Sac Size Research Articles

Toxicity assessment of TiO2-MWCNT nanohybrid material with enhanced photocatalytic activity on Danio rerio (Zebrafish) embryos

The increasing production and use of nanomaterials is causing serious concerns about their safety to human and environmental health. However, the applications of titanium dioxide nanoparticles (TiO2NP) and multiwalled carbon nanotubes (MWCNT) hybrids has grown considerably, due to their enhanced photocatalytic efficiency. To our knowledge, there are no reports available to the scientific community about their toxicity. In this work, we perform a toxicity assessment of TiO2NP and TiO2-MWCNT nanohybrid materials using Zebrafish embryos standardized 96 h early life stage assay, under different exposure conditions (with and without UV light exposure). After exposure the parameters assessed were acute toxicity, hatching rate, growth, yolk sac size, and sarcomere length. In addition, μ-probe X-ray fluorescence spectroscopy (µ-XRF) was employed to observe if nanoparticles were uptaken by zebrafish embryos and consequently accumulated in their organisms. Neither TiO2NP nor TiO2-MWCNT nanohybrids presented acute toxicity to the zebrafish embryos. Moreover, TiO2NP presents sublethal effects for total length (with and without UV light exposure) on the embryos. This work contributes to the understanding of the potential adverse effects of the emerging nanohybrid materials towards safe innovation approaches in nanotechnology.

Reconstruction of Contracted Eye Socket With Autogenic Dermal Sphere Connected to Epidermis

Because of the deficiency of blood circulation and soft tissue, reconstruction of the eye socket for severe conjunctival sac stenosis in anophthalmic patients is very difficult. In this article, the authors report an innovative technique for conducting a 1-stage operation to reconstruct the contracted eye socket with an autogenic dermal sphere connected to the epidermis (ADSE). Five patients, each having a single severely contracted eye socket and conjunctival sac, were included in this study. An ADSE was transplanted into the contracted eye socket and conjunctival sac. After the operation, several observation indexes were evaluated, such as the survival and stability of implanted autologous tissue, the improvement of the contracted eye socket, and the degree of patients' satisfaction with their appearance. All of the implanted epidermal and dermal tissues survived well after 6 months' observation. Although somewhat absorbed, the transplanted dermal ball was plump in the eye socket, and the epithelial tissues merged well with the residual conjunctival epithelium. Moreover, the transplanted epidermis assumed a mucosal appearance in 4 of 5 patients. After reconstruction of the eye socket, the size of the conjunctival sac and depth of the eye socket were corrected sufficiently for patients to wear an ocular prosthesis. The implantation of an ADSE can reconstruct a severely contracted eye socket in anophthalmic patients. Because of the high survival rate and limited absorption ratio, this 1-stage operation satisfied both patients and their ophthalmologists.

Fluorescein transit test time as a tool to assess lacrimal pump function after diode laser transcanalicular dacryocystorhinostomy and external dacryocysto-rhinostomy.

Dacryocystorhinostomy (DCR) is the gold standard surgical treatment for nasolacrimal duct obstruction. External DCR is the traditional approach (EXT-DCR); however, the advent of minimally invasive surgeries and the development of optic fiber and laser technologies have made it possible to perform laser transcanalicular DCR (T-DCR), a minimally invasive procedure. This study measured the fluorescein transit time (FTT) after EXT-DCR or T-DCR to evaluate the lacrimal drainage and lacrimal pump function after these two types of DCR. A cross-sectional study of 50 patients who underwent EXT-DCR (EXT-DCR Group) or T-DCR (T-DCR Group), who were anatomically patent upon irrigation, with a minimum 6 months of follow up. The patients' FTT was measured; it was defined as the time from the instillation of the dye into conjunctival sac to its free flow from the rhinostomy site. This evaluation was performed through nasal endoscopy performed intranasally with a blue filter that enabled the faster detection of fluorescein from the ostium site. The mean FTTs of the two groups were compared using the two-sided Student's unpaired t-test. Other variables such as sex, age, previous lacrimal sac size, and the site and shape of the rhinostomy were evaluated to determine their possible relationships with FTT. The EXT-DCR group had 80% female patients at a mean age of 58 years. The T-DCR group had the same percentage of female patients (80%) and a mean age of 56 years. The mean FTT group was 47.48 sec in the EXT-DCR and 33.04 sec in the T-DCR group. Functional success was 88% in both groups. FTT in the DCR-T Group was significantly lower than in the EXT-DCR Group. No other variables exhibited a statistically significant correlation with FTT. Lacrimal drainage was found to be better after T-DCR than after EXT-DCR, results which show that this procedure could prevent lacrimal pump damage.

