Microsurgical clipping as a retreatment strategy for previously ruptured aneurysms treated with the Woven EndoBridge (WEB) device: a mono-institutional case series.

BACKGROUND: Since its approval by the US Food and Drug Administration (FDA) in 2018, the flow disruptor Woven EndoBridge (WEB) device has become increasingly popular for the endovascular treatment of unruptured and ruptured cerebral aneurysms. However, the occlusion rates seem rather low and the retreatment rates rather high compared to other treatment methods. For initially ruptured aneurysms, a retreatment rate of 13 % has been reported. A variety of retreatment strategies has been proposed; however, there is a paucity of data concerning microsurgical clipping of WEB-pretreated aneurysms, especially previously ruptured ones. Thus, we present a single-center series of five ruptured aneurysms treated with the WEB device and retreated with microsurgical clipping. METHODS: A retrospective study including all patients presenting with a ruptured aneurysm undergoing WEB treatment at our institution between 2019 and 2021 was performed. Subsequently, all patients with an aneurysm remnant or recurrence of the target aneurysm retreated with microsurgical clipping were identified. RESULTS: Overall, five patients with a ruptured aneurysm treated with WEB and retreated with microsurgical clipping were included. Besides one basilar apex aneurysm, all aneurysms were located at the anterior communicating artery (AComA) complex. All aneurysms were wide-necked with a mean dome-to-neck ratio of 1.5. Clipping was feasible and safe in all aneurysms, and complete occlusion was achieved in 4 of 5 aneurysms. CONCLUSIONS: Microsurgical clipping for initially ruptured WEB-treated aneurysms is a feasible, safe, and effective treatment method in well-selected patients.

Impact of Implementing an Elaborated CT Perfusion Protocol for Aneurysmal SAH on Functional Outcome: CTP Protocol for SAH.

BACKGROUND AND PURPOSE: The acute phase of aneurysmal SAH is characterized by a plethora of impending complications with the potential to worsen patients' outcomes. The aim of this study was to evaluate whether an elaborated CTP-based imaging protocol during the acute aneurysmal SAH phase is able to prevent delayed infarctions and contribute to a better outcome. MATERIALS AND METHODS: In 2012, an elaborated CTP-based protocol was implemented for the management of patients with aneurysmal SAH. Retrospective analysis of patients with aneurysmal SAH treated from 2010 to 2013 was performed, comparing the patients treated before (group one, 2010-2011) with those treated after the protocol implementation (group two, 2012-2013) with regard to delayed infarctions and outcome according to the mRS at 3-months' follow-up. RESULTS: A total of 133 patients were enrolled, of whom 57 were included in group 1, and 76, in group 2. There were no significant differences between the groups concerning baseline characteristics. In the multivariate analysis, independent predictors of a good outcome (mRS ≤ 2) were younger age (P < .001), lower World Federation of Neurosurgical Societies grade (P < .001), absence of delayed infarction (P = .01), and management according to the CTP protocol (P = .01). Larger or multiple infarctions occurred significantly more often in group 1 compared with group 2 (88% versus 33% of all delayed infarctions, P = .03). The outcome in group 2 was significantly better compared with group 1 (P = .005). CONCLUSIONS: The findings suggest that implementation of an elaborated CTP protocol is associated with a better outcome. An earlier initiation of further diagnostics and treatment with prevention of large territorial and/or multiple infarctions might have led to this finding.

Cranial nerve deficits in giant cavernous carotid aneurysms and their relation to aneurysm morphology and location.

