Tratamiento endovascular a malformación aneurismática de la Vena de Galeno / Endovascular treatment of aneurysmal malformation of the Vein of Galen

Gestante de 19 años sin antecedentes de embarazos previos, presenta a las 27 semanas en ecografía del segundo trimestre hallazgo sugestivo en el feto de MAVG; a las 38 semanas se realiza parto por cesárea sin complicaciones, se planificó angiografía cerebral con embolización. Se abordó por la arteria femoral derecha utilizando lavado heparinizado continuo y sistema de navegación coaxial se estudió la MAVG de tipo mural, se canalizo de forma selectiva a las arterias coroideas postero medial y postero lateral derecha y a la arteria coroidea posteromedial izquierda y se embolizó bajo control radiológico utilizando espirales de coils y líquido embolizante Onix. Control inmediato mostro cierre completo de conexiones fistulosas y preservación de ramas sanas.

A 19-year-old pregnant woman with no history of previous pregnancies, presented at 27 weeks in a second-trimester ultrasound suggestive finding in the fetus of MAVG; At 38 weeks, cesarean delivery was performed without complications, cerebral angiography with embolization was planned. It was approached through the right femoral artery using continuous heparinized lavage and a coaxial navigation system. The mural-type AVM was studied, it was selectively channeled to the right posteromedial and posterolateral choroidal arteries and to the left posteromedial choroidal artery and it was embolized under control. radiological using coil spirals and Onix embolizing liquid. Immediate control showed complete closure of fistulous connections and preservation of healthy branches.

Malformación de la vena de Galeno en un lactante menor / Malformation of the Galeno vein in a minor infant

El aneurisma de la vena de Galeno es una afectación poco frecuente que genera una elevada morbilidad y mortalidad en neonatos y lactantes. Se presenta como una fístula arteriovenosa con comunicación directa entre las arterias piales y los canales venosos con drenaje a la vena de Galeno. Su clínica es variable de acuerdo con la edad de presentación, puede manifestarse con o sin fallo cardiaco, así como otros hallazgos neurológicos y otras malformaciones vasculares cerebrales. El diagnóstico se puede realizar en etapa prenatal, a través de ecografía y del estudio Doppler, mientras que el estándar de oro para el diagnóstico posnatal es la angiografía. El tratamiento endovascular como en el caso que se presenta es el manejo adecuado a través de una embolización. El objetivo de esta investigación fue dar a conocer los elementos clínicos que permitieron el diagnóstico de esta rara malformación en un niño de 4 meses de edad(AU)

The aneurysm of the vein of Galen is a rare condition that generates high morbidity and mortality in neonates and infants. It presents as an arteriovenous fistula with direct communication between the pial arteries and venous channels with drainage to the vein of Galen. Its clinic varies according to the age of presentation, it can manifest with or without heart failure, as well as other neurological findings and other cerebral vascular malformations. The diagnosis can be made in the prenatal stage, through ultrasound and the Doppler study, while the gold standard for postnatal diagnosis is angiography. Endovascular treatment as in the case presented below is the proper management through embolization. The objective of this research was to present the clinical elements that allowed the diagnosis of this rare malformation in a 4-month-old child(AU)

Vein of Galen Aneurysmal Malformations in Pediatric Patients Submitted to Endovascular Treatment: Report of 3 Cases

Objective To report three cases of vein of Galen aneurysmalmalformation (VGAM) in pediatric patients treated at the hemodynamics lab of Hospital Santa Isabel (HSI) in Blumenau, state of Santa Catarina, Brazil, from 2006 to 2020. Clinical presentation, endovascular treatment, and postprocedure evolution to date are included. Case description Three children aged 5 to 12 months with cardiac, respiratory, or neurological damage in the neonatal stage, were referred to the neurosurgery service and diagnosed with VGAM. The three patients underwent endovascular embolization of themalformation, with different clinical evolution throughout outpatient follow-up. Conclusion Vein of Galen aneurysmal malformations are uncommon vascular abnormalities that, until the advent of endovascular embolization, were associated with high morbidity and mortality rates. Its prognosis is linked with initial clinic, early diagnosis, and timely surgical correction.