Multicenter Experience in Translumbar Type II Endoleak Treatment in the Hybrid Room With Needle Trajectory Planning and Fusion Guidance

The objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. There were 26 consecutive T2L patients in three different institutions treated between March 2015 and September 2017 using direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting using a needle trajectory planning and guidance software (Needle ASSIST; GE Healthcare, Chicago, Ill). All patients (n = 26; 19 men, 7 women; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.27 ± 7.5 mm; sac size had increased 10.12 ± 6.5 mm at the time of treatment. Onyx (ev3, Covidien, Plymouth, Minn) or glue (n-butyl cyanoacrylate) and coil embolization were used in 20 of 26 cases; 6 patients were treated with coiling alone. Total procedure time was 75.9 ± 40.7 minutes, contrast material volume was 19.9 ± 29 mL, fluoroscopy time was 13.74 ± 12.2 minutes, and radiation dose was 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 4.3 mm to 64.6 ± 9.3 mm. The average follow-up period was 214 days. In 18 patients, the sac reduced in size from 0.2 to 47.62 mm/100 days; in 3 patients, there was continued AAA expansion (0.6 to 4.31 mm/100 days); there was no change in the sac size in 4 patients after the procedure. Once treated, the recurrence rate of T2L was low (Fig). The patients with sac growth tended to be associated with higher body mass index and baseline estimated glomerular filtration rate levels (P = .09). This initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent midterm efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L after endovascular aortic repair going forward.

Aneurysm sac failure to regress after endovascular aneurysm repair is associated with lower long-term survival

BackgroundThe early survival advantage of endovascular aneurysm repair (EVAR) compared with open repair reverses over time, possibly because of higher rates of reintervention related to endoleaks and aneurysm sac expansion. Therefore, we sought to examine the association between sac behavior, endoleaks, reintervention, and long-term survival. MethodsWe reviewed all patients undergoing EVAR in the Vascular Quality Initiative between 2003 and 2017 with an imaging study at 1 year postoperatively (±6 months). We defined aneurysm sac changes by Society for Vascular Surgery guidelines (change ≥5 mm) and determined independent predictors of sac behavior, new endoleak, and reintervention using hierarchical logistic regression. We employed Cox regression to examine the association between sac behavior and long-term survival. We performed propensity matching between patients with sac regression and those with failure to regress as a secondary analysis. ResultsOf 30,074 EVAR patients, 14,817 (49%) had a 1-year imaging study and were included in this study. At 1 year, 40% of sacs regressed, 35% remained stable, and 25% expanded. Factors independently associated with sac expansion were age (by decade: odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; P = .02), appearance of new endoleak (OR, 1.23; 95% CI, 1.10-1.37; P = .001), smaller aortic diameter (diameter <5 cm: OR, 1.37; 95% CI, 1.21-1.55; P < .001), anemia (OR, 1.47; 95% CI, 1.20-1.80; P < .001), rupture (OR, 1.33; 95% CI, 1.07-1.65; P = .01), and chronic kidney disease (OR, 1.15; 95% CI, 1.05-1.25; P < .01), whereas former smoking (OR, 0.86; 95% CI, 0.76- 0.96; P < .01), cerebrovascular disease (OR, 0.82; 95% CI, 0.67-0.99; P = .04), and statin therapy at discharge (OR, 0.83; 95% CI, 0.75-0.91; P < .001) were associated with lower risk of expansion. Both sac expansion (OR, 2.3; 95% CI, 2.0-2.7; P < .001) and a stable sac (OR, 3.1; 95% CI, 2.7-3.5; P < .001) were associated with the development of new endoleaks. Any failure of the aneurysm sac to regress was associated with long-term mortality compared with sac regression (stable sac size: hazard ratio, 1.2; 95% CI, 1.03-1.4; P = .02; sac expansion: hazard ratio, 1.6; 95% CI, 1.3-2.1; P < .001). This association persisted in patients without documented endoleaks and remained robust after accounting for reinterventions and endoleaks seen in follow-up or on completion angiography. In the propensity-matched cohort, patients with failure to regress experienced lower long-term survival (77% at 10 years compared with 82% for patients with sac regression; P = .01). ConclusionsAfter EVAR, aneurysm sac behavior is associated with the development of new endoleaks, reintervention, and long-term mortality. Not only sac expansion but any failure of the sac to regress is associated with higher long-term mortality, independent of reinterventions or endoleaks, and may be modified by statin therapy. Further study is needed to establish whether patients with stable sacs could benefit from selective reintervention.

