Absence Of Rupture Research Articles

The Second-Set Surgeries for Multiple Unruptured Aneurysms Do Not Increase Perioperative Complications

BACKGROUND AND OBJECTIVES: Intracranial aneurysms affect 3% to 4% of the population, with 20% to 25% having multiple aneurysms. Aggressive treatment is warranted for multiple unruptured aneurysms because of their higher risk of rupture and enlargement compared with single aneurysms. However, the risks and appropriate timing of secondary clipping surgeries are underreported. We assessed the prognosis and risks of treating multiple cerebral aneurysms with a second surgery and determined the differences in prognosis based on the timing of these surgeries. METHODS: We retrospectively reviewed patients who underwent secondary clipping surgery for multiple unruptured cerebral aneurysms at our hospital and affiliated institutions. The number, size, and location of aneurysms, patient demographics, and antithrombotic drug history were compared between the first and second surgeries. The modified Rankin Scale score and postoperative complications, including ischemia, hemorrhage, seizures, chronic subdural hematoma requiring surgery, infection, and postoperative hospital days, were investigated. RESULTS: A total of 38 patients (mean age, 65 years) were included. No significant differences were observed in modified Rankin Scale score worsening, postoperative hospital stay, or complication rates between the 2 surgeries. Older patients tended to undergo the second surgery within 6 months, with no significant difference in complication rates. The first surgery targeted larger aneurysms. CONCLUSION: The absence of complications between surgeries and the absence of rupture or re-treatment during follow-up emphasize the importance of choosing the most appropriate approach for each aneurysm. The first and second surgeries for multiple cerebral aneurysms did not significantly affect postoperative complications. Performing 2 craniotomies may facilitate the curative and safe treatment of aneurysms.

Pregnancies in Women with a Previous Complete Uterine Rupture.

To study the outcomes of new pregnancies after a previous complete uterine rupture. Descriptive study based on population data from the Medical Birth Registry of Norway, the Patient Administration System, and the medical records. Sample. Maternities with a previous complete uterine rupture in Norway during the period 1967-2011 (N = 72), extracted from 2 455 797 maternities. We measured the rate of new complete ruptures and partial ruptures, as well as the maternal and perinatal outcomes of these pregnancies. The characteristics of both previous ruptures and new ruptures were described. Among 72 maternities, there were thirty-seven with previous ruptures in the lower segment (LS) and 35 outside the LS. We found three new complete ruptures and six uneventful partial ruptures, resulting in a rate of 4.2% and 8.3%, respectively. All three complete ruptures occurred preterm in scars outside the LS. The rate of the new complete rupture was 0% in those with previous ruptures in the LS and 8.6% in those with previous ruptures outside the LS. The corrected perinatal mortality was 1.3%, and prematurity (<37 weeks) was high (36.1%); this was noticed even in the absence of new ruptures and was mostly iatrogenic. Two hysterectomies were performed in the absence of rupture and two cases had abnormal invasive placenta. The prognosis for pregnancies after a previous complete uterine rupture is favorable. Prematurity is a problem caused by both obstetrician and mother's anxiety; therefore, the timing of delivery is the most challenging. Management should include careful counseling, vigilance for symptoms, and immediate delivery when a rupture is suspected.

FUNCTIONAL AND TECHNOLOGICAL PROPERTIES OF COFFEE MUCILAGE (Coffea arabica) AND ITS APPLICATION IN EDIBLE FILMS

Brazil is the largest coffee producer in the world, and together with the millions of tons produced, millions of tons of residues are also generated. The generated residues are a source of environmental contamination depending on the chosen processing route. One of the main applications of food industry waste is in the production of raw materials to produce edible films and coatings. Coffee mucilage is a pectin-rich liquid residue from the coffee sector that can be used in the production of value-added products. Given this, the objective of this work was to characterize and evaluate the potential of functional and technological properties of coffee mucilage and your applicability in the production of edible films. The filmogenic mixture was obtained by casting from 10% (w/v) lyophilized coffee mucilage and solvent (water). The films produced from the coffee mucilage presented good homogeneity, continuity (absence of ruptures or fragile regions), flexibility, ease of detachment of the support and handling, without the need to add adjuvant to its formation. In addition, they presented uniformity in thickness, high light barrier and medium water vapor barrier. Thus, it can be concluded that mucilage is a potential product to be used in the cosmetic, pharmaceutical and food industries.

