Locations, associations and temporal evolution of intracranial arterial infundibular dilatations in children

2019 ◽  
Vol 12 (5) ◽  
pp. 495-498
Author(s):  
Adam A Dmytriw ◽  
Daniel-Alexandre Bisson ◽  
Kevin Phan ◽  
Afsaneh Amirabadi ◽  
Helen Branson ◽  
...  
Keyword(s):  
Temporal Evolution ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Short Term ◽  
Institutional Review ◽  
Common Location ◽  
History Of ◽  
Imaging Surveillance ◽  
Few Data

BackgroundThere are few data in the literature on the characteristics and natural history of intracranial arterial infundibular dilatations in children.MethodsAn institutional review board-approved retrospective review was performed of infundibula reported on MR angiography in patients <18 years of age at our tertiary pediatric institute from 1998 to 2016. Clinical data (age, sex, diagnosis, other vascular variants/pathologies) were recorded and images assessed for vessel of origin, infundibulum size and exact location. Ratios of infundibulum:parent artery were assessed at diagnosis and last follow-up. Temporal evolution to aneurysm was evaluated.ResultsWe found 60 intracranial infundibula in 60 children (male:female=27:33; mean age 9.7±5.2 years, range 2–18 years,). Family history of aneurysms was present in 2/60 (3.3%). Syndromic association was found in 14/60 (23.3%), most frequently sickle cell disease (4/14=28.6%). Mean infundibulum size was 2.2±0.5 mm, with mean ratio to parent artery of 0.54±0.17. The most common location was on the P1-posterior cerebral artery (34/63=56.7%), whereas posterior communicating infundibula were seen in only 4/60 (6.7%) cases. Other cerebrovascular variants were seen in 12/60 (20%) patients. On follow-up imaging (in 32/60 patients over 86 patient-years, mean 32.3±35.7 months), no significant change in infundibulum:parent artery ratio was noted. None of the infundibular dilatations showed interval evolution to aneurysm.ConclusionWe present the largest reported cohort of pediatric intracranial arterial infundibula, which we found to be distinct from their adult counterparts with regard to location, etiology and temporal evolution. Growth over time and/or aneurysmal formation are rare, not necessitating frequent short-term imaging surveillance during childhood.

scholarly journals Endovascular Internal Trapping by Low-Concentration N-butyl-2-Cyanoacrylate for a Ruptured Giant Common Carotid Artery Pseudoaneurysm

2020 ◽  
Vol 55 (1) ◽  
pp. 81-85
Author(s):  
Tomoaki Harada ◽  
Atsushi Fujita ◽  
Junichi Sakata ◽  
Masaaki Kohta ◽  
Eiji Kohmura
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Parent Artery ◽  
Artery Pseudoaneurysm ◽  
Low Concentration ◽  
Complete Obliteration ◽  
Minimum Number ◽  
History Of ◽  
Giant Pseudoaneurysm

Treating carotid blowout syndrome following rupture of giant pseudoaneurysms is difficult because the destroyed parent artery precludes conventional treatment. We present a patient with a ruptured giant pseudoaneurysm that we occluded using a modified internal trapping technique with low-concentration N-butyl-2-cyanoacrylate (NBCA) and a minimum number of coils. An 80-year-old man with a history of chemoradiation therapy for oropharyngeal cancer presented with several episodes of active bleeding from the subsequent tracheostomy site. Radiological examination revealed a giant right common carotid artery (CCA) pseudoaneurysm. Endovascular internal trapping was performed using both NBCA and coils under proximal flow control. We slowly injected 9 ml of low-concentration NBCA, which subsequently filled the entire pseudoaneurysm. We then injected an additional 2 ml of NBCA into the proximal CCA to achieve complete obliteration. No re-bleeding was observed during the 6-month follow-up. Endovascular internal trapping using low-concentration NBCA was feasible to treat a giant CCA pseudoaneurysm. The injected low-concentration NBCA filled the entire pseudoaneurysm without the risk of catheter entrapment.

scholarly journals Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1094-1105 ◽  
Author(s):  
Xuanfeng Qin ◽  
Feng Xu ◽  
Yashengjiang Maimaiti ◽  
Yongtao Zheng ◽  
Bin Xu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Parent Artery Occlusion