Aneurysm Sac Size as a Predictor for Endoleak after Endovascular Aortic Aneurysm Repair of Stanford B Dissecting Thoracic Aortic Aneurysm: Role of MDCT Angiography

Abstract Background: The endovascular techniques for repair of thoracic aortic aneurysms are significantly increased nowadays, so the possibility of endoleak is also raised.Aim of Work: Pre-operative evaluation of the aortic aneu-rysm using the sac size as a predictor for endoleak after endovascular repair of the thoracic Stanford B dissecting aortic aneurysms.Methods: The study was carried over one hundred and seven patients (88 males and 19 females, range 50-75 year old) from October 2016 to November 2017. Pre and post operative evaluation of all examined patients was done using Multislice CT angiography. Types of endoleak were docu-mented as well as the detailed assessment of the rest of the vascular tree was also done. Results: Receiver Operating Characteristics (ROC) curve analysis was performed for aneurysm sac size, area under the curve (AUC) was nearly optimal 0.938 (95% CI 0.891-0.984). The most suitable cut off point for aneurysm sac size was more than or equal to 6.2cm with sensitivity 83.9% and specificity 85.5%.Conclusion: Based on our results, aneurysmal sac size combined with patient's age can be used as predictors for post interventional endoleak.

Relationship between lacrimal sac size and duration of tearing in nasolacrimal duct obstruction

ObjectiveTo analyze the relationship among the presence of lacrimal sac mucus retention, the vertical size of the lacrimal sac, and the duration of tearing symptom in patients with nasolacrimal duct obstruction (NLDO). DesignRetrospective case series. ParticipantsWe reviewed the medical records of 473 patients (664 eyes) who underwent external dacryocystorhinostomy for primary NLDO. MethodsThe information about the presence of lacrimal sac mucus retention and vertical size of the lacrimal sac lumen was collected intraoperatively. The vertical size of the lacrimal sac was classified into 3 groups: small (<5 mm), medium (5–10 mm), and large (>10 mm). The relationship between the lacrimal sac size, presence of mucus retention, and duration of tearing was analyzed. ResultsOf the 664 eyes, 138 had a small lacrimal sac, 199 had a medium lacrimal sac, and 327 had a large lacrimal sac. The distribution of the lacrimal sac size groups differed significantly between the eyes with (n = 245) and without (n = 419) mucus retention (p < 0.001). Among all the subjects of each lacrimal sac size group, there was no significant difference in the duration of symptoms (p = 0.176). However, in patients without mucus retention, the symptom duration in the small lacrimal sac group was significantly longer than that in the large lacrimal sac group (p = 0.017). ConclusionsIn cases with mucus retention, a small lacrimal sac is rare. In cases without mucus retention, the duration of tearing symptom was significantly longer in small lacrimal sac group.

The role of ethylene-vinyl alcohol copolymer in association with other embolic agents for the percutaneous and endovascular treatment of type Ia endoleak.

To evaluate safety, technical and clinical success of embolization of type Ia endoleak (T1a EL) using ethylene-vinyl alcohol copolymer as embolic agent alone or in combination with other materials. Five patients presented T1a EL after endovascular repair of aortic aneurysms (EVAR) with radiological evidence of expanding sac size; in particular, three had contained rupture. In one patient, proximal cuff insertion was previously performed, in three patients proximal cuff was urgently inserted but T1a EL persisted; one patient, previously treated with Ovation Abdominal Stent Graft System, was directly proposed for endovascular treatment. In all cases, endovascular embolization was successfully performed and the transfemoral approach was always chosen; in one case it failed and translumbar approach by direct puncture of the sac was required. Used embolization agents were glue, ethylene-vinyl alcohol copolymer (Onyx) and coils in three cases, n-butyl cyanoacrylate and Onyx in one case, Onyx and coils in the last case. Technical success rate was 100% as well as clinical success. No major or minor complication, including non-target embolization, was registered. Clinical success was 100% until today and the sac diameter remained stable in four patients and decreased in one. Onyx may be considered a suitable embolic agent in the treatment of patients with type Ia endoleaks after EVAR, after failure of conventional treatments such as prolonged balloon inflation of the aortic neck or deployment of large bare stent.

