Unruptured tubal ectopic pregnancy with very high levels of beta HCG: a rare case report

When the fertilized ovum is implanted outside the endometrial cavity, it is termed as ectopic pregnancy. The most common site being fallopian tube. The commonest site to be affected is ampulla of the fallopian tube followed by isthmus. Fimbrial and interstitial are rare sites for ectopic pregnancy. The incidence of ectopic pregnancy is increased over couple of decades. Important causes include PID, previous history of ectopic pregnancy, h/o tubal reconstructive surgery, h/o artificial reproductive techniques like IVF, use of IUD’s, h/o of tubal ligation etc. Fallopian tubal ectopic usually ruptures at duration of 7-8 weeks gestation. A ruptured tubal ectopic pregnancy can lead to massive haemorrhage leading to tachycardia, hypotension endangering life, which requires emergency surgical intervention & transfusion blood and blood products. Ectopic pregnancy with beta HCG <5000 IU/L, Gestational sac <4 cm, & vitally stable, can be managed medically with methotrexate, whereas higher levels of beta HCG, Gestational sac > 4 cm with live ectopic pregnancy and vitally unstable becomes obstetric emergency which should be managed surgically. Thorough clinical examination, use of ultrasonography and beta HCG levels, helps in timely diagnosis and management of ectopic pregnancy which can be lifesaving. This is a rare case report of unruptured live fimbrial ectopic pregnancy with very high levels of beta HCG (>50,000 mIU/ml), which was managed surgically.

Successful multiple-dose methotrexate therapy for unruptured repeat ectopic pregnancy with high ?-human chorionic gonadotropin value: a case report

Successfully managing an unruptured ectopic pregnancy necessitates prioritizing the preservation of fertility as the primary objective. Medical management is traditionally considered to be more successful at lower �- human chorionic gonadotropin (HCG) values. However, there is emerging evidence that successful treatment can be achieved with modification of dosage regimen in the presence of high ?-HCG value. We reported the successful management of a case of unruptured repeat ectopic pregnancy in a patient with high ?-HCG. Mrs PA is a 25-year-old G4P0+3 with previous right salpingectomy due to ruptured ectopic gestation who presented with an ultrasound diagnosis of unruptured left tubal ectopic gestation at a gestational age of 6 weeks. The pre-treatment quantitative ?-HCG level was 7066 IU/l. She had multiple dose methotrexate therapy which was well tolerated with normalization of ?-HCG levels within 44 days. Hysterosalpingography done six (6) months post-treatment demonstrated patent left fallopian tube. She subsequently had spontaneous conception of an intrauterine pregnancy 16-months post-treatment. The pregnancy was carried to term and culminated in successful delivery at term. Multiple-dose chemotherapy was successful in this patient with high ?-HCG level with no reported adverse effect.

Analysis of the efficacy of flow diverter device and traditional stent in the treatment of unruptured ophthal-mic segment aneurysms / 实用医学杂志

Objective Discuss the safety and effectiveness of flow diverter device and traditional stent inthetreatment of unruptured ophthalmic segment aneurysms.Methods A retrospective analysis from January 2017 to January 2023 was performed on the clinical data of 70 cases of unruptured aneurysms in the Department of Neurosurgery of Southern Theater General Hospital treated with stent-assisted embolization.According to the type of implanted stents,theywere divided into flow diverter device group(n = 21)and traditional stent group(n = 49),and the postoperative clinical effects and complications of the two groups were compared.Results The two groups of patients followed 3 to 24 months,with an average of(14.4±1.82)months.The results of periopera-tive and follow-up showed that the inclusion rate was higher in the flow diverter device group and the traditional stent group(93.3%vs.87.9%),with no significant difference(P>0.05),and the incidence of perioperative and short-term complications was lower(0 vs.6.1%)in the flow diverter device group than in the traditional stent group,and there currencies rate in the flow diverter device group was lower than that in the traditional stent group(0 vs.6.1%),but the difference was not significant(P>0.05).Conclusion Flow diverter devices and traditional stents in the treatment of unruptured ophthalmic segment aneurysmsare feasible,safe and effective.Preliminary results suggest that the incidence of short-term complications and retreatment is lower after treatment with flow diverter devices,and the operation time is short,but further studies are needed to validate long-term complica-tions in patients.

