Normal Drainage Research Articles

In-Situ Gel Formation for Ocular Drug Delivery System an Overview

Ophthalmic In-situ gels are viscous polymer?based liquids that exhibit sol?to?gel phase transition on the ocular surface due to change in a specific physicochemical parameter like ionic strength, pH or temperature Gel dosage forms are successfully used as drug delivery systems considering their ability to prolong the drug release. To prolong the precorneal resident time and improve ocular bioavailability of the drug various polymers system were studied as in situ gelling vehicle for ophthalmic drug delivery system. The In situ formulation exhibited well, viscosity, drug content and sustained drug release. Conventional liquid ophthalmic formulations demonstrate low bioavailability because of a constant lacrimal drainage in the eye. The normal drainage of an instilled drug dose commences immediately upon instillation and is essentially completed within 5 min. typically ophthalmic bioavailability of only 1–10% is achieved due to the short precorneal residence time of ophthalmic solutions. Each system has its own advantages and drawbacks. The choice of a particular hydrogeldepends on its intrinsic properties and envisaged therapeutic use. This review includes various temperature, pH, and ion induced in situ-forming polymeric systems used to achieve prolonged contact time of drugs with the cornea and increase their bioavailability. Ophthalmic drug delivery is one of the most interesting and challenging endeavors facing the pharmaceutical scientist. The conventional ocular drug delivery systems like solutions, suspensions, and ointments show drawbacks such as increased precorneal elimination, high variability in efficiency, and blurred vision respectively.

Endovascular management of vein of Galen aneurysmal malformations. Influence of the normal venous drainage on the choice of a treatment strategy

Vein of Galen arteriovenous malformations (VGAM) are rare intracranial vascular lesions mostly involving young children. Endovascular therapy is the current standard of care. Albeit interventional techniques have greatly reduced the once dismal vital and functional prognoses previously associated with these lesions, the treatment of VGAMs remains a complex therapeutic challenge. This article reviews the available endovascular options for VGAM therapy, emphasizing three points that we have identified as critical in our practice for the establishment of a treatment strategy: (1) the importance of the deep cerebral venous anatomy, in particular the existence of normal drainage through the Galenic system in spite of the VGAM; (2) the concept of treatment staging, for arterial as well as for venous interventions; and (3) the definition of a therapeutic goal that can be attained at a reasonable cost in terms of complication risks and functional outcome.

Normal and abnormal development of pulmonary veins: State of the art and correlation with clinical entities

Interest for the pulmonary veins has increased in the past decade after the potential arrhythmogenicity of the myocardial sleeve surrounding these structures has been recognized. Furthermore, there are several clinical entities, such as anomalous connection pattern and pulmonary vein stenosis, that are related to abnormal pulmonary vein development. In this review, we will describe current literature and aim to elucidate and reorganize current opinions on normal and abnormal pulmonary vein development in relation to clinical (management of) diseases. Several unresolved questions will be addressed, as well as current conceptual controversies. First, a general overview of development of structures at the venous pole of the heart, including normal development of the pulmonary vein from a primitive Anlage, will be provided. Recent insights indicate an important contributory role of the mesoderm behind the heart, the so-called second heart field, to this area. Subsequently, the formation of a myocardial and smooth muscle vascular wall of the pulmonary veins and the left atrium is described, as well as current insights in the mechanisms involved in the differentiation of these different cell types in this area. Next, developmental concepts of normal pulmonary venous drainage patterns are reviewed, and an overview is provided of clinical entities related to abnormal development at several anatomical levels. Lastly, attention is paid to arrhythmogenesis in relation to pulmonary vein development, as well the consequences for clinical management.

Novel In Situ Collection of Tumor Interstitial Fluid from a Head and Neck Squamous Carcinoma Reveals a Unique Proteome with Diagnostic Potential

