Effect of renal embolization with trisacryl and PAVc

OBJECTIVES: Evaluate the degree of vascular occlusion, vascular recanalization, and necrosis of the vascular wall caused by polyvinyl alcohol-covered polyvinyl acetate (PVAc) particles compared to trisacryl particles after renal embolization. METHODS: Seventy-nine female albino New Zealand rabbits underwent arterial catheterization of the right kidney. Thirty-three animals were embolized with trisacryl particles, thirty-one with PVAc particles, and fifteen were kept as controls. Four animals were excluded (three trisacryl and one PVAc) due to early death. Five subgroups of six animals were created. The animals in the different groups were sacrificed either 48 hours, 5 days, 10 days, 30 days, or 90 days after embolization. The control group was divided into subgroups of three animals each and kept for the same periods of time. The kidneys were dyed with hematoxylin-eosin and Masson's trichrome and then examined using optical microscopy. RESULTS: There were significant differences in the degree of vascular occlusion caused by the trisacryl and the PVAc particles between the five-day and the ten-day groups. Additional differences were noted between the five-day and 48-hour groups in regard to the amount of necrosis. For both findings, the PVAc group members showed adequate tissue reaction (ischemia and volumetric reduction) and less recanalization than those treated with trisacryl. CONCLUSION: The use of PVAc as an embolization material exhibited an adequate tissue reaction (ischemia and volumetric reduction), more expressive vascular occlusion and necrosis, and less recanalization than the trisacryl material.

Surgical management of intracranial aneurysms in the "coiling age"

Background: Intracranial aneurysm rupture is associated with substantial rates of morbidity and mortality. The classic neurosurgical treatment for such lesions is the craniotomy for clipping. However, over the last 10 years, surgery has been increasingly replaced by the endovascular technique. Objective: Analyze the results of surgery technique in a Public Health Hospital in the "coiling age". Method:We reviewed a series of 149 patients treated for 191 aneurysms by the traditional craniotomy and clipping technique. Results:We observed an overall mortality of 12.1 por cento, poor outcome of 8 por cento and good outcome of 79.8 por cento. Hunt Hess scores >_3 in the pre-surgical evaluation were associated to a higher length of hospital stay (p=0.047).Better outcome was observed in patients with Hunt Hess score <3 comparing with patients with Hunt Hess score >_ 3 before surgery (p<0.000). Patients who presented with Fisher Scale grade 4 presented a poor prognosis when compared to the other groups (p=0.016). Conclusion:Excellent results may be achieved by craniotomy to treat aneurysms, which still represents a useful technique for lesions that can not be safely treated by endovascular techniques nowadays.

Endovascular treatment of cerebral aneurysms: a retrospective study of 163 embolized aneurysms

OBJECTIVE: To present the results of cerebral aneurysms treated by endovascular technique. METHOD: Retrospective analysis of patient files of Hospital Geral de Fortaleza, Brazil. RESULTS: We report the results of 163 cerebral aneurysms treated by endovascular techniques from January 2002 to October 2005. Patients with ruptured aneurysms (87.2 percent), according to Hunt-Hess scale were: 33.7 percent HH I, 28.4 percent HH II, 24.1 percent HH III, 13.8 percent HH IV. The Fisher scale grade IV was the most common (39.7 percent). Remodeling, coil embolization, arterial occlusion and histoacryl embolization were the techniques employed. Effective occlusion was achieved in 87.7 percent, partial occlusion in 5.3 percent and non-effective occlusion in 7.0 percent of the patients. Glasgow outcome scale results were: 76.3 percent GOS 5, 5.0 percent GOS 4, 5.8 percent GOS 3, 1.4 percent GOS 2 and 11.5 percent GOS 1. CONCLUSION: Endovascular treatment seems to be feasible within Brazilian public health system, with results as good as those obtained in larger international centers.

OBJETIVO: Apresentar os resultados de aneurismas tratados pela técnica endovascular. MÉTODO: Análise retrospectiva de prontuários do Hospital Geral de Fortaleza, Brasil. RESULTADOS: Apresentamos os resultados de 163 aneurismas cerebrais tratados por técnicas endovasculares de Janeiro de 2002 a Outubro de 2005. Os pacientes com aneurismas rotos (87,2 por cento) eram, segundo a escala de Hunt-Hess: 33,7 por cento HH1; 28.4 por cento HH II, 24.1 por cento HH III, 13.8 por cento HH IV. O Grau IV da escala de Fisher foi o mais comum (39,7 por cento). Empregaram-se as técnicas de remodeling, espiras metálicas, oclusão arterial e embolização com histoacryl. Foi obtida oclusão efetiva em 87,7 por cento, oclusão parcial em 5,3 por cento e oclusão não-efetiva em 7,0 por cento dos casos. De acordo com a Glasgow outcome scale, os resultados foram: 76,3 por cento GOS 5, 5,0 por cento GOS 4, 5,8 por cento GOS 3, 1,4 por cento GOS 2 e 11,5 por cento GOS 1. CONCLUSÃO: A aplicação de técnica endovasculares mostra-se viável na rede pública brasileira, com resultados comparáveis aos de grandes centros mundiais.

Esthesioneuroblastoma: case report

Esthesioneuroblatoma (ENB) is a rare tumor arising from the olfactory epithelium of the nasal vault which frequently invades the cranial base, cranial vault and orbit. ENB has a bimodal age distribution between 11 and 20 years and between 51 and 60 years. ENB accounts for approximately 1 to 5 percent of intranasal cancers and no consensus has been reached regarding treatment of this tumor. We report on a 66 year old female patient with a Kadish stage C tumor with frontal lobe invasion submitted a total craniofacial resection with a combined head neck and neurosurgeon team. The purpose of this study is to analyze the natural history, treatment and prognosis of this tumor, based on the literature review

Compressäo medular torácica em dois níveis por calcificaçäo de ligamento amarelo: relato de caso / Thoracic spinal cord compression at two levels due to ligamentum flavum calcification: case report

Calcificaçao e/ou ossificaçao do ligamento amarelo é patologia bem conhecida na literatura japonesa. Causa estenose do canal vertebral torácico e compressao medular. Os autores apresentam o caso de um paciente de origem nao japonesa com mielopatia torácica causada por compressao devida a calcificaçao do ligamento amarelo.