The Management of Intracranial Aneurysms: Current Trends and Future Directions.

Intracranial aneurysms represent a major global health burden. Rupture of an intracranial aneurysm is a catastrophic event. Without access to treatment, the fatality rate is 50% in the first 30 days. Over the last three decades, treatment approaches for intracranial aneurysms have changed dramatically. There have been improvements in the medical management of aneurysmal subarachnoid haemorrhage, and there has been an evolution of treatment strategies. Endovascular therapy is now the mainstay of the treatment of ruptured intracranial aneurysms based on robust randomised controlled trial data. There is now an expansion of treatment indications for unruptured intracranial aneurysms to prevent rupture with both microsurgical clipping and endovascular treatment. Both microsurgical and endovascular treatment modalities have evolved, in particular with the introduction of innovative endovascular treatment options including flow diversion and intra-saccular flow disruption. These novel therapies allow clinicians to treat more complex and previously untreatable aneurysms. We aim to review the evolution of treatment strategies for intracranial aneurysms over time, and discuss emerging technologies that could further improve treatment safety and functional outcomes for patients with an intracranial aneurysm.

Epidemiology of breast cancer in women based on diagnosis data from oncologists and senologists in Algeria.

BACKGROUND: Breast cancer (BC) is a major health issue threatening women's life. No reliable epidemiological data on BC diagnosed by oncologists/senologists are available in Algeria. METHODS: The BreCaReAl study, a non-interventional prospective cohort study, included adult women with confirmed BC in Algeria. Disease incidence, patients and disease characteristics, treatment patterns, and mortality rate were recorded up to 12 months of follow-up. RESULTS: Overall, 1,437 patients were analysed: median age was 48 [41;57] years and 337 (23.5%) women had a family history of BC. BC incidence was 22.3 (95% CI: 21.5; 23.2) cases per 100,000 inhabitants over 8 months. Delayed diagnosis was reported in 400 (29.2%) patients. First line of treatments were mainly chemotherapy and surgery. Twenty-eight serious adverse events were reported including 10 (37.0%) events which led to death. Mortality rate reached 3.2% at 12 months CONCLUSION: A delayed diagnosis highlights the importance of implementing more effective screening strategies.

Prospective observational study in early breast cancer at University Hospital of Tlemcen

Background: Breast cancer is the first cancer in women in Algeria. It affects a significant proportion of young women. Stage at diagnosis is made with a positive, massive, and often lymph node involvement. The objective of this study is to determine the clinicopathological and histological features of patients treated for invasive breast carcinoma.Methods: This is an observational prospective study from January 2006 to December 2011 done at the medical oncology department at the University Hospital Center of Tlemcen: 103 patients with early breast cancer were included.Results: Extreme age is between 29 and 70 years; 50% of patients are under 47 years. The average age at diagnosis of 46.45 ± 0.90 years; 54% are stage T2; 17% are stage T3 and 4% stage T4; stage III is the most frequent with 50.4%. Half of patients have four to nine nodes with relatively wide tumor size, and only one patient was stage I; 10% had more than 10 positive nodes. The infiltrating ductal carcinoma is the most common histological types (83.5%), followed by atypical carcinoma (5.82%). Note the predominance of grade II of Scarf Bloom and Richardson (58.25%), followed by grade III (36.89%) and grade I (1.91%). Over 50% of patients had a tumor size of 35.41 ± 1.82 mm. Hormone receptors were positive in 65% of patients (ER + PR +) and negative in 35%. HER2 status was determined in 82 patients, 12% expressed a positive score, and 67% of were negative. The luminal profile is the most common in our study population with 57.3%, followed by triple negative tumors or basal-like with 26.8%. Conservative surgical treatment was realized in 2.9% and an astectomy in most patients at 97%. Radiotherapy was performed in 83.5% of patients, and 65% of patients received hormone therapy according to hormone positivity.Conclusion: The clinical and histological profiles of the patients in our study population are different from Western populations by the average age of diagnosis of 46 years, 10 years higher for Western women, and the stage is more advanced for our population. The majority are at stage III, while Western women are diagnosed at stage I or II through screening. Given the Algerian profile, women should be offered screening at aged 40 years for earlier diagnosis and improved survival rate

Prevalence and isotype distribution of antiphospholipid antibodies in Chilean patients with systemic lupus erythematosus (SLE).