Malformaciones vasculares cerebrales de alto flujo en pediatría: experiencia en un hospital pediátrico de alta complejidad / High-flow vascular malformations of the brain in pediatrics: Experience in a tertiary care children's hospital

Introducción. Las malformaciones vasculares cerebrales de alto flujo son poco comunes en la edad pediátrica. El objetivo del trabajo es diferenciar y agrupar estas enfermedades según edad de debut, manifestaciones clínicas y angioarquitectura.Población y método. Se realizó un estudio retrospectivo y observacional. Se analizaron las historias clínicas, los estudios por imágenes y los protocolos de procedimientos de pacientes del Hospital J. P. Garrahan con diagnóstico de malformaciones vasculares cerebrales desde enero de 2010 hasta enero de 2020.Resultados. Ciento ochenta y tres pacientes cumplieron los criterios de inclusión. Se identificaron 131 pacientes con malformaciones arteriovenosas con nido (MAV) y 52 con fístulas directas (sin nido), entre los que se hallaron 19 malformaciones aneurismáticas de vena de Galeno, 23 fístulas piales y 10 fístulas durales. La edad promedio fue de 105 meses para las MAV, 1,7 meses para las malformaciones aneurismáticas de vena de Galeno, 60,5 meses para fístulas piales y 41 meses para fístulas durales.Conclusión. Según su angioarquitectura, las malformaciones vasculares cerebrales de alto flujo tuvieron nido (MAV) o fueron fístulas directas (malformaciones aneurismáticas de vena de Galeno, fístulas piales y fístulas durales). Las MAV se manifestaron a partir de la primera infancia, sobre todo, por hemorragia intracraneana. Las fístulas directas se expresaron en la primera etapa de la vida, frecuentemente, con insuficiencia cardíaca.

Introduction. High-flow vascular malformations of the brain are uncommon in pediatrics. The objective of this study is to establish the differences among these pathologies and group them by age at onset, clinical manifestations, and angioarchitecture.Population and method. This was a retrospective and observational study. The medical records, imaging studies, and procedure protocols of patients seen at Hospital J. P. Garrahan diagnosed with vascular malformations of the brain between January 2010 and January 2020 were analyzed.Results. A total of 183 patients met the inclusion criteria. It was possible to identify 131 patients with arteriovenous malformations with a nidus (AVMs) and 52 with direct fistulas (without a nidus), including 19 vein of Galen aneurysmal malformations, 23 pial fistulas, and 10 dural fistulas. The average age of patients was 105 months for AVMs, 1.7 months for vein of Galen aneurysmal malformations, 60.5 months for pial fistulas, and 41 months for dural fistulas.Conclusion. Based on their angioarchitecture, high-flow vascular malformations of the brain presented a nidus (AVMs) or direct fistulas (vein of Galen aneurysmal malformations, pial fistulas, and dural fistulas). AVMs were observed in early childhood, especially due to intracranial hemorrhage. Direct fistulas occurred in the first stage of life, commonly with heart failure.

Relevancia clínica del diagnóstico ecográfico de la malformación aneurismática en la vena de Galeno / Clinical relevance of ultrasound diagnosis of Vein of Galen aneurysmal malformation

Introducción: La malformación aneurismática en la vena de Galeno es infrecuente, pero tiene alta mortalidad en neonatos. Objetivo: Examinar la relevancia clínica del diagnóstico ecográfico de la malformación aneurismática en la vena de Galeno Métodos: Investigación observacional, prospectiva y transversal realizado en el Cardiocentro William Soler. (noviembre 1999-diciembre 2016) La muestra la conformaron 18 neonatos con diagnóstico de malformación aneurismática en la vena de Galeno variedad coroidea mediante ecografía doppler. Se configuraron dos grupos de referencia: 1) 70 niños supuestamente sanos. 2) 73 niños con malformación de la vena Galeno de diferente naturaleza que la variante coroidea estudiada. El procesamiento de la información incluyó elementos de estadística inferencial y herramientas de la medicina basada en la evidencia. Resultados: La presencia de fallo cardíaco neonatal, signos electrocardiográficos de isquemia miocárdica y detección de soplo continuo transcraneal, fueron significativamente diferentes en el grupo de estudio en relación con el grupo de referencia (p= 0,000001), con predominio en el número de pacientes del grupo estudio en todas las variables. Los resultados anteriores conjugados con diversos hallazgos ecográficos: la dilatación anómala de la vena, exceso de vasculatura aferente, reducción de los índices circulatorios encefálicos e incremento en los diámetros vasculares supraaórticos, identificaron de forma precisa la malformación aneurismática en la vena de Galeno. La evaluación del riesgo relativo reafirmó la documentación de los hallazgos expuestos. Conclusiones: La ecografía doppler, por su relevancia clínica y vínculo con otros elementos diagnósticos, es mandatoria en la detección de la malformación aneurismática en la vena de Galeno(AU)