OBJECTIVE Aneurysms of the posterior cerebral artery (PCA) are uncommon. To date, a limited number of studies have examined the outcomes of endovascular treatment for PCA aneurysms. The authors' aim in this study is to report their experience with the endovascular treatment of PCA aneurysms. METHODS Between January 2007 and December 2014, 55 patients with 59 PCA aneurysms were treated using the endovascular approach at the authors' institution. Twenty-three patients had 25 saccular aneurysms, and 32 patients had 34 fusiform/dissecting aneurysms. The endovascular modalities included the following: 1) selective occlusion of the aneurysm (n = 22); 2) complete occlusion of the aneurysm and the parent artery (n = 20); 3) parent artery occlusion (n = 6); 4) partial coiling of the aneurysm and the parent artery (n = 5); and 5) occlusion of the dissecting aneurysm sac (n = 2). RESULTS The immediate angiographic results included 45 complete occlusions (82%), 2 nearly complete occlusions (4%), and 8 incomplete occlusions (14%). The mean follow-up period of 21.8 months in 46 patients showed 37 stable results, 6 further thromboses, and 3 recurrences. The final results included 41 complete occlusions (89%), 2 nearly complete occlusions (4%), and 3 incomplete occlusions (7%). Procedure-related complications included the following: 1) rebleeding (n = 1); 2) infarction (n = 4); and 3) perforation (n = 1). There was 1 (1.8%) procedure-related death due to rebleeding, and 2 (3.6%) non–procedure-related deaths due to severe subarachnoid hemorrhage. Clinical outcomes were excellent (Glasgow Outcome Scale 5) in 47 of 49 patients at the long-term follow-up. CONCLUSIONS PCA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiological outcomes. However, patients who present with severe SAH still have an overall poor prognosis. Partial coiling of the aneurysm and the parent artery is an attractive alternative treatment for patients who may not tolerate parent artery occlusion. Further study with a larger case series is necessary for validation of the durability and efficacy of this treatment.

Short-Term Messages (SMS) and Content of Delusions in a Schizophrenic Patient

2011 ◽  
Vol 26 (S2) ◽  
pp. 1380-1380
Author(s):  
F. Estilaee ◽  
A. Ghaffari Nejad
Keyword(s):  
Schizophrenic Patient ◽  
Mobile Phones ◽  
New Technologies ◽  
Previous History ◽  
Psychiatric Ward ◽  
Short Term ◽  
Rate Of Progression ◽  
History Of ◽  
Psychiatric Problems

Since the human creation he always has tried to have easier life through invention new technologies. We use technology to reduce our weakness and limitations and become stronger, faster, happier and more intelligent. We use new technologies such as internet and mobile phones to get easier and more available connections to each other. But does the technology give us happier life? Sometimes it seems that the rate of progression in technology is faster than our adaptation to it. Using of newer technologies cause being always accessible but unfortunately it may substitute the real inter personal relations. Despite external comfort it makes newer and serious stresses. Here we introduce a 24 year old, single and 12 class educated woman without previous history of psychiatric problems. She has accustomed with a guy through SMS. They had never visited and never spoken to each other. This relation lasts several months till she begins to gets twofold conception from these SMSes. She believes the meaning of jungle in the SMSes is female genitalia and inability to go to holly shrine is equivalent by sexual intercourse in menstrual period. Patient admitted in our psychiatric ward with schizophrenia impression, she treat with antipsychotic and her symptoms reduce considerably, but in 3 month follow up she still believes have not made mistake in past. In this report, in addition to patient introduction, we discuss about technology and its role to influence on content of delusions in schizophrenia

scholarly journals Significant predictive factors of the severity and outcomes of the first attack of acute angioedema in children

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuan-Jhen Syue ◽  
Chao-Jui Li ◽  
Wen-Liang Chen ◽  
Tsung-Han Lee ◽  
Cheng-Chieh Huang ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Respiratory Symptoms ◽  
Clinical Presentation ◽  
Preschool Age ◽  
Short Term ◽  
Patient Demographics ◽  
Life Threatening ◽  
History Of ◽  
Initial Episode

