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Sample records for rabbit embolic stroke

  1. Comparison of Tenecteplase with Alteplase on clinical rating scores following small clot embolic strokes in rabbits.

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    Lapchak, Paul A; Araujo, Dalia M; Zivin, Justin A

    2004-01-01

    Tenecteplase (TNK) was engineered to have increased fibrin specificity and an increased half-life compared to Alteplase. Although Tenecteplase is currently being tested in a Phase II clinical trial in acute ischemic stroke patients, little is known about the pharmacology and dose-response or therapeutic window for Tenecteplase in embolic stroke models. In the present study, we compared Tenecteplase with Alteplase on behavioral outcome in rabbits with embolic strokes. Male New Zealand white rabbits were embolized by injecting a suspension of small blood clots into the middle cerebral artery (MCA) via a catheter. The rabbit small clot embolic stroke model (RSCEM) was used for a dose-response profile analysis of Tenecteplase (0.1 mg/kg-3.3 mg/kg) and Alteplase (0.9 mg/kg-3.3 mg/kg) given intravenously 1 h following embolization. In additional studies, Tenecteplase (0.9 mg/kg) or Alteplase (3.3 mg/kg) was administered 3 (or 6) h following embolization to determine the therapeutic window for the thrombolytics. For both studies, behavioral analysis was conducted 24 h following embolization, allowing for the determination of the effective stroke dose (P50) or clot amount (mg) that produces neurological deficits in 50% of the rabbits. Using the RSCEM, a drug is considered beneficial if it significantly increases the P50 compared with the control group. The P50 of controls 24 h after embolization was 1.13 +/- 0.15 mg. Rabbits treated 1 h post-embolization with Tenecteplase (0.1, 0.25, 0.9, 1.5 or 3.3 mg/kg) had P50 values of 1.48 +/- 0.33, 2.20 +/- 0.44, 2.76 +/- 0.37, 2.15 +/- 0.29 and 2.78 +/- 0.31 mg, respectively. In Alteplase-treated rabbits, only the 3.3 mg/kg dose significantly increased the group P50 by 189% compared to control. Tenecteplase was also effective at increasing the P50 value to 2.21 +/- 0.43 mg if there was a 3-h delay following embolization, but not if there was a 6-h delay before administration. Alteplase was only effective if administered 1 h

  2. Coadministration of NXY-059 and tenecteplase six hours following embolic strokes in rabbits improves clinical rating scores.

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    Lapchak, Paul A; Song, Donghuan; Wei, Jiandong; Zivin, Justin A

    2004-08-01

    Currently, the only FDA-approved treatment for acute ischemic stroke (AIS) is the thrombolytic, tissue plasminogen activator (tPA; alteplase; activase). It has been proposed that both the spin trap agent NXY-059 (cerovive) and tenecteplase (TNK-tPA), which are currently in phase II clinical trials, may also be useful for the treatment of ischemic stroke. However, there is little information available concerning the dose-response profiles or therapeutic window for NXY-059 in a validated embolic stroke model, nor is there information available pertaining to the effects of combining NXY-059 with tenecteplase. Thus, we determined the pharmacological profile of NXY-059 on behavioral outcome following small clot embolic strokes in rabbits when administered alone or in combination with tenecteplase. Male New Zealand white rabbits were embolized by injecting a suspension of small blood clots into cerebral circulation via a carotid catheter. NXY-059 (0.1-100 mg/kg) was infused intravenously (IV), 1 h following embolization, whereas control rabbits received infusions of saline. We also determined the therapeutic window for NXY-059 by administering the drug 1, 3, or 6 h following embolic strokes. Lastly, in combination studies, NXY-059 was given concomitantly with tenecteplase 1 or 6 h following embolization. In the vehicle control group, the P(50) value (milligrams of clots that produce behavioral deficits in 50% of the rabbits) measured 24 h following embolism was 1.20 +/- 0.15 mg, and this was increased by 100-134% if NXY-059 (1-100 mg/kg) was administered following embolization. If NXY-059 was administered beginning 3 or 6 h following embolization, there was no significant behavioral improvement. If NXY-059 (100 mg/kg) and tenecteplase (0.9 mg/kg) were administered concomitantly 1 h postembolization, we did not measure any additional behavioral improvement compared to either drug alone. However, if the drugs were administered 6 h following embolization, we measured a

  3. Transcranial near infrared laser therapy (NILT) to treat acute ischemic stroke: a review of efficacy, safety and possible mechanism of action derived from rabbit embolic stroke studies

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    Lapchak, Paul A.; Streeter, Jackson; De Taboada, Luis

    2010-02-01

    Studies using the rabbit small clot or rabbit large clot embolic stroke models (RSCEM and RLCEM respectively) allowed us to alter a single NILT variable while keeping all other variables constant to investigate the variable's effect on the rabbit's behavioral performance following embolization. In this paper we review results from multiple studies. Using the RSCEM, we found that Continuous Wave (CW) NILT significantly improves behavioral function when NILT is administered up to 6 hour post-embolization at 808nm; a durable effect that can last up to 21 days following a single treatment. Using the RLCEM we found that NILT did not significantly alter intracerebral hemorrhage (ICH) incidence following embolization, and since intravenous (IV) tissue plasminogen activator (tPA) is currently the primary treatment of acute ischemic stroke (AIS), we used the RLCEM to determine the safety profile of NILT in combination with tPA. IV tPA increased ICH incidence by 160%. NILT did not affect the tPA-induced increase in ICH. Lastly, since the cellular mechanism(s) involved in NILT-mediated neuroprotection have not been elucidated, we measured the effect of CW and Pulse Wave (PW) NILT on cortical adenosine triphosphate (ATP) content as an indicator of improved cellular energetics using the RSCEM. Embolization decreased cortical ATP content by 45% compared to naive rabbits, a decrease that was attenuated by CW NILT (p>0.05). Following PW NILT, delivering 5-35 times higher peak cortical irradiances than CW NILT, we measured larger increases in cortical ATP content. This is the first demonstration that NILT significantly increased cortical ATP content in embolized animals.

  4. Effect of internal carotid artery reperfusion in combination with Tenecteplase on clinical scores and hemorrhage in a rabbit embolic stroke model.

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    Lapchak, Paul A

    2009-10-19

    In the present study, we used a modification of the rabbit small clot embolic stroke model (RSCEM), a multiple infarct ischemia model to achieve reperfusion (REP) through the internal carotid artery (ICA) following small clot embolization. We determined if increasing regional cortical blood flow (RCBF) following an embolic stroke is beneficial to neurological outcome. We compared this to cerebral reperfusion induced by the administration of the thrombolytic Tenecteplase (TNK, 1.5 mg/kg, IV bolus) in the presence or absence of REP. In this study, we also measured the incidence of ICH following REP and thrombolytic treatment. Following embolization, RCBF was reduced to 48-55% of baseline. When REP was induced by removal of a CCA ligature, RCBF initially increased to 185% of baseline. REP (P(50)=1.18+/-0.43 mg) had no effect on embolization-induced behavior measured 24 h following embolization compared to control (P(50)=1.01+/-0.48 mg). However, TNK treatment (2-hours post-embolization) in the absence or presence of REP (initiated 2 h following embolization) significantly (p0.05) group compared to either the control group (5.5%) or TNK group (10%). This study show that reperfusion of ICA can increase RCBF following embolization, but this is not associated with improved neurological outcome measured using quantal analysis. However, TNK administration significantly increased behavioral outcome when given 2 h following embolization; an increase that is not affected by combining TNK with REP.

  5. Cerebral embolic stroke after disappearing takotsubo cardiomyopathy.

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    Matsuzono, Kosuke; Ikeda, Yoshio; Deguchi, Shoko; Yamashita, Toru; Kurata, Tomoko; Deguchi, Kentaro; Abe, Koji

    2013-11-01

    Takotsubo cardiomyopathy can induce cerebral embolic stroke because of intracardiac thrombosis, but the timing of cardiogenic embolism relating to takotsubo cardiomyopathy has not been well described. We evaluated a 71-year-old woman with takotsubo cardiomyopathy, who developed cardiogenic cerebral embolism after recovery of cardiac wall motion. Nevertheless, we treated her with anticoagulation therapy. The present clinical observation suggests that attention should be paid to the timing when takotsubo cardiomyopathy resolves against risk of cardiogenic cerebral embolism.

  6. Secondary Stroke Prevention in Cryptogenic Stroke and Embolic Stroke of Undetermined Source (ESUS).

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    Diener, Hans-Christoph; Bernstein, Richard; Hart, Robert

    2017-09-01

    The purpose of the study was to review the literature on cryptogenic stroke and embolic stroke of undetermined stroke (ESUS). Cryptogenic stroke according to TOAST criteria is a stroke which is not due to cardiogenic embolism, small vessel disease with lacunes or large vessel disease of brain supplying arteries. In the context of secondary stroke prevention studies, cryptogenic stroke is not operationally defined. The new concept of "embolic stroke of undetermined source" (ESUS) provides an operational definition. ESUS is diagnosed as a non-lacunar stroke on cerebral imaging and exclusion of large vessel atherosclerosis by CTA, MRA or ultrasound. Cardiogenic embolism is made less likely by ECG monitoring and echocardiography. At present, aspirin is used for secondary stroke prevention in patients with cryptogenic stroke. Based on the construct that ESUS might be caused by undetected atrial fibrillation or other embolic mechanisms, ongoing randomised secondary stroke prevention trials are comparing non-vitamin K oral anticoagulants (NOACs) with aspirin.

  7. 兔经股动脉插管自体血栓大脑中动脉栓塞模型%Establishment of rabbit model of embolic middle cerebral artery occlusion stroke through selective transfemoral internal carotid catheterization

    Institute of Scientific and Technical Information of China (English)

    刘振生; 张新江; 周龙江; 高珊玉; 刘一辉; 王苇; 李澄

    2013-01-01

    Objective To establish rabbit model of embolic middle cerebral artery occlusion stroke with clots through selective transfemoral internal carotid catheterization(ICA), and evaluate the feasibility and stability of the technique. Methods A total of 30 New Zealand white rabbits were enrolled, either gender, with mean age of 14-month old and mean body weight of 4.1 kg, which were divided into control group(n=10) and experimental group(n = 20). Both groups received selective transfemoral ICA and angiography, with 1-5 clots injected in experimental group and only the contrast media injected in control group. Digital subtraction angiography (DSA) was performed to observe cerebral vascular obstruction, the modified Bederson scoring was used to observe neurologic impairment, CT perfusion was performed to observe cerebral blood perfusion, and diffusion weighted imaging (DWI) and 2, 3, 5 -triphenyltetrazolium chloride (TTC) staining were used to observe cerebral infarction. Results Seventeen (85 %) embolic rabbit stroke models in experimental group were successfully established, which manifested occlusion of middle cerebral arteries, neurologic deficits, abnormalities of perfusion, DWI and TTC staining. Three embolic rabbit stroke models were failed, because internal carotid arteries were occluded in 2 rabbits and recanalization occurred in occluded middle cerebral artery in 1 rabbit. No abnormality was observed in control animals. There was obvious difference in CT parameters between 2 groups. Conclusion It is demonstrated that the technique for establishing rabbit models of embolic middle cerebral arteries occlusion stroke with clots through selective transfemoral ICA is simple, micro invasive and reliable. Selection of appropriate clots and familiarity with the anatomy and variation of ICA could obviously improve the stability and reproducibility of focal cerebral ischemia model in rabbits.%目的 经股动脉途径行选择性颈内动脉插管建立兔大脑中动

  8. Persistent Penumbra in a Rabbit Stroke Model: Incidence and Histologic Characteristics

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    Leah J. Hennings

    2011-01-01

    Full Text Available Duration and extent of penumbra determine the window and brain volume in which interventions may save injured tissue after stroke. Understanding the penumbra in animals is necessary in order to design models that translate to effective clinical therapies. New Zealand white rabbits were embolized with aged autologous clot (n=23 or insoluble microspheres (n=21. To examine effects of treatment on penumbra, sphere-stroked animals were treated with 3 μm microbubbles plus ultrasound (n=19. Rabbits were euthanized at 4 or 24 hr. Infarct volume was measured following triphenyltetrazolium chloride (TTC staining of brain sections. Penumbra was visualized using immunostaining of pimonidazole injected fifteen minutes prior to euthanasia. Potentially reversible penumbra was present in 14.3% stroked rabbits at 4 hours and 15.7% at 24 hours after embolic stroke and represented up to 35% of total lost tissue. Intervention at up to 24 hours may benefit a significant patient population.

  9. An unusual cause of ischemic stroke - Cerebral air embolism

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    Vinit Suri

    2014-01-01

    Full Text Available Air embolism is a preventable, often undiagnosed but potentially treatable cause of ischemic stroke with a high morbidity and mortality. It is usually iatrogenic ocurring especially in patients in ICU setting. We describe the case and neuroimaging of a patient with ischaemic stroke due to air embolism during manipulation of central venous line. We also review the literature with respect to aetiology, incidence pathophysiology, diagnosis, and treatment options for venous and air embolism. Cerebral air embolism should be considered in patients with sudden neurological deterioration after central venous or arterial manipulations or certain neurological procedures. Prevention, as well as early diagnosis and management, may reduce morbidity and mortality.

  10. Thrombolytic and anticoagulation treatment in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, K; Meden, P

    2003-01-01

    OBJECTIVES: The effects of pentasaccharide (PENTA), given alone or combined with thrombolysis using recombinant tissue plasminogen activator (rt-PA), on infarct size and clinical outcome were evaluated in a rat embolic stroke model. MATERIALS AND METHODS: Ninety-two rats were embolized unilaterally...

  11. Patent Foramen Ovale: Is Stroke Due to Paradoxical Embolism?

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    Ranoux, D.; Cohen, A.; Cabanes, L.; Amarenco, P.; Bousser, M. G.; Mas, J. L.

    1993-01-01

    Background and Purpose: A patent foramen ovale has been reported to be significantly more frequent in young stroke patients than in matched control subjects, and paradoxical embolism has been suggested as the main mechanism of stroke in-this situation. The present study was designed to test this hypothesis. Methods: Sixty-eight consecutive patients under 55 years of age presenting with an ischemic stroke had an extensive workup, including transesophageal echocardiography with contrast. We compared the prevalence of criteria for the diagnosis of paradoxical embolism in patients with and without a patent foramen ovale. Results: A patent foramen ovale was found in 32 patients (47%). A Valsalva-provoking activity was present at stroke onset in six patients with a patent foramen ovale and in eight patients with no patent foramen ovale (X(sup 2)=0.1, nonsignificant). Clinical/radiological features suggestive of an embolic mechanism were not more frequent in patients with a patent foramen ovale. Clinical evidence of deep vein thrombosis was present in one patient with a patent foramen ovale and in none of the others. No occult venous thrombosis was found in a subgroup of patients with a patent foramen ovale and no definite cause for stroke who underwent venography (n=13). Conclusions. Our results do not support the hypothesis that paradoxical embolism is the primary mechanism of stroke in patients with a patent foramen ovale. (Stroke 1993;24:31-34) KEY WORDS e cerebral ischemia e embolism foramen ovale, patent

  12. Evaluation of Arterial Impairment after Experimental Gelatin Sponge Embolization in a Rabbit Renal Model

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    Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Choi, Yeong Jin

    2015-01-01

    Objective Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. Materials and Methods A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were perfor...

  13. Diagnostic dilemmas in a patient with multivascular embolic stroke

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    Delsing, C.P.A.; Duijnhoven, M. van; Arnoldussen, C.; Noble, J.

    2015-01-01

    We describe a patient admitted to the intensive care unit with aphasia, which was due to an embolic ischaemic cerebral stroke associated with a previously unknown patent foramen ovale. Eventually, this finding during echocardiography led us to the diagnosis of pancreatic cancer. The thrombotic compl

  14. Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism.

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    Chung, Jong-Won; Bang, Oh Young; Ahn, Kangmo; Park, Sang-Soon; Park, Tai Hwan; Kim, Jae Guk; Ko, Youngchai; Lee, SooJoo; Lee, Kyung Bok; Lee, Jun; Kang, Kyusik; Park, Jong-Moo; Cho, Yong-Jin; Hong, Keun-Sik; Nah, Hyun-Wook; Kim, Dae-Hyun; Cha, Jae-Kwan; Ryu, Wi-Sun; Kim, Dong-Eog; Kim, Joon-Tae; Choi, Jay Chol; Oh, Mi-Sun; Yu, Kyung-Ho; Lee, Byung-Chul; Lee, Ji Sung; Lee, Juneyoung; Park, Hong-Kyun; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon

    2017-01-01

    The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Particulate matter air pollution. Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke. © 2016 American Heart Association, Inc.

  15. Pulmonary embolism and stroke associated with mechanical thrombectomy

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    Paulo Bastianetto

    2014-04-01

    Full Text Available Mechanical thrombectomy offers the advantage of rapid removal of venous thrombi. It allows venous obstructions to be removed and requires shorter duration of infusion of thrombolytic agents. However, aspiration of thrombi can lead to complications, particularly pulmonary embolism and hemolysis. The validity of using vena cava filters during thrombectomy in order to avoid embolism has not yet been established. The authors report a case of massive pulmonary embolism associated with ischemic stroke in a patient with a hitherto undiagnosed patent foramen ovale. The patient developed respiratory failure and neurological deficit after thrombectomy. This case raise questions about the value of the thrombectomy for the treatment of proximal vein thrombosis due to the risks of this procedure. The authors also discuss the need for vena cava filters and ruling out a patent foramen ovale in patients undergoing thrombectomy.

  16. Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice

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    Amre eNouh

    2016-03-01

    Full Text Available Up to a third of strokes are rendered cryptogenic or of undetermined etiology. This number is specifically higher in younger patients. At times, inadequate diagnostic workups, multiple cause or an under-recognized etiology contributes to this statistic. Embolic stroke of undetermined source, a new clinical entity particularly refers to patients with embolic stroke for whom the etiology of embolism remains unidentified despite through investigations ruling out established cardiac and vascular sources. In this article, we review current classification and discuss important clinical considerations in these patients; highlighting cardiac arrhythmias and structural abnormalities, patent foramen ovale, paradoxical sources, and potentially under-recognized, vascular, inflammatory, autoimmune and hematologic sources in relation to clinical practice.

  17. Three-Case Report of Embolic Stroke of Undetermined Source.

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    Li, Jia; Yang, Xue-Zhi; Wang, Yi-Ping; Chen, Xiao-Li; Zhang, Xu

    2017-07-01

    Embolic stroke of undetermined source (ESUS) is a new clinical construct. It signifies that the embolus in the thromboembolic ischemic stroke is of unknown origin. The anticoagulants are usually prescribed for antithrombotic prophylaxis, but whether it is appropriate for all patients with ESUS is still unknown. In this article, we describe 3 cases of ESUS, all of whose antithrombotic therapy was antiplatelet medication, and the 3 patients had no recurrence on 3- to 7-month follow-up. Because there was no obvious risk factor found in these ESUS cases, the recurrence risk is difficult to evaluate, and the optimum means of secondary prevention are still unknown. Hence, many aspects warrant resolution. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Evaluation of arterial impairment after experimental gelatin sponge embolization in a rabbit renal model

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    Oh, Jung Suk; Lee, Hae Gi; Chun, Ho Jong; Choi, Byung Gil; Choi, Yeong Jin [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2015-02-15

    Arterial stenosis is a major obstacle for subsequent interventional procedures. We hypothesized that the stenosis is caused by gelatin sponge embolization and performed an experimental study in a rabbit renal model. A total of 24 rabbits were embolized with porcine gelatin sponge particles injected into the renal arteries. Four rabbits were sacrificed on 1 day, 4 days, 1 week, 2 weeks, 3 weeks, and 4 weeks after embolization. Microscopic evaluations were performed on hematoxylin-eosin and smooth muscle actin immunohistochemical stained sections. Gelatin sponge particles were mainly observed in the segmental and interlobar arteries. Transmural inflammation of the embolized arterial wall and mild thickening of the media were observed 1 week after embolization. Resorption of the gelatin sponge and organization of thrombus accompanied by foreign body reactions, were observed from 2 to 4 weeks after embolization. Microscopic images of the 3 weeks group showed vessel lumens filled mostly with organized thrombi, resulting in severe stenosis. Additionally, vessels showed a thickened intima that contained migrating smooth muscle cells and accompanying interruption of the internal elastic lamina. The migrating smooth muscle cells were distributed around the recanalized arterial lumen. Gelatin sponge embolization may induce arterial stenosis by causing organized thrombus and intimal hyperplasia, which consists of migrating smooth muscle cells and intimal collagen deposits.

  19. Ticagrelor Versus Aspirin in Acute Embolic Stroke of Undetermined Source.

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    Amarenco, Pierre; Albers, Gregory W; Denison, Hans; Easton, J Donald; Evans, Scott R; Held, Peter; Hill, Michael D; Jonasson, Jenny; Kasner, Scott E; Ladenvall, Per; Minematsu, Kazuo; Molina, Carlos A; Wang, Yongjun; Wong, K S Lawrence; Johnston, S Claiborne

    2017-09-01

    Ticagrelor is an effective antiplatelet therapy among patients with atherosclerotic disease and, therefore, could be more effective than aspirin in preventing recurrent stroke and cardiovascular events among patients with embolic stroke of unknown source (ESUS), which includes patients with ipsilateral stenosis <50% and aortic arch atherosclerosis. We randomized 13 199 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2-90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2-90) within 24 hours of symptom onset. In all patients, investigators informed on the presence of ipsilateral stenosis ≥50%, small deep infarct <15 mm, and on cardiac source of embolism detected after enrollment or rare causes, which allowed to construct an ESUS category in all other patients with documented brain infarction. The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days. ESUS was identified in 4329 (32.8%) patients. There was no treatment-by-ESUS category interaction (P=0.83). Hazard ratio in ESUS patients was 0.87 (95% confidence interval, 0.68-1.10; P=0.24). However, hazard ratio was 0.51 (95% confidence interval, 0.29-0.90; P=0.02) in ESUS patients with ipsilateral stenosis <50% or aortic arch atherosclerosis (n=961) and 0.98 (95% confidence interval, 0.76-1.27; P=0.89) in the remaining ESUS patients (n=3368; P for heterogeneity =0.04). In this post hoc, exploratory analysis, we found no treatment-by-ESUS category interaction. ESUS subgroups have heterogeneous response to treatment (Funded by AstraZeneca). URL: http://www.clinicaltrials.gov. Unique identifier: NCT01994720. © 2017 American Heart Association, Inc.

  20. Apixaban for treatment of embolic stroke of undetermined source (ATTICUS randomized trial): Rationale and study design.

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    Geisler, Tobias; Poli, Sven; Meisner, Christoph; Schreieck, Juergen; Zuern, Christine S; Nägele, Thomas; Brachmann, Johannes; Jung, Werner; Gahn, Georg; Schmid, Elisabeth; Bäezner, Hansjörg; Keller, Timea; Petzold, Gabor C; Schrickel, Jan-Wilko; Liman, Jan; Wachter, Rolf; Schön, Frauke; Schabet, Martin; Lindner, Alfred; Ludolph, Albert C; Kimmig, Hubert; Jander, Sebastian; Schlegel, Uwe; Gawaz, Meinrad; Ziemann, Ulf

    2016-11-23

    Optimal secondary prevention of embolic stroke of undetermined source is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation. The ATTICUS randomized trial is designed to determine whether the factor Xa inhibitor apixaban administered within 7 days after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of new ischemic lesions documented by brain magnetic resonance imaging within 12 months after index stroke. Prospective, randomized, blinded, parallel-group, open-label, German multicenter phase III trial in approximately 500 patients with embolic stroke of undetermined source. A key inclusion criterion is the presence or the planned implantation of an insertable cardiac monitor. Patients are 1:1 randomized to apixaban or acetylsalicylic acid and treated for a 12-month period. It is an event-driven trial aiming for core-lab adjudicated primary outcome events. The primary outcome is the occurrence of at least one new ischemic lesion identified by axial T2-weighted FLAIR magnetic resonance imaging and/or axial DWI magnetic resonance imaging at 12 months when compared with the baseline magnetic resonance imaging. Key secondary outcomes are the combination of recurrent ischemic strokes, hemorrhagic strokes, systemic embolism; combination of MACE including recurrent stroke, myocardial infarction, and cardiovascular death and combination of major and clinically relevant non-major bleeding defined according to ISTH, and change of cognitive function and quality of life (EQ-5D, Stroke Impact Scale). Embolic stroke of undetermined source is caused by embolic disease and associated with a high risk of recurrent ischemic strokes and clinically silent cerebral ischemic lesions. ATTICUS will investigate the impact of atrial fibrillation detected by insertable cardiac monitor and the effects of early anticoagulation with apixaban compared

  1. Acute but not delayed amphetamine treatment improves behavioral outcome in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, Karsten; Kristiansen, Uffe;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the effects of d-amphetamine (amph) upon recovery after embolic stroke in rats. METHODS: Ninety-three rats were embolized in the right middle cerebral artery and assigned to: (1) controls; (2) combination (acute amph and later amph-facilitate...

  2. Recurrent Embolic Strokes of Undetermined Source in a Patient with Extreme Lipoprotein(a) Levels.

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    Bulwa, Zachary; Kim, Audrey; Singh, Karandeep; Kantorovich, Alexander; Suhail, Faten

    2016-01-01

    Lipoprotein(a) is a plasma lipoprotein and known cardiovascular risk factor, most recently implicated in the development of high-risk carotid atherosclerotic plaques without significant carotid stenosis. We present a case of a young African-American female with recurrent embolic strokes of undetermined source. After our thorough investigation, we identified the link between a small, irregular plaque in the right internal carotid artery, and an extremely elevated plasma level of lipoprotein(a) as the source of her embolic strokes.

  3. Emerging Risk Factors for Recurrent Vascular Events in Patients With Embolic Stroke of Undetermined Source.

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    Ueno, Yuji; Yamashiro, Kazuo; Tanaka, Ryota; Kuroki, Takuma; Hira, Kenichiro; Kurita, Naohide; Urabe, Takao; Hattori, Nobutaka

    2016-11-01

    Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source. Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included. Recurrent vascular events, including ischemic stroke, cardiovascular and peripheral artery diseases, and vascular death, were retrospectively analyzed. Cox proportional hazards regression analysis was used to explore factors, including clinical characteristics, embolic causes on transesophageal echocardiography, and the Calcification in the Aortic Arch, Age, Multiple Infarction score (CAM), based on the degree of aortic arch calcification on chest radiograph (0-3 points), age (≥70 years; 1 point), and multiple infarctions on magnetic resonance imaging (multiple infarcts in 1, 2, or ≥3 territories of large intracranial arteries, 1, 2, or 3 points) associated with recurrent vascular events. A total of 177 patients (age, 64.1±14.2 years; 127 men) were enrolled. Thirty-one patients had recurrent vascular events (follow-up, 3.5±2.7 years; annualized rate, 5.0% per person-year). Among embolic causes on transesophageal echocardiography, incidence of recurrent vascular events was high in patients with large aortic arch plaques (7.5% per person-year). Diabetes mellitus (hazard ratio, 2.56; 95% confidence interval, 1.23-5.32; P=0.012) and CAM score grade (hazard ratio, 2.29; 95% confidence interval, 1.11-4.72; P=0.026) predicted recurrent vascular events. History of diabetes mellitus and the CAM score could be novel risk factors for recurrent vascular events in embolic stroke of undetermined source. © 2016 American Heart Association, Inc.

  4. Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

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    Krishnamoorthy, Thamburaj; Gupta, Arun Kumar; Rajan, Jayadevan E; Thomas, Bejoy [Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, (India)

    2007-06-15

    Direct percutaneous embolization of hypervascular tumors results in more effective preoperative devascularization. Migration of glue is a well known complication of direct glue injection and it may lead to stroke or cranial nerve deficits. We report here on a case of carotid body tumor in a 52-year-old man; the tumor was mainly embolized by percutaneous injection of 50% glue and this was supported with balloon protection of the internal carotid artery. Thirteen hours later, he developed hemiparesis from delayed migration of glue. The possible mechanisms of this migration are discussed and preventive measures are suggested. Preoperative embolization of hypervascular tumors of the head and neck, including carotid body tumor, is often performed to decrease the amount of blood loss during surgery. Devascularization is mainly performed with particulate agents and by employing the transarterial route. More effective embolization may be achieved by performing percutaneous direct embolization of hypervascular tumors with liquid embolic agents. Even though there are few reports available on direct embolization, complications from glue migration have been reported, and this mainly happens during the procedure when the glue is in a liquid state. We report here on a case of delayed migration of polymerized glue (n-butyl-2-cyanoacrylate [NBCA]), many hours after the procedure, into the intracranial circulation and the final result was stroke. A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.

  5. Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits.

    Science.gov (United States)

    Tang, Chun Xiang; Zhou, Chang Sheng; Zhao, Yan E; Schoepf, U Joseph; Mangold, Stefanie; Ball, B Devon; Han, Zong Hong; Qi, Li; Zhang, Long Jiang; Lu, Guang Ming

    2017-04-01

    To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE). Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard. A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity (p PFE earlier than CTPA (all p PFE as well as earlier detection compared with conventional CTPA in this animal model study. • Fat embolism occurs commonly in patients with traumatic bone injury. • Dual-energy CT improves diagnostic performance for pulmonary fat embolism detection. • Dual-energy CT can detect pulmonary fat embolism earlier than CTPA.

  6. Study on intraluminal embolization with microcoils treating traumatic pseudoaneurysms in common carotid artery in rabbits

    Institute of Scientific and Technical Information of China (English)

    刘云松; 马廉亭; 吴佐泉

    2004-01-01

    Objective: To evaluate the long-term effect of endovascular occlusion with microcoils on traumatic pseudoaneurysms (TPAs) in the common carotid artery in rabbits.Methods: TPAs in the right common carotid artery were surgically made in 16 rabbits. At 3-4 weeks after operation, the survived 12 models were randomly divided into a control group (n = 3 ) with no treatment and an experimental group (n = 9), in which TPAs were intraluminally embolized with microcoils and corresponding therapy was given. Three months after embolization, the TPAs were examined with digital subtraction angiography and pathology.Results: The 3 rabbits in the control group all died of rupture of TPA. Among the 9 TPAs occluded with microcoils, 4 were completely occluded, 4 were partially occluded, and 1 was excluded due to the microcoils migrating into the parent artery. Three months after embolization, the 4 TPAs which were completely occluded remained obliterated as determined by digital subtraction angiographic findings. The parent artery remained unobstructed and the structure of the TPAs were replaced by a mass of scar tissues. The 4 TPAs which were partially occluded remained unruptured and the microcoils were compressed.Conclusions: The lumen in TPA can be completely occluded by microcoils and the parent artery is unblocked.Partial occlusion of the lumen can also prevent the rupture of TPA.

  7. Recurrent Embolic Strokes of Undetermined Source in a Patient with Extreme Lipoprotein(a Levels

    Directory of Open Access Journals (Sweden)

    Zachary Bulwa

    2016-08-01

    Full Text Available Lipoprotein(a is a plasma lipoprotein and known cardiovascular risk factor most recently implicated in the development of high-risk carotid atherosclerotic plaques without significant carotid stenosis. We present a case of a young African-American female with recurrent embolic strokes of undetermined source. After our thorough investigation we identified the link between a small, irregular plaque in the right internal carotid artery and an extremely elevated plasma level of lipoprotein(a as the source of her embolic strokes.

  8. Aortic Arch Atherosclerosis——An Important Potential Source Of Cerebral Embolic Stroke

    Institute of Scientific and Technical Information of China (English)

    Yi Guo; Shao wen Zhang; Si Chen

    2000-01-01

    Background and purpose: Recent years with use of transesophageal echography renew awareness of aortic atherosclerosis. The purpose of this study was to determine the prevalence, clinical significance, and embolic potential of thoracic aortic plaque in patients with cerebral emblism; and further study the correlation aortic plaque with carotid or heart disease. Method: 49 consecutive patients with cerebral embolism was included in this sutdy. We uscd TEE to evaluated potential source of emboli in aortic arch and heart, and duplex in carotid artery. A atherosclerotic lesion of thoracic aorta was defined as normal(O); mild plaque (1); moderate plaque (2); protruding plaque or mobile plaque (3). Result: 31(63%) patients showed evidence of AAA; 7 (14.3%) patients had mild AAA, 9 (18.4%) patients had moderate AAA and 15 (32.7%) patients had severe AAA, In these 15 patients 11 patients neither severe ICAA or embolic heart disease, the AAA may be responsible to the cerebral embolism; 33 patients had internal carotid arterial atherosclerosis(ICAA), 9 patients had embolic heart disease; Age, ICAA had significant correlated with aortic plaque. Conclusion: Aortic atherosclerosis is common in cerebral embolism. Aortic plaque might be not only responsible for some unexplained embolic event, but also for some of the embolic stroke in the group of patient do have carotid artery or heart disease. Age might be important risk factor for the development of atherosclerotic lesion in the thoracic aorta.

