Use of the Cascade expandable net to treat cerebral vasospasm - initial clinical experience from a single centre with in vitro benchside tests.

BACKGROUND: The use of self-expanding stents to treat post-hemorrhagic cerebral vasospasm was recently described. We sought to determine the clinical efficacy of the Cascade device to treat delayed cerebral vasospasm (DCV). We performed benchside tests to determine the chronic outward force exerted by the Cascade in comparison to the Solitaire. METHODS: The chronic outward force (COF) of the Cascade M agile and Cascade L Agile was tested with equivalent tests of the Solitaire 4x20mm. Further tests to determine the forces generated in pre-formed tubes of 1.5-6 mm were performed using both fully and partially unsheathed Cascades. A retrospective review to identify all patients with aSAH and DCV treated with a Cascade device between January 2020 and July 2021. We recorded the treatment arterial vessel diameters and hemorrhagic or ischemic complications. RESULTS: In vitro the Cascade generated greater radial force than the Solitaire. The force generated by the Cascade M Agile at 1.5 mm was approximately 64% higher than the Solitaire 6x40mm and approximately 350% higher than the Solitaire 4x20mm. 4 patients with DCV were identified all of whom were treated with a cascade device. In all cases there was a significant improvement in the diameter of the vasospastic vessels treated with an average diameter increase of approximately 300%. There were no complications from the Cascade. Delayed CT angiography showed persistent dilatation of the segments treated with the Cascade at 24 h. CONCLUSION: The Cascade is a safe and effective device when used to treat DCV secondary to aSAH. Larger studies are required to validate our initial results.

Emergence of foot-and-mouth disease virus SAT 2 in Egypt during 2012.

The epidemiology of foot-and-mouth disease (FMD) in North Africa is complicated by the co-circulation of endemic FMD viruses (FMDV), as well as sporadic incursions of exotic viral strains from the Middle East and Sub-Saharan Africa. This report describes the molecular characterization of SAT 2 FMD viruses that have caused widespread field outbreaks of FMD in Egypt during February and March 2012. Phylogenetic analysis showed that viruses from these outbreaks fell into two distinct lineages within the SAT 2 topotype VII, which were distinct from a contemporary SAT 2 lineage of the same toptype from Libya. These were the first FMD outbreaks due to this serotype in Egypt since 1950 and required the development of a tailored real-time reverse-transcription PCR assay that can be used in the laboratory to distinguish FMD viruses of these lineages from other endemic FMD viruses that might be present in North Africa. These data highlight the ease by which FMDV can cross international boundaries and emphasize the importance of deploying systems to continuously monitor the global epidemiology of this disease.

Trigeminal neuralgia related to arteriovenous malformation of the posterior fossa: three case reports and a review of the literature.

OBJECTIVE: To describe the rare association of trigeminal neuralgia (TGN) with a brain arteriovenous malformation (bAVM) of the posterior fossa. PATIENTS AND METHODS: This is a report of three patients presenting with TGN due to vascular compression by a bAVM of the posterior fossa, with emphasis on clinical presentation, diagnostic imaging, management and follow-up. Magnetic resonance imaging (MRI) was performed with sequences in thin slices in the same section plane using a 3D time of flight (TOF) and axial T2-weighted driven equilibrium (DRIVE) of the posterior fossa. RESULTS: No bleeding episodes were documented in the three patients. MRI and digital subtraction angiography (DSA) showed a posterior fossa bAVM with a nidus surrounding the trigeminal nerve, fed by arteries from the carotid and vertebrobasilar systems. Within a few days, medical treatment effectively alleviated the symptoms, with no more pain during follow-ups at 6, 10 and 18months. No invasive treatment was performed because the bAVMs were considered to have a low risk of bleeding. CONCLUSION: TGN related to a bAVM can mimic classical TGN. MRI and DSA are the imaging methods of choice. Medical treatment remains the first line of therapy, but if that fails, multimodal invasive treatment may be an alternative for pain relief.

Post-embolization perianeurysmal edema revealed by temporal lobe epilepsy in a case of unruptured internal carotid artery aneurysm treated with bare platinum coils.

We report the case of a patient with an unruptured internal carotid artery (ICA) aneurysm treated with bare platinum coils. The patient had seizures 1 month after treatment. Postoperative imaging showed perianeurysmal edema and enhancement of the aneurismal wall. After aneurysm coiling, perianeurysmal edema is an unusual complication that can be asymptomatic or cause symptoms depending on its location. Epilepsy as a clinical presentation of perianeurysmal edema has not previously been reported. Literature about post-embolization perianeurysmal edema is reviewed.

Trials for control of ixodid ticks using pheromone acaricide tick decoys.

Experimental application of Hyalomma dromedarii pheromone-impregnated in cyfluthrin (pyrethroid) decoys on experimentally infested camels revealed efficacy rate of 85.33%, while the control group showed normal pattern of tick engorgement. This study proved the rapid movement of males toward decoys and some males took the mounting position with such decoys. On the other side, the same decoys (H. dromedarii) when used on naturally infested cattle with Boophilus annulatus did not even disturb the Boophilus ticks indicating that B. annulatus contain specific pheromones which should be furtherly identified.

Cholesteryl esters on the body surfaces of the camel tick, Hyalomma dromedarii (Koch, 1844) and the brown dog tick, Rhipicephalus sanguineus (Latreille, 1806).

Cholesteryl esters were found to constitute a major component of the lipids coating the body cuticle of females of the camel tick, Hyalomma dromedarii and the brown dog tick, Rhipicephalus sanguineus. One or more cholesteryl esters, alone or in combination, have been shown to serve as the mounting sex pheromone of several species of ixodid ticks. Consequently, knowledge of these compounds is important for an understanding of the mating behavior of these ticks. Based on thin layer chromatography, cholesterol and cholesteryl esters were the most abundant neutral lipids found on the body surfaces of fed females of these two species. Analysis using HPLC demonstrated significant quantities of the following compounds, tentatively identified as cholesteryl esters (expressed in micrograms per female equivalent), in H. dromedarii: Cholesteryl acetate 18.2; cholesteryl laurate, 6.8; cholesteryl linoleate, 24.8; cholesteryl oleate, 12.9; cholesteryl palmitate, 0.3; and cholesteryl stearate 1.7. In contrast, the same method revealed only 3 cholesteryl esters in extracts of females of R. sanguineus: Cholesteryl acetate, 2.0; cholesteryl linoleate, 8.5; and cholesteryl oleate, 3.0. In both species, two unidentified peaks, with the spectral characteristics of cholesteryl esters, were also observed. Identification of the cholesteryl esters was confirmed: by (1) positive bioassay results with conspecific (H. dromedarii) males and heterospecific (Dermacentor variabilis) males; (2) similarity of ultraviolet spectra between identified sample peaks and authentic standards; and (3) demonstration of cholesterol and the corresponding free fatty acid following enzymatic digestion of each of the HPLC-separated fractions containing the different cholesteryl esters. Comparisons with the cholesteryl ester composition of the mounting sex pheromone of other metastriate Ixodidae are discussed. These findings, along with studies reported previously, suggest that differences in the mounting sex pheromones of ixodid ticks are an important factor in minimizing heterospecific matings in nature.