Complete anterior papillary muscle rupture in absence of coronary artery disease: an unsolved dilemma.

Complete anterior papillary muscle rupture in absence of coronary artery disease: an unsolved dilemma.

Long-term outcomes of paclitaxel-coated balloons for non-malignant ureteral strictures.

To evaluate the clinical efficacy and safety of drug-coated balloon (DCB) ureteroplasty for the management of non-malignant ureteral strictures. A prospective "off-label" monocentric single-arm pilot study investigating the safety and efficacy of drug-coated balloon (DCB) (Lutonix®; BD, USA) was performed. Twenty-five patients with benign ureteral strictures related to uretero-enteric anastomosis (n = 13); lithiasis (n = 5), post-surgical complications (iatrogenic n = 5), transplanted kidney (n = 1) and post-radiotherapy (n = 1) were included. Following lesion crossing, predilatation was performed using 4-7mm high-pressure balloon catheter (5-6Fr) with a balloon pressure of 6-7atm based on the manufacturer's recommendation. In the absence of rupture of the ureteral wall, the DCB was dilated for 4min. across the lesion. The process was repeated if deemed necessary to a maximum of three stricture dilatations. We analysed both clinical and radiological primary patency (no signs of ipsilateral hydronephrosis or improvement of the existing residual dilatation at the follow-up examinations) and secondarily safety endpoints. Mean lesion length was 40 ± 28.5mm. Mean time follow up was 36months ± 10.46months. Strictures were located at upper ureteric (12%), lower ureteric (32%), ureterovesical anastomosis (4%) and uretero-enteric anastomosis (52%) levels. The overall radiological success at 1-year follow-up was 88% (22/25 patients). In 56% patients (14/25 patients with primary patency) the nephrostomy catheter was removed 21days following a single DCB procedure. In 32% (8/25 patients) an additional dilatation sessions were required for maintaining the ureteral patency. The overall failure rate at 1-year follow-up was 12% (3/25 patients). Only one case of febrile urinary tract infection in a female patient (acute pyelonephritis) was encountered after the first dilatation. Paclitaxel-coated balloon ureteroplasty proved to be safe and effective for the treatment of non-malignant ureteral strictures. Larger studies are warranted to validate these promising initial results.

The role of miR-26a, miR-29a and miR-448-3p in the development of cerebral aneurysm.

Cerebral aneurysms cause the weakening and abnormal expansion of the arterial wall. MicroRNAs (miRNAs) are small noncoding RNAs of approximately 22 nucleotides in length that regulate gene expression. This study aimed to elucidate the role of miRNAs in the development of cerebral aneurysms. This study compared the expression levels of miR-26a, miR-29a and miR-448-3p in 50 samples each of cerebral aneurysm tissues and normal superficial temporal artery tissues. The miRNA expression levels were also compared in terms of aneurysm location and rupture status, i.e., presence or absence of rupture. Expression levels of miR-26a, miR-29a and miR-448-3p were increased in aneurysm tissues compared with normal vascular tissues. No significant difference was found in the miRNA expression levels with respect to aneurysm location or rupture status. This study showed that miR-26a, miR-29a and miR-448-3p overexpression could play an important role in intracranial aneurysm development independent of aneurysm location and rupture status. miR-26a, miR-29a and miR-448-3p could act as potential therapeutic targets in patients with intracranial aneurysms; however, further studies are needed on this issue.

Unruptured Intradural Posterior Circulation Dissecting/Fusiform Aneurysms Natural History and Treatment Outcome.

The natural history and outcome of unruptured posterior circulation dissecting fusiform aneurysms is not fully understood. These have a high risk of morbidity and mortality, not only due to natural history but also due to the challenging and controversial treatment approaches currently available compared to other types of intracranial aneurysms. We performed a retrospective study of a prospectively collected aneurysm database at a quaternary neurovascular hospital. We included consecutive patients with unruptured intradural vertebrobasilar dissecting aneurysms between January 2000 and July 2016 who were followed to 2020. Description of baseline, procedural, and outcomes data was performed. Comparisons of patient who had aneurysm rupture on follow-up, increase in 2 or more points of mRS in follow-up and progression of the aneurysm was performed. Seventy patients with 78 fusiform posterior circulation aneurysms were identified. Thirty-nine (55.7%) patients were male with a mean age of 51.7 years (SD ± 17.6). When multiple, aneurysms were more likely to be fusiform (60%) than saccular (40.0%). Baseline diameter (measured on CTA/MRA/DSA), length as well as symptomatic presentation were significantly higher in aneurysms which grew over time. Coronary disease, diabetes and growth were associated an >2 increase in mRS. Diabetes as well as initial symptomatic presentation were associated with rupture. Unruptured dissecting/fusiform aneurysm are associated with a considerable rate of rupture during follow-up. Growth is associated with morbidity even in the absence of rupture. Initial large size, coronary disease, diabetes, and to a lesser extent female gender may merit closer follow-up and/or prophylactic treatment.

