Intra-aneurysmal embolization for subarachnoid hemorrhage due to rupture of an aneurysm located at the anterior spinal artery and vertebral artery: illustrative case.

BACKGROUND: A vertebral artery-anterior spinal artery (VA-ASA) aneurysm is very rare. The authors report a case of successful coil embolization of a ruptured aneurysm of the VA-ASA. OBSERVATIONS: A 54-year-old man with World Federation of Neurosurgical Societies grade II subarachnoid hemorrhage presented with an aneurysm located at the region involving the origin of ASA on the VA. Endovascular treatment was chosen to prevent rerupture and preserve the perforating branches. The catheter shape was modified with steam forming to allow access to the aneurysm. Partial embolization was performed to preserve the ASA. The authors also prevented further rupture. On day 16, angiography showed thrombosis within the aneurysm and preserved blood flow in the ASA despite a neck remnant. The patient was discharged home with a modified Rankin Scale score of 0. Careful follow-up has been continued. LESSONS: Endovascular coiling in the acute phase of rupture of a VA-ASA aneurysm achieved favorable results. The aneurysm could be safely treated by selecting the appropriate device and catheter geometry.

A six-fold difference in structure results in a six-order difference in conductivity: silica shell nanoarchitectonics on carbon black particles.

Carbon black (Ketchen Black with a particle size of several tens of nm) was coated with silica with a varied thickness of 2 and 12 nm. Carbon/silica core-shell particles were grafted with the γ-methacryloxypropylsilyl group to be homogeneously dispersed into a poly(methyl methacrylate) film. The electrical conductivity of the poly(methyl methacrylate) films containing carbon/silica particles was successfully controlled by the thickness of the silica layer; silica coating with 2 nm thickness gave a conducting film, while that with 12 nm thickness gave a less conducting film with a remarkable difference on the order of 106 (in volume conductivity).

Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study.

To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130-139, 140-159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80-89, 90-109, and ≥110 mmHg) at 8-11, 12-15, and 16-19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12-13 and 14-15 weeks of gestation. At 16-19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16-19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140-159 mmHg. Subgroup analyses also showed that even at 14-15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140-159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.

Primary and recurrent serous borderline tumors during pregnancy: a case report and literature review.

The diagnosis and management of borderline ovarian tumors during pregnancy are still not standardized, because these tumors are rarely encountered. We report the case of a 27-year-old pregnant woman who presented with an ovarian mass in her first trimester. Magnetic resonance imaging revealed a multilocular cystic component with papillary lesions in the background of endometriosis, suggesting a seromucinous borderline tumor or ovarian cancer. A right salpingo-oophorectomy and partial omentectomy were performed at 7 weeks of gestation. Pathological examination demonstrated a serous borderline tumor. The subsequent pregnancy course was uneventful, and she gave birth to a healthy baby at 39 weeks of gestation. She wanted to retain fertility, and close follow-up was performed. Four years later, she became pregnant, and a lesion suggesting recurrence in the left ovary was detected. An abdominal left ovarian cystectomy was performed at 13 weeks of gestation, which demonstrated recurrence of the serous borderline tumor. She gave birth to a healthy baby at 39 weeks of gestation. Two months after delivery, she underwent total abdominal hysterectomy with left salpingo-oophorectomy, which revealed no malignant findings. We also reviewed 10 reports that included 58 cases of borderline ovarian tumors diagnosed during pregnancy. The borderline ovarian tumors diagnosed during pregnancy exhibited different characteristics according to each subtype, suggesting the importance of diagnosing borderline ovarian tumor subtypes preoperatively.

Well-defined plate and hollow disk shaped particles of silica-dialkyldimethylammonium hybrids.

Well-defined plate and hollow disk of silica-dioctadecyldimethylammonium hybrid particles were obtained by the sol-gel reaction of tetraethoxysilane in the presence of dioctadecyldimethylammonium chloride, where synthetic condition was determined based on the Stöber synthesis for micron size silica sphere. The particle size was several hundreds of nm in the radius and several tens of nm in the thickness. X-ray powder diffraction patterns indicated that the products possess layered mesostructures, which were thought to be directed by the lamellar aggregates of dioctadecyldimethylammonium.

Solitary intraosseous neurofibroma of the frontal bone. Case report.

A 54-year-old female presented with a very rare intraosseous neurofibroma of the frontal bone manifesting as forehead bulging. Skull radiography showed a radiolucent round lesion. Magnetic resonance imaging showed a mass lesion expanding from the frontal bone diploic layer to the epidural space. Fluorodeoxyglucose positron emission tomography and thallium-201 single photon emission computed tomography findings indicated tumor malignancy. The tumor was resected, and the histological diagnosis was benign intraosseous neurofibroma. Intraosseous neurofibroma usually occurs in the mandible. The origin of the present case may have been a peripheral nerve in the diploic vascular tissue.

Benefit of carotid endarterectomy for symptomatic and asymptomatic severe carotid artery stenosis: a Markov model based on data from randomized controlled trials. Clinical article.

OBJECT: Several major randomized controlled trials of carotid endarterectomy (CEA) in patients with both symptomatic and asymptomatic carotid artery stenosis have addressed the net effects of CEA on the risk of stroke. However, because the risk of stroke among patients with asymptomatic carotid stenosis is relatively low, whether to treat their stenosis with CEA remains an important public health issue. METHODS: The authors constructed a Markov model to evaluate the effectiveness of CEA. In modeling 4 health states, the probability of transition to another state was estimated using data from major randomized controlled trials. Adopting 3 comorbidity index values for baseline analyses, the authors expressed outcomes in terms of the expected number of quality-adjusted life years (QALYs) for a hypothetical cohort undergoing CEA and another without treatment. RESULTS: In the authors' baseline analysis, CEA for asymptomatic stenosis yielded a very small benefit (0.07 QALY) for 70-year-old, normal-risk CEA candidates. Benefits decreased further, often becoming negative, as patient age, surgical risk, or comorbidity index increased. In patients with symptomatic stenosis, CEA was always more effective than conservative management, even considering variables such as comorbidities limiting life expectancy, advanced age, and increased perioperative risk. CONCLUSIONS: Carotid endarterectomy for severe carotid stenosis consistently and significantly benefits patients with recent symptoms. However, surgery for asymptomatic stenosis appears justified only in carefully selected conditions: low treatment risks in relatively young individuals without any comorbidities.