Previous studies have demonstrated that ethnicity plays a role in the prevalence, isotype distribution, and clinical significance of anticardiolipin (aCL) and anti-beta2 glycoprotein I (abeta2-GPI) antibodies in systemic lupus erythematosus (SLE) patients. Few studies have been done in Latin American populations. Serum samples from 129 Chilean SLE patients were tested for IgG, IgM and IgA aCL and abeta2-GPI by ELISA. Clinical data were reviewed with the focus on clinical manifestations of antiphospholipid syndrome (APS). Positivity for at least one isotype of aCL was found in 30% of patients, while only 10% were positive for at least one isotype of abeta2-GPI. IgG was the most prevalent isotype for aCL (16%), and the isotype distribution was similar (4%) for abeta2-GPI. In general, the presence of aCL was significantly associated with the presence of abeta2-GPI, but a number of samples were positive for only one antibody, some of them associated with clinical manifestations of APS. ACL antibodies at medium-high titers were significantly correlated with thrombosis (P = 0.0007) and fetal loss (P = 0.009); however, the sensitivity of abeta2-GPI for detecting thrombosis and fetal loss was lower than aCL (19 and 17% vs 56 and 50%, respectively), and the specificity slightly higher (91 and 90% vs 84 and 82%). In Chilean SLE patients, aCL and abeta2-GPI antibodies are important in the evaluation of patients with APS. However, the utility of abeta2-GPI antibodies was limited by the low prevalence of these antibodies in comparison with other ethnic groups. Further studies are needed to define the basis of the observed differences among ethnic groups.

[Cryoglobulins in rheumatoid arthritis: exhaustive detection, immunochemical findings and clinical expression]. / Crioglobulinas en artritis reumatoide: detección exhaustiva, hallazgos inmunoquímicos y expresion clínica.

Cryoglobulins were measured in 29 patients (24 female, age 53.8 +/- 9.8 years) with rheumatoid arthritis (70% active). The cryoprecipitate was isolated, characterized and quantified. Cryoglobulinemia, always polyclonal or type III, was found in 83% of patients. The most frequent immunochemical isotypes found were IgG and A. Acrocyanosis was found in 50% and Raynaud phenomenon in 32% of patients with cryoglobulinemia. It is concluded that exhaustive detection of cryoglobulinemia in rheumatoid arthritis demonstrated a higher frequency than previously reported an is important for understanding pathogenesis of the disease.

[Erythema chronicum migrans and Lyme's disease]. / Eritema crónico migrans y enfermedad de Lyme.

A 66 year old woman with a history suggesting a tick bite on the right arm developed a slowly expanding erythematosus lesion. Similar lesions appeared on the trunk and extremities in the following months. A skin biopsy showing spiral shaped agents and the clinical findings were compatible with erythema chronicum migrans. A course of penicillin resulted in complete resolution of the lesions. After a 2 year follow up period she remains free of rheumatic, neurologic or cardiac lesions of Lyme's disease.

Transient osteoporosis of the hip.

Osteoporosis in a painful hip is usually a sign of inflammation or tumor. There exists, however, a self-limited clinical entity that presents with pain in the hip and where the only roentgenological manifestation is osteoporosis. Eight patients with this disease are described: five men and three women, ranging in age from 29 to 50 years. In four patients, the onset of disease was related to sprain, pregnancy, or delivery. Laboratory analyses and the clinical course of the disease excluded inflammation or a neoplasm as the cause. All patients fully recovered with 12 month, with no sequelae. The etiology of the disease remains unknown.