  9. Differences in clinical features and computed tomographic findings between embolic and non-embolic acute ischemic stroke. A quantitative differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Takano, Kentaro; Yamaguchi, Takenori; Minematsu, Kazuo; Sawada, Tohru; Omae, Teruo [National Cardiovascular Center, Suita, Osaka (Japan)

    1998-02-01

    A diagnosis based on the presumed mechanism of stroke onset is useful for management strategies in acute ischemic stroke. Ninety-two patients with embolic (cardiac or artery-to-artery) and 107 with non-embolic (thrombotic or hemodynamic) stroke were diagnosed on strict cerebral angiographic criteria alone. To clearly discriminate between these two groups, the neurological and computed tomographic (CT) findings were then compared. Rapidity of onset, vomiting, urinary incontinence, level of consciousness, cervical bruit, anisocoria, tongue deviation, sensory disturbance, and CT findings (location of hypodense area, findings of brain edema and hemorrhagic transformation) were discriminatory factors between the two groups (p<0.01). According to these 11 items, we prepared a numerical table for quantitative differential diagnosis. A diagnostic accuracy of 98.9% for embolic and 87.9% for non-embolic stroke in internal verification, and 90.0% and 82.9%, respectively, in external verification was observed. The differences in clinical features and CT findings between embolic and non-embolic stroke may reflect the pathophysiological mechanisms of the occlusive process of cerebral artery as well as the extent and severity of ischemia. (author)

  10. Heated lipiodol as an embolization agent for transhepatic arterial embolization in VX2 rabbit liver cancer model

    Energy Technology Data Exchange (ETDEWEB)

    Cao Wei [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: zjfurong2008@126.com; Wan Yi [Department of Health Statistics, Fourth Military Medical University, No. 17 West Changle Road, Xi' an 710032 (China); Liang Zhihui [Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, Hebei Province 050082 (China); Duan Yunyou; Liu Xi [Department of Ultrasonography, Tangdu Hospital, Fourth Military Medical University, No. 1 Xinshi Road, Xi' an 710038 (China); Wang Zhimin; Liu Yiyong; Zhu Jia; Liu Xiongtao [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China); Zhang Hongxin [Department of Interventional Radiology, Tangdu Hospital, Fourth Military Medical University, No.1 Xinshi Road, Shaanxi Province, Xi' an 710038 (China)], E-mail: cawe-001@163.com

    2010-02-15

    Purpose: To evaluate the therapeutic effect of heated (60 deg. C) lipiodol via hepatic artery administration in a rabbit model of VX2 liver cancer. Materials and methods: Thirty male New Zealand white rabbits were randomly divided into three groups with 10 rabbits assigned to each group. VX2 carcinoma cells were surgically implanted into the left hepatic lobe. The tumors were allowed to grow for 2 weeks, and studies were performed until the diameter of the tumors detected by ultrasonograph reached 2-3 cm. Under anesthesia, trans-catheter hepatic arterial embolization was performed and doxorubicin-lipiodol (37 deg. C) (1 mL), lipiodol (60 deg. C) (1 mL) or control (physiological saline (37 deg. C) (1 mL)) solution was injected into the hepatic arteries of animals in the three groups. One week later, the volume of the tumor was measured by ultrasonograph again. The serum of all rabbits was collected before injection and at 4 and 7 days after injection, and the level of aspartate aminotransferase (AST) was checked. The survival period of the three groups of rabbits after treatment was also recorded. During the last course of their disease, the rabbits were given analgesics to relieve suffering. Results: The tumor growth rate in the lipiodol (60 deg. C) group (0.92 {+-} 0.21, tumor volume from 1811 {+-} 435 to 1670 {+-} 564 mm{sup 3}) was significantly lower than that in the control group (3.48 {+-} 1.17, tumor volume from 1808 {+-} 756 to 5747 {+-} 1341 mm{sup 3}) (P < 0.05) and in the doxorubicin-lipiodol (37 deg. C) group (1.69 {+-} 0.26, tumor volume from 1881 {+-} 641 to 2428 {+-} 752 mm{sup 3}) (P < 0.05). Consequently, the survival period of the animals in the lipiodol (60 deg. C) group (41.0 {+-} 3.0 days) was significantly greater than that in the doxorubicin-lipiodol (37 deg. C) group (38.0 {+-} 2.5 days) (P < 0.05). On the other hand, there was no statistically significant difference in serum AST levels between the lipiodol (60 deg. C) group (148.2 {+-} 11

  11. Embolic stroke after ligation of the pulmonary artery in patients with functional single ventricle.

    Science.gov (United States)

    Oski, J A; Canter, C E; Spray, T L; Kan, J S; Cameron, D E; Murphy, A M

    1996-10-01

    In the setting of functional single ventricle with pulmonary overcirculation, pulmonary artery banding is frequently used to alleviate symptoms and to prepare for staged repair. At subsequent cavopulmonary anastomosis or Fontan procedure, the pulmonary artery may be ligated at the site of the pulmonary band. This article describes the association of embolic stroke and thrombus in a ligated or divided pulmonary artery stump in three patients with functional single ventricle. These events occurred from 1990 through 1992 among the 1700 inpatient pediatric cardiology admissions at two institutions. The patients, ranging in age from 15 months to 9 years, had cerebral infarctions documented by computed axial tomography scan or magnetic resonance imaging associated with the echocardiographic finding of thrombus in the proximal pulmonary artery stump after the embolic strokes. The strokes occurred 5 days to 5 years after surgery. Two patients had a second infarction within 2 to 5 weeks of the initial stroke. It is concluded that the presence of the ligated pulmonary artery stump may place patients at risk for embolic stroke. Surgical approaches to reduce the risk of thrombus formation should be considered prospectively in this patient group.

  12. Cartilage and bone neoformation in rabbit carotid bifurcation aneurysms after endovascular coil embolization

    Directory of Open Access Journals (Sweden)

    H Plenk

    2008-11-01

    Full Text Available Occurrence and histomorphology of cartilage and bone neoformations was retrospectively evaluated in rabbit experimental aneurysms after endovascular coil embolization. During product development, 115 carotid bifurcation aneurysms were treated with hydrogel-containing devices (HydroCoil®, n=77; HydroSoft®, n=28; prototype Hydrogel-only, n=10; MicroVentionTerumo, Aliso Viejo, CA. Additional 29 aneurysms were treated with standard (n=22 or with degradable polymer-covered (n=7 platinum coils. After 4 to 52 weeks, the retrieved aneurysms were methylmethacrylate embedded, and ground sections were surface-stained with Rapid Bone Stain and Giemsa solution. Cartilage and/or bone tissue was assessed by light microscopy; respective tissue areas in the aneurysms were determined by computerized histomorphometry. Cartilage neoformation was observed from 26 to 52 weeks. Single chondrocytes to hyaline or fibrous cartilage areas, occupying up to 29% of the aneurysm cavity, were found in 6 aneurysms, treated with HydroCoil (n=4, Hydrogel-only (n=1, and resorbable polymer (n=1 devices. Chondral ossification associated cartilage neoformation in 2 of these 4 HydroCoil-treated aneurysms. Membranous woven and lamellar bone ossicles were observed from 13 to 52 weeks in 7 aneurysms, treated with HydroCoil (n=3 and platinum coil (n=4 devices. Altogether, cartilage and/or bone neoformation was observed in 13 (9% of 144 rabbit bifurcation aneurysms treated with various embolic devices. Incidence was low until 26 weeks, but increased at 52 weeks in both, HydroCoil and standard platinum coil treated aneurysms. As the neoformations were predominantly located in proximity to the aneurysm neck, they could be related to the long-term mechanobiology of cell differentiation during fibrovascular healing of blood flow-exposed embolized aneurysms.

  13. Circuitous embolic hemorrhagic stroke: carotid pseudoaneurysm to fetal posterior cerebral artery conduit: a case report

    Directory of Open Access Journals (Sweden)

    Hoque Romy

    2008-02-01

    Full Text Available Abstract Introduction The cervical internal carotid artery (ICA is susceptible to injury through various mechanisms, including dissection, which can lead to pseudoaneurysm formation. Pathological processes affecting the ICA, in association with an ipsilateral fetal posterior cerebral artery (PCA, resulting in parieto-occipital strokes are rarely reported. Case Presentation We present a patient with a left PCA territory, presumably embolic, stroke with early hemorrhagic transformation. The identified nidus of the embolus was a carotid artery pseudoaneurysm. Manifestations included right homonymous hemianopsia with right hemiparesis and hemisensory loss. Conclusion Our case is unique, and of clinical interest, because it illustrates both the potential anterior-posterior circulation conduit provided by a fetal origin PCA as well as the apparent early hemorrhagic transformation of embolic infarcts that can lead to further confusion from a mechanistic standpoint.

  14. Top of the basilar artery embolic stroke and neonatal myoclonus

    NARCIS (Netherlands)

    Govaert, Paul; Dudink, Jeroen; Visser, Gerhard; Breukhoven, Petra; Vanhatalo, Sampsa; Lequin, Maarten

    2009-01-01

    Cerebellar stroke has been virtually unreported in the living newborn infant. A term newborn male weighing 3380g at birth suffered myoclonic seizures within 24 hours of birth by spontaneous vaginal delivery. Apgar scores were 3 and 4 at 1 and 5 minutes. Myoclonus persisted for 9 days, responding poo

  15. Targeted hyperthermia after selective embolization with ferromagnetic nanoparticles in a VX2 rabbit liver tumor model

    Directory of Open Access Journals (Sweden)

    Sun HL

    2013-10-01

    Full Text Available Hongliang Sun,1 Linfeng Xu,1 Tianyuan Fan,2 Hongzhi Zhan,3 Xiaodong Wang,3 Yanfei Zhou,2 Ren-jie Yang3 1Department of Interventional Therapy, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 2Pharmacy School of Beijing University, Beijing, 3Department of Interventional Therapy, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, People's Republic of China Background: The purpose of this study was to observe the effect and feasibility of hyperthermia and the influence of heat on surrounding organs in a VX2 rabbit liver model exposed to an alternating magnetic field after embolization with ferromagnetic nanoparticles. Methods: Forty rabbits containing implanted hepatic VX2 carcinomas were divided into four groups, each containing ten rabbits. Fourteen days after tumor transplantation, we opened the abdomen to observe the size and shape of the tumor. A transfemoral retrograde approach was then used for hepatic arterial catheterization in groups B, C, and D to perform angiography and embolization. The next day, three rabbits in group B and all rabbits in group D were exposed to an alternating magnetic field, and the temperature was recorded simultaneously in the center of the tumor, at the edge of the tumor, and in the normal liver parenchyma. On day 28, all animals was euthanized to observe changes in the implanted liver tumor and the condition of the abdomen. A pathologic examination was also done. Results: Before surgery, there was no significant difference in tumor volume between the four groups. Three different temperature points (center of the tumor, edge of the tumor, and in the normal liver parenchyma of group B under an alternating magnetic field were 37.2°C ± 1.1°C, 36.8°C ± 1.2°C, and 36.9°C ± 2.1°C, none of which were significantly different from pretreatment values. Three points basal temperature in group D showed no significant difference (F = 1.038, P = 0.413. Seven to 26

  16. Detection of pulmonary fat embolism with dual-energy CT: an experimental study in rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Chun Xiang; Zhou, Chang Sheng; Zhao, Yan E.; Han, Zong Hong; Qi, Li; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Mangold, Stefanie; Ball, B.D. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-04-15

    To evaluate the use of dual-energy CT imaging of the lung perfused blood volume (PBV) for the detection of pulmonary fat embolism (PFE). Dual-energy CT was performed in 24 rabbits before and 1 hour, 1 day, 4 days and 7 days after artificial induction of PFE via the right ear vein. CT pulmonary angiography (CTPA) and lung PBV images were evaluated by two radiologists, who recorded the presence, number, and location of PFE on a per-lobe basis. Sensitivity, specificity, and accuracy of CTPA and lung PBV for detecting PFE were calculated using histopathological evaluation as the reference standard. A total of 144 lung lobes in 24 rabbits were evaluated and 70 fat emboli were detected on histopathological analysis. The overall sensitivity, specificity and accuracy were 25.4 %, 98.6 %, and 62.5 % for CTPA, and 82.6 %, 76.0 %, and 79.2 % for lung PBV. Higher sensitivity (p < 0.001) and accuracy (p < 0.01), but lower specificity (p < 0.001), were found for lung PBV compared with CTPA. Dual-energy CT can detect PFE earlier than CTPA (all p < 0.01). Dual-energy CT provided higher sensitivity and accuracy in the detection of PFE as well as earlier detection compared with conventional CTPA in this animal model study. (orig.)

  17. Novel J stents reduce the risk of embolic stroke in vitro

    Energy Technology Data Exchange (ETDEWEB)

    Bartoli, Carlo R. [University of Louisville, M.D./Ph.D. Program, Louisville, KY (United States); Spence, Paul A. [SCR Inc., Louisville, KY (United States); Giridharan, Guruprasad A. [Cardiovascular Innovation Institute, University of Louisville, Department of Bioengineering, Louisville, KY (United States)

    2010-05-15

    Two and a half million Americans with atrial fibrillation are at an elevated risk for embolic stroke. Warfarin therapy is standard treatment for high-risk patients, yet 40-65% of elderly patients do not receive anticoagulation therapy due to bleeding complications. To address this clinical need, we are evaluating a minimally invasive stent-based stroke prevention device to divert emboli from entering the arterial supply of the brain. The feasibility of a J-shaped stroke prevention device was tested in a mock circulatory loop. Sixteen sets of 100 simulated emboli (1-5 mm{sup 3}) were injected into the left atrium with and without J stents protecting the aortic arch vessels. To determine efficacy, emboli were trapped in filters in the aortic arch vessels and distal aorta for manual counting. J stents decreased the number of emboli that entered the brachiocephalic trunk by 93.7% (p<0.0001), left common carotid artery by 79.8% (p<0.0001), and left subclavian artery by 89.7% (p<0.0001). In a mock circulation, J stents positioned in the aortic arch vessels and oriented downstream of aortic flow significantly decreased the number of emboli that entered the aortic arch vessels. These results warrant further investigation to determine the safety and efficacy of this prophylactic intervention to reduce embolic events, and chronic large animal studies are underway. (orig.)

  18. Embolic Stroke Caused by Staphylococcus lugdunensis Endocarditis Complicating Vasectomy in a 36-Year-Old Man.

    Science.gov (United States)

    David, Manova; Loftsgaarden, Megan; Chukwudelunzu, Felix

    2015-12-01

    Staphylococcus lugdunensis is part of the native flora in the inguinal region of the body. Inguinal surgeries, such as vasectomy, place carriers of this aggressive pathogen at risk for contamination. Native-valve endocarditis caused by coagulase-negative S. lugdunensis has a rapid and complicated clinical course. The pathogenicity of this organism is not limited to cardiac valvular destruction. We report the case of a 36-year-old man who presented with S. lugdunensis endocarditis, dysarthria, and hemiparesis 5 weeks after a vasectomy. To our knowledge, this is the first report of embolic stroke caused by S. lugdunensis endocarditis. In addition, we discuss the relevant medical literature.

  19. Embolic Stroke as the Initial Manifestation of Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Reshma M. Khan

    2015-01-01

    Full Text Available We present a case of a 21-year-old African-American female with no significant medical history, who presented to the emergency department with a one-week history of blurry and double vision. Ophthalmology evaluation revealed bilateral retinal artery occlusion. Further workup with imaging of the brain was consistent with an ischemic stroke. Hereditary hypercoagulable workup was unremarkable and initial testing for antiphospholipid syndrome was positive. She underwent transesophageal echocardiogram (TEE, which showed severe mitral regurgitation and thickening of mitral valve leaflets consistent with Libman-Sacks endocarditis. Autoimmune workup was positive for IF-ANA, anti-RNP, and anti-Smith antibody. She fulfilled 4/11 of the ACR criteria and met 5 of the SLICC (Systemic Lupus International Collaborating Clinics criteria for lupus (nonscaring alopecia, thrombocytopenia, positive ANA, and positive anti-Smith and positive anti-phospholipid antibodies. This case highlights the importance of early recognition of underlying connective tissue diseases and timely management of these diseases in young patients with no previous manifestations of diseases.

  20. Aortic valve papillary fibroelastoma causing embolic strokes: a case report and review

    Directory of Open Access Journals (Sweden)

    Miller A

    2017-03-01

    Full Text Available Avraham Miller,1 Audrik Perez,1 Swathi Pabba,2 Vijay Shetty3 1Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA; 2Chalmeda Anand Rao Institute of Medical Sciences, Telangana, India; 3Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA Abstract: Papillary fibroelastomas (PFEs are the second most common benign neoplasms of the cardiac valves and are being recognized more frequently because of higher resolution imaging technology. PFEs are associated with substantial complications that are secondary to systemic embolism. Surgical resection should be offered to all patients who have symptoms and to asymptomatic patients who have pedunculated lesions or tumors larger than 1 cm in diameter. Herein, we present a patient who presented for a second time in 2 months with stroke symptoms. During his first admission, a transthoracic echocardiogram was performed and he was sent home after resolution of his symptoms and a grossly negative workup. During his second admission, a transesophageal echocardiogram was performed and the PFE was found and later excised. While this discussion reviews the literature with regard to detection and management, it will hopefully serve as a reminder to keep this on the differential when the workup has remained without an obvious source. Keywords: stroke, fibroelastoma, papillary, embolism

  1. Myocardial infarction, ischaemic stroke and pulmonary embolism before and after breast cancer hospitalisation. A population-based study.

    NARCIS (Netherlands)

    M.P.P. van Herk-Sukel (Myrthe); S. Shantakumar (Sumitra); P.W. Kamphuisen (Pieter Willem); F.J.A. Penning-Van Beest (Fernie); R.M.C. Herings (Ron)

    2011-01-01

    textabstractWe studied the occurrence of myocardial infarction (MI), ischaemic stroke (IS) and pulmonary embolism (PE) before and after breast cancer hospitalisation compared with cancer-free controls. For this, women with a first breast cancer hospitalisation during 2000-2007 were selected from the

  2. Thermo-sensitive composite hydrogels based on poloxamer 407 and alginate and their therapeutic effect in embolization in rabbit VX2 liver tumors.

    Science.gov (United States)

    Huang, Lili; Shen, Ming; Li, Rongxin; Zhang, Xiangyu; Sun, Ying; Gao, Pei; Fu, Hao; Liu, Hongqiang; He, Yang; Du, Yuqing; Cao, Jun; Duan, Yourong

    2016-11-08

    Interventional embolization therapy is an effective, most widely used method for inoperable liver tumors. Blood-vessel-embolic agents were essential in transarterial embolization (TAE). In this work, thermo-sensitive composite hydrogels based on poloxamer 407, sodium alginate, hydroxymethyl cellulose and iodixanol (PSHI), together with Ca2+ (PSHI-Ca2+) were prepared as liquid embolic agents for TAE therapy to liver cancer. With increasing temperature, PSHI exhibited two phase states: a flowing sol and a shrunken gel. Rheology tests showed good fluidity and excellent viscoelastic behavior with a gelation temperature (GT) of 26.5°C. The studies of erosion indicated that PSHI had calcium ion-related erosion characteristics and showed a slow erosion rate in an aqueous environment. When incubated with L929 cells, the thermo-sensitive composite hydrogels had low cytotoxicity in vitro. The results of analyzing the digital subtraction angiography and computed tomography images obtained from in vitro and in vivo assays indicated a good embolic effect in the renal arteries of normal rabbits. Angiography and histological studies on VX2 tumor-bearing rabbits indicated that PSHI-Ca2+ successfully occluded the tumors, including the peripheral vessels. In conclusion, PSHI-Ca2+ was a promising embolic agent for transarterial embolization therapy.

  3. Thermo-sensitive composite hydrogels based on poloxamer 407 and alginate and their therapeutic effect in embolization in rabbit VX2 liver tumors

    Science.gov (United States)

    Huang, Lili; Shen, Ming; Li, Rongxin; Zhang, Xiangyu; Sun, Ying; Gao, Pei; Fu, Hao; Liu, Hongqiang; He, Yang; Du, Yuqing; Cao, Jun; Duan, Yourong

    2016-01-01

    Interventional embolization therapy is an effective, most widely used method for inoperable liver tumors. Blood-vessel-embolic agents were essential in transarterial embolization (TAE). In this work, thermo-sensitive composite hydrogels based on poloxamer 407, sodium alginate, hydroxymethyl cellulose and iodixanol (PSHI), together with Ca2+ (PSHI-Ca2+) were prepared as liquid embolic agents for TAE therapy to liver cancer. With increasing temperature, PSHI exhibited two phase states: a flowing sol and a shrunken gel. Rheology tests showed good fluidity and excellent viscoelastic behavior with a gelation temperature (GT) of 26.5°C. The studies of erosion indicated that PSHI had calcium ion-related erosion characteristics and showed a slow erosion rate in an aqueous environment. When incubated with L929 cells, the thermo-sensitive composite hydrogels had low cytotoxicity in vitro. The results of analyzing the digital subtraction angiography and computed tomography images obtained from in vitro and in vivo assays indicated a good embolic effect in the renal arteries of normal rabbits. Angiography and histological studies on VX2 tumor-bearing rabbits indicated that PSHI-Ca2+ successfully occluded the tumors, including the peripheral vessels. In conclusion, PSHI-Ca2+ was a promising embolic agent for transarterial embolization therapy. PMID:27602579

  4. Application of labeled radioimmunoimaging tracing in detecting pulmonary embolism in rabbits after bone cement perfusion and relevant treatment effects

    Institute of Scientific and Technical Information of China (English)

    QI Xiang-bei; ZHANG Ying-ze; PAN Jin-she; MA Li-jie; WANG Jian-zhao; WANG Lin

    2011-01-01

    Background During the process of bone cement joint replacement,some patients show a series of complications,such as a sudden drop in blood pressure or dyspnea.The cause of the complication is considered to be due to emboli caused by the femur prosthesis insertion.The purpose of the present study was to detect the pulmonary embolism in rabbits after bone cement perfusion by radioimmunoimaging,and to explore its protective measures.Methods Forty rabbits,2.5-3.0 kg weight,were randomly assigned to four groups,with ten rabbits in each group.Group Ⅰ (no intervention):Bone cement perfusion was done after medullary cavity reaming and pressurizing.Group Ⅱ (epinephrine hydrochloride intervention):The medullary cavity was rinsed with a 1:10000 normal saline-diluted epinephrine hydrochloride solution followed by bone cement perfusion after medullary cavity reaming and pressurizing.Group Ⅲ (fibrin sealant intervention):The medullary cavity was precoated with fibrin sealant followed by bone cement perfusion after medullary cavity reaming and pressurizing.Group Ⅳ (blank control group):The medullary cavity was not perfused with bone cement after reaming.In each group,the rabbits underwent femoral head resection and medullary cavity reaming.Before bone cement perfusion,2 ml of developing tracer was injected through the ear vein.Radionuclide imaging was performed at 60,120,and 180 minutes after bone cement perfusion,and the pulmonary radioactivity in vivo was measured.The rabbits were immediately sacrificed,and the pulmonary tissue was removed and its radioactivity was measured in vitro.Pulmonary tissue was then fixed and the pulmonary embolism and the associated pathological changes were observed.Results The pulmonary radioactivity in vivo was measured at 60,120,and 180 minutes after bone cement perfusion.The radioactivities of the four groups were 11.67±2.16,14.59±2.92 and 18.43±4.83 in group Ⅰ; 8.37±3.05,10.35±2.24 and 11.48±2.96 in group Ⅱ; 3.91±1.19,5.53±2

  5. Detection of pulmonary embolism by dual energy CT: correlation with perfusion scintigraphy and histopathological findings in rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Long-Jiang; Zhao, Yan-E; Hu, Xiao-Bo; Lu, Guang-Ming [Nanjing University, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing, Jiangsu Province (China); Chai, Xue [Nanjing University, Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing, Jiangsu Province (China); Nanjing Brain Hospital Affiliated to Nanjing Medical University, Department of Radiology, Nanjing (China); Wu, Sheng-Yong [Medical Imaging Institute of Tianjin, Tianjin (China); Hu, Yu-Xiao; Xue, Yang-Bo; Yang, Gui-Fen; Zhu, Hong [Nanjing University, Department of Nuclear Medicine, Jinling Hospital, Clinical School of Medical College, Nanjing, Jiangsu (China)

    2009-12-15

    The purpose of the study was to compare the ability of dual energy CT (DECT) and perfusion scintigraphy (PS) to detect pulmonary embolism (PE) in a rabbit model. Gelfoam (n = 20) or saline (n = 4) was injected into the femoral vein of rabbits. After 2 h, DECT pulmonary angiography (CTPA) was used to create blood flow imaging (BFI) and fusion images. The rabbits then underwent PS. Pathological determination of locations and numbers of lung lobes with PE was recorded. The sensitivity and specificity for BFI, CTPA, fused images and PS were calculated using the pathological results as reference standards. Compared with pathological evaluation, CTPA correctly identified PE in 40 lobes and absence of emboli in 80 lobes, corresponding to a sensitivity and specificity of 100%. BFI and fused images correctly identified PE in 40 lobes and the absence of emboli in 78 lobes, corresponding to a sensitivity and specificity of 100% and 98%, respectively. PS correctly detected 27 lobes with PE and 65 lobes without PE, corresponding to a sensitivity and specificity of 68% and 81%, respectively. BFI, CTPA and fused images derived from a single contrast-enhanced DECT provide a higher diagnostic accuracy of detecting PE than PS in a rabbit model. (orig.)

  6. Thrombolytic treatment given at the and of the first week of stroke due to pulmonary embolism in a patient with middlee cerebral artery infarction

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2014-08-01

    Full Text Available Thrombolytic treatment is the most effective and commonly used method into firs 4,5 hours of acute ischemic stroke and massive pulmonary embolism. It is known that thrombolytic treatment is definitely contraindicated in cases who had an ischemic stroke into last three months. In this paper, it was reported that thrombolytic treatment had given for pulmonary embolism which developed one week after stroke in a case with stroke due to middle cerebral artery occlusion. Here, we presented a case which is rarely seen and required difficulty in deciding.

  7. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS).

    Science.gov (United States)

    Diener, Hans-Christoph; Easton, J Donald; Granger, Christopher B; Cronin, Lisa; Duffy, Christine; Cotton, Daniel; Brueckmann, Martina; Sacco, Ralph L

    2015-12-01

    Cryptogenic ischemic strokes constitute 20-30% of ischemic strokes, the majority of which are embolic strokes of undetermined source. The standard preventive treatment in these patients is usually acetylsalicylic acid. The Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS) is designed to determine whether the oral thrombin inhibitor dabigatran, taken within three-months after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of recurrent stroke and to characterize the safety of dabigatran in this setting. Prospective, randomized, double-blind, multicenter trial in approximately 6000 patients and 550 centers with embolic stroke of undetermined source. Subjects are randomized to dabigatran or acetylsalicylic acid and treated for an expected minimum of six-months and up to approximately three-years. It is an event-driven trial aiming for 353 adjudicated primary outcome events. The primary efficacy outcome is time to first recurrent stroke (ischemic, hemorrhagic, or unspecified). Key secondary outcomes are time to first ischemic stroke and time to first occurrence in the composite outcome of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death. The primary safety outcome is major hemorrhage, including symptomatic intracranial hemorrhage. Acetylsalicylic acid is the most common antithrombotic given to patients with embolic strokes of undetermined source to reduce recurrence risk. This trial will determine whether anticoagulation with dabigatran is more effective than acetylsalicylic acid, and acceptably safe. © 2015 World Stroke Organization.

  8. A Case Report of Stroke in a Woman with Paradoxical Embolism Associated with Ebstein's Anomaly

    Directory of Open Access Journals (Sweden)

    M. Mazdeh

    2014-04-01

    Full Text Available Introduction: Ebstein's anomaly (EA is a rare congenital malformation of the tricuspid valve, often associated with PFO, which is present in 80-90% of patients & predisposes to para-doxical embolization. Case Report: The case described was a 30 year old female, in the post partum phase, (ten days after normal vaginal delivery who was presented to the emergency department with seizure & Rt sided hemiplegia & aphasia. On brain computed tomography scan there was large in-farct of Lt sided hemisphere in fronto temporopartial, and her brain MRI subsequently con-firmed the infarct. Laboratory tests including coagulation study & infectious tests were nor-mal. But electrocardiogram showed AG block grade I. Trans thoracic and Trans esophageal echocardiography revealed Ebstein's anomaly. Dynamic cardiac MRI showed severe tricus-pid regurgitation due to sown ward displacement of tricuspid valve to apical heart associated with patent foramen oral & ASD (Ejection fraction of right chamber was normal and no evi-dence of clot. Conclusion: After ruling out the other diagnoses, paradoxical emboli was considered as the cause leading to the stroke in this case. (Sci J Hamadan Univ Med Sci 2014; 21 (1:72-75

  9. Surgical Management of Infective Endocarditis Complicated by Embolic Stroke: Practical Recommendations for Clinicians.

    Science.gov (United States)

    Yanagawa, Bobby; Pettersson, Gosta B; Habib, Gilbert; Ruel, Marc; Saposnik, Gustavo; Latter, David A; Verma, Subodh

    2016-10-25

    There has been an overall improvement in surgical mortality for patients with infective endocarditis (IE), presumably because of improved diagnosis and management, centered around a more aggressive early surgical approach. Surgery is currently performed in approximately half of all cases of IE. Improved survival in surgery-treated patients is correlated with a reduction in heart failure and the prevention of embolic sequelae. It is reported that between 20% and 40% of patients with IE present with stroke or other neurological conditions. It is for these IE patients that the timing of surgical intervention remains a point of considerable discussion and debate. Despite evidence of improved survival in IE patients with earlier surgical treatment, a significant proportion of patients with IE and preexisting neurological complications either undergo delayed surgery or do not have surgery at all, even when surgery is indicated and guideline endorsed. Physicians and surgeons are caught in a common conundrum where the urgency of the heart operation must be balanced against the real or perceived risks of neurological exacerbation. Recent data suggest that the risk of neurological exacerbation may be lower than previously believed. Current guidelines reflect a shift toward early surgery for such patients, but there continue to be important areas of clinical equipoise. Individualized clinical assessment is of major importance for decision making, and, as such, we emphasize the need for the functioning of an endocarditis team, including cardiac surgeons, cardiologists, infectious diseases specialists, neurologists, neurosurgeons, and interventional neuroradiologists. Here, we present 2 illustrative cases, critically review contemporary data, and offer conceptual and practical suggestions for clinicians to address this important, common, and often fatal cardiac condition. © 2016 American Heart Association, Inc.

  10. Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source.

    Science.gov (United States)

    Sebasigari, Denise; Merkler, Alexander; Guo, Yang; Gialdini, Gino; Kummer, Benjamin; Hemendinger, Morgan; Song, Christopher; Chu, Antony; Cutting, Shawna; Silver, Brian; Elkind, Mitchell S V; Kamel, Hooman; Furie, Karen L; Yaghi, Shadi

    2017-06-01

    Biomarkers of atrial dysfunction or "cardiopathy" are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015. We reviewed medical records for clinical, radiographic, and cardiac variables. The primary outcome was a new diagnosis of AF detected during heart-rhythm monitoring. The primary predictors were atrial biomarkers: left atrial diameter on echocardiography, P-wave terminal force in electrocardiogram (ECG) lead V1, and P wave - R wave (PR) interval on ECG. A multiple logistic regression model was used to assess the relationship between atrial biomarkers and AF detection. Among 196 eligible patients, 23 (11.7%) were diagnosed with AF. In unadjusted analyses, patients with AF were older (72.4 years versus 61.4 years, P < .001) and had larger left atrial diameter (39.2 mm versus 35.7 mm, P = .03). In a multivariable model, the only predictor of AF was age ≥ 60 years (odds ratio, 3.0; 95% CI, 1.06-8.5; P = .04). Atrial biomarkers were weakly associated with AF after ESUS. This suggests that previously reported associations between these markers and stroke may reflect independent cardiac pathways leading to stroke. Prospective studies are needed to investigate these mechanisms. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Posterior Circulation Stroke After Bronchial Artery Embolization. A Rare but Serious Complication

    Energy Technology Data Exchange (ETDEWEB)

    Laborda, Alicia [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Tejero, Carlos [Hospital Clinico Universitario Lozano Blesa, Servicio de Neurologia (Spain); Fredes, Arturo, E-mail: fredesarturo@gmail.com [Universidad de Zaragoza, Hospital Quiron, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain); Cebrian, Luis; Guelbenzu, Santiago; Gregorio, Miguel Angel de, E-mail: mgregori@unizar.es [Universidad de Zaragoza, Departamento de Pediatria, Radiologia y Medicina Fisica, Grupo de Investigacion en Tecnicas Minimamente Invasivas, GITMI (Spain)

    2013-06-15

    Bronchial artery embolization (BAE) is the treatment of choice for massive hemoptysis with rare complications that generally are mild and transient. There are few references in the medical literature with acute cerebral embolization as a complication of BAE. We report a case of intracranial posterior territory infarctions as a complication BAE in a patient with hemoptysis due to bronchiectasis.

  12. High risk of pulmonary embolism and deep venous thrombosis but not of stroke in granulomatosis with polyangiitis (Wegener's)

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Obel, Niels; Baslund, Bo

    2014-01-01

    OBJECTIVE: To assess the incidence of stroke, pulmonary embolism (PE), and deep venous thrombosis (DVT) in granulomatosis with polyangiitis (Wegener's) (GPA). METHODS: Patients diagnosed with GPA at a Danish tertiary care center during 1993-2011 were identified (n = 180). Each patient was matched...... with 19 population controls (n = 3,420). Information on hospitalizations for stroke, PE, and DVT was obtained from the Danish National Hospital Register. The occurrence of vascular events in the GPA cohort was compared with that in the control group by calculation of incidence rate ratios (IRRs). RESULTS......: The median duration of followup was 7.2 years (interquartile range 3.1-11.7 years) in the GPA cohort. Within the first 2 years following the diagnosis of vasculitis, the incidences of PE and DVT were substantially increased among the patients (IRR 25.7 [95% confidence interval (95% CI) 6.9-96] for PE and IRR...

  13. Wake-up stroke and TIA due to paradoxical embolism during long obstructive sleep apnoeas: a cross-sectional study.

    Science.gov (United States)

    Ciccone, Alfonso; Proserpio, Paola; Roccatagliata, Daria Valeria; Nichelatti, Michele; Gigli, Gian Luigi; Parati, Gianfranco; Lombardi, Carolina; Pizza, Fabio; Cirignotta, Fabio; Santilli, Ignazio Michele; Silani, Vincenzo; Sterzi, Roberto; Nobili, Lino

    2013-01-01

    Long obstructive sleep apnoeas (LOSAs) can cause brain ischaemia through paradoxical embolism since they can lead to right to left shunting (RLSh) but this has never been assessed as a risk factor for stroke. We investigated whether the combination of LOSA and RLSh is associated with ischaemic stroke or transient ischaemic attack (TIA) on waking (wake-up stroke). We prospectively considered patients aged over 18 years, admitted to 13 stroke units for acute ischaemic stroke or TIA. Patients had to be able to give consent, to specify whether the event occurred on waking, and to cooperate sufficiently to undergo contrast transcranial Doppler examination and cardiorespiratory sleep study within 10 days of the onset of symptoms. Single LOSA events, lasting 20 s or more, were considered a possible harbinger of RLSh. Between April 2008 and March 2010, 335 patients (109 women; 61 TIA, mean age 64 years) were enrolled; 202 (60%) had at least one LOSA and 116 (35%) a RLSh; 69 (21%) had both. There were significantly more wake-up strokes/TIAs in subjects with RLSh plus LOSA than those without this association (27/69 vs 70/266; OR 1.91, controlled for age, sex, hypertension, diabetes, atrial fibrillation, antithrombotic therapy; 95% CI 1.08 to 3.38; p=0.03). No other risk factor was associated with an increase in the incidence of events on waking. The study suggests that the combination of LOSA and RLSh could be a new major, potentially treatable risk factor for cerebrovascular ischaemic events.

  14. Increased Visceral Adipose Tissue as a Potential Risk Factor in Patients with Embolic Stroke of Undetermined Source (ESUS)

    Science.gov (United States)

    Muuronen, Antti T.; Taina, Mikko; Hedman, Marja; Marttila, Jarkko; Kuusisto, Johanna; Onatsu, Juha; Vanninen, Ritva; Jäkälä, Pekka; Sipola, Petri; Mustonen, Pirjo

    2015-01-01

    Purpose The etiology of an ischemic stroke remains undetermined in 20–35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT) is a suggested new risk factor for both carotid artery atherosclerosis (CAA) and atrial fibrillation (AF), but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS) after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke. Methods Altogether 58 patients (mean age 57.7±10.2 years, 44 men) with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol) were also registered. Results Mean VAT area was significantly higher in stroke patients (205±103 cm2 for men and 168±99 cm2 for women) compared to all reference populations (P<0.01). 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI). Increased VAT was more common than any of the conventional risk factors. Conclusion Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients. PMID:25756793

  15. Increased visceral adipose tissue as a potential risk factor in patients with embolic stroke of undetermined source (ESUS.

    Directory of Open Access Journals (Sweden)

    Antti T Muuronen

    Full Text Available The etiology of an ischemic stroke remains undetermined in 20-35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT is a suggested new risk factor for both carotid artery atherosclerosis (CAA and atrial fibrillation (AF, but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke.Altogether 58 patients (mean age 57.7 ± 10.2 years, 44 men with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol were also registered.Mean VAT area was significantly higher in stroke patients (205 ± 103 cm2 for men and 168 ± 99 cm2 for women compared to all reference populations (P < 0.01. 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI. Increased VAT was more common than any of the conventional risk factors.Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.