Introduction: Vein of Galen aneurysmal malformation is not frequent but it has high mortality rates in newborns. Objective: To assess the clinical relevance of ultrasound diagnosis of Vein of Galen aneurysmal malformation. Methods: Observational, prospective and cross-sectional research conducted in William Soler Cardiocentro (November 1999- December 2016). The sample was formed by 18 newborns with diagnosis of Vein of Galen aneurysmal malformation (choroidal variety) through doppler echocardiography. Two reference groups were formed: 1) 70 supposedly healthy children; 2) 73 children with Vein of Galen malformation with a nature different to the studied choroidal variety. Processing of the information included elements of inferential statistics and tools from medicine based in evidences. Results: The presence of neonatal heart failure, electrocardiographic signs of myocardial ischemia and detection of transcranial continuous murmur were significantly different in the study group in relation with the reference group (p= 0,000001), with predominance in the number of patients of the study group in all the variables. The previous results combined with different ultrasound findings as the anomalous dilation of the vein, the excess of afferent vasculature, the reduction of encephalic circulation indexes and the increase of the supraaortic vascular diameters identified in a precise way the vein of Galen aneurysmal malformation. The assessment of the relative risk reaffirmed the information on the exposed findings. Conclusions: Doppler echography, due to its clinical importance and its links with other diagnostic elements, is mandatory in the detection of the vein of Galen aneurysmal malformation(AU)

Prenatal Diagnosis of Vein of Galen Aneurysmal Malformation Allows Early Transumbilical Endovascular Treatment

Neonates with vein of Galen aneurysmal malformation (VGAM) presenting with severe cardiac failure and pulmonary hypertension represent a challenge for endovascular therapy.When early treatment is required, the small femoral arteries in this population are usually difficult to cannulate. Alternatively, the umbilical vessels offer a natural pathway to reach the lesion. Therefore, prenatal diagnosis of VGAM allows for delivery planning, perinatal management, and embolization through umbilical approach, thus leading to better outcomes.

Galen Vein Aneurysm: Problem of Management in an Under-Equipped Neurosurgical Environment about a Case and Review of the Literature

Vein of GALEN aneurysmal malformation (VGAM) is a rare congenital disease caused by arteriovenous shunts between the choroidal arteries and the porencephalic ectatic vein. The diagnosis is often made in utero or during infancy, endovascular treatment remains the most suitable therapeutic means in a well-equipped environment. Here we report here the case of a patient complaining of headache for 1 year, and whose brain CT imaging showed the presence of Galen veinaneurysm with associated non-communicating hydrocephalus. In the absence of the appropriate technical platform, the placement of a ventriculoperitoneal shunt relieved our patient’s symptoms

Tálamo según Galeno: una metáfora controversial / Thalamus according to Galen: a controversial metaphor

El vocabulario técnico-científico, uno de ellos la Terminologia Anatomica, tiene un legado lingüístico de idiomas clásicos en general y del latín y griego en particular. En este contexto, la metáfora ha cumplido un importante rol en la denominación de ciertas estructuras del cuerpo humano. El análisis de estas metáforas ha permitido conocer el origen etimológico de numerosos términos anatómicos derivados de esta práctica frecuente durante la historia. Este estudio tuvo como objetivo analizar y reflexionar acerca de la utilización del término tálamo y comentar la similitud formal de esta metáfora con las características neuroanatómicas. El nombre tálamo fue asignado por Claudio Galeno (130 - 200 a. C.); procede de un lenguaje común de orden material, el cual ha sido mencionado por autores clásicos, principalmente, como "cámara interna o cámara nupcial" y llevado a un lenguaje técnico-científico a través de una metáfora motivada por una disposición espacial o entendida como una expresión de imagen o similitud formal. Si Galeno utilizó esta metáfora considerando una similitud formal, el término tálamo sería equívoco, ya que no hay correspondencia estructural del término debido a que el tálamo neuroanatómico no es una cámara, sino una estructura diencefálica compacta y esferoidal u ovalada. Bajo este contexto, el término tálamo es confuso, ya que esta metáfora se condice más bien con el tercer ventrículo. Considerando lo anterior, invitamos a reflexionar sobre una propuesta basada en una característica morfológica de la estructura, en la cual se reemplace el término tálamo por neuroovoide.

