposure has been implicated as potentially hazardous in epidemiological studies of SSc. It can activate fibroblasts to express profibrotic genes at certain conditions. The aim of this study is to examine whether the fibroblasts of SSc patients respond to silica particles with specific gene expressions differentially from normal control fibroblasts. The fibroblasts obtained from skin biopsies of 96 SSc patients and 104 controls were examined. Silica particles were used to perturb the cultures of the fibroblasts in time-course and dose-response assays. The transcript levels of COLI A2, COL3A1, MMP1, MMP3, TIMP3 and CTGF genes of the fibroblasts were measured with quantitative RT-PCR. The results showed that the expressions of all six genes in SSc fibroblasts under silica perturbation appeared significantly different from normal control fibroblasts. In age stratified analysis, compared to control fibroblasts, SSc fibroblasts from patients at age 30–40 years and 50–60 years displayed significantly decreased expressions of MMP1 gene in all dosage assays and increased expression of COL3A1 genes started at low dosages perturbation of silica particles, respectively. In autoantibody stratified analysis, specific gene expression patterns were significantly associated with autoantibody-subgroups of fibroblasts. A common feature of SSc fibroblasts was unstable and a wide range of gene expression changes in response to silica perturbation. Our studies may suggest an altered intrinsic dynamic control in SSc fibroblasts. In addition, sensitivity and specificity of SSc fibroblasts to potentially hazardous environmental trigger is age and autoantibody-subgroup-dependent. The fibroblasts of SSc patients at age 30–60 years may be more sensitive to silica perturbation toward a profibrotic gene expression.
IL-32γ Inhibits Acetaminophen-Induced Acute Hepatotoxicity through Inactivation of NF-κB and Stat1 Signals
Authors: Kim Y.R. , Jung Y.S. , Lee Y.H. , Hwang C.J. , Hwang J.L. , Seok C.H. , Seong H.C. , Yoon N.Y. , Yeom S.Y. , Han S.B. , Yoon D.Y. , Hong J.T.
Published: January 2017

Although several studies have shown physiological functions of interleukin (IL)-32, the role of IL-32 in liver has not yet been reported. This study was initiated to examine the effects of IL-32γ on APAP-induced acute hepatic failure in IL-32γ transgenic mice. IL-32Γ overexpressing and non-transgenic mice received 500 mg/kg Acetoaminophen (APAP) intraperitoneally. Serum alanine transaminase and aspartate transaminase were significantly lower in the APAP treated IL-32γ overexpressing mice compared with those APAP-treated non-transgenic. IL-32γ markedly reduced a restricted area of the necrosis and inflammation. APAP-induced reduced glutathione depletion, induction of nitric oxide and lipid peroxidation, and cytochrome P4502E1 expression was significantly lowered in the IL-32γ overexpressing mice. Elevation of Kupffer cells and natural killer cells by APAP were reduced in the IL-32γ overexpressing mice. The expression of IL-1α, IL-1rα, macrophage inflammatory protein-2, C-C motif chemokine ligand 5 and tissue inhibitor of metalloproteinase-1 was increased by APAP in non-transgenic mice, and were lowered in the IL-32γ overexpressing mice. Moreover, APAP-induced nuclear transcription factor-kappa B (NF-κB) and signal transducers and activators of transcription 1 (STAT1) activities were greatly lowered in the IL-32γ overexpressing mice. The results indicate that IL-32γ could effectively inhibit drug-induced hepatic failure, and reduce the number of cytotoxic immune cells and pro-inflammatory cytokine production through reduced activities of NF-κB and STAT1. This might be attributable to lowering APAP-induced liver toxicity in IL-32γ overexpressing mice.