BACKGROUND: Giant cavernous carotid aneurysms (GCCAs) usually exert substantial mass effect on adjacent intracavernous cranial nerves. Since predictors of cranial nerve deficits (CNDs) in patients with GCCA are unknown, we designed a study to identify associations between CND and GCCA morphology and the location of mass effect. METHODS: This study was based on data from the prospective clinical and imaging databases of the Giant Intracranial Aneurysm Registry. We used magnetic resonance imaging and digital subtraction angiography to examine GCCA volume, presence of partial thrombosis (PT), GCCA origins, and the location of mass effect. We also documented whether CND was present. RESULTS: We included 36 GCCA in 34 patients, which had been entered into the registry by eight participating centers between January 2009 and March 2016. The prevalence of CND was 69.4%, with one CND in 41.7% and more than one in 27.5%. The prevalence of PT was 33.3%. The aneurysm origin was most frequently located at the anterior genu (52.8%). The prevalence of CND did not differ between aneurysm origins (p = 0.29). Intracavernous mass effect was lateral in 58.3%, mixed medial/lateral in 27.8%, and purely medial in 13.9%. CND occurred significantly more often in GCCA with lateral (81.0%) or mixed medial/lateral (70.0%) mass effect than in GCCA with medial mass effect (20.0%; p = 0.03). After adjusting our data for the effects of the location of mass effect, we found no association between the prevalence of CND and aneurysm volume (odds ratio (OR) 1.30 (0.98-1.71); p = 0.07), the occurrence of PT (OR 0.64 (0.07-5.73); p = 0.69), or patient age (OR 1.02 (95% CI 0.95-1.09); p = 0.59). CONCLUSIONS: Distinguishing between medial versus lateral location of mass effect may be more helpful than measuring aneurysm volumes or examining aneurysm thrombosis in understanding why some patients with GCCA present with CND while others do not. CLINICAL TRIAL REGISTRATION NO: NCT02066493 ( clinicaltrials.gov ).

Efficacy and safety of durotomy after decompressive hemicraniectomy in traumatic brain injury.

Decompressive hemicraniectomy (DH) plus duroplasty was demonstrated to be effective for treating critically elevated intracranial pressure (ICP). In order to shorten operation time and to avoid the use of autologous or heterologous material, durotomy has been introduced as an alternative to duroplasty. Only limited data is available on the effect of DH and durotomy on the increased ICP in traumatic brain injury (TBI). Therefore, we collected consecutive intraoperative ICP readings during the different steps of DH and durotomy in TBI patients. Eighteen patients with TBI and uncontrollable ICP increase (measured by either an intraparenchymal or an intraventricular ICP probe) underwent DH and durotomy. ICP readings as well as mean arterial blood pressure (MAP) and arterial PCO2 were obtained during defined stages of the operation. Surgical complications of the durotomy itself and of cranioplasty after 3 months were recorded. The outcome was assessed prior to cranioplasty using the Glasgow Outcome Scale (GOS). ICP dropped significantly during surgery from a mean of 41 ( ± 16.2) mmHg at the beginning to a mean of 11.8 ( ± 7.5) mmHg at the end (p ≤ 0.001). A first significant ICP-decrease to a mean of 18 ( ± 10.8) mmHg (p ≤ 0.001) was detected after removal of the bone flap, and a second significant ICP-decrease to a mean of 10.6 ( ± 5.3) mmHg (p < 0.001) during durotomy. The mean operation time was 115.3 min ( ± 49.6). Five patients (28%) died; seven patients (39%) had a good outcome (GOS 5). There were no relevant complications associated to durotomy. Durotomy after DH is a safe and straightforward procedure, which significantly lowers critically increased ICP in patients with TBI. Although no graft is used, dural preparation for cranioplasty at 3 months is easily possible.

The immediately failed lumbar disc surgery: incidence, aetiologies, imaging and management.

Studies on immediate failed back surgery syndrome (iFBSS) following lumbar microdiscectomy are rare. Our aim is to describe the incidence and the causes of these immediate failures to define the value of radiological imaging for identification of the underlying pathology and to propose a management algorithm. We defined iFBSS as persistence, deterioration or recurrence (during hospital stay) of radicular pain and/or sensorimotor deficits and/or sphincter dysfunction after microdiscectomy, which was uneventful from the surgeon's perspective. The medical records of 1546 patients undergoing discectomy for mediolateral lumbar disc herniations were screened for iFBSS. The pre- and postoperative imaging, surgical records, therapy and outcome of patients with iFBSS were reviewed. Forty-four of 1546 patients (2.8%) with iFBSS were identified. All patients underwent reoperation. Overseen disc material/re-herniation (n = 22), epidural hematoma (n = 6), inadequate decompression of accompanying recessal stenosis (n = 2) and dural tear with fascicle herniation (n = 1) were found to be causative. In 13 patients, who revealed no clear pathology intraoperatively, we diagnosed a battered root syndrome (nerve root swelling due to excessive surgical manipulation). The correct diagnosis could be established by neuroradiological imaging in 25 of 43 radiologically investigated patients (57%). In our study, the radiological workup was of limited value for the correct differentiation of the various aetiologies of iFBSS. Therefore, the authors believe that the treatment strategy should strongly rely on the clinical presentation. To avoid unnecessary surgery in cases of battered root syndrome, we propose to proceed to reoperation only in patients with new or persistent radiculopathy despite adequate antiedematous medical therapy.