The technical-scientific vocabulary, one of them the Anatomical Terminology, has a linguistic legacy of classical languages in general and of Latin and Greek in particular. In this context, the metaphor has played an important role in the naming of certain structures of the human body. The analysis of these metaphors has allowed us to know the etymological origin of numerous anatomical terms derived from this frequent practice throughout history. The purpose of this study was to analyze and reflect on the use of the term thalamus and to comment on the formal similarity of this metaphor with the neuroanatomical characteristics. The name thalamus was assigned by Claudio Galeno (130-200 BC); It comes from a common language of material order, which has been mentioned by classical authors, mainly, as "internal chamber or bridal chamber" and brought to a technicalscientific language through a metaphor motivated by a spatial arrangement or understood as a image expression or formal similarity. If Galen used this metaphor considering a formal similarity, the term thalamus would be misleading, since there is no structural correspondence to the term because the neuroanatomical thalamus is not a chamber, but a compact, spheroidal or oval diencephalic structure. In this context, the term thalamus is confusing, since this metaphor is more consistent with the third ventricle. Considering the above, we invite you to reflect on a proposal based on a morphological characteristic of the structure, in which the term thalamus is replaced by neuroovoid.

William Shakespeare y la medicina / William Shakespeare and medicine

Si repensamos a escritores que se ocuparon de la medicina, el presente trabajo pretende destacar a William Shakespeare, como un escritor que prácticamente en toda su obra describe en sus personajes problemas de salud de todo tipo. Se harán ciertas referencias de los aspectos médicos desarrollados en la obra del escritor, advirtiendo que son sólo una parte de su extensa producción. (AU)

If we rethink writers who dealt with medicine, this paper intends to highlight William Shakespeare, as a writer who practically describes all kinds of health problems in his characters. Certain references will be made of the medical aspects developed in the writer's work, warning that they are only part of his extensive production. (AU)

Malformación aneurismática de la vena de Galeno / Aneurysms malformation of vein of Galen

Introducción: La malformación aneurismática de la vena de Galeno es una infrecuente variedad de fístula arteriovenosa cerebral de origen embriológico. Se localiza en la línea media de la fisura coroidal y tiene morfología de amplio espectro. Objetivo: Exponer información actualizada acerca del tema. Método: La información se obtuvo de la búsqueda automatizada realizada fundamentalmente en bases de datos MEDLINE, Current Contents y Scielo. Resultados: La malformación aneurismática de la vena Galeno se manifiesta con síntomas y signos derivados de la insuficiencia cardiaca severa refractaria al tratamiento médico y del daño neurológico que provoca. La entidad implica morbilidad grave y mortalidad en el periodo neonatal. La angiorresonancia es la técnica de referencia, pero la ecografía doppler es buen método de valoración. El tratamiento de elección es la embolización endovascular. Consideraciones finales: Debe existir índice elevado de sospecha para no fracasar en el diagnóstico precoz de la enfermedad. Es importante definir la anatomía de la lesión, por las implicaciones clínicas, terapéuticas y pronósticas que ello acarrea. El tratamiento exitoso sigue siendo un reto terapéutico complejo(AU)

Introduction: Vein of Galen aneurysm is a rare and congenital cerebral arteriovenous abnormality with reported incidence of 1:25 000 live births. It represents the 30 percent of the vascular congenital cerebral malformations that harm the pediatric population. Objective: To show updated information about the topic. Method: The information was obtained from the automated search mostly done in MEDLINE, CurrentContents and Scielo databases. Development: Vein of Galen malformation presents with symptoms and signs derived from the severe refractary heart failure to medical treatment and the neurologic damage it causes. That entity implies severe morbidity and mortality on the neonatal period. Angioresonance is the reference technique, but the Doppler ecography is a good valuation method. The election treatment is the endovascular embolization. Final considerations: There must be an elevated rate of suspect to do not fail on the early diagnostic of the disease. It is important to define the lesion's anatomy, because of the clinic, therapeutic and prognostic implications this represent. The successful treatment is still a complex therapeutic challenge(AU)

