The Barrel Vascular Reconstruction Device : A Retrospective, Observational Multicentric Study.

BACKGROUND AND PURPOSE: The Barrel device is an electrolytically detachable laser cut, closed-cell microstent that is used for neck reconstruction in wide-necked bifurcation and branching aneurysms to support coiling. The key feature is a barrel section that herniates over the aneurysmal ostium. The objective was to evaluate the safety, feasibility and the immediate and mid-term occlusion results of this new device. MATERIAL AND METHODS: The databases of two tertiary care centers were screened for all Barrel-based stent-assisted intracranial coil embolization of wide-necked aneurysms between June 2015 and September 2016. Case files and imaging data were retrospectively analyzed for angiographic and clinical outcome parameters, including immediate and mid-term modified Raymond-Roy aneurysm occlusion classification (RROC) rates and procedural complications. RESULTS: A total of 21 patients comprising 21 intracranial aneurysms (20 unruptured, 1 ruptured) were treated with the Barrel device and additional coiling of the aneurysm sac. All aneurysms were wide-necked, saccular bifurcation aneurysms defined by a dome/neck ratio ≤2. Immediate complete occlusion (RROC1) was observed in 19/21 (90%). An intra-interventional in-stent thrombus formation in two cases (10%) was medically resolved without neurological sequelae. A single case of symptomatic in-stent stenosis (5%) was cleared by balloon angioplasty. Follow-up (FU) was available in 20/21 cases (95%) after a median of 282 days (range: 17-591 days). At follow-up 19/20 aneurysms (95%) were completely occluded (RROC1). CONCLUSION: The Barrel device showed a satisfactory safety profile and a promising rate of immediate and mid-term complete aneurysm occlusion for stent-assisted coil embolization of wide-necked intracranial bifurcation aneurysms, warranting further investigation of the device.

Interdisciplinary clinical management of high grade arteriovenous malformations and ruptured flow-related aneurysms in the posterior fossa.

Posterior fossa arteriovenous malformations are rare entities and treatment modalities technically challenging. In recent years new therapeutic options have emerged through microsurgical and endovascular means. Based on a series of six cases we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months. Clinical case data were collected during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome. Treatment options included endovascular techniques as well as microsurgical techniques. All reported cases had SAH based on ruptured flow-related aneurysms in posterior fossa AVM; three out of six had multiple aneurysms. In one case we observed a de novo formation of two flow-associated distal aneurysms in an interval of ten years. Two patients were treated only endovascularly, one patient only surgically and three patients with combined methods. Five out of six patients had a good outcome (GOS 4 or 5). One died in the acute phase. Infratentorial AVMs are rare but characterized by a high risk of rupture and SAH, especially in conjunction with flow related aneurysms, which are predictors of poor outcome. The anatomic conditions of the posterior fossa may lead quickly to life-threatening complications due to mass effects. The present study indicates that treatment strategies in the acute phase should focus on flow-related aneurysms, followed by an elective AVM embolization and ectomy whenever possible. An experienced interdisciplinary team and the combination of techniques contribute to a reduction of complications and to a better outcome.

Ultraviolet radiation-induced non-melanoma skin cancer in the Crl:SKH1:hr-BR hairless mouse: augmentation of tumor multiplicity by chlorophyllin and protection by indole-3-carbinol.

Over 1 million new cases of ultraviolet radiation-induced non-melanoma skin cancers (NMSC) per year now occur in the USA and the incidence of these diseases continues to increase. New preventative strategies are required. The hypothesis tested was that dietary administration of the putative cancer chemopreventatives sodium-copper-chlorophyllin (Chlor) or indole-3-carbinol (I3C) would inhibit UV-induced skin carcinogenesis in the Crl:SKH1:hr-BR hairless mouse. Groups of 20 mice were pre-fed isocaloric/isonutritive 20% corn-oil AIN-76a based diets that contained either Chlor (1.52 g%), I3C (5.08 g%) or no chemopreventative (control) for 2 weeks followed by exposure of their dorsal skin to a 10 week incremental, sub-erythemal, carcinogenic simulated solar UV exposure regime. Feeding was continued for the duration of the experiment. Matched non-UV exposed dietary groups were also included in the experimental design. The diets had no significant (p > 0.05) effect on body weight, feed consumption, cutaneous methanol-extractable UV photoprotective substances or on cutaneous UV-reflective characteristics. By day 180, UV-irradiated mice fed the Chlor had a significantly (p < 0.05) higher tumor multiplicity (33.6 +/- 4.72; mean +/- SEM) than UV-irradiated control animals (22.8 +/- 4.25). UV-irradiated mice fed I3C had a significantly (p < 0.001) lower tumor multiplicity (13.0 +/- 2.42) than that of both the UV-irradiated control and UV-irradiated Chlor-fed mice. The Chlor or I3C diets did not significantly (p > 0.05) affect UV-induced systemic suppression of contact hypersensitivity responses. These results demonstrate augmentation of the UV-induced cutaneous carcinogenic process by dietary chlorophyllin and protection from this carcinogenic process by indole-3-carbinol via mechanisms that do not involve changes in skin optical properties, modulation of photoimmunosuppression or caloric/nutrient effects.

