Caroticocavernous fistula management by detachable balloon at different clinical stages

The authors describe their first experience in transarterial balloon embolization in the treatment of CCF. Six patients presenting with traumatic CCF were included in the study during the period between 1990 and 1993. All had an established clinical diagnosis after thorough neurological and ophthalmological assessment together with positive radiological evidence through head computed tomography and cerebral angiography. They ranged in age between 15 and 55 years. All were males except one. They presented mainly with machinery bruit and exophthalmos. Proptosis was unilateral in five patients and bilateral in the remaining one. Favourable results were obtained. Post- embolization improvement, and even normalization, set-in in five of the six patients regarding bruit and proptosis without any resultant complications. Only in a single patient delayed balloon deflation and intracranial migration occurred with consequent major cerebral infarction and death. The authors conclude that transarterial balloon embolization remains the procedure of choice in the treatment of symptomatic CCF. However, transvenous embolization is an alternative when the arterial route fails

Superselective endovascular embolization of brain arteriovenous malformations [BAVMS]

The authors describe their experience with fifteen BAVMs treated by superselective endovascular embolization alone. Five patients presented with intracranial hemorrhage; four with intractable seizures; three with severe headaches; two with progressive neurological deficit and one with diplopia. In 9 cases, obliteration of 50- 75% of the AVM nidus was achieved and in in 3 cases this precentage increased to between 75 and 90%. Complete obliteration of AVM nidus was achieved in two cases. In only a single patient there was no significant obliteration at all. No mortality related to embolization procedure with only negligible percentage of morbidity being reversible. Short term [3ws]. outcome showed improvement in almost all the cases. Only in a single patient with massive cerebellar hemorrhage death occurred. Endovascular embolization of brain arteries malformations [BAVMs] using microcatheters a liquid acrylic material is a useful addition to the methods of treating and controlling such a complex problem

Surgical correction of velogenic erectile dysfunction

From January 1990 to December 1991, 31 patients with venogenic erectile dysfunction [incompetent penile deep venous system] had been treated surgically by ligation of the superficial and deep venous systems of the penis by an inguinoscrotal approach which is the standard technique in all cases. The patients' ages ranged from 28 to 57 years [mean 44.7 +/- 3.4]. The duration of erectile failure ranged between 1 and 6 years. The main patient's complaint was failure to maintain erections. All patients had been investigated for blood sugar, renal and liver function tests as well as serum testosterone and prolactin. Evaluation of arterial penile vasculature and penile brachial index was done by Doppler studies. The diagnosis of venogenic incompetence had been confirmed by erectile cavernosography and cavernosometry. The postoperative follow up periods of the patients ranged between 6 and 18 months [mean 11 +/- 2.3]. Sufficient persistent improvement to permit unaided sexual intercourse for more than 18 months was achieved in 19 patients [61.3%]. Sufficient temporary improvement for 8 months or less was achieved in 6 patients [19.35%]. Six [19.35%] out of 31 patients continued to have the same preoperative erectile condition. It is recommended that the procedure in selected cases is simple, safe and gives relatively good success [80.65%] with minimal complications. For practical purposes, it is believed that venous surgery can be recommended as an acceptable alternative to a penile prosthesis in young patients with veno-occlusive dysfunction and adequate arterial function. However, longer periods of follow up are required for proper evaluation of the technique

Changes in serum immunoglobulins and complement in non bilharzial chronic liver diseased patients

This work was performed on 32 patients with non Bilharzial chronic liver disease [11 patients with alcoholic cirrhosis, 8 patients with primary biliary cirrhosis, 5 patients with chronic hepatitis and 8 patients with cryptogenic cirrhosis]. The diagnosis was confirmed by liver biopsy. The serum immunoglobulins [IgG, IgA and IgM], complement components [C[4] and C[3], the whole complement titre [CH[50]] and liver functions were investigated in all studied cases. The results revealed high incidence of increased serum IgG, IgA, IgM, C[4], C[3] levels and low CH[50]] titre in most studied groups of patients. These findings in association with the absence of any relationship with the liver function tests suggested that the changes in the studied parameters was dependent on the immune reactions and immune mechanisms [whether hepatic or extrahepatic] rather than on the hepatic pathological changes or the function of the remaining liver tissue. Moreover the results were favouring increased hepatic and or extrahepatic synthesis more than decreased catabolism of these immunoglobulins and complement components