Adjuvant Coil Assisted Glue Embolization of Vein of Galen Aneurysmal Malformation in Pediatric Patients / 신경중재치료의학

PURPOSE: Adjuvant coils may offer advantages in flow control during glue embolization of high flow vein of Galen aneurysmal malformation (VGAM) patients but involves specific issues such as feasibility, durability and coil mass effect. The purpose of this study is to assess the outcome of adjuvant coils in addition to transarterial glue embolization for treatment of these patients. MATERIALS AND METHODS: Five pediatric VGAM patients (age range; 11 weeks to 2 yrs 2 mos) with high flow fistulous angioarchitecture were treated with adjuvant coils 1) in the distal feeding artery and/or 2) in the vein of Galen followed by glue embolization of the shunt. The angiographic / clinical outcomes were assessed. RESULTS: Adjuvant coils were deployed in the distal feeding artery (n=3), vein of Galen pouch plus distal feeding artery (n=2). Additional transarterial glue embolization of the fistulae was successfully performed (n=4). Complete occlusion was achieved with coils in one case. Complete occlusion was achieved for all mural type cases (n=4). Residual feeders remained in a case of choroidal type of VGAM. No complications were noted related to the treatment. All patients showed normal development on follow up (range: 7.6 to 88.8 mo, mean 49.3 mo). Initial hydrocephalus improved on follow up despite coil mass effect in dilated vein of Galen. CONCLUSION: Adjuvant coils for flow control with glue embolization may be a safe and effective treatment method for VGAM patients with high flow fistulous feeders.

Neonato con malformación de la vena de Galeno con diagnóstico oportuno: reporte de caso / Timely diagnosis of a Newborn wth Vein of Galen aneurysmal malformation: a case report

RESUMEN La malformación de la vena de Galeno a pesar de ser una patología poco frecuente representa un desafío clínico, por lo que debe ser detectada de forma temprana y manejada por un grupo multidisciplinario, iniciando desde los médicos generales quienes son los encargados de realizar el reconocimiento durante los controles prenatales, y así continuar el manejo de la mano de perinatólogos, pediatras, neonatólogos y radiólogos intervencionistas, todos ellos encargados de supervisar la evolución del paciente y dar tratamiento oportuno para mejorar el pronóstico de vida. A continuación, se presenta un caso clínico cuyo diagnóstico prenatal y manejo medico logró disminuir las complicaciones y comorbilidades resultantes, y así garantizar su preparación para una intervención endovascular posterior.

SUMMARY The vein of Galen malformation is a clinical challenge despite its low frequency, this disease must be detected early during the prenatal age and managed by a multidisciplinary group, beginning with the general physician in the antenatal medical appointment and later receiving treatment with perinatologists, pediatricians, neonatologists and interventional radiologists; all of this in order to ensure a better outcome and neurologic and systemic consequences. This report shows a female patient with an early and accurate antenatal diagnosis of vein of Galen malformation; during the postnatal period multidisciplinary approach and rationale medical management lowered the risk and possible complications, allowing the preparation for a late endovascular intervention.

Vein of Galen Aneurysmal Malformation with Transvenous Endovascular Treatment in an Adult: Case Report

Vein of Galen aneurysmal malformation (VGAM) is the result of the direct communication between the arterial network and the median prosencephalic vein. It is a rare vascular congenital malformation representing less than 1% of intracranial abnormalities. This finding is very rare in adults, and it may or may not present symptoms during childhood. Most cases of VGAM can be detected in the fetus by ultrasonography. The referral of pregnant women with fetuses with this condition to centers where better facilities and resources for childbirth and immediate postpartum care are available has resulted in considerable improvement in the prognosis of newborns. Regarding treatment, the endovascular approach to VGAM includes arterial embolization and percutaneous transvenous techniques. The transvenous endovascular treatment was chosen in the case presented in this article.