IntroductionTumors lack normal drainage of secreted fluids and consequently build up tumor interstitial fluid (TIF). Unlike other bodily fluids, TIF likely contains a high proportion of tumor-specific proteins with potential as biomarkers.MethodsHere, we evaluated a novel technique using a unique ultrafiltration catheter for in situ collection of TIF and used it to generate the first catalog of TIF proteins from a head and neck squamous cell carcinoma (HNSCC). To maximize proteomic coverage, TIF was immunodepleted for high abundance proteins and digested with trypsin, and peptides were fractionated in three dimensions prior to mass spectrometry.ResultsWe identified 525 proteins with high confidence. The HNSCC TIF proteome was distinct compared to proteomes of other bodily fluids. It contained a relatively high proportion of proteins annotated by Gene Ontology as “extracellular” compared to other secreted fluid and cellular proteomes, indicating minimal cell lysis from our in situ collection technique. Several proteins identified are putative biomarkers of HNSCC, supporting our catalog’s value as a source of potential biomarkers.ConclusionsIn all, we demonstrate a reliable new technique for in situ TIF collection and provide the first HNSCC TIF protein catalog with value as a guide for others seeking to develop tumor biomarkers.Electronic supplementary materialThe online version of this article (doi:10.1007/s12014-010-9050-3) contains supplementary material, which is available to authorized users.

Multifocal conjunctival leaks due to the use of mitomycin C mimicking the normal drainage of the tear from the lacrimal excretory ducts

Multifocal conjunctival leaks due to the use of mitomycin C mimicking the normal drainage of the tear from the lacrimal excretory ducts Burak Turgut1, Murat Kaya1, Tamer Demir1, Orhan Aydemir1, Bengü Çobanog˘lu21Fırat University School of Medicine, Department of Ophthalmology, Elazig, Turkey; 2Fırat University School of Medicine, Department of Pathology, Elazig, TurkeyAbstract: A 20-year-old male patient underwent trabeculectomy with mitomycin C (MMC) because of glaucoma secondary to the use of corticosteroid drops. There were three conjunctival holes, which had a positive Seidel test, near the superior fornix three weeks after surgery. Because of hypotony and choroidal effusion in the operated eye, the patient was hospitalized and medical treatment carried out. Despite medical treatment, the leak continued for ten days. The conjunctiva was then partially excised and the tissue was subjected to histopathological evaluation. The conjunctiva and Tenon’s capsule were sutured and the Seidel test was negative, intraoperatively. The histopathological examination of the tissue showed necrosis due to MMC. The excising of conjunctival necrotic tissue provided successful control of intraocular pressure and the patient became asymptomatic at six months follow-up. It should be considered that a leak from superotemporal conjunctiva near the fornix after trabeculectomy with MMC may be confused with orifices of the lacrimal gland ducts.Keywords: trabeculectomy with MMC, conjunctival necrosis, leak

Particle damage observed in ring shear tests on sands

In this paper, particle damage of three test sands with different mineralogical compositions is studied using stress–displacement response measured in ring shear tests, particle-size distributions of the original sand prior to shear and from the shear band after shear, and by examining particle shape changes determined by scanning electron microscope. Particle damage during shearing produced a wider particle-size distribution, and damage typically continued until the normal stress was small (about 28 kPa) in constant volume ring shear tests and the internal stresses were distributed among sufficient particle contacts such that damage practically ceased. The dominant damage mechanism (typically either particle abrasion and shearing-off asperities or particle splitting) depended strongly on the soil response (i.e., contraction or dilation), particle hardness, and particle-size distribution, but both mechanisms produced particles that were more angular and rougher than the original sand particles. The magnitude of particle damage observed in the ring shear tests was influenced by the consolidation normal stress, shear displacement, particle mineralogy, particle-size distribution, drainage conditions, and soil fabric (in constant volume tests). Lastly, the influence of particle damage on engineering properties including hydraulic conductivity, liquefaction resistance, stress–strain response, friction angle, and critical state are briefly discussed.

顔面静脈経由にＭｉｃｒｕｓ ｃｏｉｌを用いて塞栓術を行った海綿静脈洞部硬膜動静脈瘻の１例

A 57-year-old man was referred to our hospital for detailed investigation and therapy of right exophthalmos and chemosis. Cerebral angiography demonstrated a dural arteriovenous fistula (DAVF) involving an anterior part of the right cavernous sinus (CS). The main feeders of the CS-DAVF consisted of the right inferolateral trunk and right middle meningeal artery. The predominant drainage route was the right superior ophthalmic vein (SOV), extending to the right facial vein. The right inferior petrosal sinus (IPS) was not visualized in the arterial phase, but was visualized in the venous phase, indicating that it contributes normal venous drainage. Transvenous embolization (TVE) was performed under general anesthesia through the right facial vein. We advanced a guiding catheter in the right angular vein and passed a microcatheter system through the tortuous vessel to the shunting point under single plane road mapping. The affected anterior part of the CS was occluded with Micrus coils (UltiPaq and Cashmere) (Micrus Endovascular, San Jose, CA, USA). Post-treatment angiography revealed disappearance of the fistula. In general, CS-DAVFs are treated with TVE through the IPS. However, in the present case, IPS was not used for the approach based on the angiographic appearance. Large drainage volume of the right facial vein enabled us to advance the guiding catheter to the angular vein with facility, and to pass the microcatheter system through the tortuous vessel with sufficient support of the guiding catheter. Cashmere, which is a 14 system infinity loop-shaped coil and relatively soft as a framing coil, had a tendency to attach to the anterior part of the CS wall. Because of good packing efficiency, transvenous Micrus coil embolization through the facial vein is an efficient treatment of DAVF involving the anterior part of the CS.

