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Am J Ophthalmol. 2002 Jun;133(6):801-8.
Clinical observations supporting a theoretical model of choriocapillaris blood flow in treatment of choroidal neovascularization associated with age-related macular degeneration.
Staurenghi G, Flower RW.
Department of Ophthalmology, University of Brescia, Brescia, Italy.
PURPOSE: To report clinical observations consistent with conclusions from a previous theoretical investigation indicating that photocoagulation of choroidal neovascularization (CNV) efferent vessels can be, in some instances, an effective treatment. DESIGN: Interventional case series. METHODS: In five eyes with age-related macular degeneration (five patients with mean age +/- SD of 65 +/- 11 years, range 55-79 years) requiring treatment of CNV. In each case, the appropriate treatment was location and photocoagulation of the CNV efferent vessels, since the afferent vessels were not identifiable or were located beneath the fovea. Targeted vessels were determined to be draining vessels by analysis of pretreatment high-speed indocyanine green (ICG) angiograms, and successful vessel closure by photocoagulation was demonstrated by posttreatment ICG angiograms. The eyes subsequently were followed from 2 to 12 months. RESULTS: After photocoagulation of efferent vessels, CNV-related retinal edema was significantly reduced or resolved within 1 to 4 days. Visual acuity became stabilized in three eyes and improved in two eyes. In a few days, metamorphopsia disappeared in four of the eyes and was stable for a period longer than the duration of the associated efferent vessel closure. Initial efferent vessel closure by photocoagulation persisted on average for 7 to 15 days, after which additional treatment was required. It is significant that in no case did hemorrhage result from the photocoagulation treatment. CONCLUSIONS: These observations are consistent with the earlier theoretical study prediction that photocoagulation of efferent CNV vessels can be effective in reducing CNV-associated edema. That no hemorrhage was induced by photocoagulation is consistent with the theoretical concept that there appears to be no direct hydrostatic connection between the CNV and its afferent vessels. Rather, that connection appears to be a functional one made through the choriocapillaris, which may dissipate excess CNV hydrostatic pressure produced by occlusion of a draining vessel. However, this finding is not intended to be a recommendation to attempt CNV efferent vessel photocoagulation.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12036672&dopt=Abstract hemorrhage
ORL J Otorhinolaryngol Relat Spec. 2002 May-Jun;64(3):226-8.
Histopathological examination of ruptured carotid artery after irradiation.
Okamura HO, Kamiyama R, Takiguchi Y, Kimizuka K, Ishikawa N, Kishimoto S.
Department of Head and Neck Surgery, Tokyo Medical and Dental University, School of Medicine, Yushima, Tokyo, Japan.
We report 2 cases of carotid artery rupture after irradiation that was performed 1 year and 17 years before the ruptures. When irradiation-induced arterial rupture occurs, it usually does so within a few months following irradiation. However, the histopathological sections obtained in the present cases revealed carotid artery necrosis that was presumably induced by irradiation. Carotid artery rupture is sudden, massive hemorrhage that ranks among the most dreaded complications in the head and neck. However, several patients have been saved by hospital personnel who discovered the rupture in time to take appropriate measures such as cleaning of the wound and protection with myocutaneous or myofascial flaps. Therefore, it is important to be aware of the possibility of rupture or perforation of major vessels after irradiation, even when the radiation therapy was performed a long time ago. 2002 S. Karger AG, Basel
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12037392&dopt=Abstract hemorrhage
Eur Neurol. 2002;47(4):224-32.
Does lumbar cerebrospinal fluid reflect ventricular cerebrospinal fluid? A prospective study in patients with external ventricular drainage.
Sommer JB, Gaul C, Heckmann J, Neundorfer B, Erbguth FJ.