Manejo del aneurisma de aorta abdominal sintomático no roto: últimos adelanto / Management of symptomatic unruptured abdominal aortic aneurysms: state of the art

RESUMEN El aneurisma de aorta abdominal (AAA) sintomático no roto es una patología que involucra a aquellos pacientes con AAA intacto, pero que presentan dolor abdominal y/o lumbar atribuido al aneurisma. Esta forma de presentación clínica es po tencialmente mortal dado que su etiopatogenia comprende cambios agudos en la pared aórtica, incluyendo inflamación, lo que incrementa la probabilidad de ruptura inminente. Está claro que estos pacientes deben ser derivados a reparación del AAA. Sin embargo, el momento de la intervención es controvertido. Por lo tanto, el objetivo del presente trabajo fue revisar la información actualizada sobre el abordaje diagnóstico-terapéutico del AAA sintomático no roto.

ABSTRACT Symptomatic unruptured abdominal aortic aneurysm (AAA) refers to a group of patients with intact AAA but who present abdominal and/or lumbar pain attributed to the aneurysm. This form of clinical presentation is potentially fatal since its etiopathogenesis, involving acute changes in the aortic wall, including inflammation, increases the probability of impending rupture. It is clear that these patients should be referred to AAA repair. However, the timing of the intervention is contro versial. Therefore, the aim of the present work was to review updated information on the diagnostic-therapeutic approach of symptomatic unruptured AAA.

The illness experience of patients with unruptured intracranial aneurysm undergoing interventional treatment: a qualitative research / 中国实用护理杂志

Objective:To deeply understand the illness experience of patients with unruptured intracranial aneurysm undergoing interventional treatment, and to provide reference for formulating targeted nursing intervention programs.Methods:The semi-structured interview method of qualitative research was used to conduct in-depth interviews in 17 patients with unruptured intracranial aneurysm undergoing interventional treatment. Data were analyzed by content analysis method.Results:Five themes and ten sub-themes were extracted, including limited disease cognition (ignoring disease symptoms, wrong medical treatment behavior), uncertainty of disease (fear of aneurysm rupture, fear of disease recurrence), trusting in medical resources (trusting diagnosis and treatment technology, satisfactory medical service), desire for social support (hope for family members′companionship, expecting the concern of doctors and nurses), positive self-management (maintaining emotional stability, building health behaviors).Conclusions:Medical staff should pay attention to the physical and mental feelings of patients with unruptured intracranial aneurysm during the disease process, assess their needs, support and coping ability, and provide scientific and effective help to promote their physical and mental comfort.

Clinical and imaging characteristics of patients with unruptured intracranial aneurysms accompanied by sentinel headache / 中华神经医学杂志

Objective:To explore the clinical and imaging characteristics of patients with unruptured intracranial aneurysms accompanied by sentinel headache.Methods:Forty patients with unruptured intracranial aneurysms confirmed by DSA/CTA and accompanied by sentinel headache admitted to Department of Neurology, First Affiliated Hospital of Xiangnan University from January 2018 to August 2023 were selected as the study subjects; the clinical and imaging characteristics of these patients were summarized. Forty-four patients with unruptured intracranial aneurysms without sentinel headache and 40 patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms admitted to the hospital at the same period were selected as controls. The differences in aneurysm length (maximum diameter), morphology, tumor length (maximum diameter)/neck width (AR), and risk score for rupture of intracranial aneurysms (scores of population, hypertension, age, size of aneurysm, earlier aneurysm rupture, site of aneurysm [PHASES]) among the 3 groups were analyzed.Results:Among the 40 patients with unruptured intracranial aneurysms accompanied by sentinel headache, 20 (50%) presented with pain localized at the lateral frontal and orbital regions, 3 (7.5%) with pain at the posterior neck region, and 17 (42.5%) with irregular headache sites; 34 (85%) had new onset headache, and 6 (15%) had changes in headache nature besides chronic headache; 24 patients (60%) had posterior communicating artery aneurysm, 12 (30%) had internal carotid artery aneurysm, 1 (2.5%) had middle cerebral artery aneurysm, and 3 (7.5%) had vertebral artery dissection aneurysm; 36 (90%) had irregular aneurysm morphology. Compared with patients with unruptured intracranial aneurysms without sentinel headache, patients with unruptured intracranial aneurysms accompanied by sentinel headache and those with subarachnoid hemorrhage caused by ruptured intracranial aneurysms had larger aneurysm length (maximum diameter), higher proportion of irregular morphology, higher AR value, and higher PHASES scores, with significant differences ( P<0.05). Compared with patients with subarachnoid hemorrhage caused by ruptured intracranial aneurysms, patients with unruptured intracranial aneurysms accompanied by sentinel headache had larger aneurysm length (maximum diameter) and higher PHASES scores, with significant differences ( P<0.05). Conclusion:Sentinel headache is common in patients with unruptured posterior communicating artery aneurysms, and the relatively specific headache pattern is sudden periorbital pain or posterior neck pain; patients with unruptured intracranial aneurysms accompanied by sentinel headache have a higher rupture risk due to the larger size, more irregular shape, higher AR value of the aneurysm, therefore, same attention should be payed to these patients as those with ruptured aneurysms in clinical practice.

