Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option.

OBJECT: The aim of this study was to evaluate prospectively the results of treating cerebral aneurysms with coil embolization (CE) or with surgical clipping when CE was considered the first option. METHODS: Whenever an aneurysm was to be treated, CE was first considered by our neurovascular team. Surgical clipping was reserved for cases excluded from CE or cases in which CE failed. The study consisted of 103 consecutive patients with 132 aneurysms, of which 127 were treated. Coil embolization was performed using Guglielmi detachable coils, and surgery was performed using Zeppelin clips. Three groups were defined: Group A consisted of 64 aneurysms that were treated by CE (neck/sac ratio < 1:3); Group B, 63 aneurysms that were surgically clipped; and Group C, 12 aneurysms that failed to be satisfactorily (> or = 95%) embolized and were subsequently clipped. The percentages of residual aneurysm were 31.2% in Group A, 1.6% in Group B, and 0% in Group C. The percentages of patients with poor Glasgow Outcome Scale (GOS) scores (GOS Scores 1-3) were 13.3% in Group A, 6.1% in Group B, and 8.3% in Group C. The percentages of poor outcome (GOS Scores 1-3) in patients with good clinical status before treatment were 10.7% in Group A, 0% in Group B, and 8.3% in Group C. CONCLUSIONS: Even with preselection, CE remains associated with a significant number of treatment failures and poor outcomes, even in patients with good preoperative clinical status. Surgical clipping can offer better results than CE, even for more complex aneurysms of the anterior circulation, especially for those involving the middle cerebral artery cases. However, because CE can be effective and causes less stress and invasiveness for the patient, it should be considered first in aneurysms strictly selected by a neurovascular team.

Gall stone disease in African patients with sickle cell anaemia: a preliminary report from Yaounde, Cameroon.

Cholecystosonography was undertaken in 90 patients with sickle cell disease aged 15 years and over. Gall stones were found in 26 (28.9%) patients. There was no sex difference, but the incidence increased with age from 13.2% at under 20 years to 75% at 30 years and over. The mean serum cholesterol and total and unconjugated bilirubin concentrations were not significantly different between patients with and without gall stones. As most (80.8%) stones were radiolucent they were probably of pigment type, containing little or no calcium, and further investigation into how they are produced is needed. Sickle cell patients with acute abdominal crisis should have gall bladder disease excluded before a diagnosis of vascular crisis is made.