Hyperapolytic species of Acanthobothrium (Cestoda: Onchoproteocephalidea) from batoids off Argentina

Two hyperapolytic species of Acanthobothrium Blanchard, 1848 have been collected from Discopyge tschudii Heckel, 1846 and Zapteryx brevirostris (Müller et Henle) along the coast of Argentina. Acanthobothrium stefaniae sp. n. from D. tschudii is a category one species (i.e., it is less than 15 mm in total length, possesses fewer than 50 proglottids, fewer than 80 testes and essentially symmetrical ovary), and differs from all congeners by the following combination of features: proglottid hyperapolysis, hook morphology, size and shape of the cirrus sac, and by having spinitriches in the distal bothridial surface. This is the first record of Acanthobothrium in Discopyge Heckel, 1846. The specimens from Z. brevirostris conform to the morphology of Acanthobothrium zapterycum Ostrowski de Núñez, 1971. A redescription of this species is presented, which expands most ranges of measurements originally given, and provides details omitted in the original description, including the microthrix pattern. This study allowed us to observe the intraspecific variation in ovarian symmetry in A. zapterycum, which shed some doubt on the validity of this as a diagnostic feature. The reproductive strategy (apolysis) of several species of Acanthobothrium was reviewed and summarized.

Comparison of Five Treatment Strategies for Cesarean Scar Pregnancy

Objective: To explore appropriate treatment strategy for cesarean scar pregnancy (CSP) in the first and second trimester. Methods: Clinical characteristics and treatment strategies in 182 patients with CSP were retrospectively analyzed. Treatment strategies were as follows: Group A (n = 102), uterine artery chemoembolization (UACE) followed by dilation and curettage (DC Group B (n = 63), DC Group C (n = 6), hysteroscopy; Group D (n = 6), laparotomy; and Group E (n = 5), laparoscopy. The basic clinical findings were collected and analyzed, along with the curative effects. Results: The preoperative serum beta-human chorionic gonadotropin (β-HCG) level was in the order of Group D, A>B, C>E (P = 0.001); the size of gestational sac (GS) was in the order of Group D, E>A, C>B (P = 0.000); and the thickness of the anterior myometrium was in the order of Group B>A, C>D, E (P = 0.000). Three cases in the second trimester were all in Group D; two cases were treated with UACE before laparotomy with moderate blood loss (100 and 200 mL, respectively) and the third case was initially treated with D&C and had severe hemorrhage. Conclusions: The diameter of GS, thickness of the anterior myometrium, and preoperative β-HCG level are important factors for the choice of treatment. UACE combined with D&C is a useful measure for most Type 2 CSP cases in the first trimester. For Type 2 CSP cases in the second trimester, UACE before laparotomy could be a reasonable choice.

Anatomy of the Respiratory System of the African Grey Parrot (Psittacus erithacus)

The morphology and function of the avian respiratory system has been studied and debated for over a century due to its distinct features, such as: unidirectional airflow, aerodynamic valves, and a volume‐constant lung ventilated by non‐vascularized, compliant air sacs. Intra‐ and interspecific variation in the shape, size, and number of avian bronchi and ventilatory air sacs has been described from gross dissections and latex injections, but little has been done to describe the three dimensional (3D) morphology and variation of the avian respiratory system in situ, largely due to the destructive nature of dissection. This research aims to generate a detailed anatomical description and 3D digital models of the lower respiratory system of the African grey parrot (Psittacus erithacus). Four micro‐computed tomography (micro CT) datasets of deceased P. erithacus specimens were segmented to produce 3D tetrahedral surface meshes of the pulmonary tree, lung surfaces, air sac surfaces, and skeleton. The anatomical models were then validated via latex injections. Bronchial tree measurements of P. erithacus (n=8) were collected for intraspecific and interspecific comparisons with two other well‐studied archosaurian taxa: the ostrich (Struthio camelus, n=10) and the American alligator (Alligator mississippiensis, n=10). Similarities in the relationships between the carina and the first four large secondary airways of the bronchial tree suggest a role in maintaining unidirectional airflow patterns in these taxa that would have been present in a common ancestor. In some P. erithacus specimens, the cervical air sacs were found to have a broad, thin, and sub‐sternal expansion that extended caudally to encapsulate more than half the ventral abdominal viscera. In another specimen, the right and left abdominal air sacs merged along the midline to form a single, common abdominal sac. These results suggest that the shape and extent of the air sacs in P. erithacus are more variable than previously described for other avian taxa. The models, which will be made available as a detailed 3D digital anatomical atlas through the Grey Parrot Anatomy Project, will likely become an invaluable resource to avian veterinarians for surgical planning.Support or Funding InformationAssociation of Avian Veterinarians (AAV) Research Grant AwardThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The natural history of type 2 endoleaks after endovascular aneurysm repair justifies conservative management.