  16. A modified rabbit model of stroke: evaluation using clinical MRI scanner.

    Science.gov (United States)

    Yang, Ji-Ping; Liu, Huai-Jun; Liu, Rui-Chun

    2009-12-01

    Occluding the middle cerebral artery of small animals with an intraluminal filament to build a stroke model has gained increasing acceptance. In light of the growing demand for magnetic resonance imaging (MRI) studies using the clinical MRI scanner, large animal models can be superior to small animal models. In this work, we developed a modified rabbit model of stroke, which was assessed using clinical MRI scanner and compared with a most commonly silicone-coated filament model. We presented a focal cerebral ischemia in rabbits. The key feature of this modified method is the use of a guide wire as a 'nylon suture'. At 3 days after ischemia, the percentage of brain infarct volume, neurobehavioral score, intracranial hemorrhagic incidence and dynamic changes of T(2) and apparent diffusion coefficient values were assessed respectively and compared between the focal cerebral models. Wire-induced models had more severe brain infarct size with less dispersion (32.7 +/- 6.5%, coefficient of variation=0.20) than that with filament models (25.4 +/- 8.9%, coefficient of variation=0.31; pwire, 20/20; filament, 17/20) and less intracranial hemorrhage (wire, 0/20; filament, 3/20) in wire-induced models than in filament-induced rabbits (pwire-induced method can provide a useful tool for the earlier research of ischemia.

  17. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study

    Science.gov (United States)

    Dalichampt, Marie; Raguideau, Fanny; Ricordeau, Philippe; Blotière, Pierre-Olivier; Rudant, Jérémie; Alla, François; Zureik, Mahmoud

    2016-01-01

    Objective To assess the risk of pulmonary embolism, ischaemic stroke, and myocardial infarction associated with combined oral contraceptives according to dose of oestrogen (ethinylestradiol) and progestogen. Design Observational cohort study. Setting Data from the French national health insurance database linked with data from the French national hospital discharge database. Participants 4 945 088 women aged 15-49 years, living in France, with at least one reimbursement for oral contraceptives and no previous hospital admission for cancer, pulmonary embolism, ischaemic stroke, or myocardial infarction, between July 2010 and September 2012. Main outcome measures Relative and absolute risks of first pulmonary embolism, ischaemic stroke, and myocardial infarction. Results The cohort generated 5 443 916 women years of oral contraceptive use, and 3253 events were observed: 1800 pulmonary embolisms (33 per 100 000 women years), 1046 ischaemic strokes (19 per 100 000 women years), and 407 myocardial infarctions (7 per 100 000 women years). After adjustment for progestogen and risk factors, the relative risks for women using low dose oestrogen (20 µg v 30-40 µg) were 0.75 (95% confidence interval 0.67 to 0.85) for pulmonary embolism, 0.82 (0.70 to 0.96) for ischaemic stroke, and 0.56 (0.39 to 0.79) for myocardial infarction. After adjustment for oestrogen dose and risk factors, desogestrel and gestodene were associated with statistically significantly higher relative risks for pulmonary embolism (2.16, 1.93 to 2.41 and 1.63, 1.34 to 1.97, respectively) compared with levonorgestrel. Levonorgestrel combined with 20 µg oestrogen was associated with a statistically significantly lower risk than levonorgestrel with 30-40 µg oestrogen for each of the three serious adverse events. Conclusions For the same dose of oestrogen, desogestrel and gestodene were associated with statistically significantly higher risks of pulmonary embolism but not arterial

  18. Incidence of cardioembolic stroke including paradoxical brain embolism in patients with acute ischemic stroke before and after the Great East Japan Earthquake.

    Science.gov (United States)

    Itabashi, Ryo; Furui, Eisuke; Sato, Shoichiro; Yazawa, Yukako; Kawata, Kenta; Mori, Etsuro

    2014-01-01

    The incidence of heart disease or deep vein thrombosis (DVT) reportedly increased after the Great East Japan Earthquake. We hypothesized that the incidence of cardioembolic stroke (CES) including paradoxical brain embolism (PBE) among patients with acute stroke would increase after the earthquake due to cessation of antithrombotic therapy or the increase in heart disease and DVT associated with the evacuation. The aim of this study is to evaluate the changes in the prevalence of DVT and the incidence of CES including PBE in acute ischemic stroke before and after the earthquake. We retrospectively studied 1,044 consecutive ischemic stroke patients (73.1 ± 12.5 years old, male 61.5%) who were admitted to a comprehensive stroke center (from January 2010 through March 2012) located in the earthquake disaster area within 7 days after stroke onset. The prevalence of DVT and the incidence of CES including PBE were compared before and after the earthquake of 11 March 2011. The median of the initial National Institutes of Health Stroke Scale (NIHSS) scores was 4 (interquartile range: 1-8). Two hundred and eighty-two patients (27.0% of those surveyed) were diagnosed with CES. After adjustment for sex, age, NIHSS score, and patient's residential address, the proportion of CES patients was significantly increased after the earthquake (odds ratio, OR 1.61, 95% confidence interval, 95% CI: 1.20-2.17). Eighty-nine patients (8.5% of those surveyed) had DVT. Compared with 2010 findings, the prevalence of DVT was significantly increased in the fourth quarter of 2011 and the first quarter of 2012 (OR 1.85, 95% CI: 1.05-3.24). Nineteen (1.8% of those surveyed) were diagnosed with PBE. The proportion of PBE patients was also significantly increased in the second half of 2011 (OR 3.69, 95% CI: 1.28-12.1). The incidence of CES was significantly increased after the earthquake, compared with the period before the earthquake. We encountered more PBE in the period from 3 to 9 months after

  19. The effects of early insulin treatment combined with thrombolysis in rat embolic stroke

    DEFF Research Database (Denmark)

    Meden, Per; Andersen, Martin; Overgaard, Karsten

    2002-01-01

    in % of the affected hemisphere. Mortality was calculated as the number of animals dying spontaneously before the scheduled euthanasia. The median infarct volume in control animals (n = 12) was 24%. Insulin (3 IU kg(-1)) was given subcutaneously 15 min, 3 h, and 24 h after embolization (n = 12) and reduced median...

  20. The effects of early insulin treatment combined with thrombolysis in rat embolic stroke

    DEFF Research Database (Denmark)

    Meden, Per; Andersen, Martin; Overgaard, Karsten

    2002-01-01

    in % of the affected hemisphere. Mortality was calculated as the number of animals dying spontaneously before the scheduled euthanasia. The median infarct volume in control animals (n = 12) was 24%. Insulin (3 IU kg(-1)) was given subcutaneously 15 min, 3 h, and 24 h after embolization (n = 12) and reduced median...

  1. Dabigatran for the prevention of stroke and systemic embolism in atrial fibrillation: A NICE single technology appraisal.

    Science.gov (United States)

    Faria, Rita; Spackman, Eldon; Burch, Jane; Corbacho, Belen; Todd, Derick; Pepper, Chris; Woolacott, Nerys; Palmer, Stephen

    2013-07-01

    The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of dabigatran etexilate (Boehringer Ingelheim Ltd, UK) to submit evidence for the clinical and cost-effectiveness of this drug for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) as part of the NICE single technology appraisal process. The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the evidence review group (ERG). This article presents a summary of the manufacturer's submission, the ERG report and the subsequent development of NICE guidance for the use of dabigatran within the UK National Health Service. Dabigatran was granted marketing authorisation by the European Medicines Agency for a sequential dosing regimen (DBG sequential), in which patients under 80 years are treated with dabigatran 150 mg twice daily (DBG150) and patients 80 years and over are given dabigatran 110 mg twice daily (DBG110). NICE decisions are bound by the marketing authorisation; therefore, the decision problem faced by the committee was whether the DBG sequential regimen was effective and cost-effective compared with warfarin or aspirin for patients with non-valvular AF and one or more risk factors. The RE-LY trial, a large multi-centre non-inferiority randomised clinical trial, was the primary source of clinical evidence. DBG150 was shown to be non-inferior, and subsequently superior to warfarin, for the primary outcome of all stroke/systemic embolism. DBG110 was found to be non-inferior to warfarin. Results were presented for a post hoc subgroup analysis for patients under and over 80 years of age, where DBG110 showed a statistically significant reduction of haemorrhagic stroke and intracranial haemorrhage in comparison to warfarin in patients over 80 years of age. This post hoc subgroup analysis by age was the basis for the licensed DBG sequential regimen

  2. Embolic stroke secondary to spontaneous thrombosis of unruptured intracranial aneurysm: Report of three cases.

    Science.gov (United States)

    Arauz, Antonio; Patiño-Rodríguez, Hernán M; Chavarría-Medina, Mónica; Becerril, Mayra; Merino, José G; Zenteno, Marco

    2016-04-01

    Intracranial aneurysms uncommonly present with ischemic stroke. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients are absent. We present the clinical outcome and radiological characteristics of three patients with spontaneous thrombosis of intracranial aneurysms as a cause of ischemic stroke. This information is relevant given the possible benign history in terms of stroke recurrence and risk of bleeding.

  3. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  4. Treatment of embolic stroke as a medical emergency. Implications in a managed care environment.

    Science.gov (United States)

    Lanzieri, C F

    1997-04-01

    Encouraging innovations should be a concern of the providers/gatekeepers of health-care if lower health-care costs are to become a reality. Controlled prices and improper incentives will dramatically slow innovation in American medicine. For the vertically integrated health-care system providing capitated coverage, the aggressive treatment of stroke is a sound financial decision.

  5. [Embolic stroke by thrombotic non bacterial endocarditis in an Antiphospholipid Syndrome patient].

    Science.gov (United States)

    Graña, D; Ponce, C; Goñi, M; Danza, A

    2016-01-01

    The antiphospholipid syndrome (APS) is an acquired thrombophilia, considered a systemic autoimmune disorder. We report a patient with APS who presented multiple cerebral infarcts (stroke) as a complication of a thrombotic non bacterial endocarditis. We review the literature focused on the physiological mechanism that produce this disease and its complications. Clinical features and their prognostic value and the different therapeutic options were also studied.

  6. Extract of Antrodia camphorata Exerts Neuroprotection against Embolic Stroke in Rats without Causing the Risk of Hemorrhagic Incidence

    Directory of Open Access Journals (Sweden)

    Ye-Ming Lee

    2014-01-01

    Full Text Available In this study, the neuroprotective effect of an extract of Antrodia camphorata (A. camphorata, a fungus commonly used in Chinese folk medicine for treatment of viral hepatitis and cancer, alone or in combination with aspirin was investigated in a rat embolic stroke model. An ischemic stroke was induced in rats by a selective occlusion of the middle cerebral artery (MCA with whole blood clots and then orally treated with A. camphorata (0.25 and 0.75 g/kg/day alone and combined with aspirin (5 mg/kg/day. Sixty days later, the brains were removed, sectioned, and stained with triphenyltetrazolium chloride and analysed by a commercial image processing software program. Brain infarct volume, neurobehavioral score, cerebral blood perfusion, and subarachnoid and intracerebral hemorrhage incidence were perceived. In addition, potential bleeding side effect of the combinative therapy was assessed by measuring hemoglobin (Hb content during intracerebral hemorrhage and gastric bleeding, prothrombin time (PT, and occlusion time (OT after oral administration. Posttreatment with high dose A. camphorata significantly reduced infarct volume and improved neurobehavioral score (P < 0.05. Since A. camphorata alone or with aspirin did not alter the Hb level, this treatment is safe and does not cause hemorrhagic incident. Remarkably, the combination of A. camphorata and aspirin did not show a significant effect on the bleeding time, PT and OT increase suggesting that A. camphorata may have the neuroprotective effect without the prolongation of bleeding time or coagulation time. From these observations, we suggest that combinative therapy of A. camphorata and aspirin might offer enhanced neuroprotective efficacies without increasing side effects.

  7. Fat embolism in liposuction and intramuscular grafts in rabbits Embolia gordurosa na lipoaspiração e enxertia intramuscular em coelhos

    Directory of Open Access Journals (Sweden)

    Victor Araujo Felzemburgh

    2012-05-01

    Full Text Available PURPOSE: To evaluate the effects of fat embolism in organs such as lung and liver. METHODS: Twenty rabbits underwent autologous intramuscular fat grafting in the right thigh after liposuction. The groups were determined according to the postoperative day that occurred in euthanasia: 60, 90 and 120 day. Then, lung and liver were excised and sent to the histopathology laboratory for analysis in search of late injury secondary to a prior event of fat embolism in the tissues. RESULTS: The results showed a change in the macroscopic sample with discoloration of the liver tissue heterogeneously. There were no changes consistent with embolic effect under the microscope. CONCLUSION: The option of performing a technique of fat grafting with a less traumatic surgical procedure can be considered protective against embolic events, with no impact to late embolic events on the tissues.OBJETIVO: Avaliar a repercussão da embolia gordurosa em órgãos como pulmão e fígado. MÉTODOS: Vinte coelhos foram submetidos à enxertia autóloga intramuscular de gordura em coxa direita após lipoaspiração. Os grupos foram determinados conforme os dias pós-operatórios (DPO em que ocorreu a eutanásia: 60 DPO, 90DPO, 120 DPO. Em seguida, o pulmão e o fígado foram ressecados e encaminhados ao laboratório de histopatologia para análise em busca de lesão tardia secundária a evento de embolia gordurosa prévia nos tecidos. RESULTADOS: Foi evidenciada uma alteração na amostra a analise macroscópica com alteração da coloração do tecido hepático de forma heterogênea. Não houve alterações compatíveis com repercussão de processo embólico à microscopia. CONCLUSÃO: A opção pela realização de uma técnica de lipoenxertia menos traumática e com pequeno tempo cirúrgico pode ser considerada protetora para eventos embólicos, não havendo repercussão embólica a tardiamente.

  8. microRNAs Involved in Regulating Spontaneous Recovery in Embolic Stroke Model.

    Directory of Open Access Journals (Sweden)

    Fu Jia Liu

    Full Text Available To date, miRNA expression studies on cerebral ischemia in both human and animal models have focused mainly on acute phase of ischemic stroke. In this study, we present the roles played by microRNAs in the spontaneous recovery phases in cerebral ischemia using rodent stroke models. Brain tissues were harvested at different reperfusion time points ranging from 0-168 hrs after middle cerebral artery occlusion using homologous emboli. MiRNA and mRNA expression profiles were investigated by microarray followed by multiple statistical analysis. Candidate transcripts were also validated by quantitative RT-PCR. Three specific groups of miRNAs were observed among a total of 346 differentially expressed miRNAs. miRNAs, miR-21, -142-3p, -142-5p, and -146a displayed significant upregulation during stroke recovery (48 hrs to 168 hrs compared with those during acute phases (0 hrs to 24 hrs. On the other hand, an opposite trend was observed in the expression of miR-196a/b/c, -224 and -324-3p. Interestingly, miR-206, -290, -291a-5p and -30c-1*, positively correlated with the infarct sizes, with an initial increase up to 24hrs followed by a gradual decrease from 48 hrs to 168 hrs (R = 0.95. Taken together with the expression levels of corresponding mRNA targets, we have also found that Hedgehog, Notch, Wnt and TGF-β signaling pathways could play significant roles in stroke recovery and especially in neuronal repair.

  9. Transcatheter arterial embolization combined with radiofrequency ablation activates CD8+ T-cell infiltration surrounding residual tumors in the rabbit VX2 liver tumors

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    Duan XH

    2016-05-01

    Full Text Available Xu-Hua Duan,1,2 Teng-Fei Li,2 Guo-Feng Zhou,1,* Xin-Wei Han,2,* Chuan-Sheng Zheng,1 Peng-fei Chen,2 Gan-Sheng Feng11Department of Interventional Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 2Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Henan Province, Zhengzhou, People’s Republic of China*These authors contributed equally to this work Purpose: To evaluate the effect of transcatheter arterial embolization (TAE combined with radiofrequency ablation (RFA treatment (TAE + RFA on the expression of heat shock protein 70 (HSP70 in residual tumors and explore the relationship between the HSP70 and CD8+ T-cell infiltrate surrounding residual tumors in the rabbit VX2 liver tumor model.Materials and methods: Animals with VX2 liver tumors were randomized into four groups (control, TAE, RFA, and TAE + RFA with 15 rabbits in each group. Five rabbits in each group were sacrificed on days 1, 3, and 7 after treatment. HSP70 expression and infiltration of CD8+ T-cells in the liver and residual tumors surrounding the necrosis zone were detected by immunohistochemistry staining. The maximal diameters of tumor necrosis, numbers of metastases, and tumor growth rate were compared on day 7 after treatment.Results: TAE + RFA achieved larger maximal diameter of tumor necrosis, lower tumor growth rate, and fewer metastatic lesions, compared with other treatments on day 7. The number of CD8+ T-cells in the TAE + RFA group was significantly higher than in other groups on days 1, 3, and 7. There was a positive correlation between HSP70 expression level and infiltration of CD8+ T-cells surrounding the residual tumor on day 1 (r=0.9782, P=0.012, day 3 (r=0.93, P=0.021, and day 7 (r=0.8934, P=0.034.Conclusion: In the rabbit VX2 liver tumor model, TAE + RFA activated the highest number of CD8+ T-cells surrounding residual tumors. TAE + RFA appears to be a beneficial

  10. HEMODYNAMIC INSIGNIFICANT CAROTID ARTERIES STENOSIS AND RISK OF EMBOLIC STROKE IN PATIENTS WITH ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    V. V. Semenova

    2009-01-01

    Full Text Available Aim. To assess a risk of vascular embolism in patients with ischemic heart disease (IHD and hemodynamic insignificant asymptomatic carotid stenosis.Material and methods. 100 patients with IHD were examined. Ultrasound scanning of the main cranial arteries and transcranial Dopplerography was performed in all patients as well as lipid spectrum, fibrinogen level and blood D-diameter concentration were evaluated.Results. 165 carotid atherosclerotic plaques (AP were detected in patients with IHD independently on angina severity. In IHD patients with nonhomogeneous hypoechogenic AP microembolic signals (MES were revealed in 44,78%, with nonhomogeneous hyperechogenic AP - in 25%, with homogeneous hypoechogenic AP - in 4,16% of patients. MES were not recorded in patients with homogeneous hyperechogenic AP. There were not relations between MES and parameters of lipid spectrum as well as fibrinogen and Ddiameter plasma levels.Conclusion. Thus, during transcranial dopplerographic monitoring MES were recorded in the third part (27,9% of IHD patients with hemodynamically insignificant carotid arteries stenosis. MES were predominantly observed in patients with nonhomogeneous AP especially with hypoechogenic components.

  11. Rivaroxaban in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: Clinical Implications of the ROCKET AF Trial and Its Subanalyses.

    Science.gov (United States)

    Spencer, Ryan J; Amerena, John V

    2015-12-01

    Atrial fibrillation (AF) is an increasingly common cause of stroke and systemic embolism. While warfarin has been the mainstay of stroke prevention in patients with AF, newer novel oral anticoagulant medications are now available. Rivaroxaban, a direct factor Xa inhibitor with a rapid onset and offset after oral administration, offers potential advantages over warfarin, predominantly due to its predictable pharmacokinetics across wide patient populations. It requires no coagulation monitoring, and only two different doses are needed (20 mg daily for patients with normal renal function and 15 mg daily in those with reduced renal function). A large randomized trial (ROCKET AF) has shown non-inferiority to warfarin for preventing stroke or systemic embolism in the per-protocol population and superiority to warfarin in the on-treatment safety population. Several subanalyses confirm that the treatment effect of rivaroxaban is consistent across different patient subgroups, including those with reduced renal function. The tolerability of rivaroxaban appears similar to that of warfarin, with comparable overall bleeding rates in clinical trials. In ROCKET AF, significantly lower rates of fatal and intracranial bleeding were seen with rivaroxaban, while lower rates of gastrointestinal bleeding were seen with warfarin. Important contraindications to rivaroxaban include valvular AF, the presence of a prosthetic valve (mechanical or bioprosthetic) or valve repair, the need for concurrent dual antiplatelet therapy, and creatinine clearance <30 ml/min. Once-daily dosing and the lack of coagulation monitoring may increase utilization and adherence compared with warfarin, potentially decreasing the large burden of care associated with stroke secondary to AF. Overall, rivaroxaban offers a useful alternative to warfarin for stroke prevention in patients with AF.

  12. D-amphetamine improves cognitive deficits and physical therapy promotes fine motor rehabilitation in a rat embolic stroke model

    DEFF Research Database (Denmark)

    Rasmussen, Rune Skovgaard; Overgaard, K; Hildebrandt-Eriksen, E S

    2006-01-01

    regarding gross motor performance. CONCLUSIONS: After embolization, physical therapy improved fine motor performance and D-amph accelerated rehabilitation of cognitive performance as observed in the rats of the THERAPY and D-AMPH groups. As a result of the administration of a high dose of D-amph, the rats......BACKGROUND AND PURPOSE: The purpose of this study was to examine the effects of D-amphetamine (D-amph) and physical therapy separately or combined on fine motor performance, gross motor performance and cognition after middle cerebral artery thromboembolization in rats. METHODS: Seventy-four rats...... were trained in appropriate cognitive and motor behaviours. Thirteen animals were sham-operated and fifty-nine animals were embolized in the right carotid territory. Animals were randomly assigned to five groups: 1) SHAM (non-embolized, saline), 2) CONTROL (embolized, saline), 3) D-AMPH (embolized, D...

  13. Effect of hepatic artery embolization on liver hypertrophy response in a rabbit liver VX2 tumor model

    Institute of Scientific and Technical Information of China (English)

    Krijn P van Lienden; Lisette T Hoekstra; Jessica D van Trigt; Joris J Roelofs

    2013-01-01

    BACKGROUND: Portal  vein  embolization  not  only  induces hypertrophy  of  the  non-embolized  liver,  but  also  enhances tumor growth. The latter could be prevented by embolizing the hepatic  arteries  supplying  the  tumor-bearing  liver  segments. This  study  aimed  to  determine  the  effects  of  transcatheter arterial  embolization  (TAE)  on  tumor  volume  and  liver regeneration in a rabbit VX2 tumor model. METHODS: Twenty-three  rabbits  underwent  subcapsular tumor  implantation  with  a  VX2  tumor.  Two  weeks  after implantation,  18  rabbits  were  used  for  TAE  experiments,  5 were for sham controls. Tumor response and liver regeneration response of the  embolized  cranial  and  non-embolized caudal liver lobes were assessed by CT volumetry, liver to body weight index, and the amount of proliferating hepatocytes. RESULTS: All  super-selective  arterial  tumor  embolization procedures were performed successfully. Despite embolization, the  tumor  volume  increased  after  an  initial  steady  state.  The tumor volume after embolization was smaller than that of the sham  group,  but  this  difference  was  not  significant.  Massive necrosis  of  the  tumor,  however,  was  seen  after  embolization, without  damage  of  the  surrounding  liver  parenchyma.  There was a significant atrophy response of the tumor bearing cranial lobe  after  super-selective  arterial  embolization  of  the  tumor with a concomitant hypertrophy response of the non-embolized, caudal  lobe.  This  regeneration  response  was  confirmed histologically by a

  14. The Risk of Paradoxical Embolism (RoPE Study: Developing risk models for application to ongoing randomized trials of percutaneous patent foramen ovale closure for cryptogenic stroke

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    Thaler David E

    2011-07-01

    Full Text Available Abstract Background Despite the diffusion into practice of percutaneous closure of a patent foramen ovale (PFO in patients with cryptogenic stroke (CS, the benefits have not been demonstrated, and remain unclear. For any individual presenting with a PFO in the setting of CS, it is not clear whether the PFO is pathogenically-related to the index event or an incidental finding. Further, the overall rate of stroke recurrence is low in patients with CS and PFO. How patient-specific factors affect the likelihood that a discovered PFO is related to an index stroke or affect the risk of recurrence is not well understood. These probabilities are likely to be important determinants of the benefits of PFO closure in CS. Design/Methods The goal of the Risk of Paradoxical Embolism (RoPE Study is to develop and test a set of predictive models that can identify those patients most likely to benefit from preventive treatments for PFO-related stroke recurrence, such as PFO closure. To do this, we will construct a database of patients with CS, both with and without PFO, by combining existing cohort studies. We will use this pooled database to identify patient characteristics associated with the presence (versus the absence of a PFO, and to use this "PFO propensity" to estimate the patient-specific probability that a PFO was pathogenically related to the index stroke (Model #1. We will also develop, among patients with both a CS and a PFO, a predictive model to estimate patient-specific stroke recurrence risk based on clinical, radiographic and echocardiographic characteristics. (Model #2. We will then combine Models #1 and #2 into a composite index that can rank patients with CS and PFO by their conditional probability that their PFO was pathogenically related to the index stroke and the risk of stroke recurrence. Finally, we will apply this composite index to completed clinical trials (currently on-going testing endovascular PFO closure against medical therapy

  15. [Systematic implementation of transthoracic echocardiography, transesophageal echocardiography and 24-hour Holter ECG for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. A retrospective study of 220 patients].

    Science.gov (United States)

    Vinsonneau, U; Leblanc, A; Buchet, J-F; Pangnarind-Heintz, V; Le Gal, G; Rohel, G; Paleiron, N; Piquemal, M; Blanchard, C; Zagnoli, F; Paule, P

    2014-09-01

    Embolism of cardiac origin accounts for around 20% of ischemic strokes. ECG and transthoracic echocardiography (TTE) are commonly obtained during the evaluation of patient of ischemic stroke but specific indications for the transesophageal (TEE) echocardiography and 24-hour Holter ECG (Holter) remain uncertain. The aim of this study is to report the contribution of TTE, TEE and Holter performed as a routine during the evaluation of patients with ischemic stroke (IS) or transient ischemic attack (TIA). This is a retrospective single-center study of 220 patients hospitalized between 1st January 2007 and 31st December 2010 for a first IS or TIA. One hundred and forty-three IS and 77 TIA are identified. The average age of patients was 66 years (18-88 years). TTE/TEE/24-hour Holter allowed the diagnosis of cardiac sources of embolism in 135 patents (61.3%). TTE/TEE identified potential source of cardiogenic embolism in 126 patients (52.2%). Twenty four-hour Holter ECG tracked supraventricular arrhythmia in 15 patients (6.7%), 9 (4%) which had non-contributory ultrasound assessment. The systematic implementation of TTE/TEE/Holter is useful for identifying potential sources of cardiogenic embolism. The performance of TEE remains above the TTE. Holter should be recommended because it is a cost effective and non-invasive tool. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  16. Early administration of therapeutic anticoagulation following intravenous thrombolysis for acute cardiogenic embolic stroke caused by left ventricular thrombus: case report and topic review

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    Rick eGill

    2015-02-01

    Full Text Available Cardiogenic cerebral embolism represents 20% of all acute ischemic strokes with one third of these being caused by left ventricular thrombus (LVT. LVT is not a contraindication for treatment with intravenous recombinant tissue plasminogen activator (IV rtPA for acute ischemic stroke (AIS. However the subsequent treatment of a potentially unstable LVT is contraindicated for 24 hours following the use of IV rtPA according to current guidelines. We present a 66-year-old man with AIS treated with IV rtPA. Echocardiogram shortly after treatment demonstrated both a large apical and septal thrombus in the left ventricle and at 12 hours post IV rtPA infusion, therapeutic anticoagulation with heparin was started without complication. In practice, the action of IV rtPA outlasts its apparent half-life because of thrombin-binding and the prolonged effects and longer half-life of its product, plasmin, however the pharmacokinetics do not warrant prolonged avoidance of therapeutic anticoagulation when clinically indicated. Our case demonstrates that anticoagulation for potentially unstable LVT can be safely initiated at 12 hours following IV rtPA treatment for AIS.

  17. Design and Rationale of the RELAXED (Recurrent Embolism Lessened by rivaroxaban, an Anti-Xa agent, of Early Dosing for acute ischemic stroke and transient ischemic attack with atrial fibrillation) Study.

    Science.gov (United States)

    Yasaka, Masahiro; Minematsu, Kazuo; Toyoda, Kazunori; Yamagami, Hiroshi; Yoshimura, Shinichi; Nagao, Takehiko; Mori, Etsuro; Hirano, Teruyuki; Hamasaki, Toshimitsu; Yamaguchi, Takenori

    2016-06-01

    In the acute phase of cardioembolic stroke in patients with nonvalvular atrial fibrillation (NVAF), the recurrence rate is high. Nonvitamin K antagonist oral anticoagulants may be appropriate for prevention of early recurrence because they have a much lower risk of hemorrhagic stroke than warfarin. RELAXED (Recurrent Embolism Lessened by rivaroxaban, an Anti-Xa agent, of Early Dosing for acute ischemic stroke and transient ischemic attack with atrial fibrillation) study is an observational study designed to investigate the optimal timing to start administration of rivaroxaban for prevention of recurrence in NVAF patients in the acute phase of cardioembolic stroke (ClinicalTrials.gov: NCT02129920 and UMIN-clinical trials registry: UMIN000013932). It will evaluate the efficacy and safety of rivaroxaban with regard to infarct size, timing of initiation of rivaroxaban medication, and other patient characteristics. A total of 2000 consecutive patients with acute ischemic stroke in the territory of the middle cerebral artery and NVAF will be enrolled in 100 institutes throughout Japan, and they will receive rivaroxaban within 30 days of the index stroke for secondary prevention of stroke. The infarct size within 48 hours after stroke onset will be measured by diffusion-weighted magnetic resonance imaging. The primary efficacy endpoint is recurrent ischemic stroke, and the primary safety endpoint is major bleeding during the observational period of 3 months after stroke onset. The optimal timing to start treatment with rivaroxaban during the acute stage of ischemic stroke will be determined by analysis of the correlation between primary endpoints and the size of cerebral infarct. The RELAXED observational registry study will elucidate the optimal timing of the initiation of rivaroxaban in acute cardioembolic stroke associated with NVAF. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Stroke

    Science.gov (United States)

    ... rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke. NIH: National Institute of Neurological Disorders and Stroke

  19. Successful Left Atrial Appendage Occlusion with the New Generation Amulet® Device after Late-Occurring Embolization of an Amplatzer® Cardiac Plug in a Patient with Repetitive Strokes.

    Science.gov (United States)

    Schroeter, Marco R; Schillinger, Wolfgang

    2016-01-01

    The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA). In order to protect him from further cardioembolic events a reocclusion of the LAA with the new generation of ACP device, the Amplatzer Amulet, was performed. A stable position of the device within follow-up period could be confirmed and the patient was free of additional strokes/TIA or bleeding events. This case stresses the importance of proper LAA sizing in order to prevent device embolization and notes that LAA size is not static. Moreover, it demonstrates that repeated implantation of an LAA occlusion device was still possible; one should be aware of undersizing the LAA dimensions and that the modifications of new generation LAA occlusion devices may overcome limitations of first-generation devices in order to prevent a cardioembolic stroke.

  20. Successful Left Atrial Appendage Occlusion with the New Generation Amulet® Device after Late-Occurring Embolization of an Amplatzer® Cardiac Plug in a Patient with Repetitive Strokes

    Directory of Open Access Journals (Sweden)

    Marco R. Schroeter

    2016-01-01

    Full Text Available The Amplatzer Cardiac Plug (ACP is one of the most commonly used devices for percutaneous left atrial appendage (LAA closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA. In order to protect him from further cardioembolic events a reocclusion of the LAA with the new generation of ACP device, the Amplatzer Amulet, was performed. A stable position of the device within follow-up period could be confirmed and the patient was free of additional strokes/TIA or bleeding events. This case stresses the importance of proper LAA sizing in order to prevent device embolization and notes that LAA size is not static. Moreover, it demonstrates that repeated implantation of an LAA occlusion device was still possible; one should be aware of undersizing the LAA dimensions and that the modifications of new generation LAA occlusion devices may overcome limitations of first-generation devices in order to prevent a cardioembolic stroke.

  1. Comparison of quantitative estimation of intracerebral hemorrhage and infarct volumes after thromboembolism in an embolic stroke model

    DEFF Research Database (Denmark)

    Eriksen, Nina; Rasmussen, Rune Skovgaard; Overgaard, Karsten

    2014-01-01

    . AIMS: We evaluated different methods for estimating the volume of infarcts, hemorrhages, after embolic middle cerebral artery occlusion with or without thrombolysis. METHODS: An experimental thromboembolytic rat model was used in this study. The rats underwent surgery and were placed in two groups...... of the infarct and intracerebral hemorrhage. RESULTS: No differences were observed in the infarct volume or amount of bleeding when comparing the three methods of volume estimation. Although semiautomated computer estimation and manual erythrocyte counting provided similar results as the stereological...... measurements, the stereological method was the most efficient and advantageous. CONCLUSIONS: We found that stereology was the superior method for quantification of hemorrhagic volume, especially for rodent petechial bleeding, which is otherwise difficult to measure. Our results suggest the possibility...

  2. Interrelations between blood-brain barrier permeability and matrix metalloproteinases are differently affected by tissue plasminogen activator and hyperoxia in a rat model of embolic stroke

    Directory of Open Access Journals (Sweden)

    Michalski Dominik

    2012-01-01

    Full Text Available Abstract Background In ischemic stroke, blood-brain barrier (BBB regulations, typically involving matrix metalloproteinases (MMPs and inhibitors (TIMPs as mediators, became interesting since tissue plasminogen activator (tPA-related BBB breakdown with risk of secondary hemorrhage was considered to involve these mediators too. Despite high clinical relevance, detailed interactions are purely understood. After a pilot study addressing hyperoxia as potential neuroprotective co-treatment to tPA, we analyzed interrelations between BBB permeability (BBB-P, MMPs and TIMPs. Findings Rats underwent embolic middle cerebral artery occlusion (eMCAO and treatment with normobaric (NBO or hyperbaric oxygen (HBO, tPA, tPA+HBO, or no treatment. BBB-P was assessed by intravenously applied FITC-albumin at 4 or 24 hours. MMP-2/-9 and TIMP-1/-2 serum levels were determined at 5 or 25 hours. Time point-corrected partial correlations were used to explore interrelations of BBB-P in ischemic regions (extra-/intravasal FITC-albumin ratio and related serum markers. BBB-P correlated positively with MMP-2 and MMP-9 in controls, whereas hyperoxia led to an inverse association, most pronounced for HBO/MMP-9 (r = -0.606; P Conclusions HBO was found to reverse the positively directed interrelation of BBB-P and MMPs after eMCAO, but this effect failed to sustain in the expected amount when HBO and tPA were given simultaneously.

  3. Endocarditis and stroke.

    Science.gov (United States)

    Grecu, Nicolae; Tiu, Cristina; Terecoasa, Elena; Bajenaru, Ovidiu

    2014-12-01

    Endocarditis is an important, although less common, cause of cerebral embolism. All forms of endocarditis share an initial common pathophysiologic pathway, best illustrated by the non-bacterial thrombotic form, but also a final potential for embolization. Stroke associated with endocarditis has signifficant mortality and morbidity rates, especially due to the frequent concomitant multiple sites of brain embolization. In this article we aim to briefly review endocarditis with a focus on stroke as a complication, while also presenting case correlates from our department.