Films based on mixtures of zein, chitosan, and PVA: Development with perspectives for food packaging application

This work aims at the production and characterization of promissory food packaging films based on chitosan (CS), zein (ZN), and poly (vinyl alcohol) (PVA). CS and ZN are biodegradable, biocompatible, and extracting from natural-sources and renewable. Although PVA is a synthetic polymer, it is also considered biocompatible and present water-solubility. From binary and ternary macromolecule mixtures based on CS/ZN/PVA, were obtained films solvent-free. In this facet, extrusion of the macromolecule mixture following by a hot compression to acquire the films' solvent-free. The films were characterized by several techniques such as Fourier transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), X-ray diffraction (XRD), prioritization query based on critical packaging requirements which underwent visual and sensorial (smell), mechanical properties, scanning electron microscopy (SEM), and barrier property analysis. Our findings showed that a higher proportion of ZN led to yellowish films with lower transparency and/or higher opacity. Therefore, PVA high content is interesting for our proposal since it allows films with translucency, handling, absence of rupture, and odor. The mechanical tests showed that the ZN effect is associated with reduced tensile strength, increasing elongation, and Young's modulus. Thus, ZN's presence, even if in a smaller proportion to PVA, allows the formation of more rigid films. The morphological analysis indicates the formation of compact films and homogeneous surfaces. However, films with higher amounts of CS and ZN presented greater roughness, globular clusters' presence, and heterogeneity (films' cross-section) that may have influenced water vapor permeability values and better barrier property due to tortuosity that decreases as the PVA content is increased. This finding can be associated with the higher crystallinity of the film when the film's formulation presents significant CS and ZN concentrations. Finally, we demonstrate the feasibility of using films based on the mixture of CS, ZN, and PVA as proposals for a food pack.

Ганчір'я - непотріб або цінний ресурс? Утилізація відходів в Українській СРР у 1920-х - на початку 1930-х років

The article analyzes reuse of waste in the USSR in the 1920s - early 1930s taking the example of rags. The study is done due to the non-disclosure of this scientific problem in the Ukrainian and foreign research. Based on a comparative analysis of the disposal of rags in the Russian Empire and in the USSR (case of Ukraine), the absence of ruptures in the practice of its collection has been proved. This is argued by the recognition of the value of rags as a raw material for the development of a number of industries, for example paper. The conclusion is made about the reconceptualization of waste in the early USSR, which began to be considered as a valuable raw material resource for the needs of the Soviet economy and exports. It was found that the initial interest in collecting rags was due to the need to expand exports in order to obtain additional foreign exchange earnings and purchase deficit in the USSR equipment and goods. However, since the second half of the 1920s, rags were recognized as a valuable resource for the Soviet industry. It was found that with the development of the Soviet economy, the circle of customers of rags expanded and the chemical, haberdashery and construction industries joined the paper and light industry. The similarities and differences of the multilevel mechanism of collecting rags and its main actors in tsarist Russia and in the Soviet Union are revealed. Author analyzed the evolution of its forming and found that in the 1920s, the activity in the collecting rags was decentralized. It was carried out by a wide range of actors as one of the areas of procurement of various types of agricultural and industrial raw materials for the Soviet economy. Author put the question of the need to analyze the dilemma of collecting rags in the context of a total shortage of consumer goods and poverty of the population, which widely used the practice of clothing repair. As a result, garbage often transformed in almost unusable in recycling rags. The author did not identify the environmental motivation for the reuse of rags during this period, but concluded that these activities contributed to the creation of certain elements of waste sorting and storage infrastructure, development and improvement of waste management rules, which established a basis for more efficient and conscious waste management in the second half of the 20th century.