Volume perfusion CT (VPCT) for the differential diagnosis of patients with suspected cerebral vasospasm: qualitative and quantitative analysis of 3D parameter maps.

OBJECT: Cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) implies high risk for secondary ischemia. It requires early diagnosis to start treatment on time. We aimed to assess the utility of "whole brain" VPCT for detecting localization and characteristics of arterial vasospasm. METHODS: 23 patients received a non-enhanced CT, VPCT and CTA of the brain. The distribution of ischemic lesions was analyzed on 3D-perfusion-parameter-maps of CBF, CBV, MTT, TTS, TTP, and TTD. CT-angiographic axial and coronal maximum-intensity-projections were reconstructed to determine arterial vasospasm. CT-data was compared to DSA, if performed additionally. Volume-of-interest placement was used to obtain quantitative mean VPCT values. RESULTS: 82% patients (n=19) had focal cerebral hypoperfusion. 100% sensitivity and 100% specificity was found for TTS (median 1.9s), MTT (median 5.9s) and TTD (median 7.6s). CBV showed no significant differences. In 78% (n=18) focal vessel aberrations could be detected either on CTA or DSA or on both. CONCLUSION: VPCT is a non-invasive method with the ability to detect focal perfusion deficits almost in the whole brain. While DSA remains to be the gold standard for detection of CV, VPCT has the potential to improve noninvasive diagnosis and treatment decisions.

[Laboratory investigation of the chemical disinfection against different developmental stages of the housefly (Musca domestica Linnaeus, 1758)]. / Laboruntersuchungen zur chemischen Desinfektion gegen Entwicklungsstadien der Grossen Stubenfliege (Musca domestica LINNAEUS, 1758).

Possibilities for disinfection of the developmental stages from the housefly (Musca domestica) were investigated under laboratory conditions. The developmental stages (eggs, larvae I, II, III, pupae and adults) were sprayed with solutions of disinfectants on the basis of p-chlorine-m-cresol and o-phenylphenol at different concentrations (0.025%-3%). The effectiveness of both disinfectants was established by determining the emergence rate of eggs and pupae and of the live evidence of larvae and adults. Transmission electron microscopic investigations of the cover of the eggs revealed the bactericidal effect of both disinfectants. These results show the necessity of extending its use also to noxious arthropods.

[The effectiveness of different disinfectants based on p-chloro-m-cresol against Ascaris suum eggs under laboratory conditions]. / Untersuchungen zur Wirksamkeit verschiedener Desinfektionsmittel auf p-Chlor-m-kresol-Basis gegen Ascaris suum-Eier unter Laborbedingungen.

The devitalizing effectiveness of 5 patterns of the disinfectant Neopredisan (active principle: p-chlorine-m-cresol) was tested to eggs of Ascaris suum in coincidence with the "guidelines for the testing of chemical disinfectants" of the German Veterinary Society (GVS). In the suspension-test all examined patterns indicated a 100% inhibition of development Ascaris suum-eggs. In the germ carrier test all patterns were in conformity with the necessities of the GVS-guidelines. Also in the modified testing method with a temperature in the refrigerator of +10 degrees C Neopredisan showed a reliable (100%) efficacy. The inhibition of development was clearly delayed with an admixture of 20% faeces to the suspension of eggs. In a suspension-test with Neopredisan 140 in 3% solution after 15 minutes with embryonated eggs a nearly 100% ovicide and larvicide respectively efficacy was proved. The investigations show, Neopredisan is of value as a suitable disinfectant in the complex of the combat against ascariasis in the breeding of pigs.

Effect of latanoprost on intraocular pressure following cataract extraction.

