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J Neurosurg. 2002 Mar;96(2 Suppl):157-61.
Corpectomy: a direct approach to perimedullary arteriovenous fistulas of the anterior cervical spinal cord.
Hida K, Iwasaki Y, Ushikoshi S, Fujimoto S, Seki T, Miyasaka K.
Department of Neurosurgery, University of Hokkaido Graduate School of Medicine, Sapporo, Japan. kazuhided.hokudai.ac.jp
OBJECT: In this report, the authors describe five consecutive patients with cervical perimedullary arteriovenous fistulas (AVFs) that were successfully treated using a corpectomy performed via an anterior approach. METHODS: Five patients with cervical perimedullary AVF underwent corpectomy via an anterior approach. There were four women and one man who ranged in age from 34 to 62 years (median 55 years). Four patients presented with subarachnoid hemorrhage and one with intramedullary hemorrhage. All five AVFs were located on the anterior surface of the cervical spinal cord and fed by the anterior spinal artery. All patients underwent an anterior approach with 1.5- or two-level corpectomy, opening of the dura mater, and coagulation of the fistula. After dural closure, an iliac bone graft was inserted. Four patients were treated by surgery alone and one patient by embolization and surgery. Postoperative angiography revealed complete disappearance of the AVF in all patients. Neurological status improved in two cases and stabilized in the other three. There were no surgery-related complications. CONCLUSIONS: Safe and effective interruption of cervical AVFs can be accomplished by an anterior-approach corpectomy.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12450277&dopt=Abstract hemorrhage
Indian J Pediatr. 2002 Oct;69(10):905-7.
Mycotic aneurysm: an uncommon cause for intra-cranial hemorrhage.
Bartakke S, Kabde U, Muranjan MN, Bavdekar SB.
Department of Pediatrics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai, India. gsmcom5.vsnl.net.in
Intra-cranial mycotic aneurysms due to an infective process elsewhere in the body constitute an uncommon cause of intra-cranial hemorrhage. The condition carries a grave prognosis. Mycotic aneurysms secondary to infective endocarditis (IE) rarely occur in children. This communication describes a seven-year-old girl who presented with fever and neurological abnormalities. She was diagnosed to have a mycotic aneurysm secondary to IE. Digital subtraction angiography (DSA) confirmed the diagnosis, delineated anatomical details and later detected the complete resolution of the aneurysm following conservative management with intravenous antimicrobial agents.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12450304&dopt=Abstract hemorrhage
Transplantation. 2002 Nov 15;74(9):1303-9.
Hemostatic complications in bone marrow transplantation: a retrospective analysis of 447 patients.
Pihusch R, Salat C, Schmidt E, Gohring P, Pihusch M, Hiller E, Holler E, Kolb HJ.
Medizinische Klinik III-Grobetahadern, Klinikum der Ludwig Maximilians-Universitat Munchen, Munchen, Germany. Rudolf.Pihusc-online.de.
BACKGROUND: Hemostatic complications are not uncommon after bone marrow transplantation (BMT). However, little is known about the frequency, localization, determinants, and outcome of hemostatic events in autologous and allogeneic BMT. METHODS: Four hundred forty-seven patients (364 allogeneic, 83 autologous transplants) were evaluated retrospectively for the presence of hemostatic complications (bleeding, thrombosis, hepatic veno-occlusive disease [VOD], microangiopathic hemolytic anemia) from the start of conditioning therapy until June 2000. RESULTS: A total of 83.2% of the patients presented with at least one hemostatic complication during the investigational period. Most bleeding episodes occurred within the first 4 weeks after transplantation and were relatively mild. However, 27.1% of the patients hemorrhaged severely, generally doubling the overall mortality of the BMT recipients. Fatal gastrointestinal or intracerebral hemorrhages contributed to 1.1% of the events. Bleeding was strongly associated with prolonged thrombocytopenia and graft-versus-host disease (GVHD). Hemorrhagic cystitis may additionally have been triggered by the preceding conditioning regimens containing cyclophosphamide. Thromboembolic events occurred most frequently in allogeneic transplant recipients, for whom the incidence was 14.6%. Chronic GVHD and treatment with steroids were the major determining factors. The incidence of hepatic VOD in 4.7% of the allogeneic transplant recipients was associated with a high fatality rate. Busulfan conditioning increased the VOD risk 2.6-fold. Moderate or severe microangiopathic hemolytic anemia was associated with GVHD and occurred in 14.6% of the allogeneic transplant recipients, leading to an increased overall mortality. CONCLUSION: Hemostatic disturbances, commonly found in the course of transplantation, are associated with a high transplantation risk and closely related to thrombocytopenia and immunologic complications.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451270&dopt=Abstract hemorrhage
Rev Neurol (Paris). 2002 Nov;158(11):1115-7.
[Fulminant thrombotic thrombocytopenic purpura in the course of ciprofloxacin therapy]
[Article in French]
Mouraux A, Gille M, Pieret F, Declercq I.
Service de Neurologie, Cliniques de l'Europe, Site Sainte-Elisabeth, Bruxelles, Belgique, France.
We report on a 43-year-old woman who developed a fulminant thrombotic thrombocytopenic purpura (TTP) in the early course of an oral ciprofloxacin therapy. An acute bacterial meningo-encephalitis with disseminated intravascular coagulation was first suspected. She also presented with haemolytic anaemia and a severe thrombocytopenia. The lumbar puncture was delayed and only performed after platelets transfusions. CSF examination ruled out meningo-encephalitis. A diagnosis of TTP was made and she was given plasma exchanges. However, her neurological status worsened and the cranial CT revealed a subarachnoidal hemorrhage in left sylvian valley with diffuse oedema predominating in the left cerebral hemisphere and multiple ischemic lacunes. She died four days after admission.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451346&dopt=Abstract hemorrhage
Biomed Tech (Berl). 2002;47 Suppl 1 Pt 1:289-91.
[Blood flow in cerebral aneurysms]
[Article in German]
Kertzscher U, Goubergrits L, Spuler A, Affeld K.
Labor fur Biofluidmechanik, Klinik fur Kardiovaskulare Chirurgie, Charite, Humboldt Universitat zu Berlin, Deutschland. ulrich.kertzscheharite.de
Saccular aneurysm of the cerebral arteries occur in 1 to 5% of the population; the major risk of this disease is aneurysm rupture causing subarachnoid hemorrhage associated with a mortality rate of 50 to 60%. Two methods exist to treat cerebral aneurysms: neurosurgical clipping at the base of the aneurysm and endovascular introduction of a platin coils. Both methods have advantages and disadvantages. With the knowledge of the flow in an aneurysm it is easier to choose the appropriate method. In this study we simulated the flow in four different aneurysms. The shape of the aneurysms are gained from computertomographic data. The simulated flow in four aneurysms shows the great variability of possible flow patterns.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12451841&dopt=Abstract hemorrhage
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