Identifying Ruptures and Repairs in Alliance-Focused Training Group Supervision

ABSTRACT Group supervision presents unique opportunities for psychotherapy trainees to deepen their understanding of alliance ruptures and repair strategies. Trainees can explore challenging clinical moments and benefit from diverse perspectives and support. Group supervision also provides trainees with multiple opportunities to experience ruptures and repairs firsthand in their interactions with the supervisor and other group members. More research, particularly research using observer-based methods, would enhance our knowledge of rupture and repair processes in group supervision. In this study, seven sessions of Alliance-Focused Training, a group supervision that specifically aims to improve trainees’ abilities to recognize and negotiate ruptures, were coded for alliance rupture markers and repair strategies using a modified version of the Rupture Resolution Rating System (3RS). Excerpts of the coded sessions were used to illustrate AFT process in the absence of ruptures, and in the context of ruptures between the supervisor and trainees, between trainees, and between a trainee and the group. There were no clear examples of ruptures between trainees. The ruptures between the supervisor and the trainees were deemed to have only a minor impact on the alliance, and these minor ruptures were at least partly addressed. Based on the coding, themes related to supervisor authority, complex and subtle ruptures, and the use of metacommunication within the AFT group were discussed. The findings of this exploratory study suggest that the 3RS can be useful for measuring process in group supervision and that greater attention to group process and ruptures within the group holds promise for enhancing the effectiveness of AFT.

Embolização de pseudoaneurisma de artéria gastroduodenal em paciente com tuberculose extrapulmonar: relato de caso

Objetivo: Descrever a evolução e o desfecho de um caso de pseudoaneurisma de artéria gastroduodenal em uma paciente com tuberculose extrapulmonar. Detalhamento do caso: Paciente do sexo feminino, 15 anos, sem comorbidades prévias conhecidas, deu entrada ao pronto-socorro com hematêmese sem controle por meio endoscópico e por esse motivo encaminhada ao centro cirúrgico para laparotomia de emergência. Durante cirurgia foi evidenciado tumoração em mesentério (diagnosticado posteriormente com tuberculose) e realizado duodenotomia e rafia de vaso com sangramento ativo. Topografia de lesão em segunda porção de duodeno. Evoluiu com novos episódios de hemorragia digestiva alta em pós-operatório, sendo diagnosticada com pseudoaneurisma de artéria gastroduodenal, realizando embolização com evolução favorável e alta com recuperação completa do quadro. Considerações finais: Pseudoaneurismas, normalmente, possuem uma origem secundária: traumática, inflamatória ou infecciosa. Pseudoaneurismas de artéria gastroduodenal são condições raras correspondendo a apenas 1,5% de todos os aneurismas viscerais. Na maioria das vezes, ele provoca sintomas inespecíficos, como dor abdominal, em presença ou ausência de ruptura, e hemorragia digestiva, retroperitoneal ou intraperitoneal. Embora o baixo número de casos conhecidos limite a experiência na abordagem terapêutica, normalmente se prefere o uso dos métodos endovasculares para abordagem dos mesmos.

THE INFLUENCE OF TECHNOLOGICAL FACTORS ON THE PROPERTIES OF BASALT FIBER WHEN USED IN THE MANUFACTURE OF FLEXIBLE HEAT AND SOUND INSULATING PRODUCTS

Analysis of energy efficiency and operational safety of technological equipment of industrial enterprises, engineering networks, buildings and structures, building structures in many sectors of the economy, including the housing and industrial sectors, causes interest in the use of high-tech, environmentally friendly heat and sound insulation materials with enhanced performance properties. One of the relevant representatives of these materials is basalt fibers and their use as raw materials in the production of flexible heat and sound insulating products. It is known that the chemical composition of the initial melt equally affects the physicochemical and mechanical properties of basalt fibers. The main influence factors, including the chemical composition, are the thermal past of the melt, the method for producing basalt fiber and the conditions for the formation of its structure. These factors determine the structural characteristics of the fiber and, as a consequence, its physicochemical characteristics. The degree of fiber strength is directly determined by its chemical composition and production method. The greatest strength of the fiber is obtained by ensuring the perfect fiber structure in the absence of ruptures of siliceous chains.