Influence of Serum Ferritin and B12 Levels in the Functional Outcomes of Patients with Ruptured and Unruptured Intracranial Aneurysms / Influência dos níveis séricos de ferritina e B12 nos desfechos funcionais de pacientes com aneurismas intracranianos rotos e não rotos

Introduction Pathological processes in the arterial wall that result in vessel dilation are the cause of intracranial aneurysms (IAs), and the risk factors for their formation and progression are not well established. Ferritin is associated with inflammation and angiogenesis; it has protective antioxidative activity, and controls cell differentiation. Vitamin B12 is related to neurological and hematological disorders; it can be used as differential diagnosis tool, and acts in the control of homocysteinemia, a predictor of worse prognosis. The present article aims to assess the correlation between serum ferritin and B12 levels and the patient's functional outcome. Materials and Methods In the present cohort study, we assessed the serum levels of ferritin and B12, as well as the scores on the modified Rankin and Glasgow Outcome Scales at 6 months, of 2 groups, one with 19 and the other with 49 individuals, out of 401 patients treated for IA at Universidade de São Paulo from 2018 to 2019. We performed a statistical analysis, using logistic regression, to determine the aforementioned correlation. Results In the univariable analysis, the serum levels of ferritin showed no significant impact on the functional outcome (odds ratio [OR]: 0.96 for every 100 pg/mL increase; 95% confidence interval [95%CI]: 0.761­1.210; p » 0.732); neither did the serum levels of B12 (OR: 0.998 for every 100 pg/mL increase; 95%CI: 0.826­1.206; p » 0.987). Moreover, no significant impact on the functional outcome was observed in the multivariable analysis regarding the serum levels of B12, age, hypertension, and aneurysm rupture (OR: 1.086 for every 100 pg/mL increase; 95%CI: 0.847­1.392; p » 0.513). Conclusion We were not able to confirm a statistical correlation regarding the serum levels of ferritin and B12, and functional outcome of IA patients. These variables might be linked to other determinants of the pathophysiology of IAs, like inflammation and homocysteinemia.

Introdução Processos patológicos na parede arterial, que resultam em dilatação dos vasos, são a causa dos aneurismas intracranianos (AIs), e os fatores de risco para a sua formação e evolução não estão bem estabelecidos. A ferritina está associada a inflamação e angiogênese, tem atividade antioxidante, e controla diferenciação celular. A vitamina B12 está relacionada a distúrbios neurológicos e hematológicos, é utilizada como ferramenta de diagnóstico, e atua no controle da homocisteinemia. Este artigo visa avaliar a correlação entre os níveis séricos de ferritina e B12 e o desfecho funcional do paciente. Materiais e Métodos Neste estudo de coorte, analisamos os níveis séricos de ferritina e B12, assim como as pontuações nas escalas de desfechos de Rankin modificada e Glasgow aos 6 meses de 2 grupos, um com 19 e o outro com 49 indivíduos, dos 401 pacientes com AI tratados na Universidade de São Paulo de 2018 a 2019. Para determinar a já mencionada correlação, realizamos análise estatística usando regressão logística. Resultados Na análise univariada, a ferritina sérica não resultou em impacto significativo sobre o desfecho funcional (razão de possibilidades [RP]: 0,96 para cada aumento de 100 pg/mL; intervalo de confiança de 95% [IC95%]: 0,761­1,210; p » 0,732), nem a B12 sérica (RP: 0,998 para cada aumento de 100 pg/mL; IC95%: 0,826­1,206; p » 0,987). Tampouco observou-se impacto significativo sobre o desfecho na análise multivariada usando B12 sérica, idade, hipertensão e ruptura de aneurisma (RP: 1,086 para cada aumento de 100 pg/mL; IC95%: 0,847­1,392; p » 0,513). Conclusão Não foi confirmada a correlação estatística entre os níveis séricos de ferritina e de B12 e o desfecho funcional de pacientes com AI. Essas variáveis podem estar ligadas a outros determinantes da fisiopatologia do AI, como inflamação e homocisteinemia.