A malformação aneurismática da veia de Galeno (MAVG) é resultado da comunicação direta entre a rede arterial e a veia prosencefálica mediana. Trata-se de uma malformação vascular congênita rara, que representa menos de 1% das anormalidades intracranianas. Sua ocorrência é muito rara em adultos, e a malformação pode ou não apresentar sintomas durante a infância. A maioria dos casos pode ser detectada em fetos por ultrassonografia. O encaminhamento de grávidas com fetos com esta malformação para centros mais bem estruturados, com recursos para cuidados no parto e pós-parto, tem resultado em considerável melhora do prognóstico de recémnascidos. Quanto ao tratamento, o acesso endovascular à MAVG inclui a técnica de embolização arterial e o tratamento transvenoso percutâneo. O tratamento transvenoso endovascular foi escolhido no caso apresentado neste artigo.

Prenatal Diagnosis of Galen Vein Aneurysm Using Ultrasonography and Magnetic Resonance Imaging and Perinatal and LongTerm Neurological Outcomes: A Case Series / Diagnóstico do aneurisma de veia de Galeno por meio de ultrassonografia e ressonância magnética e resultados perinatais e neurológicos: série de casos

Abstract Objective To describe the prenatal diagnosis of Galen vein aneurysm (GVA) based on ultrasonography and magnetic resonance imaging (MRI) in a series of cases, as well as its postnatal outcomes and follow-up until 4 years of age. Methods A retrospective longitudinal study was performed, analyzing a database comprising seven cases of prenatal diagnosis of GVA at two Brazilian institutions from February of 2000 to May of 2012. The following data were evaluated: gestational age at diagnosis, GVA dimensions on ultrasonography, associated fetal changes, findings on fetal echocardiography, gestational age at delivery, type of delivery, birth weight, Apgar score at the 1st and 5th minutes, neonatal outcomes, and survival with follow-up until 4 years of age. Results The mean gestational age ± standard deviation on the prenatal diagnosis of GVA based on ultrasonography was 25±4.9 weeks. The mean length of GVA was 3.2±0.4 cm. The mean gestational age at birth was 37.5±0.7 weeks, and a cesarean section was performed in 85.7% of the cases (6/7). The mean birth weight was 3,070±240.4 g. The total survival rate was 42.8% (4/7), with three neonatal deaths. Of the four survivors, three presented with normal neuropsychomotor development until 4 years of age and only one showed serious neurological sequelae. Ultrasonography and MRI showed similar findings for all seven cases. Conclusions Galen Vein Aneurysm is associated with a high neonatal death rate. Therefore, its prenatal diagnosis is essential for parent counseling and follow-up at tertiary care institutions.

Resumo Objetivo Descrever o diagnóstico pré-natal de uma série de casos de aneurisma de veia de Galeno (AVG) por meio de ultrassonografia e ressonância magnética (RM), bem como os resultados pós-natais e acompanhamento até 4 anos de vida. Métodos Realizou-se um estudo retrospectivo longitudinal com análise de banco de dados de sete casos de diagnóstico pré-natal de AVG em dois serviços brasileiros entre fevereiro de 2000 e maio de 2012. Foram avaliados a idade gestacional ao diagnóstico, dimensões do AVG na ultrassonografia, alterações fetais associadas, achados da ecocardiografia fetal, idade gestacional ao parto, tipo de parto, peso ao nascimento, índice de Apgar no 1° e 5° minutos, resultados neonatais, e sobrevida com acompanhamento até 4 anos de idade. Perinatais Resultados A idade gestacional média±desvio-padrão ao diagnóstico pré-natal do AVG pela ultrassonografia foi de 25±4,9 semanas. O comprimento médio do AVG foi 3,2±0,4 cm. A idade gestacional média ao nascimento foi 37,5±0,7 semanas, sendo que, em 85,7% dos casos (6/7) o parto foi cesáreo. O peso médio ao nascimento foi de 3.070±240,4 gramas. A sobrevida total foi de 42,8% (4/7), com três óbitos neonatais. Dos quatro sobreviventes, três apresentaram desenvolvimento neuropsicomotor normal até a idade de 4 anos, sendo que apenas um apresentou sequelas neurológicas graves. Ultrassonografia e RM apresentaram achados semelhantes nos sete casos. Conclusões O AVG está associado à elevada taxa de óbito neonatal, sendo, portanto, fundamental o seu diagnóstico pré-natal precoce para aconselhamento dos pais e seguimento em serviço terciário.