Dynamic Rupture Scenarios in the Brawley Seismic Zone, Salton Trough, Southern California

AbstractIn this paper we investigate the dynamic behavior of a system of interconnected faults in the Brawley Seismic Zone (BSZ) in southern California. The system of faults includes the southern San Andreas Fault (SSAF), the Imperial Fault (IF), and a set of cross faults in the BSZ that may serve as connecting structures between the two larger faults. Geological and seismic evidence imply that the SSAF and IF may have buried extensions that link them together in a large‐scale step over, with the cross faults in the BSZ cutting between them. Such a configuration poses the question of whether through‐going rupture across the step over is possible in this region, leading to large, plate‐boundary scale earthquakes. We investigate potential earthquakes in this region through 3‐D dynamic finite element spontaneous rupture modeling. We find that under multiple assumptions about fault stress and fault geometry, through‐going rupture is possible, both from north to south and south to north. Participation of the cross faults is facilitated by two factors: absence of rupture on one of the main two faults and a contrast in prestress between the main faults and the cross faults, leading to slow propagation speed on the main faults while maintaining ease of failure on the cross faults. The pattern of rupture propagation and slip is strongly affected by fault‐to‐fault dynamic stress interactions during the rupture process. The results may have implications for both potential earthquakes in this region, as well as for understanding the dynamics of geometrically complex/branched faults in general.

Ameloblastic Fibroma: a Case Report

Ameloblastic fibroma is a rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. A 24-year-old male patient was referred to the Stomatology Department presenting with difficulty to chew and swelling in the right posterior region of the mandible. The panoramic radiograph showed a well-circumscribed, unilocular radiolucent lesion with partially radiopaque borders involving first and second unerupted molars. Computed tomography imaging presented a hypodense image with well‑delimited isodense content, bulging cortical bones and absence of rupture. The patient underwent an incisional biopsy. Microscopically, the lesion was composed of many mesenchymal tissue cells in strand form, arranged in cords, islands and nests of odontogenic epithelium; the diagnostic was ameloblastic fibroma. The patient was referred to the hospital for enucleation and curettage of the lesion and extraction of the associated teeth. After 8 months of follow-up, no recurrence was observed. This case emphasizes the importance of differential diagnosis, anatomopathological exam, and both clinical and imaging follow-up, since tumors of this type can recur and progress to malignancy.

Wirsung atraumatic rupture in patient with pancreatic pseudocysts: a case presentation

BackgroundPancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak.Case presentationWe describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution.ConclusionPancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.

Urgency surgical treatment for ruptured hepatic adenoma: experience of 23 years

Background: Hepatocellular adenoma (HA) is a benign tumor, which mainly affects young women using oral contraceptives, usually presenting as a single nodule. The clinical picture varies from abdominal pain in the epigastrium and right hypochondrium with palpable mass to asymptomatic or by one of its complications, such as malignancy or rupture. When ruptured, it may present with acute abdominal pain, which may lead to intrahepatic or intraperitoneal bleeding with or without signs of hypovolemic shock. If the patient remains hemodynamically unstable despite adequate volume resuscitation, immediate surgical intervention is necessary, recommending principles of damage control of hepatic trauma, aiming at adequate hemostasis, hepatectomy in this situation is a procedure associated with considerable morbidity and mortality. Methods: Analyze the epidemiology, risk factors and surgical treatment of HA with rupture (RHA) in University of Campinas in a last 22 years. The records of the patients with confirmed pathology of RHA submitted to surgery on University of Campinas from 1995 to 2017 were retrospectively evaluated. The diagnosis of HA was confirmed by the histology being categorized by the presence or absence of Rupture by clinical signs or radiological findings. Results: There were 28 cases of HA submitted to surgery, of which 8 RHA (28.57%), the mean age was 35.05 years, 7 were female and 1 male. Five of these patients used oral contraceptives. Mean intraoperative bleeding was 3084.5 ml, with 3 deaths occurring. Conclusion: RHA may or may not be associated with hemodynamic instability, a potentially life threatening condition, mainly associated with lesion size and OAC use. In centers where interventional radiology is not available surgical treatment is indicated to control bleeding and stabilize the patient with high morbidity and mortality.

Successfully Surgical Repair of Giant Unruptured Aneurysm of the Sinus of Valsalva

Aneurysmal dilatation and progressive enlargement of one of the sinuses of Valsalva, most often occurs on the site of right coronary sinus and normally goes undetected during life until its rupture. Rarely, the aneurysm presents with evidence of obstruction of the right ventricular outflow tract, aortic insufficiency, conduction abnormalities, or coronary artery compression in the absence of rupture. The biggest size in the literature of aneurysm was reported as 8 cm. In this case report, we present successful surgical repair of 10 cm large sinus of Valsalva aneurysm with Bentall procedure.