Unruptured unilateral twin ectopic pregnancy: a rare case report

Unilateral twin ectopic pregnancy is a rare entity with an incidence of 1 in 125,000 pregnancies. This is a case of a 26-year-old primigravida with a spontaneous unilateral twin ectopic gestation, diagnosed on transvaginal ultrasound, treated laparoscopically by doing unilateral salpingectomy and confirmed with histopathology. The doubt for ectopic pregnancy was raised when the serum β-HCG level was constantly >1500 mIU/ml and serum progesterone level was <5 pg/ml and no intrauterine pregnancy was seen. On a follow-up scan, twin gestational sac was noted in right adnexa along with a large haemorrhagic cyst in the right ovary. On post-surgery follow-up, patient was found to have had complete recovery. This case report discusses the incidence and rarity, yet possibility of twin ectopic gestations, the need for early diagnosis and its management.

Effect of tirofiban on perioperative thrombotic events in patients with unruptured intracranial aneurysms accepted stent-assisted coil embolization / 中华神经医学杂志

Objective:To investigate the safety of intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel in patients with unruptured intracranial aneurysms accepted stent-assisted coil embolization, and explore the effect of tirofiban on perioperative thrombotic events.Methods:The clinical data of 275 patients with unruptured intracranial aneurysms who underwent stent assisted coil embolization in our hospital from January 2016 to December 2019 were retrospectively collected. Among them, 110 patients admitted to our hospital from January 2016 to December 2017 only received preoperative oral administration of aspirin and clopidogrel combined with antiplatelet treatment (classic group), and 165 patients admitted to out hospital from January 2018 to December 2019 received intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel (improved group). The differences of perioperative safety and thrombotic events between the two groups were compared and analyzed.Results:The incidence of intraoperative visual thrombotic events in the classic group and the improved group were 6.4% (7/110) and 1.2% (2/165), respectively, with significant difference ( P<0.05); the incidence of postoperative thrombotic events was 4.5% (5/110) and 2.4% (4/165), respectively, without significant difference ( P>0.05); the incidence of urethrorrhagia was 9.1% (10/110) and 21.2% (35/165), respectively, with significant difference ( P<0.05); and the incidence of gingival hemorrhage was 13.6% (15/110) and 19.4% (32/165), respectively, without significant difference ( P>0.05). No acute gastrointestinal hemorrhage or cerebral hemorrhage occurred in both groups; urethrorrhagia and gingival hemorrhage were transient and relieved spontaneously. Conclusion:Intraoperative prophylactic addition of tirofiban on the basis of preoperative oral administration of aspirin and clopidogrel can reduce the incidence of intraoperative visual thrombotic events without increasing the risk of hemorrhage in stent-assisted coil embolization of unruptured intracranial aneurysms.