  4. Novel Pharmacotherapies for the Prevention of Stroke or Systemic Embolism in Adults with Non-valvular Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Christos Dresios

    2014-06-01

    Full Text Available Over the last decade, a paradigm shift is apparent in the eld of stroke prevention in atrial brillation (AF. For more than 6 decades, warfarin has represented the mainstay of anticoagulation therapy when used in AF patients. However, warfarin has important disadvantages, which limit its use in clinical practice. The recent emergence of novel oral anticoagulant drugs (NOACs that overcome many of limitations of warfarin has allowed the provision of e ective stroke prevention for many more patients with AF, as these drugs have a favorable e cacy–safety pro le but also certain pharmacokinetic and pharmacodynamic properties that render periodic anticoagulant monitoring and dose adjustments unnecessary. The NOACs fall into 2 broad categories, the oral direct thrombin inhibitors (dabigatran and the oral factor Xa inhibitors (rivaroxaban, apixaban.The scope of this manuscript is to review currently available data regarding NOACs and to address practical issues relating to the safe and e ective use of NOACs in clinical practice.

  5. The serpentine mitral valve and cerebral embolism

    Directory of Open Access Journals (Sweden)

    Ker James

    2011-02-01

    Full Text Available Abstract Valvular strands, well-delineated filiform masses, attached to cardiac valve edges are associated with cerebral embolism and stroke. Strokes, caused by emboli from valvular strands, tend to occur among younger persons. In this case report a valvular strand, giving a peculiar serpentine appearance to the mitral valve is described. This mitral valvular strand was the only explanation for an episode of cerebral embolism, presenting with a transient right sided hemiparesis. It is proposed that a randomized study involving combined treatment with aspirin and clopidogrel is warranted in young patients with valvular strands, presenting with a first episode of cerebral embolism.

  6. Catheter Embolization

    Science.gov (United States)

    ... Polyvinyl alcohol (PVA) and gelatin-impregnated acrylic polymer spheres, which are suspended in liquid and injected into ... function will be tested to ensure no important brain area will be affected by the embolization. Then, ...

  7. 心房颤动并发脑栓塞的严重程度与纤维蛋白原的相关性%Correlation between the severity of stroke and fibrinogen in atrial fibrillation patients with cerebral embolism

    Institute of Scientific and Technical Information of China (English)

    张浩江; 罗云; 徐运

    2012-01-01

    Objective To investigate the correlation between the severity of stroke and fibrinogen in atrial fibrillation(AF) patients with cerebral embolism. Methods Plasma fibrinogen was detected and NIHSS scores were recorded in 80 AF patients with cerebral embolism, in whom the correlation between plasma fibriogen and stroke severity of cerebral embolism was analyzied. Taking NIHSS score≥l5 as a severe cerebral embolism, the relative riskiness between NIHSS and fibrinogen was analyzed with Logistic regression analysis. In the OCSP subtype of stroke, taking Lacunar infarction as reference, the relative riskiness was analyzed among other subtypes after the patients were subtyped with OCSP. Results Plasma level of fibrinogen was closely correlated to NIHSS (r=0. 264,P<0. 05). Logistic regression analysis revealed that OR(95%CI) between severe cerebral embolism and plasma fibrinogen was 2. 404 (1.107-5. 222), which was 3.292(1.322-8.200) after adjusted by age, sex, HBP and DM(P<0. 05). Plasma level of fibrinogen in the cases with total anterior circulation infarction was 3. 166 times as that in those with Lacunar infarction (95% CI = 1. 259-7. 961,P<0. 05). Conclusion Plasma fibrinogen levels can reflect the severity of AF patients with cerebral embolism in certain degrees.%目的 探讨心房颤动并发脑栓塞患者严重程度与血浆纤维蛋白原(Fib)的相关性.方法 收集住院治疗的合并心房颤动的脑栓塞患者80例,于入院时查血浆Fib,并行美国国立卫生研究院卒中量表(NIHSS)评分,分析两者之间的相关性.定义NIHSS评分≥15分为重症脑栓塞,Logistic回归分析其与Fib的危险相关度.入组患者经牛津郡社区卒中计划(OCSP)分型后,以腔隙性梗死作为参照,Logistic回归分析其他亚型Fib的水平相对危险度.结果 脑栓塞患者Fib与NIHSS评分具有显著相关性(r=0.264,P<0.05).重症脑栓塞与Fib的单因素回归分析显示OR(95 %CI)为2.404(1.107-5.222),经性别、年龄、

  8. MR Diagnosis of a Pulmonary Embolism: Comparison of P792 and Gd-DOTA for First-Pass Perfusion MRI and Contrast-Enhanced 3D MRA in a Rabbit Model

    Energy Technology Data Exchange (ETDEWEB)

    Keilholz, Shella D. [Emory University and Georgia Institute of Technology, Atlanta (United States); Bozlar, Ugur; Fujiwara, Naomi; Mata, Jaime F.; Berr, Stuart S.; Hagspiel, Klaus D. [Gulhane Military Medical Academy, Ankara (Turkmenistan); Corot, Claire [Guerbet Research, Aulnay-sous-Bois (France)

    2009-10-15

    To compare P792 (gadomelitol, a rapid clearance blood pool MR contrast agent) with gadolinium-tetraazacyclododecanetetraacetic acid (Gd- DOTA), a standard extracellular agent, for their suitability to diagnose a pulmonary embolism (PE) during a first-pass perfusion MRI and 3D contrastenhanced (CE) MR angiography (MRA). A perfusion MRI or CE-MRA was performed in a rabbit PE model following the intravenous injection of a single dose of contrast agent. The time course of the pulmonary vascular and parenchymal enhancement was assessed by measuring the signal in the aorta, pulmonary artery, and lung parenchyma as a function of time to determine whether there is a significant difference between the techniques. CE-MRA studies were evaluated by their ability to depict the pulmonary vasculature and following defects between 3 seconds and 15 minutes after a triple dose intravenous injection of the contrast agents. The P792 and Gd-DOTA were equivalent in their ability to demonstrate PE as perfusion defects on first pass imaging. The signal from P792 was significantly higher in vasculature than that from Gd-DOTA between the first and the tenth minutes after injection. The results suggest that a CE-MRA PE could be reliably diagnosed up to 15 minutes after injection. P792 is superior to Gd-DOTA for the MR diagnosis of PE.

  9. Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study.

    Science.gov (United States)

    Stecco, Alessandro; Quagliozzi, Martina; Soligo, Eleonora; Naldi, Andrea; Cassarà, Alessia; Coppo, Lorenzo; Rosso, Roberta; Bongo, Angelo Sante; Amatuzzo, Paola; Buemi, Francesco; Guenzi, Elena; Carriero, Alessandro

    2017-06-01

    The aim of this retrospective study was to map the specific ischemic lesion patterns of distribution in patent foramen ovale-related stroke (PFO-stroke) and atrial fibrillation-related stroke (AF-stroke) in patients with idiopatic ischemic stroke. 750 ischaemic strokes were screened on basis of diagnostic imaging and tests: patients with known causes were excluded. 171 patients with unknown cause were selected and divided in two groups: AF-stroke (43 patients) and PFO-stroke (128 patients). Vascular territories of ischemic involvement were divided into four classes in each group: the anterior cerebral artery, the middle cerebral artery, the vertebro-cerebral artery (including the posterior cerebral artery) and multisite (MS) involvement. Infarcts in vertebro-basilar territory and multisite represented each one about 32% of infarcts in PFO-stroke group and their involvement are more frequent than AF-stroke group (p = 0.03). Ischemic lesions in PFO-group were predominantly cortical (34.3%), and in AF-group cortical-subcortical (60.4%). Multisite pattern of ischemic lesion was more frequent in patients with severe degree of right to left shunts (37.5%). In clinical practice, PFO may be considered a cause of cortical stroke on the basis of radiological findings, when VB vascular territory or MS brain involvement is present in younger patients (<50 age).

  10. Stroke

    Science.gov (United States)

    ... how to live with the effects of the stroke so you can be as independent as possible. It may include physical therapy, occupational therapy, speech therapy, and swallowing therapy.Your doctor will decide what kind of rehabilitation will be helpful for you. Rehabilitation can begin ...

  11. Retrieval of embolized left atrial appendage devices.

    Science.gov (United States)

    Fahmy, Peter; Eng, Lim; Saw, Jacqueline

    2016-09-28

    Percutaneous left atrial appendage (LAA) closure is gaining interest as an alternative option for prevention of strokes in patients with Atrial Fibrillation (AF), especially for those with contraindications to anticoagulation. Complications from these procedures are well described in the medical literature. LAA closures may lead to pericardial effusion, device-associated thrombus, and device embolization. Understanding the reasons for embolization, strategies to avoid embolization, and the techniques for retrieval of LAA devices (ACP/AMULET and WATCHMAN) should be appreciated by endovascular implanters. We describe two cases of LAA device embolization that were both successfully retrieved percutaneously and other percutaneous techniques to safely retrieve embolized LAA devices. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Endocarditis and Stroke

    Science.gov (United States)

    GRECU, Nicolae; TIU, Cristina; TERECOASA, Elena; BAJENARU, Ovidiu

    2014-01-01

    Endocarditis is an important, although less common, cause of cerebral embolism. All forms of endocarditis share an initial common pathophysiologic pathway, best illustrated by the non-bacterial thrombotic form, but also a final potential for embolization. Stroke associated with endocarditis has signifficant mortality and morbidity rates, especially due to the frequent concomitant multiple sites of brain embolization. In this article we aim to briefly review endocarditis with a focus on stroke as a complication, while also presenting case correlates from our department. PMID:25705308

  13. Novel Hydrogel Material as a Potential Embolic Agent in Embolization Treatments

    Science.gov (United States)

    Zhou, Feng; Chen, Liming; An, Qingzhu; Chen, Liang; Wen, Ying; Fang, Fang; Zhu, Wei; Yi, Tao

    2016-08-01

    We report a novel graphene-oxide (GO) enhanced polymer hydrogel (GPH) as a promising embolic agent capable of treating cerebrovascular diseases and malignant tumors, using the trans-catheter arterial embolization (TAE) technique. Simply composed of GO and generation five poly(amidoamine) dendrimers (PAMAM-5), our rheology experiments reveal that GPH exhibits satisfactory mechanical strength, which resist the high pressures of blood flow. Subcutaneous experiments on Sprague-Dawley (SD) rats demonstrate the qualified biocompatibility of GPH. Finally, our in vivo experiments on New Zealand rabbits, which mix GPH with the X-ray absorbing contrast agent, Iohexol, reveal complete embolization of the artery. We also note that GPH shortens embolization time and exhibits low toxicity in follow-up experiments. Altogether, our study demonstrates that GPH has many advantages over the currently used embolic agents and has potential applications in clinical practice.

  14. The current issue of paradoxical embolism and cryptogenic stroke%反常栓塞与不明原因脑卒中研究的当前问题

    Institute of Scientific and Technical Information of China (English)

    张玉顺; 何璐

    2013-01-01

    The foramen ovale is a normal interatrial communication during fetal life that persists after birth in approximately 1/4 adults.The foramen ovale is a potential route for embolic transit from the systemic venous circulation to the brain.In the basal state and peripheral arterial embolism route,patent foramen ovale (PFO) does not cause any clinical symptom.When the pressure of the right atrium transiently or persistently exceeds the pressure of left atrium,right-to-left shunt happens.Emboli or primary thrombus of other body regions is likely to break off,resulting in paradoxical embolism (PDE).PDE has been associated with a series of clinical syndromes including cryptogenic stroke (CS),migraine,systemic hypoxemia from recumbent position breathing-orthodeoxia,obstructive sleep apnea syndrome,myocardial infarction with normal coronary,cerebral white matter lesions and arterial gas embolism from neural (cerebral?) decompression illness.However,due to the special anatomy of the aortic arch and brain ischemia,it is more sensitive than other organs.Most PDE assumed transient ischemic attack (TIA) or CS.Although there is convincing circumstantial evidence implicating PFO with CS,the precise role of PFO in the pathogenesis of CS is not still completely understood.This article focuses on the present condition of the study on PDE and CS,especially the results of randomized controlled trials.We expect the above results to propose a new perspective on the treatment of PFO with CS.%卵圆孔是心脏房间隔上胚胎时期遗留下来的一个通道,存在于胎儿期和近1/4的成人,是一个潜在的血栓由自体静脉系统至脑及外周动脉栓塞的途径.正常情况下,卵圆孔未闭(patent foramen ovale,PFO)不引起任何临床症状,但当右心房压力一过性或持续性增高时,可引起心房间右句左分流,身体其他部位的栓子或原位血栓就有可能脱落,造成反常栓塞(paradoxical embolism,PDE).PDE 可引起一系列临床综合征,

  15. Uterine Fibroid Embolization (UFE)

    Science.gov (United States)

    ... embolization. This occurs when fibroids located inside the uterine cavity detach after embolization. Women with this problem may require a procedure called D & C (dilatation and curettage) to ... who undergo uterine fibroid embolization, normal menstrual cycles resume after the ...

  16. Clinical characteristics of pulmonary embolism with concomitant pneumonia.

    Science.gov (United States)

    Cha, Seung-Ick; Choi, Keum-Ju; Shin, Kyung-Min; Lim, Jae-Kwang; Yoo, Seung-Soo; Lee, Jaehee; Lee, Shin-Yup; Kim, Chang-Ho; Park, Jae-Yong

    2016-04-01

    Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism and concomitant pneumonia are uncommon. The aim of the present study was to investigate the clinical features of pulmonary embolism with coexisting pneumonia. We retrospectively compared clinical, radiologic and laboratory parameters between patients with pulmonary embolism and concomitant pneumonia (pneumonia group) and those with unprovoked pulmonary embolism (unprovoked group), and then between the pneumonia group and those with pulmonary infarction (infarction group). Of 794 patients with pulmonary embolism, 36 (5%) had coexisting pneumonia and six (1%) had no provoking factor other than pneumonia. Stroke was significantly more common in the pneumonia group, than either the unprovoked group or the infarction group. In the pneumonia group, fever was significantly more common and serum C-reactive protein levels were significantly higher. By contrast, central pulmonary embolism and right ventricular dilation on computed tomography were significantly less frequent in the pneumonia group. In addition, an adverse outcome due to pulmonary embolism was less common in the pneumonia group than in either of the other two groups. The coexistence of pulmonary embolism and pneumonia is rarely encountered in clinical practice, especially without the presence of other factors that could provoke venous thromboembolism and is commonly associated with stroke. It is characterized by lower incidences of central pulmonary embolism and right ventricular dilation and by a lower rate of adverse outcomes due to pulmonary embolism itself.

  17. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Directory of Open Access Journals (Sweden)

    Cindy W. Yoon

    2016-09-01

    Full Text Available Only a few cases of Turner syndrome (TS with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  18. A Case of Turner Syndrome with Multiple Embolic Infarcts.

    Science.gov (United States)

    Yoon, Cindy W; Lee, Eungseok; Yoon, Byung-Nam; Park, Hee-Kwon; Rha, Joung-Ho

    2016-01-01

    Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  19. A Case of Turner Syndrome with Multiple Embolic Infarcts

    Science.gov (United States)

    Yoon, Cindy W.; Lee, Eungseok; Yoon, Byung-Nam; Park, Hee-Kwon; Rha, Joung-Ho

    2016-01-01

    Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.

  20. Arterial embolism

    Science.gov (United States)

    ... nih.gov/pubmed/21963765 . Read More Acute kidney failure Atrial fibrillation or flutter Atrial myxoma Blood clots Gas gangrene Heart attack Necrosis Platelet count Septic shock Stroke Transient ischemic attack Review Date 5/5/ ...

  1. Voxelwise distribution of acute ischemic stroke lesions in patients with newly diagnosed atrial fibrillation: Trigger of arrhythmia or only target of embolism?

    Science.gov (United States)

    Johnson, Timothy D.; Dittgen, Felix; Nichols, Thomas E.; Malzahn, Uwe; Veltkamp, Roland

    2017-01-01

    Objective Atrial fibrillation (AF) is frequently detected after ischemic stroke for the first time, and brain regions involved in autonomic control have been suspected to trigger AF. We examined whether specific brain regions are associated with newly detected AF after ischemic stroke. Methods Patients with acute cerebral infarctions on diffusion-weighted magnetic resonance imaging were included in this lesion mapping study. Lesions were mapped and modeled voxelwise using Bayesian Spatial Generalised Linear Mixed Modeling to determine differences in infarct locations between stroke patients with new AF, without AF and with AF already known before the stroke. Results 582 patients were included (median age 68 years; 63.2% male). AF was present in 109/582 patients [(18.7%); new AF: 39/109 (35.8%), known AF: 70/109 (64.2%)]. AF patients had larger infarct volumes than patients without AF (mean: 29.7 ± 45.8 ml vs. 15.2 ± 35.1 ml; pstroke size predicted progressive cortical but not pontine and thalamic involvement. Patients with new AF had more frequently lesions in the right insula compared to patients without AF when stroke size was not accounted for, but no specific brain region was more frequently involved after adjustment for infarct volume. Controlled for stroke size, left parietal involvement was less likely for patients with new AF than for those without AF or with known AF. Conclusions In the search for brain areas potentially triggering cardiac arrhythmias infarct size should be accounted for. After controlling for infarct size, there is currently no evidence that ischemic stroke lesions of specific brain areas are associated with new AF compared to patients without AF. This challenges the neurogenic hypothesis of AF according to which a relevant proportion of new AF is triggered by ischemic brain lesions of particular locations. PMID:28542605

  2. Combined treatment with recombinant tissue plasminogen activator and dexamethasone phosphate-containing liposomes improves neurological outcome and restricts lesion progression after embolic stroke in rats

    NARCIS (Netherlands)

    Tiebosch, I.A.; Crielaard, B.J.; Bouts, M.J.; Salas-Perdomo, A.; Lammers, T.G.G.M.; Planas, A.M.; Storm, G.; Dijkhuizen, R.M.

    2012-01-01

    Abstract Variable efficacies have been reported for glucocorticoid drugs as anti-inflammatory treatment after stroke. We applied an alternative drug delivery strategy, by injection of dexamethasone phosphate-containing liposomes in combination with recombinant tissue plasminogen activator (rtPA), i

  3. CLINICAL OBSERVATION ABOUT THE EFFECT OF BLOOD-LETTING OF JING-POINTS ON CEREBRAL BLOOD FLOW IN STROKE PATIENTS AT THE EARLY STAGE AND EXPERIMENTAL STUDY ON ITS MECHANISMS IN THE RABBIT

    Institute of Scientific and Technical Information of China (English)

    WANG Xiuyun; REN Shusheng; GUO Yi; ZHOU Guoping; ZHOU Zhiliang; PAN Rongqing; XU Tangping; LI Qing; WANG Xin; REN Huanzhong

    2002-01-01

    In this paper,the authors sum their research resuits about the effect of blood-letting of Jing(Well)-point on cerebral blood flow both in stroke patients and in experimental cerebral ischemia,cerebral hematoma and hypertension rabbits.In 30cases of stroke (cerebral hemorrhage and cerebral infarction)patients,blood flow state of the anterior cerebral artery(ACA),middle cerebral artery(MCA)and the posterior cerebral artery (PCA), and the blood flow velocity of the bilateral vertebral artery (VA)and the basil artery(BA)are determined before and afterpricking blood of the Twelve Jing-points.In experimental cerebral ischernia (by occlusion of the common carotid ertery) rabbits ,cerebral hematoma model rabbits and intravenous injection of noradrenaline induced hypertension rabbits, rheoencephalogram(REC) is detected before and after blood letting of the twelve"Jing -points.In these 30stroke patients,ultrasound Doppler examination's results show that in 22 cases (73.33%) whose blood flow velocity decreases,after blood-letting of the 12 Jing-points, it ncreases significantly(P< 0.01); in the rest 8 cases (26.67%) whose blood flow velocity speeds up,after treatment,it decreases evidently(P<tly (P< 0.01), showing a good dual-directional regulative effect of blood -letting therapy.In experimental cerebral ischemia rabbits,cerebral hematoma rabbits and hypertension rabbits whose REG lowers in the amplitude apparently ( P < 0.01 ), after blood letting stimulation of the 12 Jing-points, it increases at different degrees.Three patterns of stimulation as blood letting stimulation, pain stimulation and Jing-point stimulation, also the 3factors of blood-letting,may contribute to their effect on improvement of the cerebral blood flow.Somatic affterent nerve,sympathetic nerve of the vasular wall,central cholinergic nerve(M receptors)and adrenergic nerve (α receptors) participate in the effect of blood letting on cerebral blood flow.

  4. Embolic Stroke due to a Common Carotid Artery Thrombus in a Young Patient with Severe Iron-Deficiency Anemia without Thrombocytosis

    Science.gov (United States)

    2016-01-01

    This case report describes a 41-year-old previously healthy male who presented with stuttering transient ischemic symptoms and radiographic evidence of a left common carotid artery thrombus as well as acute and subacute ischemic infarcts in the left middle cerebral artery territory. An exhaustive stroke work-up did not provide a plausible etiology for his symptoms. His complete blood count and iron studies, however, revealed evidence of severe iron-deficiency anemia without reactive thrombocytosis. His stool guaiac test was positive. He was discharged home on oral antithrombotic agents and aggressive iron replacement therapy with a plan for repeat vascular imaging in 3 months and a colonoscopy. This case report suggests that severe iron-deficiency anemia with or without reactive thrombocytosis should be viewed as a possible hematologic condition associated with thrombotic tendencies and a risk factor for ischemic stroke, especially in young adults. Aggressive iron supplementation and short-term antithrombotic therapy with follow-up vascular imaging are a reasonable treatment for these patients. PMID:27752375

  5. Mortality and Embolic Potential of Cardiac Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Dias, Ricardo Ribeiro, E-mail: ricardo.dias@incor.usp.br; Fernandes, Fábio; Ramires, Félix José Alvarez; Mady, Charles; Albuquerque, Cícero Piva; Jatene, Fábio Biscegli [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-07-15

    Cardiac tumors are rare, mostly benign with high embolic potential. To correlate the histological type of cardiac masses with their embolic potential, implantation site and long term follow up in patients undergoing surgery. Between January 1986 and December 2011, we retrospectively analyzed 185 consecutive patients who underwent excision of intracardiac mass (119 females, mean age 48±20 years). In 145 patients, the left atrium was the origin site. 72% were asymptomatic and prior embolization was often observed (19.8%). The diagnosis was established by echocardiography, magnetic resonance and histological examination. Most tumors were located in the left side of the heart. Myxoma was the most common (72.6%), followed by fibromas (6.9%), thrombi (6.4%) and sarcomas (6.4%). Ranging from 0.6cm to 15cm (mean 4.6 ± 2.5cm) 37 (19.8%) patients had prior embolization, stroke 10.2%, coronary 4.8%, peripheral 4.3% 5.4% of hospital death, with a predominance of malignant tumors (40% p < 0.0001). The histological type was a predictor of mortality (rhabdomyomas and sarcomas p = 0.002) and embolic event (sarcoma, lipoma and fibroelastoma p = 0.006), but not recurrence. Tumor size, atrial fibrillation, cavity and valve impairment were not associated with the embolic event. During follow-up (mean 80±63 months), there were 2 deaths (1.1%) and two recurrences 1 and 11 years after the operation, to the same cavity. Most tumors were located in the left side of the heart. The histological type was predictor of death and preoperative embolic event, while the implantation site carries no relation with mortality or to embolic event.

  6. Fat embolism syndrome

    OpenAIRE

    Jacob George; Reeba George; Dixit, R; Gupta, R C; Gupta, N.

    1997-01-01

    Fat embolism syndrome, an important contributor to the development of acute respiratory distress syndrome, has been associated with both traumatic and nontraumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. Fat emboli can deform and pass through the lungs, resulting in systemic embolization, most commonly to the brain and kidneys. The diagnosis of fat embolism syndrome is based on the patient’s history, supported by clinical signs of pulmonar...

  7. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

    Directory of Open Access Journals (Sweden)

    Chen Lin

    2014-01-01

    Full Text Available Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL. Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA branches. She was emergently taken for hyperbaric oxygen therapy (HBOT. Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

  8. Intravenous thrombolysis is unsafe in stroke due to infective endocarditis.

    Science.gov (United States)

    Brownlee, W J; Anderson, N E; Barber, P A

    2014-02-01

    Embolic stroke is the most common neurological complication of infective endocarditis and a major source of morbidity and mortality. Septic embolism is considered a contraindication to intravenous thrombolysis in patients with ischaemic stroke because of concerns over an increased risk of intracranial haemorrhage. We describe a patient with occult endocarditis who was treated with thrombolysis for acute stroke and review other cases reported in the literature.

  9. Amniotic Fluid Embolism

    Science.gov (United States)

    ... embolisms are rare, which makes it difficult to identify risk factors. It's estimated that there are between 1 ... Kramer MS, et al. Amniotic fluid embolism: Incidence, risk factors, and impact on perinatal outcome. BJOG: An International Journal of Obstetrics and Gynaecology. 2012;119:874. Baskett ...

  10. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation...... in patients with acute ischemic stroke and atrial fibrillation....... are at increased risk of stroke progression and recurrence. We sought to assess whether D-dimer and other markers of hemostatic activation could predict these adverse events in such patients. Method -  Blood samples were obtained from patients included in the Heparin in Acute Embolic Stroke Trial. Stroke...

  11. Gas Embolic Stroke Secondary to Bowel Infarction.

    Science.gov (United States)

    Parikh, Dhruv; Leyon, Joe Joseph; Chavda, Swarupsinh

    2016-01-01

    A 69-year-old gentleman with metastatic esophageal adenocarcinoma presented with acute abdominal pain to the emergency medicine department and subsequently developed an acute left hemiplegia while in the resuscitation unit. An unenhanced computed tomography (CT) scan of the head showed right frontal cerebral gas emboli while an unenhanced CT scan of the abdomen and pelvis showed extensive portal venous gas and pneumatosis intestinalis, presumed secondary to bowel infarction.

  12. Disposable rabbit

    Science.gov (United States)

    Lewis, Leroy C.; Trammell, David R.

    1986-01-01

    A disposable rabbit for transferring radioactive samples in a pneumatic transfer system comprises aerated plastic shaped in such a manner as to hold a radioactive sample and aerated such that dissolution of the rabbit in a solvent followed by evaporation of the solid yields solid waste material having a volume significantly smaller than the original volume of the rabbit.

  13. Disposal rabbit

    Science.gov (United States)

    Lewis, L.C.; Trammell, D.R.

    1983-10-12

    A disposable rabbit for transferring radioactive samples in a pneumatic transfer system comprises aerated plastic shaped in such a manner as to hold a radioactive sample and aerated such that dissolution of the rabbit in a solvent followed by evaporation of the solid yields solid waste material having a volume significantly smaller than the original volume of the rabbit.

  14. Familial aggregation of stroke (Literature review)

    African Journals Online (AJOL)

    Esem

    1 and embolism from the heart. Stroke is the second leading cause of death worldwide, .... between the levels of these natural anticoagulants and stroke appears to be ..... 1999; 4: 313–320. 38. Kiely DK, Wolf PA, Cupples LA, Beiser AS, Myers.

  15. Initial Experience Using the Gore Embolic Filter in Carotid Interventions.

    Science.gov (United States)

    Hornung, Marius; Franke, Jennifer; Bertog, Stefan C; Gafoor, Sameer; Grunwald, Iris; Sievert, Horst

    2016-08-01

    This is the first clinical report on experience in the use of the Gore embolic filter in carotid interventions. It was designed as a guidewire and embolic protection system in carotid, peripheral, and coronary interventions. The ability to capture debris is driven by the frame of the filter, which is designed to improve vessel wall apposition and allows a short landing zone. We report the results of the first 20 consecutive patients undergoing carotid artery stenting using the Gore embolic filter in our institution. We analyzed technical success as well as the occurrence of transient ischemic attack (TIA), stroke, or death periprocedurally and through 30 days of follow-up. Mean patient age was 72 years and 12 patients (60%) were male. Seven patients were symptomatic and 4 patients suffered recurrent neurological events. Technical success was achieved in all procedures. In 1 patient, the retrieval catheter was caught between the proximal struts of the stent and required further retrieval maneuvers. Within 30 days of follow-up, 1 patient had a TIA. No stroke, death, or myocardial infarction occurred. This initial experience suggests that the Gore embolic filter device can be used safely for distal embolic protection during carotid stenting procedures with high technical success.

  16. 心型脂肪酸结合蛋白、肌钙蛋白Ⅰ与脑卒中继发性肺栓塞的关系%Association between heart-type fatty acid binding protein, cardiac tro-poninⅠand stroke-associated pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    韩芳; 张伟东; 廖晓凌; 王拥军

    2014-01-01

    Objective To investigate the diagnosis and prognostic value of heart-type fatty acid binding protein com-bined cardiac troponin Ⅰ in stroke-associated pulmonary embolism patients. Methods 150 patients with stroke-asso-ciated pulmonary embolism (study group) and 150 patients of stroke without pulmonary embolism (control group) from January 2011 to April 2014 in Luhe Hospital of Tongzhou District in Beijing City were selected in this study. The H-FABP and cardiac troponin Ⅰ of patients in two groups before treatment and those of the study group after treatment were detected and compared. Results The levels of plasma H-FABP and cardiac troponin Ⅰ of patients before treat-ment in study group [(9.52±2.67), (0.15±0.09) μg/L ] were higher than those of the control group [(3.87±2.96), (0.05±0.03) μg/L], the differences were statistically significant (P<0.05).After treatment, the levels of plasma H-FABP and cardiac troponinⅠ in study group [(5.51±1.97), (0.08±0.03) μg/L] were decreased than pretreatment, the differences were statistically significant (P<0.05). Conclusion The level of H-FABP and cardiac troponinⅠ increasing obviously in stroke-associated pulmonary embolism, and the detection of the two indexs can be helpful for the disease diagnosis and the access of short-time prognosis.%目的:探讨心型脂肪酸结合蛋白(H-FABP)联合肌钙蛋白Ⅰ(cTnⅠ)对脑卒中继发性肺栓塞患者早期诊断及判断预后的价值。方法选取2011年1月~2014年4月北京市通州区潞河医院收治的150例脑卒中继发性肺栓塞患者(研究组)及单纯脑卒中患者150例(对照组)。检测并比较治疗前两组及研究组治疗前后H-FABP、cTnⅠ水平。结果治疗前研究组H-FABP [(9.52±2.67)μg/L]及cTnⅠ[(0.15±0.09)μg/L]水平明显高于对照组[(3.87±2.96)、(0.05±0.03)μg/L],差异均有统计学意义(P<0.05);治疗后研究组患者血浆H-FABP、cTnⅠ水平分别为(5.51±1.97)、(0.08±0.03)

  17. Embolization of Brain Aneurysms and Fistulas

    Science.gov (United States)

    ... Z Embolization of Brain Aneurysms and Arteriovenous Malformations/Fistulas Embolization of brain aneurysms and arteriovenous malformations (AVM) ... Fistulas? What is Embolization of Brain Aneurysms and Fistulas? Embolization of brain aneurysms and arteriovenous malformations (AVM)/ ...

  18. Prosthetic valve endocarditis 1976-1987. Antibiotics, anticoagulation, and stroke.

    Science.gov (United States)

    Davenport, J; Hart, R G

    1990-07-01

    We retrospectively reviewed the clinical characteristics and outcomes of 61 patients with 62 episodes of prosthetic valve endocarditis, paying particular attention to neurologic complications (stroke). Atypical features of the group included a benign outcome of early postoperative infection (18% mortality) and a high stroke morbidity and mortality rate with Staphylococcus epidermidis infections. Eleven patients (18%) suffered an embolic stroke, most less than or equal to 3 days after diagnosis and before the initiation of antimicrobial therapy; the rate of embolic stroke recurrence was low (9%). The risk of embolic stroke was lower with bioprosthetic than with mechanical valves. No protective effect of anticoagulation therapy with warfarin was observed. Six patients (8%) suffered brain hemorrhage due to septic arteritis, brain infarction, or undetermined causes; no specific risk of hemorrhagic stroke was evident with anticoagulation therapy. Antibiotic treatment appears to be more important than anticoagulation to prevent neurologic complications in patients with prosthetic valve endocarditis.

  19. Pediatric Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... communicate with your child’s doctor. Symptoms of a Stroke Stroke is an injury to part of the ...

  20. Pulmonary embolism and impending paradoxical embolism: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHONG You; HE Qing; WANG Xin-yue; CHEN Huan; LI Jing; ZHEN Wen-jun; TONG Hong-feng; WANG Huai-bin; CHEN Qi-hang

    2008-01-01

    @@ Adefinitive diagnosis of paradoxical embolism is based on the evidence that a thrombus crosses through the right-to-left shunting. We report a case of impending paradoxical embolism in a patient with pulmonary embolism diagnosed by echocardiography and proved by operation later.

  1. [Prophylaxis of venous thromboembolism after severe stroke].

    Science.gov (United States)

    Riabinkina, Iu V; Gnedovskaia, E V; Piradov, M A; Kuntsevich, G I

    2010-01-01

    Venous thromboembolism (VTE), a deep and superficial thrombosis and pulmonary embolism, is a very important problem of severe stroke. Pulmonary embolism (PE) significantly influences the course and outcome of severe stroke. The cause of this effect lies not only in severe patient's condition, high risk of VTE and difficulties in diagnosis of VTE but in still common limits in prophylaxis and treatment of PE in severe stroke, first of all, in brain hemorrhages and large brain infarctions with secondary hemorrhage. The paper presents the main principles and methods of prophylaxis of VTE in severe stroke. The suggested approach allows to decrease the frequency of VTE and fatal outcomes in severe stroke in the modern neuro-intensive care units.

  2. [A new embolic material: super absorbent polymer (SAP) microsphere and its embolic effects].

    Science.gov (United States)

    Jiaqi, Y; Hori, S; Minamitani, K; Hashimoto, T; Yoshimura, H; Nomura, N; Ishida, T; Fukuda, H; Tomoda, K; Nakamura, H

    1996-01-01

    SAP-Microsphere (sodium acrylic acid-vinyl alcohol copolymer) has the ability to absorb fluids within a few minutes and increase its diameter. Its diameter can also be calibrated. The diameters in ionic contrast material and human serum are 2.1 and 3.5 times larger, respectively, than the original size. It can pass through a microcatheter with an ionic contrast material, and swells at the occluding point into the desired size. It can be recognized under fluoroscopy due to its absorption of contrast material. A total of 10 rabbit kidney embolizations were done followed by resection in 1-14 weeks. Recanalization was absent in all cases. No adhesion to the perirenal tissue was found. Limited reactive change in endothelial cells was found at one week. No changes in the smooth muscle layer were found at any time during the study. Limited infiltration of neutrophil cells was found in perivascular tissue within a period of one week. SAP-Microspheres maintained their spherical shape during a 14-week period. Extensive fibrosis and calcification were found after 4 weeks. SAP-Microspheres are promising as an embolic agent to obtain satisfactory results of embolization therapy.

