ABSTRACT
The Outreach DAC is an intermediate-sized catheter designed for use with the Merci clot retriever in acute stroke. We investigated its utility as an adjunctive device during AVM pedicle embolization. In the authors' opinion, the DAC provided additional guide-catheter and microcatheter support, improved selective angiographic visualization of AVM angioarchitecture, aided microcatheter removal from its embedded position in the AVM Onyx cast, and enhanced local microcatheter control and safety, compared with embolization with the guide and microcatheter alone.
Subject(s)
Embolization, Therapeutic/instrumentation , Intracranial Arteriovenous Malformations/therapy , Polyvinyls/administration & dosage , Tantalum/administration & dosage , Vascular Access Devices , Drug Combinations , Embolization, Therapeutic/methods , Equipment Design , Equipment Failure Analysis , Hemostatics/administration & dosage , Humans , Male , Miniaturization , Treatment Outcome , Young AdultABSTRACT
We report a 54-year-old man who suffered a stroke from a complete right internal carotid artery (ICA) occlusion. Two months later, he presented with right eye blindness. Imaging demonstrated 50% recanalization of his right ICA. He underwent a right carotid endarterectomy to prevent contralateral stroke from emboli through a patent anterior communicating artery. Recanalization of a completely occluded proximal ICA due to atherosclerotic disease has been reported but is rare, but such patients emphasize the importance of follow-up vascular studies.
Subject(s)
Blindness/etiology , Carotid Artery Diseases/complications , Carotid Artery, Internal/pathology , Ophthalmic Artery/pathology , Thromboembolism/etiology , Blindness/pathology , Brain Ischemia/complications , Carotid Artery Diseases/pathology , Cerebral Angiography , Endarterectomy, Carotid , Functional Laterality/physiology , Humans , Male , Middle Aged , Stroke/etiology , Thromboembolism/pathology , Tomography, X-Ray ComputedABSTRACT
Distal ventriculoperitoneal shunt obstruction is typically associated with cerebrospinal fluid (CSF) infection, fluid pseudocysts, bowel obstruction, bowel perforation, or improper shunt placement in the abdomen. We describe a unique etiology for distal shunt obstruction secondary to Clostridium difficile pancolitis that occurred because of inflammation and ascites, which led to incomplete drainage and absorption of CSF. This case illustrates the importance of considering distal shunt obstruction in a patient with signs of abdominal pathology in the setting of mental status changes, and the effective treatment of this patient initially with distal catheter externalization followed by internalization of a new distal catheter after resolution of the pancolitis.
Subject(s)
Clostridioides difficile , Enterocolitis, Pseudomembranous/microbiology , Hydrocephalus/surgery , Neurosurgical Procedures/adverse effects , Postoperative Complications/microbiology , Ventriculoperitoneal Shunt/adverse effects , Ascites/complications , Ascites/microbiology , Ascites/physiopathology , Cerebral Ventricles/pathology , Cerebral Ventricles/physiopathology , Cerebrospinal Fluid/physiology , Enterocolitis, Pseudomembranous/complications , Enterocolitis, Pseudomembranous/physiopathology , Female , Humans , Hydrocephalus/etiology , Intestines/diagnostic imaging , Intestines/microbiology , Intestines/pathology , Middle Aged , Neurosurgical Procedures/instrumentation , Pancreatitis/complications , Pancreatitis/physiopathology , Peritoneal Cavity/diagnostic imaging , Peritoneal Cavity/microbiology , Peritoneal Cavity/pathology , Postoperative Complications/pathology , Postoperative Complications/physiopathology , Reoperation , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Anti-Inflammatory Agents/classification , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/classification , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antirheumatic Agents/classification , Antirheumatic Agents/pharmacology , Arthritis, Rheumatoid/economics , Arthritis, Rheumatoid/epidemiology , Arthritis, Rheumatoid/psychology , Cost of Illness , Disease Progression , Drug Interactions , Drug Therapy, Combination , Humans , Quality of Life , Steroids , Treatment OutcomeABSTRACT
OBJECTIVE: The most common etiology of infectious diarrhea in hospitalized patients is Clostridium difficile. No single laboratory test yields a definitive diagnosis. Four methods were evaluated for their sensitivity and specificity in patients who had clinically defined C difficile-associated diarrhea. METHODS: Clinical criteria for C difficile-associated diarrhea were defined. All adult in-hospital patients whose stools were tested for C difficile were prospectively followed. Stools were examined with culture on a selective medium, a commercial cytotoxicity assay (cta), and two commercially available enzyme immunoassays (eias) for toxin A (Meridian) and toxin AB (cbc). RESULTS: During the study period 235 stool specimens from 185 patients were tested. Fifty-one patients were positive for C difficile or its markers, cta was most sensitive (80%), whereas cbc-eia was most specific (98%). Differences in the sensitivities of cta and Meridian-eia were minor (80% versus 73.3%) and they were equally specific (95.5%). CONCLUSIONS: The sensitivity and specificity of eia for toxin A is similar to other tests. However, due to rapidity and ease of performance, it may be a more practical test for the diagnosis of C difficile-associated diarrhea, especially if the cytotoxin assay is not available.