Objective Management of type 2 endoleaks after endovascular aneurysm repair has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of type 2 endoleaks in order to derive direction in management. Methods Patients who had endovascular aneurysm repair at the Veterans Affairs Long Beach were retrospectively identified and computerized tomographic angiography was independently reviewed by a radiologist and a vascular surgeon. Type 2 endoleaks were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results Of the 160 patients who had completed required follow-up to date (mean 3 years) after endovascular aneurysm repair, 39 (24.4%) patients were identified as having a type 2 endoleak on computerized tomographic angiography imaging. 6 (15.4%) of these 39 patients required repair due to aneurysm sac growth >1cm. 2 (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified type 2 endoleak. Spontaneous resolution of type 2 endoleaks occurred in 16 (41.0%) patients. 4 patients (10.3%) had delayed type 2 endoleaks that presented 4, 9, 12, and 23 months after their 30 day post op computed tomography was normal. None of the 4 patients with delayed type 2 endoleaks required reintervention and none had aneurysm sac growth greater than 5mm. Conclusions Overall, we found that 85% of patients who had type 2 endoleaks did not require intervention after a mean follow-up time of 3 years. The association of a type 1 or 3 endoleak with a type 2 endoleak was more likely to require correction due to aneurysm expansion >1cm, thus type 2 endoleaks associated with another type of endoleak require more aggressive management.

Developmental toxicity of deltamethrin and 3-phenoxybenzoic acid in embryo–larval stages of zebrafish (Danio rerio)

Synthetic pyrethroids are the major insecticides used widely in agriculture and household pest control. Deltamethrin (DM), a widely used type II pyrethroid insecticide, is a relatively potent neurotoxicant. 3-Phenoxybenzoic acid (PBA) is the major metabolite formed due to metabolism of DM. In order to illustrate the toxic response of zebrafish embryos/larvae to DM and PBA the present research was carried out. For this 4hpf embryos were treated with two concentrations of DM (100 and 200 μg/L) for 48 h and PBA (1000 and 2000 μg/L) for 96 h or 99.9% ethanol (solvent control). Early life stage parameters were observed at specified time points. DM-treated embryo/larvae exhibited increased mortality, delay in hatching time, decrease in percentage of hatched embryos, increase of heartbeat rate and decrease in blood flow; lightening of body and eye pigmentation in a dose dependent manner. Pericardial and yolk sac edema along with were also caused by DM. Along with these crooked notochord, tail deformation was noticed in hatched and unhatched embryos. In case of PBA treated embryos and larvae, increased embryos/larvae length and yolk sac size were observed. Other abnormalities like edema (yolk sac and pericardial), decreased eye and body pigmentation were also observed but in some embryos only. These were not as severe as observed in parental compound indicating that DM is more toxic than its metabolite PBA. The data contributes to a better understanding of the potential consequences of fish exposed to DM and PBA.

Parallel stent grafts for the treatment of complex aortic aneurysms: A single center study

Background "Chimney" techniques with parallel grafts used in order to extend the landing zones in endovascular aneurysm repair (ch-EVAR) are increasingly being reported. Conflicting data has been reported regarding the success and durability of the repair. We report a single center experience using ch-EVAR in treating complex aortic pathologies. Methods We performed a retrospective review of all patients treated with ch-EVAR in our institution between 2013 and 2017. Data collected included patients demographics, indications for surgery, configuration of parallel grafts, technical success, and perioperative morbidity and mortality. Follow-up data included aortic sac size, reintervention rate, and overall mortality. Results Thirty-five patients underwent treatment of their aneurysms with parallel grafts. Sixty parallel grafts were placed. Mean age was 75 years (range 59-93) and 30 (85%) were male. Technical success was achieved in 32 (91%) patients. Mean follow up was 12 months. Sac size decreased in diameter or remained unchanged in 26 of the 30 (86.6%) patients. Four patients were found to have enlarging aneurysms due to gutter endoleaks. All were treated successfully with endovascular methods. The estimated primary patency was 95% at 12 months. Probability of freedom from intervention was 75% at 12 months. No late aneurysm related mortality occurred. Conclusion The use of ch-EVAR in treating complex aortic aneurysms is technically feasible and safe. Gutter endoleaks are encountered only in a minority of the cases, and can be treated with minimally invasive techniques. Longer term follow up is required to evaluate the patency of these parallel grafts and the durability of the aneurysm exclusion.