  3. Stroke Treatments

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  4. Partial Splenic Artery Embolization

    Directory of Open Access Journals (Sweden)

    Gh. Shadmani

    2010-05-01

    Full Text Available Background/Objective: Hypersplenism often accompanies chronic liver disease and splenomegaly is one of the four cardinal signs of hypersplenism, the other three being cytopenia, normal or hyperplastic bone marrow and response splenectomy. Surgical splenectomy is the traditional treatment."nIn the recent years, partial splenic embolization has been widely used in patients with hypersplenism and cirrhosis.This study was conducted to assess the safety and efficacy of partial splenic embolization using PVA (poly vinyl alcohol and steel coil in the management of hypersplenism."nPatients and Methods: Between Aban 1387 and Aban 1388, ten patients with hypersplenism related hematologic abnormalities (leukopenia, thrombocytopenia, variceal hemorrhage or other sequels underwent partial splenic embolization with PVA and coil. A comparison between pre-procedure and post-procedure lab data, endoscopy and splenic volumetery was done."nResults: All patients showed dramatic improvement in platelet and leukocyte counts. Platelet and leukocyte counts remained at an appropriate level during the follow up period. In one patient after one year progressive decline in the platelet count was noted, however the values remained significantly higher than before PSE (70000 vs 15000."nAlmost all patients had problems related to post embolization syndrome. In one patient severe pain was noted that lasted nearly ten days, in the other patients, pain was less severe. No significant complication (splenic abscess, pancreatitis, portal vein thrombosis developed in this study."nConclusion: The efficacy of PSE observed in our study confirms the results of previous studies in pa-tients with hypersplenism. This safe, fast method can be used bridging therapy for cirrhotic patients waiting for liver transplantation. Hematological response is related to the extension of embolization.

  5. Transcatheter Arterial Embolization of Renal VX-2 Carcinoma: Ethiodol-Ethanol Capillary Embolization Combined with Carboplatin

    Energy Technology Data Exchange (ETDEWEB)

    Konya, Andras; Pelt, Carolyn S. Van; Wright, Kenneth C. [The University of Texas MD Anderson Cancer Center, Hoston (United States); Choi, Byung Gil [The Catholic University of Korea, Seoul (Korea, Republic of)

    2007-04-15

    We wanted to determine whether transcatheter Ethiodol-based capillary embolization in combination with carboplatin could improve the efficiency of a 1:1 Ethiodol-ethanol mixture (EEM) to ablate kidneys that been inoculated with VX-2 carcinoma. The right kidney in 34 New Zealand white rabbits were inoculated with fresh VX-2 tumor fragments. One week later, the kidneys were subjected to transarterial treatment (4-5 rabbits/group): Saline infusion (Group 1); carboplatin infusion (5 or 10 mg, Groups 2A and 2B); carboplatin- Ethiodol (CE) alone (Group 3) and followed by main renal artery occlusion with ethanol (RAO) (Group 4); carboplatin-EEM (C-EEM) followed by RAO (Group 5); carboplatin infusion followed by EEM plus RAO (Group 6); and EEM followed by RAO (Group 7). The animals were followed for up to 3-weeks. The treated kidneys were evaluated angiographically and macroscopically. The kidneys that showed successful embolization macroscopically were entirely cut into serial sections, and these were examined microscopically. Histologically, the kidneys were evaluated on the basis of the residual tumor found in the serial sections. The results obtained with carboplatin infusion alone (Groups 2A and 2B) and CE without RAO (Group 3) were similar to those of the control animals (Group 1). Kidneys from Groups 4-7 demonstrated macroscopically successful embolization with histologically proven complete renal parenchyma infarction; however, some residual tumor was evident in all but one animal. None of the Ethiodol-based modalities combined with locoregional carboplatin were more efficacious for tumor ablation than EEM alone.

  6. Biocompatibility of Bletilla striata Microspheres as a Novel Embolic Agent

    Directory of Open Access Journals (Sweden)

    ShiHua Luo

    2015-01-01

    Full Text Available We have prepared Chinese traditional herb Bletilla striata into microspheres as a novel embolic agent for decades. The aim of this study was to evaluate the biocompatibility of Bletilla striata microspheres (BSMs. After a thermal test of BSMs in vitro, the cell biocompatibility of BSMs was investigated in mouse fibroblasts and human umbilical vein endothelial cells using the methyl tetrazolium (MTT assay. In addition, blood biocompatibility was evaluated. In vivo intramuscular implantation and renal artery embolization in rabbits with BSMs were used to examine the inflammatory response. The experimental rabbits did not develop any fever symptoms after injection of BSMs, and BSMs exhibited no cytotoxicity in cultured mouse fibroblasts and human umbilical vein endothelial cells. Additionally, BSMs exhibited high compatibility with red blood cells and no hemolysis activity. Intramuscular implantation with BSMs resulted in a gradually lessened mild inflammatory reaction that disappeared after eight weeks. The occlusion of small renal vessels was associated with a mild perivascular inflammatory reaction without significant renal and liver function damage. In conclusion, we believe that BSMs exhibit high biocompatibility and are a promising embolic agent.

  7. Biocompatibility of Bletilla striata Microspheres as a Novel Embolic Agent.

    Science.gov (United States)

    Luo, ShiHua; Song, SongLin; Zheng, ChuanSheng; Wang, Yong; Xia, XiangWen; Liang, Bin; Feng, GanSheng

    2015-01-01

    We have prepared Chinese traditional herb Bletilla striata into microspheres as a novel embolic agent for decades. The aim of this study was to evaluate the biocompatibility of Bletilla striata microspheres (BSMs). After a thermal test of BSMs in vitro, the cell biocompatibility of BSMs was investigated in mouse fibroblasts and human umbilical vein endothelial cells using the methyl tetrazolium (MTT) assay. In addition, blood biocompatibility was evaluated. In vivo intramuscular implantation and renal artery embolization in rabbits with BSMs were used to examine the inflammatory response. The experimental rabbits did not develop any fever symptoms after injection of BSMs, and BSMs exhibited no cytotoxicity in cultured mouse fibroblasts and human umbilical vein endothelial cells. Additionally, BSMs exhibited high compatibility with red blood cells and no hemolysis activity. Intramuscular implantation with BSMs resulted in a gradually lessened mild inflammatory reaction that disappeared after eight weeks. The occlusion of small renal vessels was associated with a mild perivascular inflammatory reaction without significant renal and liver function damage. In conclusion, we believe that BSMs exhibit high biocompatibility and are a promising embolic agent.

  8. Predictors of recurrent stroke after percutaneous closure of patent foramen ovale

    DEFF Research Database (Denmark)

    Rudolph, Volker; Augustin, Jahan; Hofmann, Thomas;

    2014-01-01

    AIMS: Closure of patent foramen ovale following presumed paradoxical embolic stroke remains controversial. The answer to the question as to whether cardiovascular risk factors (CVRF) impact on the recurrence of stroke in patients who have undergone PFO closure remains elusive so far. We aimed...... to investigate the potential impact of CVRF on the long-term rate of stroke/TIA recurrence in patients treated with an occluder following presumed paradoxical embolic stroke. METHODS AND RESULTS: 443 patients (mean age: 50.0±12.6 yrs, female: 206 [46.5%]) undergoing percutaneous PFO closure after presumed...... paradoxical embolic stroke were followed for a median time of 43.0 [interquartile range: 20.0-86.0] months. During the follow-up period a total of 22 (5.0%) strokes/TIAs and 17 (3.8%) deaths were observed. Cox regression analysis identified hypertension, age and the Essen stroke risk score as predictors...

  9. An interesting septic embolism

    Directory of Open Access Journals (Sweden)

    Funda Uluorman

    2014-01-01

    Full Text Available Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

  10. An interesting septic embolism.

    Science.gov (United States)

    Uluorman, Funda; Tanrıverdi, Zülkif; Sevinç, Can; Badak, Özer; Çatalyürek, Hüdai

    2014-01-01

    Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

  11. Amniotic fluid embolism

    OpenAIRE

    Thongrong, Cattleya; Kasemsiri, Pornthep; Hofmann, James P; Bergese, Sergio D.; Thomas J Papadimos; Gracias, Vicente H.; Adolph, Michael D.; Stawicki, Stanislaw P A

    2013-01-01

    Amniotic fluid embolism (AFE) is an unpredictable and as-of-yet unpreventable complication of maternity. With its low incidence it is unlikely that any given practitioner will be confronted with a case of AFE. However, this rare occurrence carries a high probability of serious sequelae including cardiac arrest, ARDS, coagulopathy with massive hemorrhage, encephalopathy, seizures, and both maternal and infant mortality. In this review the current state of medical knowledge about AFE is outline...

  12. Cholesterol Embolism: An Overlooked Diagnosis

    Directory of Open Access Journals (Sweden)

    Sinem Nihal ESATOĞLU

    2012-01-01

    Full Text Available Acute renal failure following angiography is usually due to radiocontrast nephropathy; however, cholesterol embolism should be kept in mind when making the differential diagnosis. Cholesterol embolism is a multisystem disease, usually seen in elderly men who have severe atherosclerosis. In this case report, we describe a patient with cholesterol embolism who had a typical clinical history of progressive renal failure. We hope that this case report will emphasize the importance of this overlooked syndrome.

  13. Amniotic fluid embolism

    Directory of Open Access Journals (Sweden)

    Kiranpreet Kaur

    2016-01-01

    Full Text Available Amniotic fluid embolism (AFE is one of the catastrophic complications of pregnancy in which amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse. Etiology largely remains unknown, but may occur in healthy women during labour, during cesarean section, after abnormal vaginal delivery, or during the second trimester of pregnancy. It may also occur up to 48 hours post-delivery. It can also occur during abortion, after abdominal trauma, and during amnio-infusion. The pathophysiology of AFE is not completely understood. Possible historical cause is that any breach of the barrier between maternal blood and amniotic fluid forces the entry of amniotic fluid into the systemic circulation and results in a physical obstruction of the pulmonary circulation. The presenting signs and symptoms of AFE involve many organ systems. Clinical signs and symptoms are acute dyspnea, cough, hypotension, cyanosis, fetal bradycardia, encephalopathy, acute pulmonary hypertension, coagulopathy etc. Besides basic investigations lung scan, serum tryptase levels, serum levels of C3 and C4 complements, zinc coproporphyrin, serum sialyl Tn etc are helpful in establishing the diagnosis. Treatment is mainly supportive, but exchange transfusion, extracorporeal membrane oxygenation, and uterine artery embolization have been tried from time to time. The maternal prognosis after amniotic fluid embolism is very poor though infant survival rate is around 70%.

  14. Cholesterol crystal embolism (atheroembolism)

    Science.gov (United States)

    VENTURELLI, CHIARA; JEANNIN, GUIDO; SOTTINI, LAURA; DALLERA, NADIA; SCOLARI, FRANCESCO

    2006-01-01

    Cholesterol crystal embolism, known as atheroembolic disease, is caused by showers of cholesterol crystals from an atherosclerotic plaque that occludes small arteries. Embolization can occur spontaneously or as an iatrogenic complication from an invasive vascular procedure (angiography or vascular surgery) and after anticoagulant therapy. The atheroembolism can give rise to different degrees of renal impairment. Some patients show a moderate loss of renal function, others severe renal failure requiring dialysis. Renal outcome can be variable: some patients deteriorate or remain on dialysis, some improve and some remain with chronic renal impairment. Clinically, three types of atheroembolic renal disease have been described: acute, subacute or chronic. More frequently a progressive loss of renal function occurs over weeks. Atheroembolization can involve the skin, gastrointestinal system and central nervous system. The diagnosis is difficult and controversial for the protean extrarenal manifestations. In the past, the diagnosis was often made post-mortem. In the last 10 yrs, awareness of atheroembolic renal disease has improved. The correct diagnosis requires the clinician to be alert. The typical patient is a white male aged >60 yrs with a history of hypertension, smoking and arterial disease. The presence of a classic triad (precipitating event, renal failure and peripheral cholesterol crystal embolization) suggests the diagnosis. This can be confirmed by a biopsy of the target organs. A specific treatment is lacking; however, it is an important diagnosis to make because an aggressive therapeutic approach can be associated with a more favorable clinical outcome. PMID:21977265

  15. Ischemic Stroke

    Science.gov (United States)

    ... fit. Learn more Survivors Just Experienced a Stroke Stroke Recovery Caregivers and Family Careliving Guide Careliving Community Stroke Support Groups Online Education Healthcare Professionals Join Us ...

  16. Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

    Energy Technology Data Exchange (ETDEWEB)

    Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

    2008-10-15

    Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

  17. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Easton, J Donald; Lopes, Renato D; Bahit, M Cecilia

    2012-01-01

    In the ARISTOTLE trial, the rate of stroke or systemic embolism was reduced by apixaban compared with warfarin in patients with atrial fibrillation (AF). Patients with AF and previous stroke or transient ischaemic attack (TIA) have a high risk of stroke. We therefore aimed to assess the efficacy ...

  18. Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis.

    Science.gov (United States)

    Kirschen, Matthew P; Dori, Yoav; Itkin, Maxim; Licht, Daniel J; Ichord, Rebecca; Vossough, Arastoo

    2016-09-01

    An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

  20. Stroke - discharge

    Science.gov (United States)

    ... Know Stroke. Post-Stroke Rehabilitation. Updated September 2014. stroke.nih.gov/materials/rehabilitation.htm . Accessed July 22, 2016. The American Occupational Therapy Association. Recovering From Stroke. AOTA.org. 2013. www. ...

  1. Thrombolytic therapy in pulmonary embolism.

    LENUS (Irish Health Repository)

    Nagi, D

    2010-01-01

    Massive pulmonary embolism carries a high mortality. Potential treatment includes anticoagulation, thrombolytic therapy and embolectomy. We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome.

  2. Corticosteroids for fat embolism after multiple fractures

    Institute of Scientific and Technical Information of China (English)

    CHEN Huai-sheng; ZHANG Qing-mei; WEN Jun-min; WEN Shun-kang; YI Jing; ZHOU Zhi-qiang; WU Sheng-nan

    2007-01-01

    @@ Fat embolism is a common complication of multiple fractures. Corticosteroids are usually prescribed in prophylactic and treatment of fat embolism. A case of fat embolism followed multiple fractures was hospitalized, and we searched best evidences about corticosteroids for fat embolism so as to provide best therapeutics for the patient.

  3. Circulating and brain BDNF levels in stroke rats. Relevance to clinical studies.

    Directory of Open Access Journals (Sweden)

    Yannick Béjot

    Full Text Available BACKGROUND: Whereas brain-derived neurotrophic factor (BDNF levels are measured in the brain in animal models of stroke, neurotrophin levels in stroke patients are measured in plasma or serum samples. The present study was designed to investigate the meaning of circulating BDNF levels in stroke patients. METHODS AND RESULTS: Unilateral ischemic stroke was induced in rats by the injection of various numbers of microspheres into the carotid circulation in order to mimic the different degrees of stroke severity observed in stroke patients. Blood was serially collected from the jugular vein before and after (4 h, 24 h and 8 d embolization and the whole brains were collected at 4, 24 h and 8 d post-embolization. Rats were then selected from their degree of embolization, so that the distribution of stroke severity in the rats at the different time points was large but similar. Using ELISA tests, BDNF levels were measured in plasma, serum and brain of selected rats. Whereas plasma and serum BDNF levels were not changed by stroke, stroke induced an increase in brain BDNF levels at 4 h and 24 h post-embolization, which was not correlated with stroke severity. Individual plasma BDNF levels did not correlate with brain levels at any time point after stroke but a positive correlation (r = 0.67 was observed between individual plasma BDNF levels and stroke severity at 4 h post-embolization. CONCLUSION: Circulating BDNF levels do not mirror brain BDNF levels after stroke, and severe stroke is associated with high plasma BDNF in the very acute stage.

  4. Monitoring for suspected pulmonary embolism.

    Science.gov (United States)

    Capan, L M; Miller, S M

    2001-12-01

    It is fortunate that serious embolic phenomena are uncommon because, with the exception of neurosurgery in the sitting position and cardiac surgery, thoracic echocardiography and the precordial Doppler device, the most sensitive indicators of embolism, are seldom used. Vigilance is required of the anesthesiologist to recognize the rapid fall in end-tidal PCO2, the usual first indicator of a clinically significant PE. Any sudden deterioration in the patient's vital signs should include embolism in the differential diagnosis, particularly during procedures that carry a high risk of the complication.

  5. "Air embolism during fontan operation"

    Directory of Open Access Journals (Sweden)

    Madan Mohan Maddali

    2014-01-01

    Full Text Available In patients with a right to left intracardiac shunt, air embolism results in an obligatory systemic embolization. Nonembolization of entrained air is described in a child with a single ventricle physiology who had earlier undergone bidirectional Glenn shunt construction and Damus-Kaye-Stansel anastomosis. The air entrainment was detected by intra-operative transesophageal echocardiography. The combined effect of a "diving bell" phenomenon and mild aortic valve regurgitation are suggested as the reasons for the confinement of air into the ventricle preventing catastrophic systemic embolization.

  6. Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

    Directory of Open Access Journals (Sweden)

    Youming Long

    2014-01-01

    Full Text Available Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9% patients were women. Fifteen (55.6% patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2, moyamoya disease (n = 1, and neuromyelitis optica (n = 1. We found positive associations between mRS (>3 and female gender (r = 0.873, P10 × 109/L (r = 0.722, P = 0.002, tumour size (r = 0.866, P0.05. Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

  7. First multimodal embolization particles visible on x-ray/computed tomography and magnetic resonance imaging.

    Science.gov (United States)

    Bartling, Soenke H; Budjan, Johannes; Aviv, Hagit; Haneder, Stefan; Kraenzlin, Bettina; Michaely, Henrik; Margel, Shlomo; Diehl, Steffen; Semmler, Wolfhard; Gretz, Norbert; Schönberg, Stefan O; Sadick, Maliha

    2011-03-01

    Embolization therapy is gaining importance in the treatment of malignant lesions, and even more in benign lesions. Current embolization materials are not visible in imaging modalities. However, it is assumed that directly visible embolization material may provide several advantages over current embolization agents, ranging from particle shunt and reflux prevention to improved therapy control and follow-up assessment. X-ray- as well as magnetic resonance imaging (MRI)-visible embolization materials have been demonstrated in experiments. In this study, we present an embolization material with the property of being visible in more than one imaging modality, namely MRI and x-ray/computed tomography (CT). Characterization and testing of the substance in animal models was performed. To reduce the chance of adverse reactions and to facilitate clinical approval, materials have been applied that are similar to those that are approved and being used on a routine basis in diagnostic imaging. Therefore, x-ray-visible Iodine was combined with MRI-visible Iron (Fe3O4) in a macroparticle (diameter, 40-200 μm). Its core, consisting of a copolymerized monomer MAOETIB (2-methacryloyloxyethyl [2,3,5-triiodobenzoate]), was coated with ultra-small paramagnetic iron oxide nanoparticles (150 nm). After in vitro testing, including signal to noise measurements in CT and MRI (n = 5), its ability to embolize tissue was tested in an established tumor embolization model in rabbits (n = 6). Digital subtraction angiography (DSA) (Integris, Philips), CT (Definition, Siemens Healthcare Section, Forchheim, Germany), and MRI (3 Tesla Magnetom Tim Trio MRI, Siemens Healthcare Section, Forchheim, Germany) were performed before, during, and after embolization. Imaging signal changes that could be attributed to embolization particles were assessed by visual inspection and rated on an ordinal scale by 3 radiologists, from 1 to 3. Histologic analysis of organs was performed. Particles provided a

  8. Pulmonary embolism; Lungenarterienembolie

    Energy Technology Data Exchange (ETDEWEB)

    Sudarski, Sonja; Henzler, Thomas [Heidelberg Univ., Universitaetsmedizin Mannheim (Germany). Inst. fuer Klinische Radiologie und Nuklearmedizin

    2016-09-15

    Pulmonary embolism (PE) requires a quick diagnostic algorithm, as the untreated disease has a high mortality and morbidity. Crucial for the diagnostic assessment chosen is the initial clinical likelihood of PE and the individual risk profile of the patient. The overall goal is to diagnose or rule out PE as quickly and safely as possible or to initiate timely treatment if necessary. CT angiography of the pulmonary arteries (CTPA) with multi-slice CT scanner systems presents the actual diagnostic reference standard. With CTPA further important diagnoses can be made, like presence of right ventricular dysfunction. There are different scan and contrast application protocols that can be applied in order to gain diagnostic examinations with sufficient contrast material enhancement in the pulmonary arteries while avoiding all kinds of artifacts. This review article is meant to be a practical guide to examine patients with suspected PE according to the actual guidelines.

  9. Pulmonary Embolism in Children

    Directory of Open Access Journals (Sweden)

    Ahmar Urooj Zaidi

    2017-08-01

    Full Text Available Pulmonary embolism (PE in the pediatric population is relatively rare when compared to adults; however, the incidence is increasing and accurate and timely diagnosis is critical. A high clinical index of suspicion is warranted as PE often goes unrecognized among children leading to misdiagnosis and potentially increased morbidity and mortality. Evidence-based guidelines for the diagnosis, management, and follow-up of children with PE are lacking and current practices are extrapolated from adult data. Treatment options include thrombolysis and anticoagulation with heparins and oral vitamin K antagonists, with newer direct oral anticoagulants currently in clinical trials. Long-term sequelae of PE, although studied in adults, are vastly unknown among children and adolescents. Additional research is needed in order to provide pediatric focused care for patients with acute PE.

  10. Embolization for gastrointestinal hemorrhages

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J.; Rilinger, N.; Aschoff, A.J.; Vogel, J.; Brambs, H.J. [Dept. of Diagnostic Radiology, University of Ulm (Germany); Siech, M. [Dept. of Abdominal Surgery, University of Ulm (Germany)

    2000-05-01

    Retrospective evaluation of interventional embolization therapy in the treatment of gastrointestinal hemorrhage over a long-term observation period from 1989 to 1997. Included in the study were 35 patients (age range 18-89 years) with gastrointestinal bleeding (GI) referred for radiological intervention either primarily or following unsuccessful endoscopy or surgery. Sources of GI bleeding included gastric and duodenal ulcers (n = 7), diverticula (n = 3), erosion of the intestinal wall secondary to malignancy (n = 6), vascular malformations (n = 4), and hemorrhoids (n = 2), as well as from postoperative (n = 6), posttraumatic (n = 2), postinflammatory (n = 4) or unknown (n = 1) causes. Ethibloc (12 cases) or metal coils (14 cases) were predominantly used as embolisates. In addition, combinations of tissue adhesive and gelfoam particles and of coils and Ethibloc were used (six cases). Finally, polyvinyl alcohol particles, a coated stent, and an arterial wire dissection were utilized in one case each. Bleeding was stopped completely in 29 of 35 cases (83 %). In one case (3 %) the source of bleeding was recognized but the corresponding vessel could not be catheterized. In five other cases (14 %) there was partial success with reduced, though still persistent, bleeding. The rate of complications was 14 %, including four instances of intestinal ischemia with fatal outcome in the first years, and, later, one partial infarction of the spleen without serious consequences. Gastrointestinal hemorrhage can be controlled in a high percentage of patients, including the seriously ill and those who had previously undergone surgery, with the use of minimally invasive interventional techniques. The availability of minicoils instead of fluid embolization agents has reduced the risk of serious complications. (orig.)

  11. Rabbit hematology.

    Science.gov (United States)

    Marshall, Kemba L

    2008-09-01

    Using laboratory animal medicine as an established resource, companion animal veterinarians have access to many physiologic and basic science studies that we can now merge with our clinical impressions. By working with reference laboratories, companion animal veterinarians are poised to accelerate our knowledge of the normal rabbit rapidly. The aim of this article is to discuss normal hematopoiesis and infectious and metabolic diseases that specifically target the hemolymphatic system. Additionally, photographic representation of cell types is provided.

  12. Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?

    Science.gov (United States)

    Dalen, James E; Alpert, Joseph S

    2016-11-01

    More than 25% of all ischemic strokes per year are cryptogenic, that is, their cause is not determined after an appropriate evaluation. In 1988, it was reported that the incidence of a patent foramen ovale was 30 to 40% in young patients with a cryptogenic stroke compared with 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation. Few of the patients considered to have paradoxical embolism were shown to have coexistent venous thromboembolism. This suspicion of paradoxical embolism led to thousands of patients undergoing surgical closure of their patent foramen ovale. Surgical closure was replaced by closure of the patent foramen ovale by a variety of transvenous devices. Others recommended anticoagulant or antiplatelet therapy to prevent recurrent ischemic strokes. Three randomized clinical trials totaling more than 2000 patients compared closure of the patent foramen ovale with medical therapy. All 3 trials reported that closure of the patent foramen ovale provided no benefit compared with medical therapy. Subsequent trials have demonstrated no benefit of anticoagulation compared with antiplatelet therapy in patients with cryptogenic strokes with or without a patent foramen ovale. Patients with cryptogenic strokes should be evaluated for the presence of venous thromboembolism. If venous thromboembolism is present, treatment should be the same as for pulmonary embolism: anticoagulation. If venous thromboembolism is not present, antiplatelet therapy is indicated. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Stroke of undetermined cause: workup and secondary prevention.

    Science.gov (United States)

    Weimar, Christian

    2016-02-01

    The purpose of this review is to update the reader on current concepts of workup and secondary prevention in patients with stroke of undetermined cause. Clinical research in patients with cryptogenic stroke has been hampered by the lack of standardized, widely accepted diagnostic criteria. The new definition of 'Embolic stroke of undetermined etiology' postulates an embolic mechanism of ischemic stroke. It is based on the exclusion of lacunar infarction by brain imaging, arterial stenosis more than 50% or dissection of the respective brain-supplying artery by computed tomography/magnetic resonance-angiography or ultrasound, atrial fibrillation by at least 24 h EKG monitoring, as well as some rare etiologies such as vasculitis, drug abuse, or coagulopathies. However, it still comprises many patients with atherosclerotic etiologies (but undetermined etiology enabled three ongoing randomized controlled trials which investigate oral anticoagulation versus aspirin for secondary stroke prevention.

  14. Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism%动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究

    Institute of Scientific and Technical Information of China (English)

    程伟; 包艳娥; 聂莉; 李婉秋; 乔向亮; 程晓玲

    2013-01-01

    目的在动脉-动脉栓塞性缺血性卒中患者中,探讨晨峰高血压与颈动脉溃疡斑块的相关性。方法连续入组120例经中国缺血性卒中亚型(Chinese Ischemic Stroke Subclassification,CISS)分型诊断为动脉-动脉栓塞性缺血性卒中患者,利用24 h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型,研究晨峰血压与颈动脉溃疡斑块的相关性。结果120例缺血性卒中患者的平均年龄为(62.6±12.8)岁,女性占36.8%。晨峰高血压组(n=48)溃疡斑块的检出率与无晨峰高血压组(n=72)相比,差异无显著性(31.3% vs 30.6%,P=0.84)。进一步将溃疡斑块按照检出部位(出现在卒中病灶同侧颈动脉或对侧颈动脉)进行分类发现,晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组(27.1% vs 19.4%,P=0.008)。多因素分析的结果显示,在调整了年龄、性别之后,晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比(odds ratio,OR):1.42;95%可信区间(confidence interval,CI):1.09~4.22)];进一步校正其他危险因素之后,两者相关性仍存在(OR 1.23;95%CI 1.02~3.46)。结论在动脉-动脉栓塞性缺血性卒中患者中,晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性,提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。%Objective To investigate the association of morning blood pressure surge (MBPS) with carotid artery plaque ulceration (CAPU) in ischemic stroke (IS) patients. Methods One hundred and twenty IS patients diagnosed with artery to artery embolism based on Chinese Ischemic Stroke Subclassiifcation (CISS) were enrolled in this study. MBPS was monitored by ambulatory blood pressure monitoring within 24 hours, and CAPU

  15. Preventing stroke

    Science.gov (United States)

    Stroke - prevention; CVA - prevention; cerebral vascular accident - prevention; TIA - prevention, transient ischemic attack - prevention ... something that increases your chance of having a stroke. You cannot change some risk factors for stroke. ...

  16. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  17. Hemorrhagic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  18. Cerebral fat embolism: pulmonary contusion is a more important etiology than long bone fractures.

    Science.gov (United States)

    Aydin, M D; Akçay, F; Aydin, N; Gündogdu, C

    2005-01-01

    Lipid embolism is a serious and life-threatening problem and usually arises as a complication of severe trauma associated with long bone or pelvic fractures. It is generally thought that fat droplets enter the circulation at the site of fracture. In the systemic circulation, they become emboli to brain, kidney and other areas. Lipids are absorbed from the intestinal tract and transported into pulmonary tissue via thoracic duct and exposed to first catabolic procedures in the lungs. We have predicted that systemic lipid embolism may not occur unless bone fractures lead to pulmonary injury. This study was planned to investigate this hypothesis with respect to the role of pulmonary contusion and long bone fractures in the formation of cerebral fat embolism. Twenty male hybrid rabbits were included in this study. Pulmonary contusion was performed on half of the rabbits (n = 10) and femur fracture was applied to the remaining ones (n = 10). Ten days after procedure, all rabbits were sacrificed. Brain specimens were taken by frozen-section method and stained with Sudan black. Intraarteriolar lipid particles in the brain were examined microscopically. Cerebral fat embolism was detected in seven animals exposed to pulmonary contusion and only in one animal exposed to femur fracture. The mean number of branches of middle cerebral artery at midparietal level occluded with fat particles were higher in the pulmonary contusion group than in the long bone fracture group. In conclusion, we found that pulmonary contusion had more deleterious effects than long bone fracture in the formation of cerebral fat embolism.

  19. [Transcranial Doppler test for evaluation of cerebral artery embolism--microemboli detection].

    Science.gov (United States)

    Jovanović, Zagorka B; Pavlović, Aleksandra M; Zidverc-Trajković, Jasna J; Mijajlović, Milija D; Radojicić, Aleksandra P; Covicković-Sternić, Nadezda M

    2008-01-01

    About one third of ischaemic cerebrovascular diseases have embolic properties. Because of that, transcranial Doppler (TCD) test for detection of microembolic signals (MES), as the only one method for detection of microemboli, is a very important test for the evaluation of cerebral artery embolism. Cerebral emboli are particles of thrombus or atheromatous plaque, platelet aggregates, lipid or air particles in cerebral circulation, which can occlude arterioles and cause ischaemic transient attack (TIA) or stroke. Most frequently, they derive from exulcerated plaques of the carotid bifurcation or the aortic arch, from the atrial thrombus, prosthetic heart valves, as well as during carotid endarterectomy, arterial stent, aortocoronary by-pass. For MES detection, bilateral monitoring of a. cerebri mediae (ACM) is performed with each probe held in place over a temporal bone. MES are represented as brightly coloured embolic tracks as they pass through the insonated arteries. A computer hard disk provides continuous recording that is replayed for counting embolic signals. Colour intensity or acoustic range indicate the size and structure of MES. MES in the range of one ACM indicate the source of embolism on the ipsilateral carotid artery, while the bilateral detection of MES suggests a cardiogenic source. Indications for TCD detection of MES are the evaluation of pathogenesis and risk for embolic stroke or TIA and assessing the source of embolism. We started applying this method at the Institute of Neurology in Belgrade 2 years ago. We have investigated 78 patients till today and detected MES in 23 patients (28.7%). The Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, 2004, considers that TCD is probably useful for detection of cerebral MES in various cardiovascular and cerebrovascular disorders and procedures.

  20. Transcranial Doppler test for evaluation of cerebral artery embolism: Microemboli detection

    Directory of Open Access Journals (Sweden)

    Jovanović Zagorka B.

    2008-01-01

    Full Text Available About one third of ischaemic cerebrovascular diseases have embolic properties. Because of that, transcranial Doppler (TCD test for detection of microembolic signals (MES, as the only one method for detection of microemboli, is a very important test for the evaluation of cerebral artery embolism. Cerebral emboli are particles of thrombus or atheromatous plaque, platelet aggregates, lipid or air particles in cerebral circulation, which can occlude arterioles and cause ischemic transient attack (TIA or stroke. Most frequently, they derive from exulcerated plaques of the carotid bifurcation or the aortic arch, from the atrial thrombus, prosthetic heart valves, as well as during carotid endarterectomy, arterial stent, aortocoronary by-pass. For MES detection, bilateral monitoring of a. cerebri mediae (ACM is performed with each probe held in place over a temporal bone. MES are represented as brightly coloured embolic tracks as they pass through the insonated arteries. A computer hard disk provides continuous recording that is replayed for counting embolic signals. Colour intensity or acoustic range indicate the size and structure of MES. MES in the range of one ACM indicate the source of embolism on the ipsilateral carotid artery, while the bilateral detection of MES suggests a cardiogenic source. Indications for TCD detection of MES are the evaluation of pathogenesis and risk for embolic stroke or TIA and assessing the source of embolism. We started applying this method at the Institute of Neurology in Belgrade 2 years ago. We have investigated 78 patients till today and detected MES in 23 patients (28.7%. The Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology, 2004, considers that TCD is probably useful for detection of cerebral MES in various cardiovascular and cerebrovascular disorders and procedures.

  1. Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke: A Biplane Transesophageal Echocardiography Study

    Science.gov (United States)

    Homma, S.; DiTullio, M. R.; Sacco, R. L.; Mihalatos, D..; LiMandri, G.; Mohr, J. P.

    1994-01-01

    Patent foramen ovale is associated with ischemic stroke in patients without a clearly identifiable etiology for stroke (cryptogenic stroke). Paradoxical embolization is thought to be a potential mechanism. However, patent foramen ovale is also found in patients with known cause of stroke. Therefore, using contrast transesophageal echocardiography, we characterized the patent foramen ovale in cryptogenic stroke patients to assess morphological factors that may contribute to paradoxical embolization. Methods: Contrast transesophageal echocardiographic studies of 74 consecutive patients referred for ischemic stroke were reviewed. Twenty-three patients with patent foramen ovale were identified. These patients were classified as having strokes of determined origin or cryptogenic strokes according to criteria developed for the Stroke Data Bank of the National Institute of Neurological Disorders and Stroke. Separation of septum primum from secundum and the number of microbubbles appearing in left atrium were then quantitated. These parameters were compared between patients with cryptogenic stroke and those with known cause of stroke. Results: The patent foramen ovale dimension was significantly larger in patients with cryptogenic stroke compared with patients with an identifiable cause of stroke (2.1+/-1.7 mm versus 057+/-0.78 mm [mean+/-SD]; Ppatent foramen ovale with more extensive right-to-left inter-atrial shunting than patients with stroke of determined cause. Transesophageal echocardiographically identifiable characteristics of patent foramen ovale may be important in defining the clinical significance of individual patent foramina.

  2. Amniotic fluid embolism

    Directory of Open Access Journals (Sweden)

    Rudra A

    2009-01-01

    Full Text Available The disastrous entry of amniotic fluid into the maternal circulation leads to dramatic sequelae of clinical events, characteristically referred to as Amniotic fluid embolism (AFE. The underlying mechanism for AFE is still poorly understood. Unfortunately, this situation has very grave maternal and fetal consequences. AFE can occur during labor, caesarean section, dilatation and evacuation or in the immediate postpartum period. The pathophysiology is believed to be immune mediated which affects the respiratory, cardiovascular, neurological and hematological systems. Undetected and untreated it culminates into fulminant pulmonary edema, intractable convulsions, disseminated intravascular coagulation (DIC, malignant arrhythmias and cardiac arrest. Definite diagnosis can be confirmed by identification of lanugo, fetal hair and fetal squamous cells (squames in blood aspirated from the right ventricle. Usually the diagnosis is made clinically and by exclusion of other causes. The cornerstone of management is a multidisciplinary approach with supportive treatment of failing organs systems. Despite improved modalities for diagnosing AFE, and better intensive care support facilities, the mortality is still high.