Abstract Background The initial episode of angioedema in children can be potential life-threatening due to the lack of prompt identification and treatment. We aimed to analyze the factors predicting the severity and outcomes of the first attack of acute angioedema in children. Methods This was a retrospective study with 406 children (< 18 years) who presented in the emergency department (ED) with an initial episode of acute angioedema and who had subsequent follow-up visits in the out-patient department from January 2008 to December 2014. The severity of the acute angioedema was categorized as severe (requiring hospital admission), moderate (requiring a stay in the short-term pediatric observation unit [POU]), or mild (discharged directly from the ED). The associations among the disease severity, patient demographics and clinical presentation were analyzed. Result In total, 109 (26.8%) children had severe angioedema, and the majority of those children were male (65.1%). Most of the children were of preschool age (56.4%), and only 6.4% were adolescents. The co-occurrence of pyrexia or urticaria, etiologies of the angioedema related to medications or infections, the presence of respiratory symptoms, and a history of allergies (asthma, allergic rhinitis) were predictors of severe angioedema (all p < 0.05). Finally, the duration of angioedema was significantly shorter in children who had received short-term POU treatment (2.1 ± 1.1 days) than in those who discharged from ED directly (2.3 ± 1.4 days) and admitted to the hospital (3.5 ± 2.0 days) (p < 0.001). Conclusion The co-occurrence of pyrexia or urticaria, etiologies related to medications or infections, the presence of respiratory symptoms, and a history of allergies were predictors of severe angioedema. More importantly, short-term POU observation and prompt treatment might be benefit for patients who did not require hospital admission.

P3843Ischemic-bleeding balance according to history of prior bleeding in patients with acute coronary syndrome during treatment with dual antiplatelet therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Dominguez Erquicia ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
F D'Ascenzo ◽  
S Manzano Fernandez ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Dual Antiplatelet Therapy ◽  
Bleeding Risk ◽  
Short Term ◽  
History Of ◽  
The Impact

Abstract Introduction ESC guidelines recommend short-term dual antiplatelet therapy (DAPT) in patients with high bleeding risk. In this sense, patients with prior admissions by bleeding are considered of high-risk of bleeding. With our study, we aimed to show the ischemic-bleeding profile of patients with prior bleeding in comparison with those without prior bleeding during treatment with DAPT. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without prior admission by bleeding. The impact of prior prior bleeding in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction, whereas for bleeding risk we have considered major bleeding defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,105 have PAD (4.2%). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), 640 had myocardial infarction (2.5%) and 685 had major bleeding (2.6%). After propensity-score matching, we obtained two matched groups of 1,101 patients. In comparison with patients without prior bleeding, those with prior bleeding had higher risk of major bleeding (sHR 2.03, 95% CI 1.33–3.11, p=0.001) with similar risk of myocardial infarction (sHR 0.98, 95% CI 0.61–1.59, p=0.945), in comparison with those without PAD. The cumulative incidence of myocardial infarction was 31 and 32 per 1,000 patients/year in patients with and without prior bleeding, respectively. The cumulative incidence of major bleeding was 63 and 29 per 1,000 patients/year in patients with and without prior bleeding, respectively. The difference between myocardial infarction rate and major bleeding rate was −32 and +3 per 1,000 patient-years in patients with and without prior bleeding (Figure). Conclusions Patients with ACS and prior history of bleeding have a significant increment of bleeding risk during treatment with DAPT. In these patients, short-term DAPT (6 months) should be recommended.

scholarly journals Stent-assisted coil embolization of a recurrent posterior cerebral artery aneurysm following surgical clipping

2016 ◽  
Vol 30 (1) ◽  
pp. 99-103 ◽  
Author(s):  
Tomonori Takeshita ◽  
Tomoaki Nagamine ◽  
Kohei Ishihara ◽  
Yasuhiko Kaku
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Surgical Clipping ◽  
Substantial Risk ◽  
Multiple Recurrences ◽  
Cerebral Artery Aneurysm

Posterior cerebral artery (PCA) aneurysms are rare, and direct surgery of these is considered difficult. Coil embolization of PCA aneurysms is becoming popular. However, it is difficult to completely obliterate the aneurysm while preserving the flow of the parent artery in large or giant PCA aneurysms with a wide neck with this technique. We report a case of a large and wide-necked PCA aneurysm with multiple recurrences following successful surgical clipping and coil embolization. A 77-year-old man with a large unruptured right PCA (P2) aneurysm was successfully treated by surgical clipping. Postoperative digital subtraction angiography (DSA) showed complete aneurismal occlusion. Four years afterward, the aneurysm recurred and grew toward the contralateral. Surgical retreatment of this complicated aneurysm was considered difficult, with a substantial risk of complications. Therefore, the aneurysm was treated with an endovascular procedure. Because simple coil embolization was not expected to achieve satisfactory obliteration of the aneurysm with preservation of parent artery patency, we used stent-assisted coil embolization. The patient tolerated the treatment well. On DSA obtained six months after the first endovascular treatment, coil compaction and recanalization of the aneurysm were detected. A second coil embolization was successfully performed without any complications. The aneurysm was stable during the next six-month follow-up. Stent-assisted coil embolization may be feasible and effective for such postoperatively complicated aneurysms.