Prenatal diagnosis of ultrasound and MRI in the vein of Galen aneurysmal malformation / 中华医学超声杂志（电子版）

Objective To explore the clinical value of prenatal ultrasound and magnetic resonance imaging in the vein of Galen aneurysmal malformation. Methods The ultrasonographic characteristics and magnetic resonance imaging features of 17 fetuses who were diagnosed as the vein of Galen aneurysmal malformation in Maternal and Child Heath Hospital of Hubei from January 2011 to December 2016 were compared. Results Fifteen cases of Galen aneurysmal malformation. Were diagnosed by prenatal ultrasound during the third trimester. The sonographic feature was a hypoechogenic structure located in the middle line with arteriovenous fistula waveform in doppler analysis, and the cerebral venous sinus of all cases were dilated. Real time three dimensional power doppler can display the angioarchitecture and the communications between widened vascular sinus. MRI feature was the expansion of venous aneurysm located in the middle line, greater cerebral venous pool and quadrigeminal area and tortuous flow void vessels. Among 17 cases, 2 cases of Galen venous aneurysm malformation were misdiagnosed and 7 cases were diagnosed by MRI. There were 15 terminations and 2 neonatal died after birth. Conclusions Galen aneurysmal malformations have typical sonographic findings, and MRI can show neurologic development and impairment. Combined application of ultrasound and magnetic resonance imaging technology can more accurately and comprehensively observe the pathological features of Galen venous aneurysm malformation and diagnose the related complications early.

The application value of CT and MRI on children’s vein of Galen malformation / 实用放射学杂志

Objective To investigate the clinical application value of CT and MRI on the children’s vein of Galen malformation (VGAM).Methods CT and MRI images of 10 children cases with VGAM were analyzed retrospectively.Results CT and MRI find-ings:10 cases with dilatation of the vein of Galen,8 cases with straight sinus dilation,6 cases with dilation of confluence sinus,and 6 cases with other sinus dilatation.Blood supply vessels:basilar artery in 6 cases,posterior cerebral artery in 2 cases,anterior cerebral artery in 1 case and other vascular in 1 case.Complications:bleeding in 4 cases,thrombosis in 2 cases,and calcification in 2 cases. Conclusion CT and MRI can confirm the diagnosis of children’s VGAM,and abnormal blood-supply vessels.CT has advantages of observation of calcifications,and MRI has advantages of observation of hemorrhage and thrombosis.

A case of Galen vein thrombosis occurring after bilateral acetabular fractures in the Tibet plateau - what can we learn? / 中华创伤杂志(英文版)

Hypoxia leads to increased red blood cells and blood viscosity at high altitude while moderate trauma increases coagulation in blood. Under the above-mentioned conditions, venous sinus thrombosis is more likely to occur. A patient suffering bilateral acetabular fractures together with the gradual disturbance of consciousness was admitted to our hospital. Though computed tomography arteriogram (CTA) of the brain displayed normal blood vessels; bilateral thalamus and brainstem infarction were found on head computed tomography (CT) and Galen vein thrombosis on cerebral computed tomography venography (CTV). Dehydration and tracheotomy were immediately conducted with antiplatelet, anticoagulant and neurotrophic medicine administered to the patient. After three days' treatment, the patient's consciousness gradually improved and eventually became clear enough to leave the hospital. On follow-up, no dysfunction was documented.

Experiencia en el despliegue del piloto de galen clínicas en los laboratorios del instituto de hematología e inmunología / Experience in deploying of pilot galen clínicas laboratories in the institute of hematology and immunology

SOFTEL, es la empresa encargada por el Ministerio de las Comunicaciones de informatizar las entidades de Salud Pública. Para ello se han desarrollado varias aplicaciones, para ser desplegadas en hospitales, clínicas, policlínicos y bancos de sangre, fundamentalmente. Específicamente los laboratorios constituyen un área muy sensible debido a que en ellos se realizan todos los medios diagnósticos, que resultan de gran utilidad el almacenamiento de esta información para futuros estudios de los pacientes. Este trabajo expone la experiencia obtenida en el despliegue de dicho módulo, como una primera experiencia, conocida como despliegue de piloto o prueba beta. Esta experiencia sirve de base para las futuras instalaciones en otros clientes, reportó una serie de inconformidades que se resolvieron antes de concluir el mismo y finalmente quedo concluido el despliegue. Este tuvo complicaciones relacionadas con la existencia de laboratorios fuera del área de cobertura del Instituto y la preparación de las interfaces con los diferentes auto analizadores(AU)