Ameloblastic fibroma: a case report

Ameloblastic fibroma is a rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. A 24-year-old male patient was referred to the Stomatology Department presenting with difficulty to chew and swelling in the right posterior region of the mandible. The panoramic radiograph showed a well-circumscribed, unilocular radiolucent lesion with partially radiopaque borders involving first and second unerupted molars. Computed tomography imaging presented a hypodense image with well‑delimited isodense content, bulging cortical bones and absence of rupture. The patient underwent an incisional biopsy. Microscopically, the lesion was composed of many mesenchymal tissue cells in strand form, arranged in cords, islands and nests of odontogenic epithelium; the diagnostic was ameloblastic fibroma. The patient was referred to the hospital for enucleation and curettage of the lesion and extraction of the associated teeth. After 8 months of follow-up, no recurrence was observed. This case emphasizes the importance of differential diagnosis, anatomopathological exam, and both clinical and imaging follow-up, since tumors of this type can recur and progress to malignancy.

Papillary Muscles Rupture as Delayed Sequelae of Trauma

Background : Spontaneous rupture of papillary muscle from sepsis is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe a case of spontaneous acute papillary muscle rupture in absence of history of ischemic cardiomyopathy or blunt chest trauma. Case Report: A 42 year-old man was transferred to intensive care unit with signs and symptoms of cardiogenic shock. Past history revealed that he had met with a road traffic accident 19 months ago with fracture mid shaft of left femur. He was treated for the same and failed to have regular follow up visits. Physical examination revealed osteomyelitis at the fractured site with sinus formation and pyrexia. His general condition declined thereafter and expired due to cardiac failure few hours later. At autopsy there was rupture of antero-lateral papillary muscle of mitral valve. Microscopic section of the ruptured papillary muscle revealed formation of focal abscess with neutrophil infiltration. Conclusion: Papillary muscle ruptures are associated with significantly increased morbidity and mortality. Therefore early diagnosis is very important in providing appropriate treatment. This case emphasized the fact that delay in diagnosis and institution of appropriate antimicrobial therapy for sepsis may result in life threatening complications. Although this occurrence is uncommon, papillary muscle necrosis and subsequent rupture must be considered as cause of delayed deaths in cases of road traffic accidents with septicemia.

脳動脈瘤コイル塞栓2年以後の塞栓状態の画像上変化

In this study, we evaluated the embolic state based on imaging findings two years after embolization, and divided our patients into groups to examine postoperative changes in imaging findings. We studied 61 patients with cerebral aneurysms who underwent embolization in our hospital. There were 23 males and 38 females (mean age 60.6 y) with 66 aneurysms (16 ruptured and 50 unruptured). Embolic state was evaluated two years after treatment, and subsequent imaging-based follow-up with MR angiography was continued for six months or more. The follow-up period ranged from 30 to 146 months after embolization (median: 49, mean: 63). Based on the embolic state two years after coil embolization, the aneurysms were divided into three groups: complete occlusion (C group), neck remnant (N group), and body filling (B group) groups. Changes in the embolic state at the final evaluation point were investigated. Two years after embolization, 39 aneurysms were assigned to C group, 21 to N group, and six to B group. According to the final results, complete occlusion was noted in 37 aneurysms (94.8%) in C group, neck remnants in 18 (85.7%) in N group, and body filling in six (100%, additional treatment: 1) in B group; there were no changes in comparison with the results two years after embolization. We compared the results between ruptured and unruptured groups. In the former, there were no changes in 13 aneurysms, improvement was achieved in one, and deterioration was noted in two. In the latter, there were no changes in 47 aneurysms, improvement was achieved in two, and deterioration was noted in one (additional treatment: one aneurysm); there were no differences. With respect to the aneurysmal size, there were no differences in the results among three groups with a capacity of ＜100 mm3 (41 aneurysms), 100 to 200 mm3 (nine aneurysms), and ≧200 mm3 (nine aneurysms). With respect to the volume embolic ratio (VER), there were also no differences among three groups with a VER of ＜20% (14 aneurysms), 20 to 30% (25 aneurysms), and ≧30% (21 aneurysms). There were no changes in imaging findings two years or more after the coil embolization of cerebral aneurysms. The long-term result was very favorable regardless of the presence or absence of rupture, aneurysmal capacity, and VER. However, long-term follow-up was possible in only a small number of patients in specific groups, consisting of body filling or ruptured aneurysms; a larger number of patients should be investigated in the future.