Coronary Intra-orbital Atherectomy Complications and Procedural Failure: Insight From the Manufacturer and User Facility Device Experience (MAUDE) Database.

BACKGROUND: The Diamondback 360® Coronary Orbital Atherectomy System (Cardiovascular Systems Inc., St. Paul, MN) is the first and only orbital atherectomy system approved by the US FDA for the treatment of severely calcified lesions. While the device has proven to be safe in clinical trials, real-world data are minimal. METHODS: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for reports on the Diamondback 360® Coronary from January 2019 to January 2022. RESULTS: A total of 566 events were reported during the study period. After the exclusion of duplicate reports, the final cohort included 547 reports. The most common mode of failure was break or separation of a device part (40.4%, n = 221) mainly due to breaking in the tip of the ViperWire (66.1%), driveshaft (22.7%), or crown (12.2%). The most common vessel associated with events was the left anterior descending artery (31.4%), followed by the right coronary artery (26.9%), left circumflex (21.6%), and left main coronary artery (6.4%). The most common clinical adverse outcome was perforation (33.0%, n = 181) with 23.7% resulting in cardiac tamponade. Most perforation cases were treated by covered stent (44.2%), surgery (30.5%), stent (98%), and balloon angioplasty (9%). There were 89 (16.3%) events of death with 67% due to perforation (p < 0.001). CONCLUSION: Our study provided a glimpse of real-world adverse outcomes and common modes of failure due to orbital atherectomy. The most common mode of failure was the break or separation of a device part and the most common complication was perforation according to the MAUDE database. It will help physicians to anticipate complications and escalate care appropriately.

Large pineal parenchymal tumor of intermediate differentiation causing compression with resultant obstructive hydrocephalus: a case report.

The epithalamus region contains the tiny, functionally endocrine pineal gland, which has the shape of a pinecone. Less than 1% of adult primary intracranial malignancies are pineal parenchymal tumors, which are incredibly uncommon brain tumors. A rare variety of pineal parenchymal tumors are those with intermediate differentiation. These tumors, whose namesake refers to a malignant pineal parenchymal tumor, are intermediate between pineoblastomas and pineocytomas (a benign pineal parenchymal tumor). Case Presentation: A female patient, age 13, who had been experiencing terrible headaches on and off for a month, went to the emergency room. Along with the headache, she experienced nausea, vomiting, dizziness, and blurred eyesight. A nonenhanced computed tomography scan was used for the initial brain neuroimaging, which showed a hypodense mass posterior to the midbrain and superior to the cerebellum. A heterogeneous bulk was visible on MRI. Clinical Outcome: The headache, vertigo, visual disturbance, nausea, and vomiting have all improved, according to the patient. Both postoperative MRIs with and without contrast revealed the resolution of the obstructive hydrocephalus and the absence of any residual enhancing mass. The patient was followed up for 2 months without any complications or adverse events. Conclusion: One should carefully investigate a headache as the early symptom of many illnesses and rule out any other potential causes. This would therefore enable us to create a management structure for such a very unusual malignancy.

Radiological diagnosis of median nerve lipoma: A case report from Palestine.

Lipomas are benign neoplasms that develop from adipocyte-rich adipose tissue. They affect up to 2% of the population and make up about 50% of all soft-tissue neoplasms. The most common locations for them to appear asymptomatically are the neck, upper back, proximal limbs, and chest. They typically start off as single, distinct, movable lumps. A 50-year-old man who had pain and edema in his right wrist came to our hospital. The patient's history dates back to 9 years ago, when he first began to complain of swelling in his wrist rest but no discomfort. According to a clinical examination, he has a soft, non-painful bump in his right wrist. After being monitored for 9 years with no change in the size of the tumor on his right wrist, the patient started to experience right hand pain and a weak right grasp. Magnetic resonance imaging is the preferred visualization method for examining hand tumors; it is advised to perform a preoperative complementary ultrasound or magnetic resonance imaging investigation in cases of atypical findings or nonfrequent locations of nerve compression, which are clinically interpreted as idiopathic compression.

Molecular defects in BRAF wild-type ameloblastomas and craniopharyngiomas-differences in mutation profiles in epithelial-derived oropharyngeal neoplasms.

The aim of this study was to evaluate the mutation profile of BRAF wild-type craniopharyngiomas and ameloblastomas. Pre-screening by immunohistochemistry and pyrosequencing for identifying BRAF wild-type tumors was performed on archived specimens of ameloblastic tumors (n = 20) and craniopharyngiomas (n = 62). Subsequently, 19 BRAF wild-type tumors (nine ameloblastic tumors and ten craniopharyngiomas) were analyzed further using next-generation sequencing (NGS) targeting hot spot mutations of 22 cancer-related genes. Thereby, we found craniopharyngiomas mainly CTNNB1 mutated (8/10), including two FGFR3/CTNNB1-double mutated tumors. Ameloblastic tumors were often FGFR2 mutated (4/9; including one FGFR2/TP53/PTEN-triple mutated case) and rarely CTNNB1/TP53-double mutated (1/9) and KRAS-mutated (1/9). In the remaining samples, no mutation could be detected in the 22 genes under investigation. In conclusion, mutation profiles of BRAF wild-type craniopharyngiomas and ameloblastomas share mutations of FGFR genes and have additional mutations with potential for targeted therapy.