Department of Neurology, University of Erlangen-Nurnberg, Erlangen, Germany. jan.sommeeuro.imed.uni-erlangen.de
Ventriculitis may sometimes occur after an external ventricular drain has been removed, and diagnosis has to be made by lumbar puncture. But are the lumbar findings comparable to previously obtained ventricular results? In a prospective study, sample pairs of ventricular and lumbar cerebrospinal fluid (CSF) were obtained at an interval of <30 min in 25 patients with increased intracranial pressure suffering from cerebral hemorrhage (n = 15), meningitis/encephalitis (n = 6), cerebral infarction (n = 3), and meningeosis carcinomatosa (n = 1). CSF was analyzed for protein, albumin, IgG, IgA, IgM, glucose, lactate, and leukocytes including cytological differentiation. A significant ventriculo-lumbar increase was observed for protein, albumin, and the immunoglobulins. Lactate was distributed equally in ventricular and lumbar CSF, as well as glucose in the cerebral hemorrhage subgroup (n = 15). Cell count failed to show a clear ventriculo-lumbar ratio. Cytological distribution was comparable in lumbar and ventricular CSF, except for macrophages showing a significant rostrocaudal decrease. In conclusion, in cases of clinically suspected bacterial central nervous system infection after removal of an external ventricular drain, lumbar CSF lactate, glucose, and cytology are comparable to previously determined ventricular values, and thus may help physicians to choose the best treatment. 2002 S. Karger AG, Basel
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12037437&dopt=Abstract hemorrhage
Medicina (B Aires). 2002;62(2):135-40.
[Respiratory distress due to pulmonary hemorrhage in leptospirosis]
[Article in Spanish]
Seijo A, Coto H, San Juan J, Videla J, Deodato B, Cernigoi B, Garcia Messina O, Collia O, de Bassadoni D, Schtirbu R, Olenchuk A, de Mazzonelli DG, Parma A.
Hospital FJ Muniz, GCBA, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina.
Two patients who lived in Buenos Aires suburbs died from leptospirosis in July 2000 and March 2001. They developed a nonspecific febrile illness followed by hemorrhagic pneumonia and respiratory distress in absence of typical manifestations such as jaundice, nephropathy, thrombocitopenia or hemorrhages in other organs. In the house and surroundings of one patient rodents were captured and three strains of leptospira, serogroup Icterohaemorrhagiae were isolated. Laboratory guinea pigs were inoculated and they were sacrificed as soon as respiratory symptoms appeared. Necropsy showed primary lung injury, which was similar to the histopathological lesions found in one of the patients. Neither jaundice, nor renal damage was found. Pericardiac hemorrhages were considered as a possible cause of cardiopulmonary collapse. This clinical form has not been reported previously in this region, where conditions are indeed suitable for the human illness to appear.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12038034&dopt=Abstract hemorrhage
Neurochirurgie. 2002 Nov;48(5):419-25.
[Neurosurgical and endovascular treatment of intracranial aneurysms: a cost analysis of two different strategies at the University Hospital of Bordeaux (France)]
[Article in French]
Ballet AC, Guerin J, Berge J, Taboulet F, Martin S, Philip V, Saux MC, Woronoff-Lemsi MC.
Pharmacie des Dispositifs Medicaux Steriles, Service de Neuroradiologie, CHU, Bordeaux, France. ac_balleahoo.fr
BACKGROUND: Rupture of intracranial aneurysms causes major mortality and morbidity. Moreover, treatment of this vascular malformation generates high medical costs. We compared the cost of two different strategies employed at the University of Bordeaux to prevent aneurysms from rebleeding: a classical neurosurgical technique consisting in clipping the neck of the aneurysm and a new less invasive neuroradiological technique based on embolization using platinum coils. METHOD: A micro-cost study was carried out retrospectively from May 1998 to June 2000) comparing data from 44 patients admitted for ruptured intracranial aneurysm: 22 operated patients and 22 patients treated with an endovascular approach. Each operated patient was matched with an embolized patient for clinical status at admission (World Federation of Neurological Surgeons Scale) and complications resulting from cerebral hemorrhage (hydrocephalus, vasospasm, rebleeding). RESULTS AND CONCLUSION: Our results showed the same cost for the same efficiency . Expenditures are however made differently. The endovascular technique allows a shorter hospital stay (8 days less), balancing the high cost of single use medical supplies (coils, microcatheters.). The endovascular technique has many advantages for the patients, but cannot be successful in all types of intracranial aneurysms. Both techniques remain indispensable.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12483120&dopt=Abstract hemorrhage
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