PURPOSE: To compare the effect of latanoprost 0.005% with that of a placebo (balanced salt solution [BSS]) applied after phacoemulsification on intraocular pressure (IOP). SETTING: Pasco Eye Institute, New Port Richey, Florida, USA. METHODS: A group of patients having cataract extraction by phacoemulsification was randomized following surgery to receive one drop of latanoprost 0.005% (1.5 micrograms) or a placebo (BSS). Exclusion criteria included ocular diagnosis in addition to cataract, previous eye surgery, history of glaucoma, previous use of glaucoma medications, or vitreous loss during surgery. Standard phacoemulsification was performed through a scleral tunnel approach and a one-piece, poly(methyl methacrylate) intraocular lens implanted in the capsular bag. Approximately 24 hours after surgery, IOP was measured with a Goldmann applanation tonometer by the surgeon. The anterior chamber reaction was qualitatively graded from 1+ to 4+. RESULTS: The study included 103 eyes (latanoprost = 53; control = 50). Latanoprost treatment resulted in significantly lower postoperative (IOP) (16.4 mm Hg +/- 3.7 [SD]) than preoperative IOP (17.9 +/- 3.0 mm Hg) (P < .025). There was no decrease in postoperative IOP in the control group (18.2 +/- 3.5 mm Hg) compared with preoperative IOP (18.3 +/- 2.6 mm Hg). When two groups were compared, postoperative IOP after treatment with latanoprost was significantly less than control IOP (P < .01). Preoperative IOP was not significantly different in the placebo and latanoprost groups. Anterior chamber reaction was not increased by latanoprost; it averaged 1+ in both groups. CONCLUSIONS: Latanoprost may pharmacologically enhance uveoscleral outflow immediately after cataract extraction. In this study, latanoprost was a safe, effective method of reducing postoperative IOP.

Anticonvulsant therapy for mood disorders.

Lithium therapy for bipolar illness is well accepted, despite some difficulties with its use. The administration of anticonvulsants has increased over the past 20 years. This paper outlines advantages and problems associated with anticonvulsant therapy for mood disorders.

pIV, a filamentous phage protein that mediates phage export across the bacterial cell envelope, forms a multimer.

Filamentous phage pIV is an outer membrane protein required for phage assembly and secretion. Chemical cross-linking and sedimentation experiments have been used to demonstrate that pIV from f1-infected Escherichia coli exists as a homo-multimer, probably composed of 10 to 12 subunits. pIV secreted from spheroplasts remains soluble and does not form multimers. Synthesis of pIV from distantly related filamentous phages or from a bacterial homolog that participates in a specialized form of extra-cellular protein secretion in the same cell with pIVf1 resulted in the formation of mixed multimers. This suggests that the homologous proteins themselves form homo-multimers. These structures could form gated channels that conduct assembling phage or specific substrate proteins across the outer membrane to the extracellular milieu.

[Morphological studies of Babesia divergens during continuous transfer in Meriones unguiculatus]. / Morphologische Untersuchungen an Babesia divergens beim kontinuierlichen Transfer in Meriones unguiculatus.

A strain of Babesia divergens was propagated by inoculation of 1.5 x 10(7) parasitized erythrocytes in 30 passages under same conditions on altogether 150 jirds. The developmental stages of Babesia divergens revealed pleomorphism in the erythrocytes of the jird. Single parasites were observed as being pyriform, globular, budding, ring-like or amoebid. The shape of dividing parasites varied between the spherical and the pyriform. The stages in the erythrocytes were localized predominantly intermedia. The reduction of the number of dividing forms and the increase of single forms occurred with increasing numbers of passages. Length and breadth of double pyriforms increased by approximately 20%.

[A new system for the quantitative evaluation of the effectiveness of an Eimeria tenella radiovaccine]. / Ein neues System zur quantitativen Bewertung der Wirksamkeit einer Eimeria tenella-Radiovakzine.