scholarly journals Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts

2018 ◽  
Vol 54 ◽  
pp. 19-26 ◽  
Author(s):  
Federico M. Daray ◽  
Ángeles R. Arena ◽  
Arnaldo R. Armesto ◽  
Demián E. Rodante ◽  
Soledad Puppo ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Serotonin Transporter ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Age Of Onset ◽  
Short Term ◽  
History Of ◽  
Multicenter Prospective Cohort Study ◽  
Adjusted Model

AbstractObjective:The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship.Methods:A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months.Results:At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity.Conclusion:The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.

scholarly journals Nasal Planum Vasculopathy in a Scottish Terrier Dog Treated with Ciclosporin and Endonasal Stents

2018 ◽  
Vol 5 (3) ◽  
pp. 73
Author(s):  
Roberta Sartori ◽  
Valeria Colombo ◽  
Silvia Colombo ◽  
Chiara Noli
Keyword(s):  
Response To Therapy ◽  
Short Term ◽  
Medical Treatments ◽  
Once Daily ◽  
Clinical Appearance ◽  
History Of ◽  
Ulcerative Lesions ◽  
Optimal Quality

A two-year-old, intact female Scottish Terrier presented with one-and-a-half-year history of erosive and ulcerative lesions affecting the nasal planum. Clinical appearance, history, histopathology, and response to therapy were suggestive of a rare vasculopathy of the nasal planum that has been previously described in Scottish Terrier dogs. In previously published reports, medical treatments of the disease had failed, leading to euthanasia of five dogs, while a short-term follow-up was available for one case that was controlled with prednisolone and ciclosporin. The dog reported herein was successfully treated with medical therapy consisting initially of a combination of ciclosporin and prednisolone and endonasal stents applied over the first six months. Stents were inserted in order to prevent abnormal scarring and nostril stenosis. More than one and a half years after diagnosis, the dog is still being administered ciclosporin once daily, breathes normally, and has an optimal quality of life.

scholarly journals Short-term skin problems in infants aged 0–3 months affect food allergies or atopic dermatitis until 2 years of age, among infants of the general population

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Kaori Yonezawa ◽  
Megumi Haruna
Keyword(s):  
Atopic Dermatitis ◽  
Family History ◽  
Food Allergies ◽  
Control Group ◽  
Short Term ◽  
Skin Problem ◽  
Significant Difference ◽  
History Of

Abstract Background This study examined whether infants aged 0–3 months exhibited long-term effects of using a moisturizer skincare intervention and whether a short-term skin problem resulted in the subsequent development of food allergies or atopic dermatitis (AD) until the age of 2 years. Methods This study was a follow-up of a completed randomized control trial (RCT) of moisturizer skincare for infants aged 0–3 months. A self-reported questionnaire was mailed to the parents of children aged 1–2 years who had participated in the RCT. Data were analyzed using a Chi square test, by intention to treat analysis, and by multiple logistic regression. Results Of 155 infants, 22 (14.2%) and 28 (18.1%) had food allergies and AD/eczema until 2 years of age, respectively. No significant difference was seen in food allergies or AD between the group that received moisturizer skincare intervention and the control group. On the contrary, food allergies until 2 years of age were significantly associated with short-term (4–7 days) and long-term (more than 7 days) body skin problems occurring in the first 3 months of life, a family history of AD, and the time of starting complementary food. High value of face transepidermal water loss at 3 months of age was also associated with food allergies. Moreover, a short duration of severe diaper dermatitis during the first 3 months, a family history of AD, and being male were significantly associated with AD/eczema until the age of 2 years. Conclusions After adjusting for family history of AD, a short-term skin problem in the first 3 months of life was significantly associated with the development of food allergies or AD/eczema until the age of 2 years. Prevention or prompt treatment of skin problems in newborns is essential for preventing future allergic diseases. Trial registration This was a follow-up study conducted 2 years after the completed RCT of a moisturizer skincare intervention for early infants, which was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013260)

scholarly journals Endovascular Management for P2 Aneurysms of the Posterior Cerebral Artery

2009 ◽  
Vol 15 (3) ◽  
pp. 341-348 ◽  
Author(s):  
X. Lv ◽  
Y. Li ◽  
C. Jiang ◽  
Z. Wu
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Effective Treatment ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Endovascular Management ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Presenting Symptoms ◽  
Parent Vessel Occlusion

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.

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