Health-related quality of life in patients with asymptomatic unruptured intracranial aneurysms after endovascular treatment / 中国脑血管病杂志

Objective: The aim of this study was to analyze the health-related quality of life (HRQoL) and their influencing factors in patients with asymptomatic unruptured intracranial aneurysms (UIAs) after endovascular treatment. Methods: We retrospectively reviewed 44 patients with asymptomatic UIAs (56aneurysms) received endovascular treatment in Xuanwu Hospital of Capital Medical University from January 2015 to May 2017. The average follow-up time was (28 ±9) month. The clinical data of patients were collected, and the HRQoL was evaluated by the SF-36 questionnaire. The SF-36 results and influencing factors were analyzed. Results: Forty-four patients with UIAs in this study showed significantly lower body pain,physical function,and mental health in the three dimensions of the SF-36 scale than the normal population in China (75 ± 15,82 ± 15 and 71 ± 14 vs. 83 ±20,88 ± 17 and 79 ± 15;t =2.89,2. 14 and 3. 34 Respectively; all P 3 months were respective 76 ±15 and 89 ± 7 points (t = -2. 11); the differences were significant (both P 3 months were respective 73 ± 17 and 90 ± 5 (l = -2.74);the differences were significant (both P <0.05). Multivariate analysis showed that the course of disease ≤ 3 months was the independent risk factor of PCS (95% CI 2. 23 -27. 42, P = 0. 02), and sleep time<6h was the independent risk factor of MCS (95% CI 1. 44 -28. 92, P = 0. 03). 12.5% (4/32) of these patients failed to recover to normal work before treatment even after long-term recovery (28 ± 9 months). Conclusions: HRQoL results in patients with asymptomatic UIAs after endovascular treatment were lower than those in the general population in multiple dimensions of SF-36. The course of disease ≤3 months and daily sleep time < 6h are independent risk factors for PCS and MCS,respectively.

External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. METHODS: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). RESULTS: We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. CONCLUSIONS: The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane.METHODS: This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index.RESULTS: Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616–45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007–0.683).CONCLUSION: This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.

Risk factors of neurological complication after endovascular treatment of unruptured intracranial aneurysm / 第二军医大学学报

Objective To explore the risk factors of neurological complication (NC) after the endovascular treatment of unruptured intracranial aneurysm (UIA), so as to provide strategies for reducing the incidence of NC. Methods We retrospectively analyzed the clinical and imaging features of patients with UIA, who underwent endovascular treatment in Changhai Hospital, Navy Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2017. Univariate analysis and multivariate logistic analysis were performed to analyze the risk factors of NC. Results NC occurred in 60 (5.02%) of 1 196 patients with UIA in this study. Univariate analysis showed that hypertension (P=0.026), smoking (P=0.038), previous transient ischemic attack or cerebral infarction (P10 mm (OR= 3.139, P10 mm and irregular shape or having a daughter sac are independent risk factors of NC after endovascular treatment of UIA.

Risk assessment of chronic subdural hematoma after surgical clipping of intracranial aneurysms / 中国脑血管病杂志

Objective To compare the incidence of chronic subdural hematoma(CSDH) and its risk factors after surgical clipping unruptured intracranial aneurysms(UIA) and ruptured intracranial aneurysms (RIA). Methods From January 2006 to December 2015,410 consecutive patients with UIA and 464 patients with RIA treated with aneurysm clipping at the Department of Neurosurgery,Hanzhong Central Hospital were enrolled retrospectively. According to whether having postoperative CSDH or not(evaluating subdural effusion and its degree with head CT scan),the difference of the incidence of CSDH after aneurysm clipping in patients with UIA and RIA were compared,and logistic regression analysis was used to evaluate the risk factors for the occurrence of postoperative CSDH. Results (1) The incidence of CSDH after UIA clipping was higher than that of RIA(11.0% [45/410] vs. 3.0% [14/464]). There was significant difference (P<0.01). The rate of surgical treatment for CSDH because of the symptoms of nervous system injury in patients with UIA was higher than that in patients with RIA(35.6% [16/45] vs. 28.6% [4/14], P<0.05). (2) Multivariate logistic regression analysis showed that unruptured aneurysms (OR,2.59, 95% CI 2.19-3.06,P<0.01),subdural effusion ≥5 mm (OR,1.98,95% CI 1.94-2.03,P<0.01), and CT value≥40 HU (OR,2.87,95% CI 2.65-3.01,P<0.01) were the independent risk factors for postoperative CSDH in patients with intracranial aneurysm. Conclusions The incidence of CSDH was significantly higher than that of RIA after UIA clipping. UIA,subdural effusion ≥5 mm,and CT value ≥40 HU were the independent risk factors for CSDH of intracranial aneurysms.

Endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms / 中国脑血管病杂志

Objective To investigate the safety and efficacy of endovascular reconstruction for ruptured and unruptured vertebral artery fusiform aneurysms (VAFAs).Methods The clinical,imaging and follow-up data of 26 consecutive patients with VAFA treated with endovascular reconstruction at the Department of Neurosurgery,Beijing Hospital between October 2009 and September 2017 were analyzed retrospectively.Results (1) Twenty-six patients had 26 VAFAs.Their age ranged from 38 to 69 years old.Nine patients had ruptured aneurysms and 17 had unruptured aneurysms.The diameter of the aneurysms ranged from 5 to 12 mm.The success rate of reconstruction technology was 100％.(2)In 9 patients of the rupture group,8 were embolized by stent-assisted coils,1 was treated with stent-assisted coil embolization alone.Five patients were treated with multiple-stent reconstruction and 4 were treated with stent reconstruction alone.Of the 17 patients in the unrupture group,13 were treated with stent-assisted embolization and 4 were treated with stent implantation alone;7 were treated with multiple-stent reconstruction,and 10 were treated with stent reconstruction alone.No perioperative complications occurred.(3) The patients were followed up for 8.0-97.5 months with a median time of 39.5 months.No new cerebral infarction or cerebral hemorrhage occurred.The patients with good prognosis (the modified Rankin scale scale 0-2) was 100％.Twenty-two patients were followed up for 3.5 to 34.0 months with a median time of 10.3 months.Fourteen patients (63.6％) were cured,4 (18.2％) were stable or improved,and 4 (18.2％) had recurrence;Five of 8 patients were cured in the rupture group;9 of 14 were cured in the unrupture group.There were 2 cases of relapse in each of the two groups.Conclusions Endovascular reconstruction for ruptured and unruptured VAFAs is clinically feasible and the safety is higher.The efficacy of mid-term and long-term follow-up is better.The recurrence rate of ruptured VAFAs has an increasing trend,and close follow-up is required after procedure.

The First Awake Clipping of a Brain Aneurysm in Malaysia and in ASEAN: Achieving International Standards

World-renowned neurosurgeon, Professor Saleem Abdulrauf, has been featured in several medical journals for his successful “Awake Brain Aneurysm Surgery”. Regarded as a “world first”, this surgery, involves clipping un-ruptured brain aneurysms while patients are awake. Only one or two neurosurgery centres worldwide are capable of this. Performing the surgery while the patient is awake lowers risks of brain ischemia with neurological deficits and ventilator associated morbidities. The technique has been viewed as the start of a new era in brain surgery. Physicians from the Universiti Sains Malaysia (USM) School of Medical Sciences, at the Health Campus in Kelantan, headed by Professor Dr Zamzuri Idris (neurosurgeon) and Dr Wan Mohd Nazaruddin Wan Hassan (neuroanaesthetist), recently performed a similar procedure, the first such surgery in Malaysia and Southeast Asia. The USM team can therefore be considered to be among the first few to have done this brain surgery and achieved successful patient outcomes.

Clinical features and risk factors of internal carotid artery stenosis coexisting with unruptured intracranial aneurysm / 中华内科杂志

Objective To analyze the incidence of intracranial unruptured aneurysms in patients with internal carotid artery (ICA) stenosis (≥30％),the characteristics of aneurysms and risk factors in patients with ICA stenosis and intracranial aneurysm.Methods Clinical data of patients receiving digital subtraction angiography (DSA) at Peking University Third Hospital between January 2012 and June 2015 were retrospectively reviewed to identify patients with ICA stenosis and unruptured intracranial aneurysm.Results Among 247 patients with ICA stenosis,16 patients (6.5％) with intracranial unruptured aneurysms were found including 7 females and 9 males with age from 47 to 83 years old.The severity of ICA stenosis in aneurysm group was (85.3± 13.2)％,whereas it was (77.7± 17.9)％ in non-aneurysm group.The incidence of aneurysms in male patients with ICA stenosis was 4.5％ (9/202),and 15.6％(7/45) in female patients (P＜ 0.05).The incidence of aneurysms in patients with only in cervical segment (C 1 segment) of ICA was 4.4％ (10/226),whereas that of other segment was 28.6％(6/21) (P＜0.05).Logistic multivariate regression analysis showed that gender and stenosis location were independent risk factors of aneurysms in patients with ICA stenosis.Conclusions In patients with ICA stenosis,the incidence of aneurysm is much higher than that in general population.Intracranial aneurysms are more likely to occur in women and patients with ICA stenosis other than C 1 segment.