Images at the time of admission, show significant interval increase in size of the aneurysm sac

Images at the time of admission, show significant interval increase in size of the aneurysm sac

3:54 PM Abstract No. 107 Intermediate-term results of the microvascular plug (MVP) for treatment of pulmonary arteriovenous malformations

To evaluate intermediate-term results for embolotherapy of pulmonary arteriovenous malformations (PAVMs) using the Micro Vascular Plug (MVP). Patients with HHT and PAVMs treated by MVPs between October 2014 and January 2017 were retrospectively reviewed. Data collected included age, gender, number and type of PAVM, feeding artery size, device migration, aneurysmal sac size and perfusion. Technical success was defined as immediate intraprocedural angiographic occlusion of the feeding artery beyond the plug. Successful intermediate-term treatment was defined in 2 ways: 1. No sac enhancement (no perfusion of the PAVM sac on follow-up contrast-enhanced CT), and 2. No persistence (> 70% reduction in PAVM sac diameter on latest available CT). MVP-3, 5, 7 and 9 were chosen to embolize feeding arteries measuring < 3, 3-5, 5-7, and 7-9 mm respectively. One hundred and twenty-two MVPs (91 MVP-3, 28 MVP-5, 2 MVP-7, and 1 MVP-9) were deployed in 106 PAVMs (82 simple, 24 complex). Average feeding artery size was 2.6 mm (1.1-7.1 mm). Immediate technical success was achieved in 115 of 122 (94%) deployments. CT was available for 19 patients (18 female, 11 male) with 67 treated PAVMs with an average age of 41. Average latest available CT follow-up.: 14.6 months (range, 5.6-38.8). There was no enhancement of the PAVM sac on CECT in 63 of 67 (94%) PAVMs. No persistence was seen in 50 of 67 PAVMs (75%). There were 2 complications: One migration occurred when a MVP-5 placed in a 5 mm feeding artery migrated to the draining vein on 3 mo follow-up CT requiring re-embolization. One patient developed a toe microemboli after delayed electrolytic detachment. Our series of 106 PAVMs treated with 122 MVPs demonstrated a high rate of immediate angiographic occlusion, and successful treatment on intermediate follow-up CT with an average follow-up of 14.6 months. The MVP should be oversized beyond manufacturer recommendations to prevent migration, particularly when the draining vein is large.Tabled 1Feeding Artery Size Embolized with the MVPFeeding Artery DiameterMVP-3MVP-5MVP-7MVP-9Ave (mm)2.14.15.07.1Range (mm)1.1-3.03.0-5.04.2-5.8n/aTotal912821 Open table in a new tab

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations

PurposeTo evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs).Materials and MethodsThirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9–83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5–6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6–36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135–0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography.ResultsIn 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2–47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization.ConclusionsHydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome.

To evaluate and compare grading systems of subchorionic hematoma (SCH) on first-trimester ultrasound examinations with live embryos to assess which best correlates with early pregnancy outcome and to assess the effect of gestational age at the time of diagnosis on outcome. First-trimester live singleton pregnancies between 6 and 11 weeks' gestational age with SCH were identified by an institutional database search. First-trimester outcome was categorized as "live" or "demise" based on ultrasound or medical record documentation. Hematomas were categorized in 4 ways: (1) subjective (small, moderate, or large); (2) subjective size based on fraction comparison with gestational sac size; (3) subjective grading based on the estimated percentage of the gestational sac surrounded by hematoma; and (4) 3 orthogonal measurements of the hematoma. A total of 434 sonograms met study inclusion criteria. The overall rate of first-trimester pregnancy failure was 12.0%. The rate of demise was significantly higher for hematomas diagnosed at or before 7 weeks (19.6%) than for those after 8 weeks (3.6%; P < .001). The size of the hematoma estimated as a fraction of gestational sac size significantly correlated with first-trimester pregnancy loss (P < .001). There was no statistical significance between first-trimester outcome and the other 2 subjective grading methods. Volume-based measurements provided spurious results because of the irregular shape of most hematomas. Subjective hematoma size based on the fraction of gestational sac size correlates best with first-trimester pregnancy outcome. The earlier in pregnancy an SCH is detected, the higher the rate of subsequent pregnancy failure.