Feasibility of Performing Sentinel Lymph Node Biopsy (SLNB) after Mastectomy: A Case Report

Introduction: Previous mastectomy remains a contraindication to SLNB as normal drainage patterns of the breast can be disturbed. Patients diagnosed with DCIS on core biopsy and later found to have microinvasive or invasive carci-noma at the time of mastectomy are deprived of the opportunity for SLNB and need to undergo axillary dissection. We explored the option and feasibility of performing SLNB in a 39-year-old female who underwent a simple mastectomy without axillary sampling for extensive DCIS and later found to have microinvasive ductal carcinoma on permanent pathology. Results: Lymphatic mapping using subdermal injection of 99mTc-labeled sulfur colloid and blue dye led to the identification of five SLNs. Histopathologic examination showed no metastasis. Conclusion: SNLB is feasible in this setting. However, before its use is routinely adopted, its feasibility and accuracy has to be demonstrated in larger num-bers of patients in whom a negative SLNB is followed by a completion axillary dissection.

Incidence of Otitis Media in Children With Deformational Plagiocephaly

In the past decade, deformational plagiocephaly has seen a staggering increase attributed to the Back to Sleep Campaign of April 1992. With this increase, the possible clinical associations need to be fully understood. The anatomic changes seen include ipsilateral occipital flattening, ipsilateral frontal bossing, ipsilateral anterior ear displacement, contralateral occipital bossing, and contralateral frontal flattening [J Craniofac Surg 2004;15:368-372, erratum in J Craniofac Surg 2004;15:705; Fig. l]. Children with deformational plagiocephaly can have malpositioned ears affecting normal drainage of the eustachian tube as it shifts with this deformity. The eustachian tube plays an important role in draining the middle ear. As evidenced by children with cleft palates, structural differences in the anatomy of the middle ear and eustachian tube can result in an increased susceptibility to otitis media. An institutional review board-approved retrospective study was conducted on all patients whose conditions were diagnosed as deformational plagiocephaly from a cleft and craniofacial deformities clinic for a 2-year period. Parents of patients self-reported the number of ear infections on a questionnaire. The questionnaire results were compared to age-matched patient data available from the Center for Disease Control. There were 1259 patients who fit the inclusion criteria for the questionnaire part of the study, and of these, 634 (50.4%) reported at least 1 ear infection by 1 year of age. In addition to the questionnaire, a subset of infants with deformational plagiocephaly up to 1 year of age were administered a tympanogram, to assess the state of the middle ear. There were 124 patients who fit the inclusion criteria for the tympanometry part of the study, and of these 121 had an abnormal tympanogram at 1 or more clinic visits. The questionnaire did not show deformational plagiocephaly to be a significant risk factor for otitis media in our patient population; however, a trend directly correlating otitis media and the severity level of deformational plagiocephaly was observed. Although this trend lacked statistical significance, further studies should explore these differences. Tympanogrametry showed a marked percentage of infants with deformational plagiocephaly to have eustachian tube dysfunction. Future studies will focus on the significance of these findings.

Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms

In psoriatic arthritis, swelling and pitting oedema may be caused by different pathogenic mechanisms: on one hand, the involvement of tenosynovial structures; on the other hand, the involvement of lymphatic vessels, which may be rarely implicated by the inflammatory process. This different involvement is responsible for a different response to therapy and a different clinical outcome. In fact, patients with inflammation of the tenosynovial structures and normal lymphatic drainage have a more favourable clinical outcome and response to pharmacologic treatment, whilst patients affected by psoriatic arthritis with chronic lymphatic vascular damage are characterized usually by resistance of oedema to therapy. In this study, we report two cases of psoriatic arthritis with distal extremity swelling and pitting oedema. In the first patient, the swelling and pitting oedema were associated with lymphatic obstruction, as detected by lymphoscintigraphy. In the second, the predominant involvement of the tenosynovial structures, as shown by magnetic resonance, with normal lymphatic flow, may have been the cause of arthritis with oedema. These different pathogenetic mechanisms were associated with different response to therapy. Nevertheless, oedema was resistant to therapy in both patients probably because of other unknown factors, which influence therapy and clinical outcome.