[Visceral lesions in mammals and birds exposed to agents of human cercarial dermatitis]. / Lésions viscérales de mammifères et oiseaux, exposés aux agents de dermatite cercarienne humaine.

Over the past few years, the cercarial dermatitis has become a new problem of public health, obviously linked to the prolonged stay of migrant birds on our territory. This is a skin affection characterized by pruriginous and papulous eruptions caused by penetration of avian bilharzian larvae under the skin. These larvae are emitted by molluscs, mostly limneids. In aquatic birds, especially in migrating Anatidae, these larvae reach the visceral vessels, become adults in a few weeks, lay eggs, then degenerate. Corresponding miracidia contaminate new limneids. Since 1993, the total number of annual cases of cercarial dermatitis has increased from only ten to thousands in France and the affection rages in pools where limneids, migrating water birds and swimmers gather together. Fever, respiratory and/or digestive allergic symptoms appear in some cases. This clinical pattern has encouraged to undertake research on the future of these bilharzian larvae in mammals organism. A preliminary investigation on a rodent model showed that, once the skin barrier had been crossed, the schistosomulae migrated into the lungs of the host; there they survived a week and induced lesions. The goal of this study is to carry on the research, over a longer period, after exposure to cercariae, simultaneously in mammals and birds, with two species of bilharziae present in France. The selected models are the gerbil Meriones unguiculatus for mammals, and the ducks Anas platyrhynchos and Cairina moschata, for birds. 5 M. unguiculatus and 2 A. platyrhynchos were exposed to cercariae emitted by Radix auricularia; 2 gerbils and 5 A. platyryhnchos to larvae of R. peregra, 3 C. moschata to larvae emitted by two species of molluscs: 70-230 from R. auricularia and 330-585 from R. peregra. 5 gerbils died between 2 and 5 weeks after exposure, 2 gerbils sacrificed early, served as control animals for skin manifestations. Eight ducks were sacrificed between 2 and 4 weeks after; the 2 last ones, exposed several times, were sacrificed respectively 7 and 13 weeks after the first exposure. Visceral and skin samples were submitted to histological study. The control gerbils developed skin dermatitis. In ducks, R. auricularia was the vector of Trichobilharzia franki, whose selective dwelling site was the mesentery; R. peregra was the vector of an indeterminate species found in the lungs and nose. This species is called Bilharzia sp. in this study. The ducks, exposed to two kinds of larvae, displayed worms in these two main locations. In gerbils, T. franki induced lesions in the mesenteric veins and the peritoneum. Bilharzia sp. gave rise to lesions in lung arteries, pleura and liver veins. Vascular changes encompassed endothelitis and lymphocytic vasculitis, while serosa displayed mesothelial hyperplasia. The types of lesions observed in gerbils were noticed in ducks, and, according to the species of bilharzia, in the homologous viscera. Additional foreign body granulomas centred on worm's debris or their eggs, and vascular thromboses were present, too. In addition, ducks displayed lesions involving several other viscera including the intestine, the kidneys and the peripheral nerves. These changes were multiple and diffuse in C. moschata exposed to two species of bilharziae. They were observed mainly in mesenteric and intestinal vessels, pulmonary arteries and hepatic veins. In gerbils, the lesions persisted 2 to 5 weeks after exposure, but worms were not identified in the neighbouring tissues near the damaged vessels. In ducks, lesions were important between 2 and 7 weeks after exposure; they co-existed with live or dead worms, sometimes paired, with or without eggs. The hepatic lesions regressed 13 weeks, after exposure. In mammals and birds, young worms could migrate into the same visceral vessels, and stimulating formation of persistent lesions. In individuals exposed to the same cercariae, development of similar lesions would be probable.