  3. Bronchial artery embolization in hemoptysis

    Institute of Scientific and Technical Information of China (English)

    DAI Hong-xiu; YANG Ding-cai; LIU Wei-hong; TANG He-qing; LIU Ke-yong; ZHAO Xiao-hua; TAN Yi-qing; WANG Jun

    2005-01-01

    Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.

  4. Pregnancy after uterine arterial embolization

    Directory of Open Access Journals (Sweden)

    Cláudio E. Bonduki

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate pregnancy outcomes, complications and neonatal outcomes in women who had previously undergone uterine arterial embolization. METHODS: A retrospective study of 187 patients treated with uterine arterial embolization for symptomatic uterine fibroids between 2005-2008 was performed. Uterine arterial embolization was performed using polyvinyl alcohol particles (500-900 mm in diameter. Pregnancies were identified using screening questionnaires and the study database. RESULTS: There were 15 spontaneous pregnancies. Of these, 12.5% were miscarriages (n = 2, and 87.5% were successful live births (n = 14. The gestation time for the pregnancies with successful live births ranged from 36 to 39.2 weeks. The mean time between embolization and conception was 23.8 months (range, 5-54. One of the pregnancies resulted in twins. The newborn weights (n = 14 ranged from 2.260 to 3.605 kg (mean, 3.072 kg. One (7.1% was considered to have a low birth weight (2.260 kg. There were two cases of placenta accreta (12.5%, treated with hysterectomy in one case [6.3%], one case of premature rupture of the membranes (PRM (6.3%, and one case of preeclampsia (6.3%. All of the patients were delivered via Cesarean section. CONCLUSION: In this study, there was an increased risk of Cesarean delivery. There were no other major obstetric risks, suggesting that pregnancy after uterine arterial embolization is possible without significant morbidity or mortality.

  5. Stroke Rehabilitation

    Science.gov (United States)

    ... or other long-term facility 15% die shortly after the stroke Approximately 14% of stroke survivors experience a second stroke in the first year following a stroke. Successful rehabilitation depends on: Amount of damage to the brain Skill on the part of ...

  6. Cerebrovascular Accident Secondary to Paradoxical Embolism Following Arteriovenous Graft Thrombectomy

    Directory of Open Access Journals (Sweden)

    Jolina Pamela Santos

    2012-01-01

    Full Text Available Thrombectomy is a common procedure performed to declot thrombosed dialysis arteriovenous fistula (AVF or arteriovenous graft (AVG. Complications associated with access thrombectomy like pulmonary embolism have been reported, but paradoxical embolism is extremely rare. We report a case of a 74-year-old black man with past medical history significant for end-stage renal disease (ESRD, atrial fibrillation on anticoagulation with warfarin, who presented to our hospital with lethargy, aphasia, and right-sided hemiparesis following thrombectomy of a clotted AVG. Computed tomography (CT scan of brain showed a hypodensity within the left posterior parietal lobe. INR was 2.0 on admission. Echocardiogram revealed a normal sized left atrium with no intracardiac thrombus, and bubble study showed the presence of right-to-left shunting. These findings suggest that the stroke occurred as a result of an embolus originating from the AVG. Paradoxical cerebral embolism is uncommon but can occur after thrombectomy of clotted vascular access in ESRD patients. Clinicians and patients should be aware of this serious and potentially fatal complication of vascular access procedure.

  7. U turn to venous air embolism

    Directory of Open Access Journals (Sweden)

    Singh Harsimran

    2009-01-01

    Full Text Available There is a definitive risk of venous air embolism when the fluid infusion is complete and the drip set is still open in a glass bottle.We have devised a novel way of preventing the chances of air embolism when the fluid in the glass bottle finishes. It really gives a "U" turn to the chances of venous air embolism.

  8. Palliative embolization of renal tumors

    Directory of Open Access Journals (Sweden)

    Jaganjac Suad

    2015-01-01

    Full Text Available Background/Aim. Palliative embolization of renal tumors is the method of choice in the treatment of advanced inoperable renal cell carcinoma in patients with hematuria and pain. Patients with small tumors in the remaining solitary kidney who refuse surgery are suitable for this type of therapy as well as patients with centrally located inoperable tumors. The prerequisite for successful capillary embolization is the closure of the main arte-rial trunk with metal spirals. Methods. In the period from 2000 to 2010 we conducted 42 palliative embolizations. The average age of the patients was 75 years, including 26 men and 16 women. In 8 of the patients the intervention was repeated and in one with severe AV shunts embolization was performed 4 times. Embolization was performed with alcohol, Ivalon 150-250 μm and with metal coils. Results. No serious complications were observed during and after the intervention. Fourteen patient were still alive then and among the deceased patients the average survival time was 13.5 ± 10.8 months with the range of 1 to 56 months. The minimal survival time was 1 month with a maxi-mum survival time of 56 months. Conclusion. Our results are consistent with data in the literature. Survival in patients without metastases was longer than in those with metastases, as con-firmed by the 14 of the patients from the study. An additional therapeutic safety in the treatment of small cancers is provided with a combination therapy of embolization and radiofrequency thermoablation.

  9. Radionuclide Diagnosis of Pulmonary Embolism

    DEFF Research Database (Denmark)

    Hess, Søren; Madsen, Poul Henning

    2016-01-01

    Diagnostic imaging plays an integral role in the diagnostic workup of suspected pulmonary embolism, and several modalities have been employed over the years. In recent years, the choice has been narrowed to either computer tomographic or radionuclide based methods, i.e. computer tomographic angio...

  10. Viral infections of rabbits.

    Science.gov (United States)

    Kerr, Peter J; Donnelly, Thomas M

    2013-05-01

    Viral diseases of rabbits have been used historically to study oncogenesis (e.g. rabbit fibroma virus, cottontail rabbit papillomavirus) and biologically to control feral rabbit populations (e.g. myxoma virus). However, clinicians seeing pet rabbits in North America infrequently encounter viral diseases although myxomatosis may be seen occasionally. The situation is different in Europe and Australia, where myxomatosis and rabbit hemorrhagic disease are endemic. Advances in epidemiology and virology have led to detection of other lapine viruses that are now recognized as agents of emerging infectious diseases. Rabbit caliciviruses, related to rabbit hemorrhagic disease, are generally avirulent, but lethal variants are being identified in Europe and North America. Enteric viruses including lapine rotavirus, rabbit enteric coronavirus and rabbit astrovirus are being acknowledged as contributors to the multifactorial enteritis complex of juvenile rabbits. Three avirulent leporid herpesviruses are found in domestic rabbits. A fourth highly pathogenic virus designated leporid herpesvirus 4 has been described in Canada and Alaska. This review considers viruses affecting rabbits by their clinical significance. Viruses of major and minor clinical significance are described, and viruses of laboratory significance are mentioned. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Know Stroke

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section Know Stroke Past Issues / Summer 2007 Table of Contents For ... D. Director, National Institute of Neurological Disorders and Stroke Photo courtesy of NIH/NINDS Welcome to this ...

  12. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  13. Stroke: Overview

    Science.gov (United States)

    ... NICHD Research Information Clinical Trials Resources and Publications Stroke: Overview Skip sharing on social media links Share this: Page Content Stroke is a leading cause of disability and death ...

  14. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... WHERE TO LIVE AFTER A STROKE Most people will need stroke ... after they leave the hospital. Stroke rehab will help you ...

  15. Transcatheter Arterial Embolization for Upper Gastrointestinal Nonvariceal Hemorrhage: Is Empiric Embolization Warranted?

    Energy Technology Data Exchange (ETDEWEB)

    Arrayeh, Elnasif; Fidelman, Nicholas, E-mail: nicholas.fidelman@ucsf.edu; Gordon, Roy L.; LaBerge, Jeanne M.; Kerlan, Robert K. [University of California San Francisco, Department of Radiology (United States); Klimov, Alexander; Bloom, Allan I. [Hadassah Hospital, Department of Radiology (Israel)

    2012-12-15

    Purpose: To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Methods: Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared.ResultsFor patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Conclusion: Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  16. Transcatheter arterial embolization for upper gastrointestinal nonvariceal hemorrhage: is empiric embolization warranted?

    Science.gov (United States)

    Arrayeh, Elnasif; Fidelman, Nicholas; Gordon, Roy L; LaBerge, Jeanne M; Kerlan, Robert K; Klimov, Alexander; Bloom, Allan I

    2012-12-01

    To determine whether transcatheter arterial embolization performed in the setting of active gastric or duodenal nonvariceal hemorrhage is efficacious when the bleeding source cannot be identified angiographically. Records of 115 adult patients who underwent visceral angiography for endoscopically documented gastric (50 patients) or duodenal (65 patients) nonvariceal hemorrhage were retrospectively reviewed. Patients were subdivided into three groups according to whether angiographic evidence of arterial hemorrhage was present and whether embolization was performed (group 1 = no abnormality, no embolization; group 2 = no abnormality, embolization performed [empiric embolization]; and group 3 = abnormality present, embolization performed). Thirty-day rates and duration of primary hemostasis and survival were compared. For patients with gastric sources of hemorrhage, the rate of primary hemostasis at 30 days after embolization was greater when embolization was performed in the setting of a documented angiographic abnormality than when empiric embolization was performed (67% vs. 42%). The rate of primary hemostasis at 30 days after angiography was greater for patients with duodenal bleeding who either underwent empiric embolization (60%) or embolization in the setting of angiographically documented arterial hemorrhage (58%) compared with patients who only underwent diagnostic angiogram (33%). Patients with duodenal hemorrhage who underwent embolization were less likely to require additional invasive procedures to control rebleeding (p = 0.006). Empiric arterial embolization may be advantageous in patients with a duodenal source of hemorrhage but not in patients with gastric hemorrhage.

  17. Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report

    Directory of Open Access Journals (Sweden)

    Guo Shan

    2007-09-01

    Full Text Available Abstract Introduction Coexistence of pulmonary embolism and systemic arterial embolism suggest the diagnosis of paradoxical embolism which suggests the presence of intracardiac defects such as patent foramen ovale (PFO. Case presentation A 42 year old man was found to have a paradoxical embolism in the systemic arterial circulation, in the setting of pulmonary embolism and deep vein thrombosis (DVT in the lower extremities. Conclusion Paradoxical embolism and intracardiac shunt should be immediately considered in a patient with pulmonary embolism and systemic arterial embolism. Diagnostic modalities included arteriogram and saline contrast echocardiography. Closure of intracardiac shunt is needed for patients who are at risk for recurrent embolic events.

  18. The Rabbit Stream Cipher

    DEFF Research Database (Denmark)

    Boesgaard, Martin; Vesterager, Mette; Zenner, Erik

    2008-01-01

    The stream cipher Rabbit was first presented at FSE 2003, and no attacks against it have been published until now. With a measured encryption/decryption speed of 3.7 clock cycles per byte on a Pentium III processor, Rabbit does also provide very high performance. This paper gives a concise...... description of the Rabbit design and some of the cryptanalytic results available....

  19. PREPARATION AND DRUG RELEASE CHARACTERISTICS OF PINGYANGMYCIN GELATIN MICROSPHERES FOR EMBOLIZATION THERAPY

    Institute of Scientific and Technical Information of China (English)

    吴红; 张镇西; 吴道澄; 于开涛; 李晓晔

    2003-01-01

    Objective: To prepare Pingyangmycin gelatin microspheres (PYM-GMS) for carotid artery embolization therapy and to study the release characteristics in vivo and in vitro. Methods: PYM-GMS was prepared by optical double-phase emulsified condensation polymerization. Through UV-spectrophotometer drug content and encapsulation rate were measured. The characteristics of drug release in vitro which could simulate the actual state in vivo were tested by HPLC. Three ways of vein drop, artery perfusion and artery embolization were contrasted. Under the supervision of X-ray, PYM-GMS were perfused into the external carotid artery of rabbits by superselective artery embolization. Blood samples were tested at different time and analyzed statistically. Results: The roundness of PYM-GMS was 1.02±0.005. The mean diameter was 85.6 (m, 78% of them ranging from 50(200 (m, which fitted the use of embolization. PYM content and encapsulation rate were 6.8% and 91.3% respectively. 70% of the drug was released in 3 h in the simulated environment in vivo and total drug was released after more than 6 h. After artery embolization with small dosage of PYM-GMS, the local drug concentration was 8 times higher than the blood drug concentration and the high level of local drug concentration was kept for more than 120 min. Conclusion: External carotid artery embolization with PYM-GMS, which significantly reduced the circulating drug level and employment dosage, could prolong the duration higher drug concentration and suit the purpose of targeted tumor therapy.

  20. Fat embolism syndrome and pulmonary microvascular cytology.

    Science.gov (United States)

    Castella, X; Vallés, J; Cabezuelo, M A; Fernandez, R; Artigas, A

    1992-06-01

    Pulmonary microvascular cytology consists of analysis of capillary blood sampled while a Swan-Ganz catheter is in the wedge position. This technique has proved to be useful in the diagnosis of lymphangitic spread of carcinoma in the lungs and there are case reports of their use in amniotic fluid embolism. Its usefulness in diagnosing fat embolism syndrome has been shown only rarely. We report a new case in which pulmonary microvascular cytologic study allowed a definite diagnosis of fat embolism syndrome. We suggest obtaining routinely samples of capillary blood when a pulmonary catheter is in place and fat embolism is suspected on a clinical basis.

  1. Embolization biomaterial reinforced with nanotechnology for an in-situ release of anti-angiogenic agent in the treatment of hyper-vascularized tumors and arteriovenous malformations.

    Science.gov (United States)

    Jubeli, E; Yagoubi, N; Pascale, F; Bédouet, L; Slimani, K; Labarre, D; Saint-Maurice, J P; Laurent, A; Moine, L

    2015-10-01

    A polymer based material was developed to act as an embolic agent and drug reservoir for the treatment of arteriovenous malformations (AVM) and hyper vascularized solid tumors. The aim was to combine the blocking of blood supply to the target region and the inhibition of the embolization-stimulated angiogenesis. The material is composed of an ethanolic solution of a linear acrylate based copolymer and acrylate calibrated microparticles containing nanospheres loaded with sunitinib, an anti-angiogenic agent. The precipitation of the linear copolymer in aqueous environment after injection through microcatheter results in the formation of an in-situ embolization gel whereas the microparticles serve to increase the cohesive properties of the embolization agent and to form a reservoir from which the sunitinib-loaded nanospheres are released post-embolization. The swollen state of the microparticles in contact with aqueous medium results in the release of the nanospheres out of microparticles macromolecular structure. After the synthesis, the formulation and the characterization of the different components of the material, anti-angiogenic activity was evaluated in vitro using endothelial cells and in vivo using corneal neovascularization model in rabbit. The efficiency of the arterial embolization was tested in vivo in a sheep model. Results proved the feasibility of this new system for vascular embolization in association with an in situ delivery of anti-angiogenic drug. This combination is a promising strategy for the management of arteriovenous malformations and solid tumors.

  2. Ischemic stroke in young adults: an overview of etiological aspects

    Directory of Open Access Journals (Sweden)

    Fábio Iuji Yamamoto

    2012-06-01

    Full Text Available Stroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS. On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.

  3. Variant rabbit hemorrhagic disease virus in young rabbits, Spain.

    Science.gov (United States)

    Dalton, Kevin P; Nicieza, Inés; Balseiro, Ana; Muguerza, María A; Rosell, Joan M; Casais, Rosa; Álvarez, Ángel L; Parra, Francisco

    2012-12-01

    Outbreaks of rabbit hemorrhagic disease have occurred recently in young rabbits on farms on the Iberian Peninsula where rabbits were previously vaccinated. Investigation identified a rabbit hemorrhagic disease virus variant genetically related to apathogenic rabbit caliciviruses. Improved antivirus strategies are needed to slow the spread of this pathogen.

  4. METABOLIC DISORDERS AND PULMONARY EMBOLISM

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    O. Ya. Vasiltseva

    2015-01-01

    Full Text Available The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE in hospitals inTomsk(2003–2012. Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012. The degree of obesity was assessed according to WHO classification (1997. Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012. The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE. The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82

  5. Ovarian protection by selective coil embolization of a uteroovarian anastomosis before uterine fibroid embolization: a report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seung Boo; Im, Han Hyeok [Soonchunhyang University, Gumi (Korea, Republic of); Chang, Yun Woo; Goo, Dong Erk [Soonchunhyang University Hospital, Gumi (Korea, Republic of)

    2006-09-15

    Premature menopause can be developed as a result of undesired nontarget ovary embolization during the performance of uterine fibroid embolization. The etiology of varian failure after uterine fibroid embolization is not yet clearly defined, but one of the leading possibilities is nontarget embolization of the varies. We report here on two cases in which superselective coil embolization of distal uterine artery collateral pathways to the ovary was performed during uterine fibroid embolization.

  6. Peculiarities of Blood Flow Changes in Venae Cavae during Experimental Pulmonary Embolism.

    Science.gov (United States)

    Evlakhov, V I; Poyassov, I Z; Shaidakov, E V

    2016-10-01

    The model of acute pulmonary embolism in rabbits demonstrated reduced pulmonary blood flow, cardiac output, left atrial pressure, and blood flow in venae cavae against the background of elevated left pulmonary artery pressure and increased pulmonary vascular resistance. Simultaneously, the blood flow in the superior vena cava decreased to a lesser extent than that in the inferior vena cava, which was a characteristic feature of the model of pulmonary pathology. In contrast, when histamine was infused into the left jugular vein to equally elevate pressure in pulmonary artery as in the above model, the blood flow in the superior vena cava decreased to a greater extent than that in inferior vena cava. During stenosis of inferior vena cava that decreased the cardiac output to the level observed during modeled pulmonary embolism, the blood flows in both venae cavae dropped equally.

  7. A CLINICAL STUDY OF STROKE IN YOUNG

    Directory of Open Access Journals (Sweden)

    Kumbha Thulasi Ram

    2015-02-01

    Full Text Available NTRIDUCTION : Stroke is one of the important causes of morbidity and mortality all over the world. Incidence of stroke steadily increases with age. Experts are concerned of the emerging stroke epidemic in India. Stroke affecting the young has potentially devastating consequence son the individual and his family. Certain risk factors are unique to the young. I t needs more studies for identification and modification of risk factors. The study aims to evaluate clinical features, risk factors, etiology and mortality of stroke in young patients. METHODS : 74 young patients satisfying the inclusion criteria were included in this study. A detailed history was taken from young stroke patients, systemic examination and required investigations were done. Data was collected in standardized proforma and analysed. RESULTS: Stroke in young accounts for 7.95% of stroke cases of all age groups. The mean age of the patients was 34.66 ± 7.48 years. Among 74 patients, 47(63.51% were male and 27(36.49% were female. Seizures, decreased consciousness, speech involvement and motor deficit were observed in 33.78%, 44.59%, 22.97% and 100% of cases respectively. 82.43% patients had ischemic and 17.57% patients had hemorrhagic stroke. Among ischemic stroke, large artery atherosclerosis was 16.21%, tuberculous meningoencephalitis with vasculitis was 16.21%, lacunar stroke was 10.81%, CVT was 10.81% and cardio embolic stroke was 6.76%. Smoking (59.45%, alcoholism (58.10%, hypertension (43.24%, coronary artery disease (8.10%, diabetes mellitus (10.81%, elevated total cholesterol (25.67%, elevated low density lipo proteins (22.97%, elevated triglycerides (27.02% and low HDL (22.97% were important risk factors. Carotid doppler was abnormal in 9.45% of patients. 6.76% patients had mitral stenosis in echocardiogram. Low protein C and protein S were found in 1.35% of patients. Eight (10.81% patients died during the hospital stay. INTERPRETATION AND CONCLUSIONS: The major risk

  8. The case for an elderly-targeted stroke management

    Directory of Open Access Journals (Sweden)

    Osvaldo eFustinoni

    2011-12-01

    Full Text Available The elderly, in whom atrial fibrillation is most prevalent, carry the greatest risk, undergoing more recurrent, deadlier strokes, with bigger deficits, slower recoveries, and more comorbidities. Age-related cerebral changes might undermine the benefit of established stroke treatments. Nevertheless, the elderly should probably also undergo thrombolysis for ischemic stroke: they do not bleed more, and die not because of hemorrhage but of concomitant illnesses. Beyond natural bleeding risks, atrial fibrillation in advanced age has a high embolic potential if not anticoagulated. Standard or lower intensity warfarin anticoagulation prevents embolic stroke in the elderly with a hemorrhage risk even lower than aspirin. Excess anticoagulation hazards are prevented with lower starting doses, stricter corrections, more frequent INR monitoring. Direct thrombin inhibitors have recently shown a benefit similar to warfarin with fewer hemorrhages. Antihypertensives probably help 80-plus stroke patients as well, but the risk/benefit of lowering blood pressure in secondary stroke prevention at that age is uncertain. In summary, emerging data suggest that stroke management should be specifically targeted to the elderly.

  9. Patent foramen ovale and paradoxical systemic embolism: a bibliographic review

    Science.gov (United States)

    Foster, Philip P.; Boriek, Aladin M.; Butler, Bruce D.; Gernhardt, Michael L.; Bove, Alfred A.

    2003-01-01

    A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.

  10. Patent foramen ovale and paradoxical systemic embolism: a bibliographic review

    Science.gov (United States)

    Foster, Philip P.; Boriek, Aladin M.; Butler, Bruce D.; Gernhardt, Michael L.; Bove, Alfred A.

    2003-01-01

    A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.

  11. Cerebral fat embolism: Use of MR spectroscopy for accurate diagnosis

    Directory of Open Access Journals (Sweden)

    Laxmi Kokatnur

    2015-01-01

    Full Text Available Cerebral fat embolism (CFE is an uncommon but serious complication following orthopedic procedures. It usually presents with altered mental status, and can be a part of fat embolism syndrome (FES if associated with cutaneous and respiratory manifestations. Because of the presence of other common factors affecting the mental status, particularly in the postoperative period, the diagnosis of CFE can be challenging. Magnetic resonance imaging (MRI of brain typically shows multiple lesions distributed predominantly in the subcortical region, which appear as hyperintense lesions on T2 and diffusion weighted images. Although the location offers a clue, the MRI findings are not specific for CFE. Watershed infarcts, hypoxic encephalopathy, disseminated infections, demyelinating disorders, diffuse axonal injury can also show similar changes on MRI of brain. The presence of fat in these hyperintense lesions, identified by MR spectroscopy as raised lipid peaks will help in accurate diagnosis of CFE. Normal brain tissue or conditions producing similar MRI changes will not show any lipid peak on MR spectroscopy. We present a case of CFE initially misdiagnosed as brain stem stroke based on clinical presentation and cranial computed tomography (CT scan, and later, MR spectroscopy elucidated the accurate diagnosis.

  12. Hemorrhagic complications of thrombolytic therapy in experimental stroke.

    Science.gov (United States)

    Slivka, A; Pulsinelli, W

    1987-01-01

    Recent success with thrombolytic therapy for acute myocardial infarction has stimulated interest in its use for stroke. To determine the hemorrhagic potential of thrombolytic therapy in experimental cerebral infarction, we compared a group of tissue plasminogen activator-treated rabbits (n = 4) with 2 groups of streptokinase-treated rabbits (n = 6 in each), as well as with 3 groups of heparin-treated rabbits (n = 5 in each) and untreated controls (n = 12). Focal cerebral infarction was produced in rabbits by occlusion of the right common carotid and middle cerebral arteries coupled with 2 hours of halothane-induced hypotension. Treatment with heparin or thrombolytic agents began 24 hours after occlusion. One additional group was treated with streptokinase 1 hour after occlusion (n = 6) to determine the hemorrhagic potential of thrombolytic agents in evolving infarction. Rabbits were killed 29-33 hours after occlusion, and brain sections were examined using light microscopy. The results demonstrate that microscopic hemorrhage is frequently present in infarcted tissue irrespective of treatment. Gross cerebral hemorrhage did not occur in untreated rabbits or in rabbits treated with streptokinase 1 hour after occlusion. Only rabbits treated with streptokinase, tissue plasminogen activator, or excessive doses of heparin 24 hours after occlusion, at a time when cerebral infarction was well established, exhibited gross hemorrhage in the area of infarction. These data suggest that treatment of ischemic stroke with thrombolytic agents carries an increased risk of cerebral hemorrhage unless the agents are given early after the onset of symptoms.

  13. Atherosclerosis and Stroke

    Science.gov (United States)

    ... After Stroke Inspirational Stories Stroke Heroes Among Us Atherosclerosis and Stroke Updated:Oct 24,2016 Excerpted and ... cause difficulty walking and eventually gangrene. Stroke and atherosclerosis There are two types of ischemic stroke caused ...

  14. Transarterial embolization of acute intercostal artery bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Park, Auh Whan; Lee, Seon Joo [Inje University College of Medicine, Busan (Korea, Republic of); Ko, Gi Young; Yoon, Hyun Ki [University of Ulsan College of Medicine, Seoul (Korea, Republic of); Yoon, Chang Jin [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Shin, Tae Beom [Donga University College of Medicine, Busan (Korea, Republic of); Kim, Young Hwan [Kyimyung University School of Medicine, Daegu (Korea, Republic of)

    2005-09-15

    To report our experiences of transarterial embolization for acute intercostal artery bleeding. A retrospectively analysis of the causes, clinical manifestations, angiographic findings and transarterial embolization technique in 8 patients with acute intercostal artery bleeding, with a review of the anatomical basis. The causes of intercostal artery bleeding were iatrogenic and traumatic in 88 and 12% of cases, respectively. Active bleeding from the collateral intercostal or posterior intercostal arteries was angiographically demonstrated in 75 and 25% of cases, respectively. Transarterial embolization successfully achieved hemostasis in all cases. However, two patient with hypovolemic shock expired due to a massive hemothorax, despite successful transarterial embolization. Intercostal access should be performed through the middle of the intercostal space to avoid injury to the collateral intercostal artery. Transarterial embolization is an effective method for the control of intercostal artery bleeding.

  15. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  16. Embolization Therapy for Traumatic Splenic Lacerations

    Energy Technology Data Exchange (ETDEWEB)

    Dasgupta, Niloy; Matsumoto, Alan H., E-mail: ahm4d@virginia.edu; Arslan, Bulent; Turba, Ulku C.; Sabri, Saher; Angle, John F. [University of Virginia Health System, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2012-08-15

    Purpose: This study was designed to evaluate the clinical success, complications, and transfusion requirements based on the location of and agents used for splenic artery embolization in patients with splenic trauma. Methods: A retrospective study was performed of patients with splenic trauma who underwent angiography and embolization from September 2000 to January 2010 at a level I trauma center. Electronic medical records were reviewed for demographics, imaging data, technical aspects of the procedure, and clinical outcomes. Results: Fifty patients were identified (34 men and 16 women), with an average age of 48 (range, 16-80) years. Extravasation was seen on initial angiography in 27 (54%) and was absent in 23 (46%). All 27 patients with extravasation were embolized, and 18 of 23 (78.2%) without extravasation were embolized empirically. Primary clinical success was similar (>75%) across all embolization locations, embolic agents, and grades of laceration treated. Of 45 patients treated, 9 patients (20%) were embolized in the main splenic artery, 34 (75.6%) in the splenic hilum, and 2 (4.4%) were embolized in both locations. Partial splenic infarctions developed in 47.3% treated in the splenic hilum compared with 12.5% treated in the main splenic artery. There were four (8.9%) mortalities: two occurred in patients with multiple critical injuries and two from nonbleeding etiologies. Conclusions: Embolization of traumatic splenic artery injuries is safe and effective, regardless of the location of treatment. Embolization in splenic hilar branches may have a higher incidence of infarction. The grade of laceration and agents used for embolotherapy did not impact the outcomes.

  17. Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient

    Directory of Open Access Journals (Sweden)

    Hyun-Jung Lee

    2016-02-01

    Full Text Available The most feared complication of left ventricular thrombus (LVT is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.

  18. Playing games with a thrombus: a dangerous match. Paradoxical embolism from a huge central venous cathether thrombus: a case report

    Directory of Open Access Journals (Sweden)

    Mariana Sylvie

    2010-03-01

    Full Text Available Abstract Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC may result in CVC associated thrombosis. Patent Foramen Ovale (PFO, especially when associated with atrial septal aneurysm (ASA is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.

  19. Denoising performance of modified dual-tree complex wavelet transform for processing quadrature embolic Doppler signals.

    Science.gov (United States)

    Serbes, Gorkem; Aydin, Nizamettin

    2014-01-01

    Quadrature signals are dual-channel signals obtained from the systems employing quadrature demodulation. Embolic Doppler ultrasound signals obtained from stroke-prone patients by using Doppler ultrasound systems are quadrature signals caused by emboli, which are particles bigger than red blood cells within circulatory system. Detection of emboli is an important step in diagnosing stroke. Most widely used parameter in detection of emboli is embolic signal-to-background signal ratio. Therefore, in order to increase this ratio, denoising techniques are employed in detection systems. Discrete wavelet transform has been used for denoising of embolic signals, but it lacks shift invariance property. Instead, dual-tree complex wavelet transform having near-shift invariance property can be used. However, it is computationally expensive as two wavelet trees are required. Recently proposed modified dual-tree complex wavelet transform, which reduces the computational complexity, can also be used. In this study, the denoising performance of this method is extensively evaluated and compared with the others by using simulated and real quadrature signals. The quantitative results demonstrated that the modified dual-tree-complex-wavelet-transform-based denoising outperforms the conventional discrete wavelet transform with the same level of computational complexity and exhibits almost equal performance to the dual-tree complex wavelet transform with almost half computational cost.

  20. Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Syuichi Tetsuka

    2015-01-01

    Full Text Available A 21-year-old woman developed left hemiparesis during work and was hospitalized. Her National Institutes of Health Stroke Scale score was 4. Hyperintense areas in the left basal ganglia, corona radiata, and cortex of the temporal lobe were found by brain diffusion-weighted magnetic resonance imaging, indicating acute cerebral infarction. Echocardiography showed a giant mass of diameter 7 × 4 cm in the left atrium. Therefore, she was diagnosed with cerebral embolism due to a left atrial myxoma. Currently, thrombolytic therapy may continue to be effective because the embolic source may be composed of tumor tissue itself. In case of atrial myxoma, we considered that the use of tPA as emergency treatment in all patients with infarction by atrial myxoma may be questioned. Thus, cardiac tumor extraction was performed the next day after hospitalization without thrombolytic therapy. The excised myxoma measured 7 × 6 × 4 cm. The patient recovered and her neurological symptoms also improved. Furthermore, her National Institutes of Health Stroke Scale score improved to 0. Thirteen days after admission, the patient was discharged from our hospital. Cardiac myxoma is often associated with a high risk of embolic episodes, which emphasizes the need for prompt surgical excision as soon as the diagnosis is confirmed.

  1. [Preditive clinical factors for epileptic seizures after ischemic stroke].

    Science.gov (United States)

    Fukujima, M M; Cardeal, J O; Lima, J G

    1996-06-01

    Preditive clinical factors for epileptic seizures after ischemic stroke. Clinical features of 35 patients with ischemic stroke who developed epilepsy (Group 1) were compared with those of 35 patients with ischemic stroke without epilepsy (Group 2). The age of the patients did not differ between the groups. There were more men than women and more white than other races in both groups. Diabetes melitus, hypertension, transient ischemic attack, previous stroke, migraine, Chagas disease, cerebral embolism of cardiac origin and use of oral contraceptive did not differ between the groups. Smokers and alcohol users were more frequent in Group 1 (p < 0.05). Most patients of Group 1 presented with hemiparesis; none presented cerebellar or brainstem involvement. Perhaps strokes in smokers have some different aspects, that let them more epileptogenic than in non smokers.

  2. Mortality after portal vein embolization

    Science.gov (United States)

    Lee, Eung Chang; Park, Sang-Jae; Han, Sung-Sik; Park, Hyeong Min; Lee, Seung Duk; Kim, Seong Hoon; Lee, In Joon; Kim, Hyun Beom

    2017-01-01

    Abstract Portal vein embolization (PVE) is increasingly performed worldwide to reduce the possibility of liver failure after extended hepatectomy, by inducing future liver remnant (FLR) hypertrophy and atrophy of the liver planned for resection. The procedure is known to be very safe and to have few procedure-related complications. In this study, we described 2 elderly patients with Bismuth–Corlette type IV Klatskin tumor who underwent right trisectional PVE involving the embolization of the right portal vein, the left medial sectional portal branch, and caudate portal vein. Within 1 week after PVE, patients went into sepsis combined with bile leak and died within 1 month. Sepsis can cause acute liver failure in patients with chronic liver disease. In this study, the common patient characteristics other than sepsis, that is, trisectional PVE; chronic alcoholism; aged >65 years; heart-related comorbidity; and elevated serum total bilirubin (TB) level (7.0 mg/dL) at the time of the PVE procedure in 1 patient, and concurrent biliary procedure, that is, percutaneous transhepatic biliary drainage in the other patient might have affected the outcomes of PVE. These cases highlight that PVE is not a safe procedure. Care should be taken to minimize the occurrence of infectious events because sepsis following PVE can cause acute liver failure. Additionally, prior to performing PVE, the extent of PVE, chronic alcohol consumption, age, comorbidity, long-lasting jaundice, concurrent biliary procedure, etc. should be considered for patient safety. PMID:28178122

  3. Fever in acute pulmonary embolism.

    Science.gov (United States)

    Stein, P D; Afzal, A; Henry, J W; Villareal, C G

    2000-01-01

    Although fever has been reported in several case series of acute pulmonary embolism (PE), the extent to which fever may be caused by PE, and not associated disease, has not been adequately sorted out. Clarification of the frequency and severity of fever in acute PE may assist in achieving an accurate clinical impression, and perhaps avoid an inadvertent exclusion of the diagnosis. The purpose of this investigation is to evaluate the extent to which fever is caused by acute PE. Patients participated in the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Temperature was evaluated among patients with angiographically proven PE. A determination of whether other causes of fever were present was based on a retrospective analysis of discharge summaries, PIOPED summaries, and a computerized list of all discharge diagnoses. Among patients with PE and no other source of fever, fever was present in 43 of 311 patients (14%). Fever in patients with pulmonary hemorrhage or infarction was not more frequent than among those with no pulmonary hemorrhage or infarction, 39 of 267 patients (15%) vs 4 of 44 patients (9%; not significant). Clinical evidence of deep venous thrombosis was often present in patients with PE and otherwise unexplained fever. Low-grade fever is not uncommon in PE, and high fever, although rare, may occur. Fever need not be accompanied by pulmonary hemorrhage or infarction.

  4. Cardiac arrest caused by multiple recurrent pulmonary embolism

    DEFF Research Database (Denmark)

    Hannig, Kjartan Eskjaer; Husted, Steen Elkjaer; Grove, Erik Lerkevang

    2011-01-01

    Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1) The ...... and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism....

  5. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  6. Coronary air embolism treated with aspiration catheter.

    Science.gov (United States)

    Patterson, M S; Kiemeneij, F

    2005-05-01

    Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of the aspiration system in the distal section of an obtuse marginal artery indicates that such dedicated aspiration systems may prove useful in the standard treatment of air embolism.