The critical role of the conjunctiva in glaucoma filtration surgery

This review considers the critical role of the conjunctiva in determining the success or failure of glaucoma filtration surgery. Glaucoma filtration surgery can be defined as an attempt to lower intraocular pressure (IOP) by the surgical formation of an artificial drainage pathway from the anterior chamber to the subconjunctival space. Many types of glaucoma filtration surgery have been developed since the first attempts almost 180 years ago. The wide range of new techniques and devices currently under investigation is testament to the limitations of current techniques and the need for improved therapeutic outcomes. Whilst great attention has been paid to surgical techniques and devices to create the drainage pathway, relatively little attention has been given to address the question of why drainage from such artificial pathways is often problematic. This is in contrast to normal drainage pathways which last a lifetime. Furthermore, the consequences of potential changes in aqueous humour properties induced by glaucoma filtration surgery have not been sufficiently addressed. The mechanisms by which aqueous fluid is drained from the subconjunctival space after filtration surgery have also received relatively little attention. We propose that factors such as the degree of tissue damage during surgery, the surrounding tissue reaction to any surgical implant, and the degree of disruption of normal aqueous properties, are all factors which influence the successful formation of long term drainage channels from the conjunctiva, and that these channels are the key to successful filtration surgery. In recent years it has been suggested that the rate of fluid drainage from the subconjunctival space is actually the determining factor in the resultant IOP reduction. Improved knowledge of aqueous humour induced changes in such drainage pathways has the potential to significantly improve the surgical management of glaucoma. We describe for the first time a novel type of drainage surgery which attempts to minimise surgical trauma to the overlying conjunctiva. The rationale is that a healthy conjunctiva allows drainage channels to form and less opportunity for inflammation and scar tissue formation which are a frequent cause of failure in glaucoma filtration surgery. Successful drainage over extended periods of time has been demonstrated in monkey and rabbit eyes. Long lasting drainage pathways were clearly associated with the presence of lymphatic drainage pathways. A new philosophy in glaucoma drainage surgery is proposed in which minimisation of surgical trauma to the conjunctiva and the encouragement of the development of conjunctival drainage pathways, particularly lymphatic pathways, are central pillars to a successful outcome in glaucoma filtration surgery.

Rectangular 3-snip Punctoplasty Outcomes: Preservation of the Lacrimal Pump in Punctoplasty Surgery

To report a method of rectangular 3-snip punctoplasty (2 vertical cuts at either side of the vertical canaliculus and 1 cut at the base). Outcomes are compared with the more conventional and anatomically destructive 3-snip triangular punctoplasty (1 cut at the vertical canaliculus, 1 cut at the horizontal canaliculus, and 1 cut at the base). Retrospective review of all eyes undergoing 3-snip punctoplasty between January 1, 2003 and January 8, 2005. Seventy-five patients were eligible for this study. One hundred eight eyes with patent punctum and lacrimal systems prior to surgery underwent punctoplasty (49 rectangular and 59 triangular punctoplasty). Follow-up of 8 days to 2.3 years (mean, 0.68 years). Ages ranged between 16.8 and 99.8 years (mean, 69.5 years). Forty-five patients (60%) were women. There was a trend for patients to be symptomatic postoperatively despite patent punctum and lacrimal systems following triangular (10 of 59, 16.9%) than those who underwent rectangular punctoplasty (5 of 49, 10.2%) although this difference was not significant (difference in proportions = 0.05; CI: -17.635 to 17.645; p = 0.99). This study showed that there were more failures in eyes with triangular punctoplasty. Previous studies have shown that the punctae and canaliculi are important in normal lacrimal drainage. Rectangular punctoplasty is a simple, safe, and quick procedure that maintains the normal anatomy and physiology of the canalicular system, while maintaining a patent punctum and should be considered as a less destructive alternative to the traditional triangular punctoplasty.

A pilot study of vascular endothelial growth factor inhibition with bevacizumab in patients with lymphedema following breast cancer treatment.