Patient adaptive control of end-effector based gait rehabilitation devices using a haptic control framework.

Robot assisted training has proven beneficial as an extension of conventional therapy to improve rehabilitation outcome. Further facilitation of this positive impact is expected from the application of cooperative control algorithms to increase the patient's contribution to the training effort according to his level of ability. This paper presents an approach for cooperative training for end-effector based gait rehabilitation devices. Thereby it provides the basis to firstly establish sophisticated cooperative control methods in this class of devices. It uses a haptic control framework to synthesize and render complex, task specific training environments, which are composed of polygonal primitives. Training assistance is integrated as part of the environment into the haptic control framework. A compliant window is moved along a nominal training trajectory compliantly guiding and supporting the foot motion. The level of assistance is adjusted via the stiffness of the moving window. Further an iterative learning algorithm is used to automatically adjust this assistance level. Stable haptic rendering of the dynamic training environments and adaptive movement assistance have been evaluated in two example training scenarios: treadmill walking and stair climbing. Data from preliminary trials with one healthy subject is provided in this paper.

Fetal hydrocephalus, intrauterine diagnosis and therapy considerations: an experimental rat model.

MATERIALS AND METHODS: Fetal hydrocephalus is induced by a single intraperitoneal injection of 8 mg/kg 6-aminonikotinamide (6-AN), a niacinamide antagonist, in Sprague-Dawley rats on day 13 of gestation. Laparotomy was carried out in some rats 3, 6, 7 and 8 days after the intraperitoneal injection. The fetuses were collected by uterotomy and fixed in a formalin solution after measuring head circumference and body length for further histological investigations. The ventricular areas and volumes of the lateral ventricles were measured using a computer morphometric technique after all fetuses were serially sectioned sagittally or coronally. Furthermore, 8 maternal rats (4 treated with 6-AN and 4 controls) were used for ultrasound investigation. The fetal ventricular system and the central canal were demonstrated and compared by transabdominal ultrasound in the 6-AN and control groups. On day 19 of gestation the cerebrospinal fluid (CSF) was drained in some fetuses for 18 h through a thin micro-catheter, which was inserted into the lateral ventricle. In some other fetuses the intracranial pressure (ICP) and the intra-amniotic pressure (IAP) were measured after Doppler sonography of the cerebral blood flow (CBF). These measurements were carried out using a transuterine approach following the laparotomy. RESULTS: Hydrocephalus was produced due to the closure of all outlets of the fourth ventricle. Macrocephalus was clear on day 17 (4 days after 6-AN injection). The entire ventricular system was dilated, including the aqueduct and foramen of Monro, and cerebellar hypoplasia was revealed. CONCLUSION: Increased ICP in 6-AN fetuses was associated with decreasing CBF. The cerebral mantel was better developed after CSF drainage. The intra-amniotic pressure was increased in all pregnant rats and was either similar to or higher than ICP.

Laparoscopic cholecystectomy: the outcome with minimal conversion rate: experience in a district hospital.

BACKGROUND: Since introducing laparoscopic cholecystectomy (LC) different centres have reported different conversion rate (CR) to open cholecystectomy (OC) and different reasons for conversion. OBJECTIVE: To evaluate the role of LC in the treatment of symptomatic gallstones and establish the outcomes of this treatment modality in general, looking especially into the rate of conversion to OC, at a district hospital. PATIENTS AND METHODS: From July 1992-July 1998, 751 patients who underwent LC were retrospectively reviewed. All patients with symptomatic gallstones were offered LC with no exclusion criteria apart from anaesthetic opinion. No attempts were made at selection of patients for LC. RESULTS: There were 751 patients with symptomatic gallstones (617 females, 134 males) underwent LC. Chronic cholecystitis represented the majority of cases (83%). The mean operative time was 65.52 minutes: pre-operation and main hospital stay was 2.46 days. Our total conversion rate was 0.9% and 0.4% if malignancy of the gallbladder is excluded. In comparison to the published data, there was obvious lower conversion rate, which was neither associated with increased morbidity nor mortality. CONCLUSION: Laparoscopic cholecystectomy is a reliable, safe and cost effective treatment modality for symptomatic gallstones. With growing experience in laparoscopic technique, proper settings and harmony of the operating team, it is possible to bring the conversion rate to OC to the minimum without any increment in mortality or morbidity.

Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated.

De novo development of a cavernous malformation of the brain: significance of factors with paracrine and endocrine activity: case report.

OBJECTIVE AND IMPORTANCE: De novo development of cavernous malformations is poorly documented in the literature. CLINICAL PRESENTATION: We report the case of a 37-year old woman with de novo growth of a cavernous malformation of the brain. The patient presented with a 12-month history of nonspecific headaches and paresthesias after two pregnancies. After computed tomographic scanning of the cranium, a cavernous malformation located parieto-occipitally within the right brain hemisphere was diagnosed. Control magnetic resonance imaging scans obtained 12 years earlier did not reveal a similar lesion. INTERVENTION: Surgery was performed, and the specimen was analyzed histopathologically. CONCLUSION: Immunohistochemistry demonstrated lack of expression of pituitary hormones as well as of androgen, estrogen, and progesterone hormone receptors. However, strong expression of both basic fibroblast growth factor and CD44 was detected in surrounding tissue, and expression of CD44 was noted within the matrix of the cavernous malformation.