  7. Pulmonary embolism. The implications of prospective investigation of pulmonary embolism diagnosis.

    Science.gov (United States)

    Ralph, D D

    1994-07-01

    PIOPED represents a milestone in the study of pulmonary embolism diagnosis because of its well-designed protocol, proper execution, and the large number of patients enrolled. The most important conclusions of the study are 1. Interobserver agreement is good for classifying ventilation-perfusion scans either as normal or as high probability for pulmonary embolism, but interobserver agreement is lower for classifying scans as intermediate or low probability. 2. About 40% of patients with pulmonary embolism have high probability ventilation-perfusion scans, 40% have intermediate probability scans, and 20% have low probability scans. Few (less than 1%) patients with normal perfusion scans have pulmonary embolism. 3. Eighty-seven percent of patients with high probability scans have pulmonary embolism, and 30% of patients with intermediate probability scans have embolism. Unfortunately, 14% of patients with low probability scans have pulmonary embolism. 4. Clinical suspicion can be combined with the ventilation-perfusion scan results to improve the accuracy of diagnosis of pulmonary embolism. About 90% of patients with high probability scans and high or intermediate clinical suspicion for pulmonary embolism indeed have embolism. At the other extreme, only 4% of patients with both low probability scans and low clinical suspicion have embolism. In the remaining combinations of categories 6% to 66% of patients have embolism. 5. Suggested modifications of the original PIOPED criteria for classifying ventilation-perfusion scans make the analysis simpler and more useful. New studies have examined subgroups from PIOPED to refine guidelines for clinical practice further and to incorporate the results of tests for deep venous thrombosis into the diagnostic evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Autoantibody Production in Rabbits

    Science.gov (United States)

    Asherson, G. L.; Rose, M. Elaine

    1963-01-01

    The finding that the serum of apparently healthy rabbits fixed complement with rabbit liver and kidney has been confirmed. Experimental infection of rabbits with Eimeria stiedae, the cause of hepatic coccidiosis, led to a rise in the titre of serum complement-fixing factors. The rise was statistically significant 14, 21 and 28 days after infection. The factors were regarded as antibodies because they behaved as macroglobulins on diethylaminoethyl—cellulose chromatography and sucrose gradient centrifugation, and as autoantibodies because they fixed complement with the kidney of the rabbits in which they occurred. The antibody reacted with widely distributed antigen(s) with high activity in brain and low activity in skeletal muscle. The possibility that coccidial infection may be responsible for the natural autoantibody of rabbits is discussed. PMID:13965167

  9. Radionuclide Diagnosis of Pulmonary Embolism.

    Science.gov (United States)

    Hess, Søren; Madsen, Poul Henning

    2017-01-01

    Diagnostic imaging plays an integral role in the diagnostic workup of suspected pulmonary embolism, and several modalities have been employed over the years. In recent years, the choice has been narrowed to either computer tomographic or radionuclide based methods, i.e. computer tomographic angiography (CTA) and ventilation-perfusion scintigraphy (V/Q-scan). Both methods display advantages and shortcomings, and while we provide some insights into CTA and alternative methods, the paper's main focus is a review of the V/Q-scan. We discuss basic considerations, interpretation criteria, clinical value, and controversies of conventional planar lung scintigraphy as well as the more contemporary 3-dimensional imaging technique of single photon emission tomography (SPECT) with or without CT.

  10. Do stroke models model stroke?

    Directory of Open Access Journals (Sweden)

    Philipp Mergenthaler

    2012-11-01

    Full Text Available Stroke is one of the leading causes of death worldwide and the biggest reason for long-term disability. Basic research has formed the modern understanding of stroke pathophysiology, and has revealed important molecular, cellular and systemic mechanisms. However, despite decades of research, most translational stroke trials that aim to introduce basic research findings into clinical treatment strategies – most notably in the field of neuroprotection – have failed. Among other obstacles, poor methodological and statistical standards, negative publication bias, and incomplete preclinical testing have been proposed as ‘translational roadblocks’. In this article, we introduce the models commonly used in preclinical stroke research, discuss some of the causes of failed translational success and review potential remedies. We further introduce the concept of modeling ‘care’ of stroke patients, because current preclinical research models the disorder but does not model care or state-of-the-art clinical testing. Stringent statistical methods and controlled preclinical trials have been suggested to counteract weaknesses in preclinical research. We conclude that preclinical stroke research requires (1 appropriate modeling of the disorder, (2 appropriate modeling of the care of stroke patients and (3 an approach to preclinical testing that is similar to clinical testing, including Phase 3 randomized controlled preclinical trials as necessary additional steps before new therapies enter clinical testing.

  11. Carbon Dioxide Embolism during Laparoscopic Surgery

    Science.gov (United States)

    Park, Eun Young; Kwon, Ja-Young

    2012-01-01

    Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literature regarding carbon dioxide embolism in detail and set out to describe the complication from background to treatment. We hope that the present work will improve our understanding of carbon dioxide embolism during laparoscopic surgery. PMID:22476987

  12. The case for an elderly targeted stroke management.

    Science.gov (United States)

    Fustinoni, Osvaldo

    2011-01-01

    Stroke is a leading cause of death and disability worldwide. The elderly, in whom atrial fibrillation (AF) is most prevalent, carry the greatest risk, undergoing more recurrent, deadlier strokes, with bigger deficits, slower recoveries, and more comorbidities. Evidence-based data on advanced age stroke management are scarce. Age-related cerebral changes might undermine the benefit of established stroke treatments. Nevertheless, the elderly should probably also undergo thrombolysis for ischemic stroke: they do not bleed more, and die not because of hemorrhage but of concomitant illnesses. Beyond natural bleeding risks, AF in advanced age has a high embolic potential if not anticoagulated. Standard or lower intensity warfarin anticoagulation prevents embolic stroke in the elderly with a hemorrhage risk even lower than aspirin. In fact, adverse effects seem to occur more often with aspirin. Excess anticoagulation hazards are prevented with lower starting doses, stricter corrections, more frequent International Normalized Ratio monitoring, and longer adjustment intervals. Validated prognostic scores such as CHADS(2) help minimize bleeds. Direct inhibitors have recently shown a benefit similar to warfarin with fewer hemorrhages. Carefully tailoring antithrombotics to this age group is therefore useful. Antihypertensives probably help 80-plus stroke patients as well, but the risk/benefit of lowering blood pressure in secondary stroke prevention at that age is uncertain. Evidence-based data on diabetes management and use of lipid-lowering drugs are still lacking in this age group. In summary, emerging data suggest that stroke management should be specifically targeted to the elderly to better prevent its devastating consequences in the population at the highest risk.

  13. Pulmonary Cement Embolism following Percutaneous Vertebroplasty

    Directory of Open Access Journals (Sweden)

    Ümran Toru

    2014-01-01

    Full Text Available Percutaneous vertebroplasty is a minimal invasive procedure that is applied for the treatment of osteoporotic vertebral fractures. During vertebroplasty, the leakage of bone cement outside the vertebral body leads to pulmonary cement embolism, which is a serious complication of this procedure. Here we report a 48-year-old man who was admitted to our hospital with dyspnea after percutaneous vertebroplasty and diagnosed as pulmonary cement embolism.

  14. Coronary air embolism treated with aspiration catheter

    OpenAIRE

    Patterson, M S; Kiemeneij, F.

    2005-01-01

    Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of...

  15. Transcatheter embolization therapy of the gastrointestinal hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Sim, Jae In; Park, Auh Whan; Ryeom, Hun Kyu; Kim, Yong Joo [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    1994-05-15

    To evaluate the effectiveness of transcatheter embolization for the treatment of massive gastrointestinal arterial bleeding. The study was based on retrospective analysis of twelve cases(8 men, 4 woman) including two patients with hemobilia in which transcatheter embolization was attempted for the control of massive gastrointestinal bleeding from March 1987 to October 1993. Clinical diagnoses of these patients were peptic ulcer(5), pseudoaneurysm formation(3) following percutaneous transhepatic biliary drainage or traffic accident, stomach cancer(1), typhoid fever(1), duodenal leiomyoma(1) and Osler-Weber-Rendu disease (1). Embolized vessels are as follows: gastroduodenal artery(6), left gastric artery(2), ileocolic artery(2), and hepatic artery(2). Embolization was effective in immediate control of bleeding in all patients. Although five of the six patients who had undergone embolization of the gastroduodenal artery developed rebleeding within 24 hour, only 2 required surgery and none showed serious complication. Embolization therapy is safe and effective initial treatment of choice for life-threatening massive gastrointestinal bleeding.

  16. Zoonoses of rabbits and rodents.

    Science.gov (United States)

    Hill, William Allen; Brown, Julie Paige

    2011-09-01

    Millions of households in the US own rabbits or rodents, including hamsters, guinea pigs, and gerbils. Activities such as hunting and camping also involve human interactions with wild rabbits and rodents. In many environments, feral rabbits and rodents live in close proximity to humans, domesticated animals, and other wildlife. Education of rodent and rabbit owners and individuals with occupational or recreational exposures to these species is paramount to reduce the prevalence of zoonoses associated with rabbit and rodent exposure.

  17. An emboligenic pulmonary abscess leading to ischemic stroke and secondary brain abscess

    Directory of Open Access Journals (Sweden)

    Albrecht Philipp

    2012-11-01

    Full Text Available Abstract Background Ischemic stroke by septic embolism occurs primarily in the context of infective endocarditis or in patients with a right-to-left shunt and formation of a secondary cerebral abscess is a rare event. Erosion of pulmonary veins by a pulmonary abscess can lead to transcardiac septic embolism but to our knowledge no case of septic embolic ischemic stroke from a pulmonary abscess with secondary transformation into a brain abscess has been reported to date. Case presentation We report the case of a patient with a pulmonary abscess causing a septic embolic cerebral infarction which then transformed into a cerebral abscess. After antibiotic therapy and drainage of the abscess the patient could be rehabilitated and presented an impressive improvement of symptoms. Conclusion Septic embolism should be considered as cause of ischemic stroke in patients with pulmonary abscess and can be followed by formation of a secondary cerebral abscess. Early antibiotic treatment and repeated cranial CT-scans for detection of a secondary abscess should be performed.

  18. Rabbit orthopedic surgery.

    Science.gov (United States)

    Rich, Gregory A

    2002-01-01

    Orthopedic surgery in rabbits poses several unique parameters for the veterinary surgeon. It is imperative for the veterinarian to be knowledgeable about the anatomic features of the surgical repair site and to become familiar with a rabbit's pain and discomfort often associated with orthopedic injuries. Handling the perioperative and postoperative pain and potential GI disturbances are crucial for a successful outcome of the surgical case. This article is designed to help the veterinary surgeon prepare for the orthopedic surgical procedure and the peripheral physiologic needs of the rabbit from presentation through recovery.

  19. RabbitMQ essentials

    CERN Document Server

    Dossot, David

    2014-01-01

    This book is a quick and concise introduction to RabbitMQ. Follow the unique case study of Clever Coney Media as they progressively discover how to fully utilize RabbitMQ, containing clever examples and detailed explanations.Whether you are someone who develops enterprise messaging products professionally or a hobbyist who is already familiar with open source Message Queuing software and you are looking for a new challenge, then this is the book for you. Although you should be familiar with Java, Ruby, and Python to get the most out of the examples, RabbitMQ Essentials will give you the push y

  20. Driving After a Stroke

    Science.gov (United States)

    ... Inspirational Stories Stroke Heroes Among Us Driving After Stroke Updated:Jul 23,2015 Can I drive after ... more tips for daily living . Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, ...

  1. Stroke (For Kids)

    Science.gov (United States)

    ... de los dientes Video: Getting an X-ray Stroke KidsHealth > For Kids > Stroke Print A A A ... get help quickly. continue What Happens During a Stroke? A stroke usually happens suddenly, and a person ...

  2. Stroke (For Kids)

    Science.gov (United States)

    ... Emergency Room? What Happens in the Operating Room? Stroke KidsHealth > For Kids > Stroke A A A What's ... get help quickly. continue What Happens During a Stroke? A stroke usually happens suddenly, and a person ...

  3. Stroke in central nervous system infections

    Directory of Open Access Journals (Sweden)

    Carod-Artal Francisco

    2008-01-01

    Full Text Available Background: Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. Objective: To review the main infectious diseases associated with stroke. Discussion: Prevalence of stroke in HIV patients is around 1%. Pathogenic mechanisms include HIV vasculopathy, vasculitis, cardioembolism, acquired hypercoagulability, and the effect of opportunistic infections. Treatment with protease inhibitors has been associated with premature atherosclerotic vascular disease. Emerging viral infections that are associated with stroke include viral hemorrhagic fevers, Japanese encephalitis, dengue, and West Nile virus. Vasculitis involving perforating vessels of the brain is a cerebrovascular complication of tuberculous meningitis. Small, medium, and large arteries of the anterior circulation can be involved. A progressive intracranial arteriopathy after Leptospira interrogans infection has been described, which involves the large intracranial arteries. Cerebrovascular complications of mycosis are associated with large vessel vasculitis, direct vessel damage by invasion or embolization, and subarachnoid hemorrhage due to mycotic aneurysm rupture. Pathological findings of cerebral malaria include diffuse cerebral edema, perivascular ring hemorrhages, white matter necrosis, parenchyma petechial hemorrhages, occlusion of brain vessels, and sequestration of infected erythrocytes in cortical and perforating arteries. Stroke can occur in subarachnoid neurocysticercosis and the lesions in such cases consist mostly of deep lacunar infarctions resulting from endarteritis of small penetrating arteries. Cardiac arrhythmias, congestive heart failure, apical aneurysm, and mural thrombus are the conditions that predispose patients with American trypanosomiasis to cardioembolism. Gnathostoma spinigerum infestation is a cause of hemorrhagic stroke in Asia. Conclusion: Infectious and

  4. Antithrombotic Medication for Cardioembolic Stroke Prevention

    Directory of Open Access Journals (Sweden)

    M. Àngels Font

    2011-01-01

    Full Text Available Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH, unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.

  5. Thrombectomy assisted by carotid stenting in acute ischemic stroke management

    DEFF Research Database (Denmark)

    Steglich-Arnholm, Henrik; Holtmannspötter, Markus; Kondziella, Daniel;

    2015-01-01

    -term outcome (mRS ≤ 2). Harms included complications during and following EVT. Mean age was 64.3 years (standard deviation ±12.5), 40 (85%) patients received IVT initially. Median NIHSS was 16 (inter-quartile range 14-19). Mean time from stroke onset to recanalization was 311 min (standard deviation ±78......Extracranial carotid artery occlusion or high-grade stenosis with concomitant intracranial embolism causes severe ischemic stroke and shows poor response rates to intravenous thrombolysis (IVT). Endovascular therapy (EVT) utilizing thrombectomy assisted by carotid stenting was long considered risky......-center analysis of 47 consecutive stroke patients with carotid occlusion or high-grade stenosis and concomitant intracranial embolus treated between September 2011 and December 2014. Benefits included early improvement of stroke severity (NIHSS ≥ 10) or complete remission within 72 h and favorable long...

  6. [Basilar ectasia and stroke: clinical aspects of 21 cases].

    Science.gov (United States)

    de Oliveira, R de M; Cardeal, J O; Lima, J G

    1997-09-01

    Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

  7. Outpatient diagnosis of pulmonary embolism: the MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) study.

    Science.gov (United States)

    Hogg, K; Dawson, D; Mackway-Jones, K

    2006-02-01

    Pleuritic chest pain, a symptom of pulmonary embolism, is a common presenting symptom in the emergency department. The aim of this study was to validate an algorithm for the diagnosis of pulmonary embolism in emergency department patients with pleuritic chest pain. This was a prospective, diagnostic cohort study conducted in a large UK city centre emergency department. A total of 425 patients with pleuritic chest pain presenting to the emergency department between February 2002 and June 2003 were recruited. Patients scoring a low modified Wells clinical probability of pulmonary embolism, who had a normal latex agglutination D-dimer, were discharged. All others followed a diagnostic imaging protocol to exclude and diagnose pulmonary embolism using PIOPED interpreted ventilation-perfusion scanning, CT pulmonary angiography, and digital subtraction pulmonary angiography. All patients were followed up for three months for evidence of pulmonary embolism or deep vein thrombosis. An independent adjudication committee reviewed all deaths. A total of 408 patients completed the diagnostic algorithm; 86.5% (353/408) were investigated as outpatients, 5.4% (22/408) were diagnosed as having pulmonary embolism, and 98.8% (403/408) were followed up for three months. Of the 381 patients without pulmonary embolism who completed follow up, the incidence of thromboembolic disease was 0.8% (95% CI 0.3% to 2.3%): two patients had pulmonary embolism and one had a deep vein thrombosis. The MIOPED (Manchester Investigation Of Pulmonary Embolism Diagnosis) diagnostic protocol can safely exclude pulmonary embolism in outpatients with pleuritic chest pain.

  8. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack

    DEFF Research Database (Denmark)

    Hankey, Graeme J; Patel, Manesh R; Stevens, Susanna R

    2012-01-01

    In ROCKET AF, rivaroxaban was non-inferior to adjusted-dose warfarin in preventing stroke or systemic embolism among patients with atrial fibrillation (AF). We aimed to investigate whether the efficacy and safety of rivaroxaban compared with warfarin is consistent among the subgroups of patients ...

  9. Novel Oral Anticoagulants for Stroke Prophylaxis and Venous Thromboembolism Prevention and Treatment

    Directory of Open Access Journals (Sweden)

    Laith G. Alsayegh

    2015-08-01

    Full Text Available Novel oral anticoagulants (NOACs are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

  10. Trial of ORG 10172 in acute stroke treatment classification and associated risk factors of ischemic stroke: a prospective study from a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Sandhya Manorenj

    2016-11-01

    Conclusions: LAA was observed frequently than SVO. Frequency of SVO was lower than Asian but higher than western, while cardio embolism was lower than Western and similar to Asian stroke studies. Dyslipidemia was the predominant risk factor than hypertension reported from Asian and Western stroke registry. This unique pattern can be attributed to differences in demographic and risk factor profiles. The study confirms the need for vigorous primary and secondary prevention measures targeting modifiable risk factors of stroke. [Int J Res Med Sci 2016; 4(11.000: 5012-5018

  11. Peripheral arterial embolism. Report of hospitalized cases

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Pereira Barretto

    2000-04-01

    Full Text Available OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of São Paulo. The age was 51.89±18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0%,in the left lower 11(37.9% and right upper 3 (10.3% limbs, and in the left arm (1. Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0%; infective endocarditis (7- 24.1%; dilated cardiomyopathy (6 - 20.6%; ischemic coronary heart disease (6 patients - 20.6%; and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9%, chronic in 12 patients (41.3% and acute in 8 (27.5%. All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8%; patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60% of the patients.Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up, 2 patients (6.8% required limbs amputation, and 5 (17.2% died due to embolism. CONCLUSION: Most of the time, embolism does not cause permanent complications. Our data highlight the importance of anticoagulation for patients acute atrial fibrillation in myocardial dysfunction and for patients with chronic atrial fibrillation in cases of mitral valvar heart disease to prevent peripheral embolism.

  12. Dermatomyositis masquerading as pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Mroz RM

    2009-12-01

    Full Text Available Abstract A 61-year-old Caucasian was admitted to Department of Chest Diseases and Tuberculosis, Medical University of Bialystok, Poland for progressive muscle weakness and weight loss. Eighteen months prior to admission, the patient had been diagnosed with pulmonary embolism. At that point he was started on Enoxaparin QD. Past medical history was unremarkable. In the interim, the patient developed fever, myalgia and progressive dyspnea. Physical examination on admission revealed a rash on his upper torso and back, and the extensor surfaces of all four extremities. Laboratory values included CPK 8229, MB fraction 219, LDH 981. Chest X-ray and CT scan revealed bilateral patchy consolidations and ground-glass opacities. EMG was consistent with myositis. The patient was started on solumedrol 40 mg i.v., b.i.d., and then switched to prednisone 40 mg b.i.d. His symptoms and muscle strength improved remarkably. The patient was discharged with prednisone with an outpatient follow up.

  13. Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

    Directory of Open Access Journals (Sweden)

    Felipe Torres Pacheco

    2015-05-01

    Full Text Available Objective The potential of computed tomography angiography (CTA was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours. Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2% based on both clinical grounds and imaging follow-up (stroke group, with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86% while artery-to-artery embolization was the most common stroke mechanism (52%. Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism.

  14. In vitro and in vivo evaluation of chitosan microspheres with different deacetylation degree as potential embolic agent.

    Science.gov (United States)

    Zhou, Xuan; Kong, Ming; Cheng, Xiao Jie; Feng, Chao; Li, Jing; Li, Jing Jing; Chen, Xi Guang

    2014-11-26

    To evaluate the potential of N-acetylated chitosan microspheres used as a chemoembolic agent in vivo and in vitro. Calibrated spherical chitosan microspheres (CMs) were prepared via Water-in-Oil emulsification method and CMs were acetylated (ACMs). The swelling rate of CMs was greatly affected by pH than that of ACMs and both of them affected by temperature. Microspheres with excellent thermal stability demonstrated controllable degradation in lysozyme solution. Doxorubicin was released from microspheres in vitro and exhibited excellent control release profile. ACMs caused hemolysis less than CMs (microspheres have non-cytotoxic nature. Microspheres planted in a rat gluteal muscle demonstrated that it were biodegradable and biocompatible. ACMs were performed in rabbit ear embolization model and ischemic necrosis on ear was visible due to the vascular occlusion after 15 days. Acetylated chitosan microspheres could be used as potential biocompatible and biodegradable embolic agents.

  15. Viral diseases of the rabbit.

    Science.gov (United States)

    Krogstad, Aric P; Simpson, Janet E; Korte, Scott W

    2005-01-01

    Viral disease in the rabbit is encountered infrequently by the clinical practitioner; however, several viral diseases were reported to occur in this species. Viral diseases that are described in the rabbit primarily may affect the integument, gastrointestinal tract or, central nervous system or maybe multi-systemic in nature. Rabbit viral diseases range from oral papillomatosis, with benign clinical signs, to rabbit hemorrhagic disease and myxomatosis, which may result in significant clinical disease and mortality. The wild rabbit may serve as a reservoir for disease transmission for many of these viral agents. In general, treatment of viral disease in the rabbit is supportive in nature.

  16. Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in individuals at risk (The LOOP study)

    DEFF Research Database (Denmark)

    Diederichsen, Søren Zöga; Haugan, Ketil Jørgen; Køber, Lars

    2017-01-01

    Atrial fibrillation (AF) increases the rate of stroke 5-fold, and AF-related strokes have a poorer prognosis compared with non-AF-related strokes. Atrial fibrillation and stroke constitute an intensifying challenge, and health care organizations are calling for awareness on the topic. Previous...... anticoagulation will be initiated according to guidelines. Expected follow-up is 4years. The primary end point is time to stroke or systemic embolism, whereas secondary end points include time to AF diagnosis and death. CONCLUSION: The LOOP study will evaluate health benefits and cost-effectiveness of ILR...

  17. Study of some genetic predisposition in pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Gehan Elassal

    2014-10-01

    Conclusion: Gene mutation especially factor V Leiden mutation is very important to be considered in young patients presented with venous thrombo-embolism, patients with thrombosis in unusual sites or patients with recurrent thrombo-embolic manifestations.

  18. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Tabitha Schrufer-Poland

    2015-04-01

    Full Text Available Introduction - Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description - A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion - Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality.

  19. Transcatheter hepatic artery embolization of liver cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Tae; Yoo, Hyung Sik; Suh, Jung Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Yun, Heun Yung [Indiana University Hospital, Bloomington (United States)

    1985-12-15

    From March 1985 to September 1985, transcatheter hepatic arterial embolization was performed in 17 primary hepatoma and 8 metastasis of liver in Department of Radiology, Yonsei University College of Medicine. Metastasis cancers of liver were one nasopharyngeal cancer, one small bowel leiomyosarcoma, one gall bladder cancer and 5 colon cancers. The used embolization materials were the followings: Gelfoam particles for one primary hepatoma, 95% absolute ethanol for 4 patients, lvalon (250-590 {mu} m) for 19 patients and autologous blood clots for one metastasis. The results were summarized as the follows: 1. The devascularization of tumor vessels in post-embolization hepatic angiogram was complete in 6 primary hepatoma and one metastasis and partial in 11 primary hepatoma and 7 metastasis. 2. In the follow-up CT evaluation 3 to 4 weeks after embolization, well necrotic density was revealed in 8 primary hepatoma and one metastasis. 3. The complications were fever with higher than 38 .deg. C (92%), abdominal pain (72%) and nausea or vomiting (40%). They were subsided within one to 7 days after embolization. 4. In liver function study, sGOT and sGPT were elevated in 96% of total cases and retuned to normal within 3 to 7 days. Alkaline phosphatase was elevated in 80% of total cases and retuned to normal within 15 to 30 days. LDH was variable. In 4 cases of absolute ethanol infusion, above liver enzymes were markedly elevated as 10 times or more as normal range.

  20. Uterine artery embolization to treat uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Machan, L.; Martin, M. [Univ. of British Columbia Hospital, Dept. of Radiology, Vancouver, BC (Canada)

    2001-06-01

    The first reported application of uterine artery embolization, in 1979, was to treat life-threatening hemorrhage after a failed hysterectomy. Since then, uterine artery embolization has been used very successfully to control acute or delayed post-partum hemorrhage, post-surgical hemorrhage and hemorrhage from ectopic pregnancy, to treat uterine arteriovenous malformations and as prophylaxis before high-risk surgery, such as cesarean delivery in women with placenta previa. In contrast to these proven but underutilized applications, uterine embolization for fibroids has, in a short time, achieved significant notice in the lay press and is being widely offered. Ravina and colleagues, first reported uterine fibroid shrinkage after embolization for the treatment of acute bleeding. Since then, his group has performed over 100 procedures with up to a 6-year follow-up. The cumulative clinical success rate for the treatment of abnormal uterine bleeding due to fibroids is reported to be approximately 85% and for treatment of pain or pressure symptoms, about 75%. Six-month follow-up sonography reveals an average reduction of fibroid size of approximately 40%. However, to date, no studies have compared patients who undergo embolization with a nontreatment cohort or with surgical intervention. (author)

  1. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  2. Air Embolism: Diagnosis, Clinical Management and Outcomes

    Directory of Open Access Journals (Sweden)

    Colin J. McCarthy

    2017-01-01

    Full Text Available Air embolism is a rare but potentially fatal complication of surgical procedures. Rapid recognition and intervention is critical for reducing morbidity and mortality. We retrospectively characterized our experience with air embolism during medical procedures at a tertiary medical center. Electronic medical records were searched for all cases of air embolism over a 25-year period; relevant medical and imaging records were reviewed. Sixty-seven air embolism cases were identified; the mean age was 59 years (range, 3–89 years. Ninety-four percent occurred in-hospital, of which 77.8% were during an operation/invasive procedure. Vascular access-related procedures (33% were the most commonly associated with air embolism. Clinical signs and symptoms were related to the location the air embolus; 36 cases to the right heart/pulmonary artery, 21 to the cerebrum, and 10 were attributed to patent foramen ovale (PFO. Twenty-one percent of patients underwent hyperbaric oxygen therapy (HBOT, 7.5% aspiration of the air, and 63% had no sequelae. Mortality rate was 21%; 69% died within 48 hours. Thirteen patients had immediate cardiac arrest where mortality rate was 53.8%, compared to 13.5% (p = 0.0035 in those without. Air emboli were mainly iatrogenic, primarily associated with endovascular procedures. High clinical suspicion and early treatment are critical for survival.

  3. [Selective embolization to treat obstetric hemorrhage].

    Science.gov (United States)

    Ferrer Puchol, M D; Lanciego, C; Esteban, E; Ciampi, J J; Edo, M A; Ferragud, S

    2014-01-01

    To describe cases of obstetric hemorrhage that have called for selective intra-arterial embolization and the different embolization techniques used. To assess the clinical outcomes and postprocedural fertility. We studied 27 women with obstetric hemorrhage. In 24 patients, embolization was performed by catheterizing both uterine arteries and in 2 patients only one uterine artery was catheterized (pseudoaneurysm). The materials used for embolization consisted of Spongostan in 17/27, particles in 9/27, and coils in 1/27. Clinical follow-up included an analysis of early and late complications and of postprocedural fertility. Hemorrhage was classified as primary (25/27) or secondary (2/27). The cause of bleeding was vaginal delivery (20), cesarean sections (5), abortion (1), and cervical ectopic pregnancy (1). The initial technical success rate was 100% and the clinical success rate was 92.6% (25 of the 27 patients). Bleeding ceased and the outcome was satisfactory in 25 patients. During clinical follow-up ranging from one to seven years, 23 patients had normal menstruation and 6 patients completed 7 full-term pregnancies. Intra-arterial embolization for obstetric hemorrhage leads to good outcomes and few complications and it preserves fertility. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  4. Primary stroke in a woman with sickle cell anemia responsive to hydroxyurea therapy.

    Science.gov (United States)

    Ballas, Samir K; Martinez, Ubaldo; Savage, Michael

    2014-01-01

    The most common cause of stroke in children with sickle cell anemia is infarction due to ischemia. In adults, however, stroke is most commonly hemorrhagic in nature. Other causes of stroke in patients with sickle cell disease are very rare. In this short communication, we describe a woman with sickle cell anemia responsive to hydroxyurea (HU) therapy who had primary stroke due to paradoxical embolization caused by a large atrial septal defect. Successful management of the stroke included surgical closure of the defect with trans-esophageal echocardiographic guidance. To the best of our knowledge, this is the first patient with sickle cell anemia and stroke due to congenital heart disease who did not require open heart surgery for successful management.

  5. Denoising embolic Doppler ultrasound signals using Dual Tree Complex Discrete Wavelet Transform.

    Science.gov (United States)

    Serbes, Gorkem; Aydin, Nizamettin

    2010-01-01

    Early and accurate detection of asymptomatic emboli is important for monitoring of preventive therapy in stroke-prone patients. One of the problems in detection of emboli is the identification of an embolic signal caused by very small emboli. The amplitude of the embolic signal may be so small that advanced processing methods are required to distinguish these signals from Doppler signals arising from red blood cells. In this study instead of conventional discrete wavelet transform, the Dual Tree Complex Discrete Wavelet Transform was used for denoising embolic signals. Performances of both approaches were compared. Unlike the conventional discrete wavelet transform discrete complex wavelet transform is a shift invariant transform with limited redundancy. Results demonstrate that the Dual Tree Complex Discrete Wavelet Transform based denoising outperforms conventional discrete wavelet denoising. Approximately 8 dB improvement is obtained by using the Dual Tree Complex Discrete Wavelet Transform compared to the improvement provided by the conventional Discrete Wavelet Transform (less than 5 dB).

  6. The Safety and Efficacy of Triple Antiplatelet Therapy after Intracranial Stent-Assisted Coil Embolization.

    Science.gov (United States)

    Matsumoto, Yoshihisa; Iko, Minoru; Tsutsumi, Masanori; Mitsutake, Takahumi; Eto, Ayumu; Nii, Kouhei; Nakai, Kanji; Oishi, Hiromichi; Aikawa, Hiroshi; Kazekawa, Kiyoshi

    2015-07-01

    Stent-assisted coil embolization is effective for intracranial aneurysms, especially for wide-necked aneurysms; however, the optimal antiplatelet regimens for postoperative ischemic events have not yet been established. We aimed at determining the efficacy and safety of a triple antiplatelet therapy regimen after intracranial stent-assisted coil embolization. We retrospectively evaluated patients who underwent stent-assisted coil embolization for unruptured intracranial aneurysms or during the chronic phase of a ruptured intracranial aneurysm (≥ 4 weeks after subarachnoid hemorrhage onset). We recorded the incidence of ischemic and bleeding events 140 days postoperatively. We assessed 79 cases in patients who received either dual (n = 51) or triple (n = 28) antiplatelet therapy. The duration of triple antiplatelet therapy was 49 ± 29 days. Seven patients in the dual group experienced postoperative ischemic events. Compared to the dual group, the triple group had a similar incidence of postoperative bleeding events but a significantly lower incidence of postoperative ischemic events (P antiplatelet therapy had a significantly lower incidence of postoperative ischemic events and a similar incidence of postoperative bleeding events 140 days postoperatively. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. Pulmonary embolism presenting with ST segment elevation in inferior leads

    Directory of Open Access Journals (Sweden)

    Muzaffer Kahyaoğlu

    2017-03-01

    Full Text Available Acute pulmonary embolism is a form of venous thromboembolism that is widespread and sometimes mortal. The clinical presentation of pulmonary embolism is variable and often nonspecific making the diagnosis challenging. In this report, we present a case of pulmonary embolism characterized by ST segment elevation in inferior leads without reciprocal changes in the electrocardiogram.

  8. 21 CFR 870.3300 - Vascular embolization device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vascular embolization device. 870.3300 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3300 Vascular embolization device. (a) Identification. A vascular embolization device is an intravascular implant intended to...

  9. Pulmonary embolism in cancer patients

    Directory of Open Access Journals (Sweden)

    S P Sawant

    2012-01-01

    Full Text Available Aims and Objectives: Pulmonary embolism (PE is rare in the Indian population and is under-reported in patients with malignancy. We studied the clinical profile and outcome of patients with PE and cancer in the Indian population. Materials and Methods: Data of cancer patients with PE, admitted in a tertiary cancer centre, was analyzed. The prevalence of PE was calculated as the number of patients with PE per 10,000 hospital admissions. The demographic data, details of cancer, co-morbidities, details of PE, and treatment given for PE and their outcomes were recorded and analyzed. Results: There were 56,425 hospital admissions in the study period. The prevalence of PE was 6.4 per 10,000 hospital admissions .Thirty-six cancer patients were diagnosed to have PE. In females, gynecological malignancies (36.84% and in males gastrointestinal, head and neck cancers, and hematological malignancies were the most common sites (17.7% each. PE was associated with DVT in 41.7%. Dyspnea was the most common presenting symptom. Five patients (13.88% were asymptomatic and were incidentally detected to have PE . The most common echocardiographic finding was right ventricular dysfunction (55.55%. Mortality among the treated patients was 22% (7 / 31 and in untreated patients it was 80% (4 / 5. The factors that had an impact on a three-month survival were, the presence of massive PE (P = 0.019 and the presence of RV dysfunction at presentation (P = 0.005. Conclusion: The prevalence of PE and mortality due to PE is high in cancer patients. Risk stratification for venous thromboembolism (VTE should be done in all cancer patients and thromboprophylaxis should be optimally used.