Abstract Abstract #6142 Purpose: Lymphedema is a significant long-term complication of primary therapy for breast cancer but little is known regarding its etiology and persistence other than relation to the number of lymph nodes (LN) removed. We suggest the following model: Mechanical disruption of normal lymphatic drainage leads to increased back pressure on lymphatic vessels producing an increase in interstitial fluid pressure (IFP). The increased in IFP triggers local production of VEGF-C to stimulate compensatory lymphangiogenesis. As VEGF-A (and to a lesser extent –C) also increases vascular permeability, the consequent increase in interstitial fluid and edema predominate. Anecdotally, several patients (pts) with metastatic disease treated with bevacizumab monotherapy noted improvement in long-standing lymphedema. This pilot study was conducted to explore these observations prospectively.
 Methods: We used an existing biospecimen bank to conduct a case-control study to compare VEGF-A, -C, -D and VEGFR-3 serum concentrations in breast cancer pts with and without lymphedema (matched for age and LN status). In a separate pilot trial, pts with significant unilateral lymphedema receive bevacizumab, 15 mg/kg every 3 weeks. Baseline assessments include arm volume, interstitial fluid pressure (IFP), extracellular fluid volume by lymphometer (ECF), quality of life (QOL) and plasma VEGF-C, -D, and R-3. IFP is measured serially for 24 hours after the first treatment; arm volume, ECF, QOL, and plasma VEGF-C/D/R-3 are assessed at 3 and 6 weeks.
 Results: Samples were available for 16 pts with chronic lymphedema and 24 matched controls. Median VEGF-C levels were significantly increased in pts with lymphedema (6895 pg/ml vs. 5349 pg/ml, p=0.001). Median VEGF-A levels were slightly higher in pts with lymphedema (375 pg/ml vs.250 pg/ml, p=NS). Eight pts have been enrolled in the pilot trial thus far. Median duration of lymphedema was 4.4 years (2.2-16.6) Median time since surgery was 7.1 years (3.4-17.6); median time since radiation (n=7) was 4.4 years (2.3-7.9). Complete IFP data is available in 5 pts. Baseline IFP was significantly higher in the affected compared to unaffected arm (9.04 vs. -2.07 mmHg; p=0.0017). Median IFP in the affected arm decreased an average of 42.6% 24 hours after bevacizumab infusion (11.1 vs. 6.9 mmHg; p=0.09). Total arm circumference decreased by an average of 2.8 cm three weeks after initial treatment.
 Conclusions: Preliminary data supports the hypothesis that VEGF plays a central role in the development and persistence of lymphedema after local therapy for breast cancer. Inhibiting VEGF acutely decreases IFP and may be an effective treatment. Treatment and accrual to the pilot trial continues; full data will be available by December 2008. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6142.

Pure robotic retrocaval ureter repair

To demonstrate the feasibility of pure robotic retrocaval ureter repair. A 33 year old female presented with right loin pain and obstruction on intravenous urography with the classical "fish-hook" appearance. She was counseled on the various methods of repair and elected to have a robot assisted repair. The following steps are performed during a pure robotic retrocaval ureter repair. The patient is placed in a modified flank position, pneumoperitoneum created and ports inserted. The colon is mobilized to expose the retroperitoneal structures: inferior vena cava, right gonadal vein, right ureter, and duodenum. The renal pelvis and ureter are mobilized and the renal pelvis transected. The ureter is transposed anterior to the inferior vena cava and a pyelopyelostomy is performed over a JJ stent. This patient was discharged on postoperative day 3. The catheter and drain tube were removed on day 1. Her JJ stent was removed at 6 weeks postoperatively. The postoperative intravenous urography at 3 months confirmed normal drainage of contrast medium. Pure robotic retrocaval ureter is a feasible procedure; however, there does not appear to be any great advantage over pure laparoscopy, apart from the ergonomic ease for the surgeon as well the simpler intracorporeal suturing.