Microsurgical management results of occipital encephalocele

Background Encephalocele is a central nervous system birth anomaly with a herniation of the brain and the covering meninges through a bony skull defect to the exterior.Objective The aim of this research was to describe the prognostic factors and current possible hypotheses explaining associated anomalies observed in a series of 17 patients with encephalocele and show the effectiveness of setting up a microsurgical technique in the treatment of these cases.Materials and methods Seventeen patients who were identified with occipital encephaloceles and referred to our Neurosurgery Clinic at the Mansoura University Hospital, Mansoura Insurance Hospital, between October 2004 and July 2013 were enrolled in this study. Patients’ sex, age at the time of the procedure, features of the lesion including site, size, associated cerebrospinal fluid leak, radiological evaluation and intraoperative findings (sac contents), and intracranial and extra cranial-associated anomalies were determined in the study.Results In our study, 17 patients (12 female and five male) were included. Their ages varied between newborn and 1 month. The encephalocele sac was situated in the occipital region in 15 (88.2%) patients and in the occipitocervical region in two (11.8%) patients. We used a microsurgical technique on all patients. Five (29.4%) of the 17 patients died: three in the postoperative early period (0–7 days) and two in the late postoperative period (2 weeks to 3 months). The mortality rate in our study was 29.4%.Conclusion The evidence in our series showed the importance of some factors that can alter the survival of patients with occipital encephalocele such as the sac size, the neural tissue existence in the content, hydrocephalus, infections, and other associated malformations. In this study, we report improvements in the surgical results by introducing the microsurgical technique as an alternative to traditional management despite the high morbidity and mortality linked to this congenital anomaly.

Surgical Repair of Encephaloceles in Gabriel Tour&amp;#233; Hospital: Review of 17 Cases

Background: Encephaloceles are congenital neural tube defects characterized by the protrusion of meninges and/or brain tissue from a defect in the skull. The incidence of the disease is about 0.8 - 5.6/10,000 live births. They are classified based on the location and type of skull defect as occipital encephalocele, encephalocele of the cranial vault, frontoethmoidal encephalocele, and basal encephaloceles. Surgical reduction being the first line treatment and resection of herniated structures may be necessary when the encephalocele is large. In the present study, the authors present their experience in treating 17 patients with encephaloceles. Methods: This study is a retrospective analysis of 17 patients from January 2013 to December 2016 in Gabriel Toure Hospital, Bamako, Mali. A history was obtained from the family at presentation. Medical information before and during the pregnancy was compiled. All patients underwent CT scan as a routine preoperative imaging study, to evaluate the encephalocele and to plan the surgical procedure. The following data were recorded for analysis: age, sex, location of encephalocele, neurological status, operative method, postoperative complications and surgical results. Results: There were 10 (58.8%) female and 7 (41.2%) male patients. The patients ranged in age from 3 days to 36 months. The most common site of encephalocele sac was the occipital region in 14 (82.4%) cases followed by the frontal region in 2 (11.8%) cases and the vertex in 1 (5.9%) case. The sac size was less than 3 cm in 5 (17.6%) cases, 3 - 5 cm in 8 (47.1%) cases and more than 5 cm in 4 (23.5%) cases. Three (17.6%) children presented with CSF leakage. Hydrocephalus was present in the preoperative period in 6 (35.3%) cases; all of them required VP shunt procedure. None of the cases had a preoperative neurologic deficit. Surgical excision was performed in all cases. In the postoperative period, meningitis developed in 2 cases (11.8%), wound infection in 1 case (5.9%) and seizure in 1 case (5.9%). Three patients (17.6%) died during postoperative follow-up. Postoperative hydrocephalus occurred in 1 (5.88%) patient requiring a VP shunt. Conclusion: Encephaloceles are commonly seen in the practice of neurosurgery in the world as well as in Mali. In this study, the clinical manifestations and surgical results of 17 cases have been reviewed. We recommend early repair and excision of encephaloceles to avoid rupture or skin excoriation.