SOFTEL is the enterprise commissioned by the Ministry of Communications to computerize public health institutions. For that has been developed several applications to be deployed in hospitals, clinics and blood banks, basically. Specifically, laboratories are a very sensitive area because in them all the diagnostic tools are used, so it is useful storage of this information for future studies of patients. This paper describes the experience gained in the deployment of the module, as a first experience, known as pilot or deployment of beta testing. This experience, which forms the basis for future installations on other customers, reported a series of disagrees which were resolved before the end of the same and finally the deployment was completed. This had complications related to the existence of laboratories outside the coverage area of the Institute and the preparation of the interfaces with the different analyzers(AU)

Visión histórica de la estructura y función del nervio: la visión pre-galénica y galénica / Historic view of the structure and function of the nerve: pregalenic and galenic view

Ordenar a lo largo del tiempo desde épocas remotas hasta el tiempo de Galeno -siglo II- las ideas imperantes sobre los nervios. Se revisaron variadas fuentes bibliográficas sobre los nervios y se ordenaron en el tiempo hasta el siglo II en relación a los conceptos sobre la constitución y funcionalidad de los nervios, comparando dichas ideas y conceptos. Históricamente se muestra que con el avance de la cultura escrita y con el lento desarrollo de nuevas ideas, tuvo que transcurrir varios miles de años para que se llegara a una mejor comprensión menos filosófica mediante la experimentación anatomo-funcional de estos elementos del sistema nervioso.

The objective of this study was to organize over time, from ancient times until the Galen-century, the prevailing ideas about the nerves. We reviewed various bibliographic sources about nerves, and we organized those references during the time of the second century in relation to the concepts related to the constitution and function of nerves, comparing those ideas and concepts. Historically, it is shown that with the advancement of literacy and slow development of new ideas, it took several thou sand years to reach a less philosophical understanding through experimentation based on anatomical and functional elements of the Nervous System.

La docimasia pulmonar en el tratado de medicina legal de Emilio Federico Pablo Bonnet / Hydrostatic pulmonary docimasy in Federico Pablo Emilio Bonnet's textbook of legal medicine

La docimasia pulmonar es una prueba muy útil en la actividad médica forense para investigar y diagnosticar la existencia de vida extrauterina del recién nacido, para establecer si el feto nació muerto o sufrió el delito de homicidio. Una cita repetida en algunos textos de Medicina Legal, de la cual no se menciona en ningún caso la fuente, mostró varias curiosidades al intentar verificarla. Las obras sobre Historia de la Medicina consultadas no lograron despejar las dudas sobre la veracidad del dato y tampoco agotan los temas tratados. Éste sería el caso de Galeno, cuya obra y personalidad tanta influencia tuvieron durante mil quinientos años de nuestra era y aún continúan generando controversias. No se halló ningún dato concreto sobre el conocimiento atribuido a Galeno de la docimasia pulmonar hidrostática, aunque tampoco se encontraron datos que rechacen categóricamente el aserto. Paradójicamente, las referencias históricas relacionadas con la mencionada docimasia en los textos de Medicina Legal no mencionan al holandés Jan Swammerdam, quien habría sido el que la describió y fundamentó

Hydrostatic pulmonary docimasy is a very useful test in forensic medical activity to investigate and diagnose the existence of extra-uterine life of the newborn, to determine whether the fetus was stillborn or was murdered. A repeated reference in some texts of Forensic Medicine, without mention of the source, showed several paradoxes when we tried to verify it. Books on the History of Medicine consulted failed to dispel doubts about the veracity of the data and did not go to the bottom of the issue. This is the case of Galen, whose work and personality had much influence during 1,500 years of our era and continues to generate controversy. No firm information was found about the knowledge Galen might have had on hydrostatic pulmonary docimasy; but no source categorically rejected the possibility. Paradoxically, the historical references on docimasy mentioned in the texts of Forensic Medicine fail to mention name of the Dutch Jan Swammerdam, who described and explained the method .