Pathomechanisms of Symptomatic Developmental Venous Anomalies

Although it is generally accepted that developmental venous anomalies (DVAs) are benign vascular malformations, over the past years, we have seen patients with symptomatic DVAs. Therefore, we performed a retrospective study and a literature study to review how, when, and why DVAs can become clinically significant. Charts and angiographic films of 17 patients with DVAs whose 18 vascular symptoms could be attributed to a DVA were selected from a neurovascular databank of our hospital. MRI had to be available to rule out any other associated disease. In the literature, 51 cases of well-documented symptomatic DVAs were found. Pathomechanisms were divided into mechanical and flow-related causes. Mechanical (obstructive or compressive) pathomechanisms accounted for 14 of 69 symptomatic patients resulting in hydrocephalus or nerve compression syndromes. Flow-related pathomechanisms (49 of 69 patients) could be subdivided into complications resulting from an increase of flow into the DVA (owing to an arteriovenous shunt using the DVA as the drainage route; n=19) or a decrease of outflow (n=26) or a remote shunt with increased venous pressure (n=4) leading to symptoms of venous congestion. In 6 cases, no specific pathomechanisms were detected. Although DVAs should be considered benign, under rare circumstances, they can be symptomatic. DVAs, as extreme variations of normal venous drainage, may represent a more fragile venous drainage system that can be more easily affected by in- and outflow alterations. The integrity of the DVA needs to be preserved irrespective of the treatment that should be tailored to the specific pathomechanism.

O.072 Urgent adjustment of variable Medos-, Sophysa- and Miethke-ProGAV-valves with standard permanent magnets. Possibilties and limitations

To provide a simple and reliable method for the diagnosis of ventriculoperitoneal shunt malfunction.A total of 14 participants were enrolled in this study, consisting of 7 patients with suspected shunt malfunction and 7 control cases with apparent normal drainage. In all cases, 0.1 mL of 5% glucose solution was injected into the reservoir and 0.1 mL of cerebrospinal fluid was withdrawn from the reservoir 20 minutes later to measure glucose concentration.The glucose concentration in cerebrospinal fluid of the shunt malfunction group was greater than that of the control group (P < 0.05).The proposed method is reliable, safe, and relatively simple for the diagnosis of ventriculoperitoneal shunt malfunction and provides a reference for treatment.

The anterior medullary–anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs.

Extraordinary effects of liquid capsule application after resection of a giant meningioma

Extraordinary effects of liquid capsule application after resection of a giant meningioma

Vein of Galen Aneurysmal Malformation With Deep Venous Communication and Subarachnoid Hemorrhage

A previously healthy 2-year-old boy presented with the acute onset of left middle cerebral artery syndrome. Evaluation revealed subarachnoid hemorrhage and a vein of Galen aneurysmal malformation with angiographic reflux into the deep venous system. Analysis of the angioarchitecture of the lesion demonstrated the basis of the hemorrhage to be reflux into cortical veins. The case supports and underscores the clinical relevance of recent reports indicating that the venous drainage of a vein of Galen aneurysmal malformation may communicate with the normal deep venous system. Such a communication implies that endovascular or surgical obliteration of the venous side of a vein of Galen aneurysmal malformation may impair normal venous drainage, potentially resulting in a venous infract or hemorrhage.

Tectonic geomorphology of the easternmost extension of the Gulf of Corinth (Beotia, Central Greece)

The easternmost sector of the Gulf of Corinth, the Beotia area in Central Greece, is an area with active normal faults located between the two major rift structures of Central Greece, the Gulf of Corinth and the North Gulf of Evia. These active normal faults include WNW to E–W and NE to ENE-trending faults affect the landscape and generate basin and range topography within the Beotia. We study four normal fault zones and drainage basin geometry in the easternmost sector of the Gulf of Corinth to document the impact of active tectonics on the landscape evolution. Fault and drainage geometry are investigated based on detailed field mapping and high-resolution digital elevation models. Tectonic geomorphic analysis using several parameters of active tectonics provides information concerning the relative tectonic activity and fault growth. In order to detect areas of lateral stream migration that could indicate recent tectonic activity, the Transverse Topographic Symmetry Factor and the Asymmetry Factor are used to analyse drainage basin geometry in six large drainage basins and a drainage domain covering the study area. Our results show that vertical motions and tilting associated with normal faulting influence the drainage geometry and its development. Values of stream-gradient indices ( S L) are relatively high close to the fault traces of the studied fault zones suggesting high activity. Mountain-front sinuosity ( S mf) mean values along the fault zones ranges from 1.08 to 1.26. Valley floor width to valley height ratios ( V f) mean values along the studied fault zones range between 0.5 and 1.6. Drainage basin shape ( B S) mean values along the fault zones range from 1.08 to 3.54. All these geomorphic parameters and geomorphological data suggest that the analyzed normal faults are highly active. Lateral fault growth was likely produced by primarily eastward propagation, with the WNW to E–W trending faults being the relatively more active structures.