The quantitative valuation of efficiency of an Eimeria tenella radiovaccine was performed on the basis of 21 tests under floor-pen conditions and on 34 tests under the conditions of industrial broiler production using the vaccination index, the recycling index and coccidiosis protection index. The immunogenic quality of the vaccine was classified quantitatively by the indices 1 to 4, in which the classes 1 and 2 fulfilled the requirements. Under floor-pen conditions the valuation in the classes 1 and 2 was ascertained on the vaccination index with 76.2%, on the recycling index with 44.4% and on the coccidiosis protection index with 100%. Under the conditions of the industrial mast these values amounted 66.7%, 64.7% and 66.7%.

[Morphological and biological characterization of a pure strain of Eimeria mitis]. / Morphologische und biologische Charakterisierung eines reinen Stammes von Eimeria mitis.

A pure strain of Eimeria mitis was obtained from a crude field isolate by single oocyst inoculation of chicken. The strain was identified as Eimeria mitis by the morphology of the oocysts. Sporulated oocysts measured 16.1 +/- 2.1 microns in length and 13.6 +/- 1.0 microns in width. The shape index was 1.18. The prepatent period was 4 days and patency lasted 12 to 13 days. The highest number of oocysts was shed at day 6 after infection of chicken with 1 x 10(4), 5 x 10(4), or 1 x 10(5) oocysts and at day 8 after infection with 5 x 10(5) oocysts. A single infection of chicken with 1 x 10(4), 5 x 10(4), 1 x 10(5), or 5 x 10(5) oocysts resulted in reproduction values of 1:118,662, 1:15,720, 1:9,977 and 1:731, respectively.

A modified TnphoA useful for single-stranded DNA sequencing.

The TnphoA transposon constructed by Manoil and Beckwith [Proc. Natl. Acad. Sci. USA 82 (1985) 8129-8133] has been modified to permit easy isolation of single-stranded (ss) DNA of target plasmids. The intergenic region (IG) of filamentous phage f1, which consists of the phage origin of replication and packaging signal, was inserted into a nonessential region of TnphoA. This modified transposon should be useful for the analysis of genes cloned in plasmids that lack a filamentous phage IG. Transposition of TnphoA-IG into a plasmid carries the IG with it; subsequently, after infection with a filamentous helper phage, ss plasmid DNA suitable for sequence analysis and useful for oligodeoxyribonucleotide-mediated mutagenesis of TnphoA-generated fusions can be isolated. The utility of TnphoA-IG was confirmed by analysis of 'blue hops' into the bla (encoding beta-lactamase) and pspE (encoding phage shock protein) genes whose products are secreted into the Escherichia coli periplasm.

[Detection of Eimeria tenella antibodies by the serum dye test]. / Nachweis von Eimeria tenella-Antikörpern mit dem Serofarbtest.

The serum dye test by Sabin-Feldman used in the toxoplasmosis serology was adapted to the Eimeria tenella system. The antibodies detected by this specific test reflect a protective immune response. All animals immunized with virulent and attenuated Eimeria tenella oocyst antigens demonstrated serologically immune reactions. Antigen reactivities over 50% correlate with the grade of protection of animals in challenge test.

[Determination of the purity of Eimeria species of chickens]. / Reinheitsdeterminierung von Eimeria-Spezies des Huhnes.

The morphologic criteria length and breadth were used for the examination of the purity from 23 strains of different Eimeria species in the fowl (Eimeria tenella, E. acervulina, E. maxima, E. necatrix) by three methods: Tabulate graphic method, determination of the size of concentration, analysis with counter. The tabulate graphic method by use of peak value as only criterion of valuation has suitable proved for the screening test. A qualification of the degree of purity is reached in the form of classes of homogeneity with the criteria peak value, first and second classes of the neighbour by the determination of the size of concentration. The quantitative certainly of the assertion increases by the analysis with counter from six statistical parameters (frequency of peak value, frequency of the sum from peak value, first and second classes of the neighbour, number of taking classes in the specific range of species, coefficient of variation, coefficient of correlation, divergence of specific index of the form in the species).

[The sporogony of Eimeria tenella]. / Untersuchungen zur Sporogonie von Eimeria tenella.

In the course of the sporogony of Eimeria tenella 7 stages were differentiated: stage of rounded sporont, stage of knob formation, first four-globe stage, pyramid-stage, second four-globe stage, stage of sporozoit differentiation, stage of complete sporulation.