Modified Arachnoid Plasty Reduces Chronic Subdural Hematoma after Unruptured Aneurysm Clipping : Technical Note

OBJECTIVE: Chronic subdural hematoma (CSDH) is a rare complication of unruptured intracranial aneurysm (UIA) clipping surgery. To prevent postoperative CSDH by reducing subdural fluid collection, we applied the modified arachnoid plasty (MAP) during the UIA clipping surgery to seal the dissected arachnoid plane. METHODS: This retrospective study included 286 patients enrolled from July 2012 to May 2015. We performed arachnoid plasty in all patients, with MAP used after June 17, 2014. Patients were divided into two groups (non-MAP vs. MAP), and by using uni- and multivariate analyses, baseline characteristics, and relationships with postoperative CSDH between the two groups were analyzed. The degree of preoperative brain atrophy was estimated using the bicaudate ratio (BCR) index. RESULTS: Ten patients (3.5%) among 286 patients had postoperative CSDH after clipping. Nine (3.1%) were in the non-MAP group, and one (0.9%) was in the MAP group. The higher BCR index showed statistical significance with occurrence of postoperative CSDH in both uni- (p=0.018) and multivariate (p=0.012; odds ratio [OR], 8.547; 95% confidence interval [CI], 1.616–45.455) analyses. MAP was associated with a lower risk of postoperative CSDH (p=0.022; OR, 0.068; 95% CI, 0.007–0.683). CONCLUSION: This study shows that the degree of preoperative brain atrophy is associated with an increased occurrence of CSDH after clipping and that MAP could help reduce the risk of postoperative CSDH after unruptured aneurysm clipping via a lateral supraorbital approach.

Summarization of the Experience of Luteinized Unruptured Follicle Syndrome's Treatment by Professor TAN Yong / 浙江中医药大学学报

[Objective] This paper introduces the experience of Professor TAN Yong's treatment of the luteinized unruptured follicle syndrome(LUFS) with a view to provide references for the related study.[Methods]Through studying with Professor TAN, collecting and analyzing clinical case data, researching editorial book and articles. From the etiology, pathogenesis and drug selection of the LUFS, the clinical experience of the teacher was discussed, Professor TAN's academic characteristics on the treatment of LUFS were summarized, and a medical case was provided to support the idea.[Results]Professor TAN believes that the pathogenesis of this disease is mostly due to deficiency of the kidney Yin, the weak Yang qi, Yin and Yang conversion is unfavorable during intermenstrual period, combined with pathological factors such as liver depression, blood stasis, and phlegm dampness. Unsmooth running of Qi and blood, so that the follicular can not be discharged smoothly, the disease occurs. In the treatment of combination of Traditional Chinese Medicine(TCM) and western Medicine, in the intermenstrual period attach importance to the function of the heart and brain, to tonifying kidney and blood circulation as a method, the use of "Tonifying Kidney Stimulating Ovulation" medicine treatment, combined with western medicine, in the clinically achieved good results. The medical case was based on the "Tonifying kidney Stimulating Ovulation" medicine as the basis for the successful pregnancy after the treatment, which fully proved the above mentioned dialectical thinking and treatment experience. [Conclusion]It is worthwhile to learn and promote the treatment of LUFS with tonifying kidney and blood circulation therapy.

Kissing Aneurysms at Fenestrated Proximal Basilar Artery: Double-barrel Stent-assisted Coiling Using Dual Closed-cell Stents

Kissing aneurysms associated with a proximal basilar artery fenestration are an exceedingly rare and unique therapeutic challenge due to anatomical complexity. This report describes double-barrel stent-assisted technique with dual closed-cell stents for the successful endovascular coiling of kissing aneurysms from a proximal basilar artery fenestration.