Stent-assisted coil embolization of challenging intracranial aneurysms: initial and mid-term results with low-profile ACCLINO devices.

BACKGROUND: Stent-assisted coiling using low-profile, self-expandable and retrievable stents is a valid option in endovascular treatment of challenging intracranial aneurysms. This study aims to evaluate the feasibility and efficacy of ACCLINO 1.9 F and ACCLINO Flex stent systems, designed for use as adjunctive products in coil embolization of intracranial aneurysms. METHODS: Case files of 47 patients, and 52 aneurysms in total, treated with at least one ACCLINO 1.9 F or ACCLINO Flex stent were retrospectively evaluated. Technical success, complications, and angiographic outcomes were assessed based on immediate post-procedural controls along with 6th and 12th month angiograms. RESULTS: Mechanical untoward event rate, including asymptomatic complications, is 9.6 % (five out of 52 aneurysms). Failed dual-stenting attempt rate is 15.4 % (two out of 13). Overall procedure-related morbidity is 4.2 % with no neurologic sequelae. Initial occlusion rate is 90.4 % (47 aneurysms). One patient had residual filling in the aneurysm neck, which was stable throughout follow-up. The remaining four cases had spontaneous follow-up occlusion. Recanalization rate at 6th month is 2.1 % with one aneurysm requiring retreatment. One patient was lost to follow-up. There is no mortality associated with treatment. CONCLUSIONS: Stent-assisted coil embolization with ACCLINO stents in single or dual configurations is a feasible treatment option for challenging intracranial aneurysms. Follow-up results are encouraging; techniques were effective in complex cases and there were no clinically significant adverse outcomes.

The effect of bilateral oophorectomy on bone mineral density.

The objective of this study is to investigate the effect of bilateral oophorectomy with total abdominal hysterectomy on bone loss, comparing the cases having surgery before and after the menopause. Bone mineral density (BMD) measurements were obtained from the lumbar spine and femoral neck of totally 127 cases. Out of 127, 105 had surgery before menopause and 22 cases were operated on postmenopausally. The results were compared with the USA normal values. The average age of surgical menopause (SM) cases was 48.45 years with a mean duration of menopause of 5.77 years. The average height and weight were 157.67 cm and 68.19 kg, respectively. The average age of cases having surgery after menopause (SAM) was 62.45 years with a mean duration of 5.59 years after the surgery (duration after menopause is 13.23 years). The average height and weight were 157.45 cm and 73.55 kg, respectively. The average of BMD measurements of lumbar spines L2-L4 was 1.04 gr/cm(2) (BMD = 85.65% and T score = -0.96) in the cases with SM. On the contrary, the average of the BMD measurements of lumbar spines L2-L4 was 1.05 gr/cm(2) (BMD = 101.14% and T score = 0.24) in the cases with SAM. The average of the BMD measurements of femoral neck was 0.85 gr/cm(2) (BMD = 91.39% and T score = -0.64) in the cases with SM. On the contrary, the average of the BMD measurements of femoral neck was 0.82 gr/cm(2) (BMD = 96.69% and T score = -0.31) in the cases with SAM. The bilateral oophorectomy as a surgical procedure is not a statistically significant factor for the acceleration of the bone loss. The main points are the age and the duration of menopause of the patient affecting the bone loss if the surgery is performed before menopause.

Renal artery stenting in solitary functioning kidneys: technical and clinical results.

OBJECTIVE: To evaluate the clinical and technical results of renal artery stenting for the treatment of renovascular hypertension and renal failure in patients with solitary functioning kidney. MATERIALS AND METHODS: Fifteen patients with solitary functioning kidney underwent renal artery stenting and were followed up for 12-60 months. Before the procedures, systolic and diastolic blood pressures and serum creatinine levels were measured and the number of antihypertensive drugs was recorded and followed up after stenting. In case of restenosis, either in-stent percutaneous transluminal renal angioplasty or stent-in-stent placement was performed. RESULTS: Primary technical success rate was 100%. One lesion was nonostial while 14 were ostial. Primary patency rates were 100% for 6 months, 92.3% for 12 months, and 69.2% for 24 months. The secondary patency rate at 24 months was 100%. The differences between the baseline and postprocedural values of systolic blood pressures, diastolic blood pressures and the number of antihypertensive drug were statistically significant (P < 0.05), except the values of serum creatinine. Hypertension was cured in 1 (6.7%) patient, improved in 4 (26.6%) and stabilized in 10 (66.7%) patients. Renal function improved in 9 (60%), stabilized in 4 (26.6%), and deteriorated in 2 (13.4%) patients. Minor complication rate was 13.4% and major complication rate was 13.4%. CONCLUSION: Revascularization of renal artery stenosis using stent in solitary functioning kidneys is a safe and efficient procedure with high primary technical results, low restenosis rates and acceptable complication rates. It has an improving and controlling effect on blood pressure and renal functions.

Fat necrosis mimicking liposarcoma in a patient with pelvic lipomatosis. CT findings.

Pelvic lipomatosis is a rare condition characterized by an overgrowth of normal fat in the perirectal and perivesical spaces. The most important differential diagnosis is liposarcoma. We present a case of pelvic lipomatosis associated with a mass, which was diagnosed radiologically as a liposarcoma, but surgical biopsy result revealed fat necrosis.

Inguinoscrotal bladder herniation: is CT a useful tool in diagnosis?

Urinary bladder herniation into the inguinal canal is a rare occurrence. The condition is often diagnosed during inguinal hernia surgery. We present a rare case of inguinoscrotal bladder herniation with its computed tomography findings.