  10. Permanent cortical blindness after bronchial artery embolization.

    Science.gov (United States)

    van Doorn, Colette S; De Boo, Diederick W; Weersink, Els J M; van Delden, Otto M; Reekers, Jim A; van Lienden, Krijn P

    2013-12-01

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  11. Permanent Cortical Blindness After Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  12. Neural Hypernetwork Approach for Pulmonary Embolism diagnosis

    CERN Document Server

    Rucco, Matteo; Merelli, Emanuela; Johnson, Jeffrey H; Falsetti, Lorenzo; Nitti, Cinzia; Salvi, Aldo

    2014-01-01

    This work introduces an integrative approach based on Q-analysis with machine learning. The new approach, called Neural Hypernetwork, has been applied to a case study of pulmonary embolism diagnosis. The objective of the application of neural hyper-network to pulmonary embolism (PE) is to improve diagnose for reducing the number of CT-angiography needed. Hypernetworks, based on topological simplicial complex, generalize the concept of two-relation to many-body relation. Furthermore, Hypernetworks provide a significant generalization of network theory, enabling the integration of relational structure, logic and analytic dynamics. Another important results is that Q-analysis stays close to the data, while other approaches manipulate data, projecting them into metric spaces or applying some filtering functions to highlight the intrinsic relations. A pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches, frequently fatal. Our study uses data on 28 diagnostic features of 1,427...

  13. Cerebral Fat Embolism: A diagnostic challenge

    Science.gov (United States)

    Gupta, Babita; Kaur, Manpreet; D’souza, Nita; Dey, Chandan Kumar; Shende, Seema; Kumar, Atin; Gamangatti, Shivanand

    2011-01-01

    Fat embolism syndrome (FES) is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism (CFE). We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain (DWI and T2 weighted sequences) in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal. PMID:21957425

  14. Arterial embolization in patients with renal carcinoma

    DEFF Research Database (Denmark)

    Christensen, S W; Berg, J; Brynitz, S;

    1989-01-01

    The literature concerning embolization of the renal artery in patients with renal cell carcinoma is reviewed. Based on this review it is concluded that the method is useful in this patient group as it will facilitate the surgical procedure if nephrectomy is performed afterwards. Used as a palliat......The literature concerning embolization of the renal artery in patients with renal cell carcinoma is reviewed. Based on this review it is concluded that the method is useful in this patient group as it will facilitate the surgical procedure if nephrectomy is performed afterwards. Used...

  15. Pulmonary Embolism with Vertebral Augmentation Procedures

    Directory of Open Access Journals (Sweden)

    Swetha Bopparaju

    2013-01-01

    Full Text Available With the prevalence of an aging American population on the rise, osteoporotic vertebral fractures are becoming a common occurrence, resulting in an increase in vertebral augmentation procedures and associated complications such as cement leakage, vertebral compressions, and pulmonary embolism. We describe a patient who presented with respiratory distress three years following kyphoplasty of the lumbar vertebra. Computed tomography (CT angiogram of the chest confirmed the presence of polymethylmethacrylate (PMMA cement in the lung fields and pulmonary vessels. We conducted a systematic review of the published literature identifying effective management strategies for the treatment of vertebroplasty-associated pulmonary embolism.

  16. Cerebral fat embolism: A diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Babita Gupta

    2011-01-01

    Full Text Available Fat embolism syndrome (FES is a rare but a serious clinical catastrophe occurring after traumatic injury to long bones. Cerebral involvement in the absence of pulmonary or dermatological manifestation on initial presentation may delay the diagnosis of cerebral fat embolism (CFE. We discuss a case series of CFE which posed a challenge in diagnosis. The clinical presentations of these patients did not satisfy the commonly used clinical criteria for aiding the diagnosis of FES. Early MRI brain (DWI and T2 weighted sequences in patients with neurological symptoms after trauma even in the absence of pulmonary and dermatological findings should be the goal.

  17. Electron-beam computed tomography findings of left atrial appendage in patients with cardiogenic cerebral embolism

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Makiko; Takahashi, Satoshi; Yonezawa, Hisashi [Iwate Medical Univ., Morioka (Japan). School of Medicine

    2002-04-01

    We studied electron-beam computed tomography (EBCT) findings in the left atrial appendage of 72 patients with cerebral embolism [27 in the acute phase (<48 hours) and 45 in the chronic phase], 9 cases with nonvalvular atrial fibrillation (NVAF) but without stroke, and 13 controls. EBCT was performed in the early (during injection of contrast medium), late-1 (5 min after injection), and-2 (10 min after injection) phases. In the acute phase patients, 41% showed filling defect (FD) in the early phase alone (FDE), 15% showed FD until late phase-1 (FDL-1), and 15% showed FD until late phase-2 (FDL-2). The chronic phase patients showed FDE in 33% of cases, FDL-1 in 8% and FDL-2 11%. Only FDE was observed in 44% in NVAF cases without stroke. No FDs were observed in controls. Flow velocity in the appendage measured by transesophageal echocardiography was 23{+-}10 cm/sec in 21 FDE cases, 14{+-}3 cm/sec in 3 FDL-1 cases, 29{+-}23 cm/sec in 4 FDL-2 cases, significantly lower in comparison with 58{+-}25 cm/s in the 23 cases with no FD. FDL-1 and -2 suggested severe stasis or presence of thrombus in the appendage, which indicated high risk of embolism slower the movement of MES through the sample volume. (author)

  18. Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke.

    Science.gov (United States)

    Senda, Joe; Ito, Keiichi; Kotake, Tomomitsu; Kanamori, Masahiko; Kishimoto, Hideo; Kadono, Izumi; Suzuki, Yoshiro; Katsuno, Masahisa; Nishida, Yoshihiro; Ishiguro, Naoki; Sobue, Gen

    2016-01-01

    We investigated the factors influencing inpatient convalescent rehabilitation outcomes in patients with ischemic stroke, particularly severity of leukoaraiosis on magnetic resonance imaging. Participants included 520 patients with ischemic stroke (317 men and 203 women; mean age, 72.8±8.4 years) who were transferred from acute care hospitals for inpatient convalescent rehabilitation. Ischemic stroke subtypes included lacunar infarction (n=41), atherothrombosis (n=223), artery-to-artery embolism (n=67), cardiogenic embolism (n=97), undetermined embolism (n=76), and uncategorized ischemic stroke (n=16). Leukoaraiosis was graded according to periventricular hyperintensity (PVH) and deep white matter hyperintensity on magnetic resonance imaging. Functional Independence Measure scores were assessed on admission and at discharge. Multiple regression analysis revealed that rehabilitation outcomes, measured as total Functional Independence Measure scores, were significantly associated with leukoaraiosis estimated by PVH grade. This association was observed after adjustment for factors such as severity, age, and poststroke history. In all patients, PVH grades were associated with Functional Independence Measure motor scores (PFunctional Independence Measure cognitive scores (Pstroke. Furthermore, the PVH grade was associated with motor function outcome, whereas the deep white matter hyperintensity grade correlated with cognitive function outcome, likely because the progression patterns and anatomic backgrounds of PVH and deep white matter hyperintensity differ according to ischemic stroke subtype. © 2015 American Heart Association, Inc.

  19. Mixed Stroke

    Institute of Scientific and Technical Information of China (English)

    HuangRuxun(黄如训); Zeng Jinsheng(曾进胜)

    2000-01-01

    Purpose To summarize the chnical, autoptic and animal experimental dala of stroke, propose the concept of mixed stroke (MS) and demonstrate the enoiogy, pathogenesis, clinical mainfestations, prophylaxis and treatment of MS Background At present. stroke still is classified in the national and international academic fields as two main groups: hemorrhage and ischema In fact, thc cerebral vascular disease with hemorrhage forus and ischema focus at the same time is not rare moreover, this type of stroke has special etiology, pathogenesis and clinical manifestations. But it is always made a main dagnosis and neglected the other nature of coexistent focus on either clinical or pathological diagnosis according to traditional classification of stroke Data sources and methods Mort of pablished originsl articles about MS in our department and laboralory wcre reviewed. Resulta The clinical autoptic and animal experimental dats all prcved that hemorrhage and infarction could occur in the course of a stroke simultaneously or in suecession during a short time, which demonstrated the existence of MS It was found clinically that MS patients all had the hustory of hypcrtension and in the autoptic data the MS patients dying of stroke all had typical hypertensive changes in the heart and kidney. and had hypertensive arteriosclerosis in the cerebral arteriole and small artery. MS was cas lily thdueed in stroke-prone renovascular hypertensivc rats This kind of rats are free from genetic deficiency and arc not affected by senile factor, so their cerebral vascular foci are mainly induced by the single factor -hypertension. TThese indicate definitely that hypertensive cerebral vascular lesion is the basis inducing MS. The main lesions of hypertensive cerebral arteriole and small artery were hyalinosis and fibrinoid of the walls, and the formation of microaneurysms or hyperplasla of iniernal and external layers The math lcsions of hypertensive cerebral capillaries were increasing vascular

  20. Recovery After Stroke: Recurrent Stroke

    Science.gov (United States)

    ... cholesterol or are overweight. If you are at risk for high blood pressure, ask your doctor how to manage it more ... feel fine. Medicines Medicine may help reduce stroke risk. In addition to those that treat high blood pressure, drugs are also available to control high cholesterol ...

  1. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  2. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  3. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Chun Xiang; Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Chowdhury, Shahryar M. [Medical University of South Carolina, Department of Pediatrics, Charleston, SC (United States); Fox, Mary A. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Pulmonary embolism is a life-threatening condition affecting people of all ages. Multidetector row CT pulmonary angiography has improved the imaging of pulmonary embolism in both adults and children and is now regarded as the routine modality for detection of pulmonary embolism. Advanced CT pulmonary angiography techniques developed in recent years, such as dual-energy CT, have been applied as a one-stop modality for pulmonary embolism diagnosis in children, as they can simultaneously provide anatomical and functional information. We discuss CT pulmonary angiography techniques, common and uncommon findings of pulmonary embolism in both conventional and dual-energy CT pulmonary angiography, and radiation dose considerations. (orig.)

  4. Embolization of Intracranial Dural Arteriovenous Fistulas Using PHIL Liquid Embolic Agent in 26 Patients

    DEFF Research Database (Denmark)

    Lamin, S; Chew, H S; Chavda, S

    2017-01-01

    BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid ...

  5. Ischemic Stroke during Pregnancy and Puerperium

    Directory of Open Access Journals (Sweden)

    Elisabetta Del Zotto

    2011-01-01

    Full Text Available Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consider several questions related to pregnancy-associated ischemic stroke, dwelling on epidemiological and specific etiological aspects, diagnostic issue concerning the use of neuroimaging, and the related potential risks to the embryo and fetus. Therapeutic issues surrounding the use of anticoagulant and antiplatelets agents will be discussed along with the few available reports regarding the use of thrombolytic therapy during pregnancy.

  6. Genetics of ischaemic stroke; single gene disorders.

    Science.gov (United States)

    Flossmann, Enrico

    2006-08-01

    Examples of single gene disorders have been described for all major subtypes of ischaemic stroke: accelerated atherosclerosis and subsequent thrombo-embolism (e.g. homocysteinuria), weakening of connective tissue resulting in arterial dissections (e.g. Ehler-Danlos type IV), disorders of cerebral small vessels (e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and the collagen COL4A1 mutation), disorders increasing the thrombogenic potential of the heart through affecting the myocardium or the heart valves or through disturbance of the heart rhythm (e.g. hypertrophic cardiomyopathy), mitochondrial cytopathies increasing cerebral tissue susceptibility to insults (e.g. mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes), and finally disorders of coagulation that can either directly cause stroke or act synergistically with the aforementioned abnormalities (e.g. sickle cell disease). Most of these disorders are rare but they are important to consider particularly in young patients with stroke, those with a family history or those who have other characteristics of a particular syndrome.

  7. Radiological strategy in acute stroke in children

    Energy Technology Data Exchange (ETDEWEB)

    Paonessa, Amalia [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)], E-mail: apaonessa7@hotmail.com; Limbucci, Nicola [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy); Tozzi, Elisabetta [Dept. of Pediatrics, University Hospital ' S. Salvatore' , L' Aquila (Italy); Splendiani, Alessandra; Gallucci, Massimo [Dept. of Neuroradiology, University Hospital ' S. Salvatore' , L' Aquila (Italy)

    2010-04-15

    The aim of the study was to estimate the preponderance of patterns of pediatric stroke, ischemic or hemorrhagic, their etiologies and the correct diagnostic protocol for acute management. Forty-one consecutive pediatric patients (age range 5-16 years) with an acute stroke observed in acute phase during a 10-year period, were retrospectively evaluated. Twenty-three patients underwent magnetic resonance imaging (MRI), 3 cases were studied by computed tomography (CT) without MRI, and 15 underwent both CT and MRI studies. In 9 cases, intra-arterial digital subtraction angiography (IADSA) was performed after non-invasive preliminary assessment. Seventeen hemorrhagic (41%) and 24 ischemic (59%) strokes were found. Among hemorrhagic forms, 5 cases were due to arteriovenous malformation (AVM), 7 to cavernoma, and 2 to aneurysm. Among ischemic forms, 2 were due to sickle-cell disease, 1 to hyperomocysteinemia, 1 to moyamoya syndrome, 1 to pseudoxantoma elasticum, 3 to prothrombotic state, 1 to Fabry's disease, 1 concomitant with CO intoxication, 5 to venous sinus thrombosis, and 4 to cardio-embolic state. Etiology remains unknown in 8 cases (20.5%). This study shows a moderate prevalence of ischemic over hemorrhagic strokes. Moreover, personal experience suggests that MRI is always more informative than CT and in selected cases should be the first-choice examination in the acute phase.

  8. [Hippocampal stroke].

    Science.gov (United States)

    Rollnik, J D; Traitel, B; Dietrich, B; Lenz, O

    2015-02-01

    Unilateral cerebral ischemia of the hippocampus is very rare. This paper reviews the literature and presents the case of a 59-year-old woman with an amnestic syndrome due to a left hippocampal stroke. The patient suffered from retrograde amnesia which was most severe over the 2 days prior to presenting and a slight anterograde amnesia. In addition, a verbal memory disorder was confirmed 1 week after admission by neurological tests. As risk factors, arterial hypertension and a relative hyper-beta lipoproteinemia were found. This case shows that unilateral amnestic stroke, e.g. in the hippocampus region, may be the cause of an amnestic syndrome and should be included in the differential diagnostics.

  9. Hepatitis E Virus in Farmed Rabbits, Wild Rabbits and Petting Farm Rabbits in the Netherlands

    NARCIS (Netherlands)

    Burt, S.A.; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; van der Poel, Wim H.M.

    2016-01-01

    Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates. Dut

  10. Hepatitis E Virus in Farmed Rabbits, Wild Rabbits and Petting Farm Rabbits in the Netherlands

    NARCIS (Netherlands)

    Burt, Sara A.; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; Poel, van der Wim H.M.

    2016-01-01

    Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates.

  11. Hepatitis E Virus in Farmed Rabbits, Wild Rabbits and Petting Farm Rabbits in the Netherlands

    NARCIS (Netherlands)

    Burt, Sara A.; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; Poel, van der Wim H.M.

    2016-01-01

    Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates.

  12. Hepatitis E Virus in Farmed Rabbits, Wild Rabbits and Petting Farm Rabbits in the Netherlands

    NARCIS (Netherlands)

    Burt, S.A.|info:eu-repo/dai/nl/140114432; Veltman, Jorg; Hakze-van der Honing, Renate; Schmitt, Heike; van der Poel, Wim H.M.

    2016-01-01

    Rabbits have been suggested as a zoonotic source of Hepatitis E virus. Phylogenetic analysis of HEV isolates from farmed, wild and pet rabbits in the Netherlands (23, 0, and 60 % respectively) showed them to be grouped amongst published rabbit HEV sequences and distinct from most human isolates.

  13. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-12-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  14. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)

    DEFF Research Database (Denmark)

    Halperin, Jonathan L; Hankey, Graeme J; Wojdyla, Daniel M;

    2014-01-01

    BACKGROUND: Nonvalvular atrial fibrillation is common in elderly patients, who face an elevated risk of stroke but difficulty sustaining warfarin treatment. The oral factor Xa inhibitor rivaroxaban was noninferior to warfarin in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compar...... younger patients, but the efficacy and safety of rivaroxaban relative to warfarin did not differ with age, supporting rivaroxaban as an alternative for the elderly....

  15. MDCT angiography and transcatheter embolization in management ...

    African Journals Online (AJOL)

    Hassan Abdelsalam

    2015-12-18

    Dec 18, 2015 ... Production and hosting by Elsevier B.V.. This is an open .... 10/33 of the embolized cases were post-operative; the com- monest cause ... (b) Digital subtraction IMA selective angiography showing the site of active bleeding ...

  16. Clinical Application of Partial Splenic Embolization

    Directory of Open Access Journals (Sweden)

    Yong-Song Guan

    2014-01-01

    Full Text Available Partial splenic embolization (PSE is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  17. Clinical application of partial splenic embolization.

    Science.gov (United States)

    Guan, Yong-Song; Hu, Ying

    2014-01-01

    Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.

  18. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  19. Acute Thrombo-embolic Renal Infarction.

    Science.gov (United States)

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

  20. Vulnerability of several conifers to air embolism.

    Science.gov (United States)

    Cochard, H

    1992-07-01

    Hydraulic properties of xylem in seven species of conifer were studied during late winter and early spring 1991. Vulnerability to cavitation and air embolism was investigated using hydraulic conductivity and acoustic techniques. Embolisms were induced in branches excised from mature trees by air-drying them in the laboratory. Both techniques gave comparable results indicating that they both assess the same phenomenon. Within a tree, vulnerability was related to the permeability of the xylem, the largest stems tended to cavitate before the smallest ones when water deficits developed in a branch. Interspecific comparisons showed large differences in the xylem water potential needed to induce significant embolism, values ranged from -2.5 MPa in Pinus sylvestris to -4 MPa in Cedrus atlantica, but these differences did not correlate with differences in the xylem permeability of the species. The vulnerability of a species to air embolism was found to be consistent with its ecophysiological behavior in the presence of water stress, drought-tolerant species being less vulnerable than drought-avoiding species.

  1. Radiological aspects of portal vein embolization

    NARCIS (Netherlands)

    van Lienden, K.P.

    2012-01-01

    This thesis deals with liver regeneration after portal vein embolization (PVE) or portal vein ligation (PVL). Several aspects of these portal vein occlusion techniques are evaluated in clinical and experimental studies. In addition, the role of dynamic liver function tests and CT-volumetry in risk a

  2. National Stroke Association

    Science.gov (United States)

    ... Virginia Washington West Virginia Wisconsin Wyoming Go National Stroke Association Our mission is to reduce the incidence ... and support for all impacted by stroke. Understanding stroke and the recovery journey can be overwhelming, but ...

  3. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  4. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... look to maintain health and wellness. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  5. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Current Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents ... campaign for the U.S. Hispanic community. 1 Know Stroke A stroke occurs when the blood supply to ...

  6. Stroke - risk factors

    Science.gov (United States)

    ... Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a ...

  7. Stroke of a cardiac myxoma origin

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2015-04-01

    Full Text Available AbstractObjective:The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition.Methods:Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014.Results:Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery, multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery and areas (the basal ganglion, cerebellum and parietal and temporal regions corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%.Conclusion:Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

  8. Endovascular embolization of pulmonary arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; DUAN Feng; WANG Zhi-jun; SONG Peng

    2010-01-01

    Background The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients (n=23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04±8.22)% to (95.13±3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (fe=9.101, P <0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who

  9. WEIGHTS or RABBITS

    African Journals Online (AJOL)

    heart and spleen from_male and femalerabbits were made, in rabbits fed graded levels (0, 4, 8, 12%) of oil palm indiets. ..... aeetyl CoA derived mainly from carbohydrate wasdepressed ... an integral part in the synthesis and metabolism of.

  10. A Clever Rabbit

    Institute of Scientific and Technical Information of China (English)

    呼振璞; 付晓明

    2002-01-01

    1. Once there lived an elephant and a lion in the mountains, who both wanted to be the king of the beasts. One day the lion caught a rabbit. Before he ate it, he said, “Do you know I am the king here? ”

  11. Rabbit Repellent Paint

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Five gallons of rabbit repellent paint were sent to George Wilson to be applied on the trees of the Tewaukon tree plot. Mr. Wilson requires a 3 or 4 in. brush for...

  12. The Cutaneous Rabbit Revisited

    Science.gov (United States)

    Flach, Rudiger; Haggard, Patrick

    2006-01-01

    In the cutaneous rabbit effect (CRE), a tactile event (so-called attractee tap) is mislocalized toward an adjacent attractor tap. The effect depends on the time interval between the taps. The authors delivered sequences of taps to the forearm and asked participants to report the location of one of the taps. The authors replicated the original CRE…

  13. [Pulmonary embolism in patients with chronic hypoxemia].

    Science.gov (United States)

    Ristić, Lidija; Rancić, Milan; Pejcić, Tatjana

    2010-01-01

    The aim of this prospective, originally designed, clinical--diagnostic study including 200 chronic hypoxemic patients was to assess the possibility of implementation of noninvasive diagnostic strategy and to investigate the incidence of pulmonary embolism and parameters of diagnostic accuracy of radiological findings according to Shintz criteria, echocardiography, lung perfusion scanning according to PIOPED criteria. The study included 200 chronic hypoxemic patients divided into 2 groups, the group I consisting of 42 women and 58 men and the group II consisting of 48 women and 52 men. Out of 200 hypoxemic patients, 49 patients (24.5%) were found to have pulmonary embolism. In the group I of 100 patients (42 women and 58 men) with chronic hypoxemia and secondary erythrocytosis the diagnosis of pulmonary embolism was confirmed in 39%, that being statistically significantly different (p < 0.001) from 100 patients (48 women and 52 men) in the group II with chronic hypoxemia without secondary erythrocytosis, where pulmonary embolism was found in 10% of the patients. The predictive value was positive for direct radiological signs in 92.3% of patients in the group I for PTE, for indirect ones in 74.35%, and in the group II it was positive for direct radiological signs in 60% and for indirect ones in 90%. The predictive value of perfusion scan was positive in 59% of the group I and in only 22% of the group II. The predictive value for high pressure in the pulmonary artery was positive in 93.7% of the group I and in 66.6% of the group II. The following were found to be a variable predictor: hypoxemia, enlargement of the pulmonary artery, peripheral oligemia and elevation of diaphragm. Logistic regression according to backward--conditional method showed that the chronic hypoxemic patients with secondly erythrocytosis, who had radiological sign of peripheral oligemia--Westermark sign, had 2.286 times higher probability of having pulmonary embolism than similar patients

  14. Risk of Cerebral Embolization with Caseous Calcification of the Mitral Annulus: Review Article

    Science.gov (United States)

    Dietl, Charles A.; Hawthorn, Christopher M.; Raizada, Veena

    2016-01-01

    Background: Caseous calcification of the mitral annulus (CCMA) is believed to have a benign prognosis. Several authors have recommended conservative management in asymptomatic patients. However, the prevalence of cerebrovascular events (CVE) in patients with CCMA has never been evaluated before. The aims of this study are to investigate whether patients with CCMA are at increased risk of cerebral embolization, and to determine whether elective surgical resection of CCMA should be considered to prevent a cardioembolic stroke. Methods: A comprehensive literature search was obtained from MEDLINE via PubMed.gov, ScienceDirect.com, and Google Scholar using the following search queries: caseous calcification of the mitral annulus, intracardiac pseudotumor, mitral annular calcification, and cardioembolic stroke. Results: From our initial search that yielded 1,502 articles, we identified a total of 130 patients with CCMA reported in 86 publications. Literature review revealed that the prevalence of CVE associated with CCMA is 19.2% (25 of 130) which is significantly higher than the prevalence of CVE reported with mitral annular calcification (MAC), 11.8% (214 of 1818) (range 4.8% to 24.1%) (P = 0.01796) (odds ratio = 1.78; 0.95 confidence interval = 1.1278 – 2.8239). Only four of 25 (16.0%) patients with CCMA who suffered a CVE had history of atrial fibrillation (AF). Conclusion: Based on our review, it would be reasonable to consider elective surgical resection of CCMA in asymptomatic patients who are good surgical candidates, because patients with CCMA may be at increased risk of embolic strokes, which are unrelated to AF. PMID:27990181

  15. COMPLICATION ANALYSIS OF INTRACRANIAL ANEURYSM EMBOLIZATION WITH CONTROLLABLE COILS

    Institute of Scientific and Technical Information of China (English)

    王大明; 凌锋; 王安顺

    2004-01-01

    Objective To explore the causes, prevention, and management of the complications during intracranial aneurysm embolization with controllable coils (mechanical detachable spiral, MDS; and Guglielmi detachable coil, GDC). Methods Retrospective review of 120 cases with 125 intracranial aneurysms embolized with controllable coils from March 1995 to July 1999 was conducted. The 20 accidents (in 18 cases) including aneurysm rupture, over-embolization, protrusion of coil end into the parent artery, and thrombosis of the parent artery were analyzed. Results Among the 20 accidents, there were 6 aneurysm ruptures, 6 over-embolizations (in 5cases), 6 coil protrusions, and 2 thromboses (one was secondary to coil protrusion). The embolizationrelated mortality was 3.33% (4/120), the permanent neurological deficit was 1.67% (2/120), and the transitory neurological deficit was 3.33% (4/120). The occurrence and outcome of the complications were related to the embolizing technique, the pattern of aneurysm and its parent artery, the imperfection of embolic materials, and the observation and management during embolization. Conclusion Skilled embolizing technique, better understanding of the angio-anatomy of an aneurysm and its parent artery, correct judgement and management during embolization, and improvement of embolic materials are beneficial to the reduction of complications and to the melioration of the outcome of complications.

  16. Clinical Characteristics of Patients with Acute Pulmonary Embolism

    Science.gov (United States)

    Stein, Paul D.; Beemath, Afzal; Matta, Fadi; Weg, John G.; Yusen, Roger D.; Hales, Charles A.; Hull, Russell D.; Leeper, Kenneth V.; Sostman, H Dirk; Tapson, Victor F.; Buckley, John D.; Gottschalk, Alexander; Goodman, Lawrence R.; Wakefied, Thomas W.; Woodard, Pamela K.

    2007-01-01

    BACKGROUND Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism based on the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II) had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism as well as the characteristics of severe pulmonary embolism. METHODS Data are from the national collaborative study, PIOPED II. RESULTS There may be dyspnea only on exertion. The onset of dyspnea is usually, but not always, rapid. Orthopnea may occur. In patients with pulmonary embolism in main or lobar pulmonary arteries, dyspnea or tachypnea occurred in 92%, but in only 65% in whom the largest pulmonary embolism was in segmental pulmonary arteries. In general, signs and symptoms were similar in elderly and younger patients, but dyspnea or tachypnea were less frequent in elderly patients with no prior cardiopulmonary disease. Dyspnea may be absent even in patients with circulatory collapse. Patients with a low probability objective clinical assessment sometimes had pulmonary embolism, even in proximal vessels. CONCLUSION Symptoms may be mild and generally recognized symptoms may be absent, particularly in patients with pulmonary embolism only in segmental pulmonary branches, but they may be absent even with severe pulmonary embolism. A high or intermediate probability objective clinical assessment may suggest the need for diagnostic studies, but a low probability objective clinical assessment does not exclude the diagnosis. Maintenance of a high level of suspicion is critical. PMID:17904458

  17. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    BACKGROUND: Uncertainty remains about whether stroke affects men and women similarly. We studied differences between men and women with regard to stroke severity and survival. METHODS AND RESULTS: We used the Danish Stroke Registry, with information on all hospital admissions for stroke in Denmark...... between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death...... reported on death certificates as due to stroke was related to the index stroke if death occurred within the first week or month after stroke. Multivariate Cox regression analysis and multiple imputation were applied. Stroke was the cause of death for 4373 and 5512 of the 79 617 patients within 1 week (5...

  18. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  19. Demethylation of Circulating Estrogen Receptor Alpha Gene in Cerebral Ischemic Stroke.

    Directory of Open Access Journals (Sweden)

    Hsiu-Fen Lin

    Full Text Available Estrogen is involved in neuron plasticity and can promote neuronal survival in stroke. Its actions are mostly exerted via estrogen receptor alpha (ERα. Previous animal studies have shown that ERα is upregulated by DNA demethylation following ischemic injury. This study investigated the methylation levels in the ERα promoter in the peripheral blood of ischemic stroke patients.The study included 201 ischemic stroke patients, and 217 age- and sex-comparable healthy controls. The quantitative methylation level in the 14 CpG sites of the ERα promoter was measured by pyrosequencing in each participant. Multivariate regression model was used to adjust for stroke traditional risk factors. Stroke subtypes and sex-specific analysis were also conducted.The results demonstrated that the stroke cases had a lower ERα methylation level than controls in all 14 CpG sites, and site 13 and site 14 had significant adjusted p-values of 0.035 and 0.026, respectively. Stroke subtypes analysis showed that large-artery atherosclerosis and cardio-embolic subtypes had significantly lower methylation levels than the healthy controls at CpG site 5, site 9, site 12, site 13 and site 14 with adjusted p = 0.039, 0.009, 0.025, 0.046 and 0.027 respectively. However, the methylation level for the patients with small vessel subtype was not significant. We combined the methylation data from the above five sites for further sex-specific analysis. The results showed that the significant association only existed in women (adjusted p = 0.011, but not in men (adjusted p = 0.300.Female stroke cases have lower ERα methylation levels than those in the controls, especially in large-artery and cardio-embolic stroke subtypes. The study implies that women suffering from ischemic stroke of specific subtype may undergo different protective mechanisms to reduce the brain injury.

  20. A review of stroke and pregnancy: incidence, management and prevention.

    Science.gov (United States)

    Moatti, Zoe; Gupta, Manish; Yadava, Rajendra; Thamban, Sujatha

    2014-10-01

    Stroke, defined as a focal or global disturbance of cerebral function lasting over 24h resulting from disruption of its blood supply, is a devastating event for a pregnant woman. This can result in long-term disability or death, and impact on her family and unborn child. In addition to pre-existing patient risk factors, the hypercoagulable state and pre-eclampsia need to be taken into account. The patterns and types of stroke affect pregnant women differ from the non-pregnant female population of child-bearing age. Like other thrombo-embolic diseases in pregnancy, stroke is essentially a disease of the puerperium. Population studies have estimated the risk of stroke at between 21.2 and 46.2 per 100,000. The US Nationwide Inpatient Sample, identified 2850 pregnancies complicated by stroke in the United States in 2000-2001, for a rate of 34.2 per 100,000 deliveries. There were 117 deaths, a mortality rate of 1.4 per 100,000. Both the mortality and disability rates were higher than previously reported, with 10-13% of women dying. With the increasing prevalence of obesity, hypertension and cardiac disease amongst women of child-bearing age, so is the incidence of stroke during pregnancy and the puerperium. In the United States, an alarming trend toward higher numbers of stroke hospitalizations during the last decade was demonstrated in studies from 1995 to 1996 and 2006 to 2007. The rate of all types of stroke increased by 47% among antenatal hospitalizations, and by 83% among post-partum hospitalizations. Hypertensive disorders, obesity and heart disease complicated 32% of antenatal admissions and 53% of post-partum admissions. In addition to pre-existing patient risk factors, the hypercoagulable state and pre-eclampsia need to be taken into account. The patterns and types of stroke affect pregnant women differ from the non-pregnant female population of child-bearing age. Like other thrombo-embolic diseases in pregnancy, stroke is essentially a disease of the

  1. A Novel Inherently Radiopaque Bead for Transarterial Embolization to Treat Liver Cancer - A Pre-clinical Study

    Science.gov (United States)

    Duran, Rafael; Sharma, Karun; Dreher, Matthew R.; Ashrafi, Koorosh; Mirpour, Sahar; Lin, MingDe; Schernthaner, Ruediger E.; Schlachter, Todd R.; Tacher, Vania; Lewis, Andrew L.; Willis, Sean; den Hartog, Mark; Radaelli, Alessandro; Negussie, Ayele H.; Wood, Bradford J.; Geschwind, Jean-François H.

    2016-01-01

    Purpose: Embolotherapy using microshperes is currently performed with soluble contrast to aid in visualization. However, administered payload visibility dimishes soon after delivery due to soluble contrast washout, leaving the radiolucent bead's location unknown. The objective of our study was to characterize inherently radiopaque beads (RO Beads) in terms of physicomechanical properties, deliverability and imaging visibility in a rabbit VX2 liver tumor model. Materials and Methods: RO Beads, which are based on LC Bead® platform, were compared to LC Bead. Bead size (light microscopy), equilibrium water content (EWC), density, X-ray attenuation and iodine distribution (micro-CT), suspension (settling times), deliverability and in vitro penetration were investigated. Fifteen rabbits were embolized with either LC Bead or RO Beads + soluble contrast (iodixanol-320), or RO Beads+dextrose. Appearance was evaluated with fluoroscopy, X-ray single shot, cone-beam CT (CBCT). Results: Both bead types had a similar size distribution. RO Beads had lower EWC (60-72%) and higher density (1.21-1.36 g/cc) with a homogeneous iodine distribution within the bead's interior. RO Beads suspension time was shorter than LC Bead, with durable suspension (>5 min) in 100% iodixanol. RO Beads ≤300 µm were deliverable through a 2.3-Fr microcatheter. Both bead types showed similar penetration. Soluble contrast could identify target and non-target embolization on fluoroscopy during administration. However, the imaging appearance vanished quickly for LC Bead as contrast washed-out. RO Beads+contrast significantly increased visibility on X-ray single shot compared to LC Bead+contrast in target and non-target arteries (P=0.0043). Similarly, RO beads demonstrated better visibility on CBCT in target arteries (P=0.0238) with a trend in non-target arteries (P=0.0519). RO Beads+dextrose were not sufficiently visible to monitor embolization using fluoroscopy. Conclusion: RO Beads provide better

  2. Laparoscopic ovariectomy in rabbits

    Directory of Open Access Journals (Sweden)

    M. S. Al-Badrany

    2009-01-01

    Full Text Available A comparative evaluation of three different techniques of laparoscopic ovariectomy was carried out in 33 healthy female in rabbits, which included resection and removal of ovary after clip application, electrocautery of the ovary, then resection, and pulling ovary outside abdomen, ligation by silk, then ovary was removed. The ovaries and associated structures were better visualized by laparoscopy and all three techniques were carried out perfectly. All rabbits after operation were healthy and they were monitored for one month after operation. However, 3 of them died after operation, two of them died due to bleeding and the other of them died due to unknown causes. General anesthesia by using ketamine-xylazine i.m., was suitable for this technique, and the anesthesia provided good analgesia and good muscle relaxation. CO2 was used to establish pneumoperitoneum. In conclusion, resection and removal of the ovaries after clip application technique was found superior to the other two techniques.

  3. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...

  4. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when normal blood flow to ... next several hours. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  5. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  6. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  7. Recurrent Hemarthrosis Following Knee Arthroplasty Treated with Arterial Embolization.

    Science.gov (United States)

    Weidner, Zachary D; Hamilton, William G; Smirniotopoulos, John; Bagla, Sandeep

    2015-11-01

    Recurrent hemarthrosis is an uncommon but troublesome complication following knee arthroplasty. This study reports the results for 13 patients with spontaneous recurrent hemarthrosis after knee arthroplasty treated with arterial embolization. The average interval between arthroplasty and embolization was 47 months (range, 2-103 months), and the average time from onset of hemarthrosis to embolization was 4.1 months (range, 1-11 months). Geniculate arterial embolization lead to resolution of hemarthrosis in 12 of 13 patients (92.3%). The one clinical failure likely represented a case of misdiagnosed periprosthetic joint infection. Two patients experienced transient cutaneous ischemia related to distal particulate embolization that resolved spontaneously. Selective geniculate arterial embolization is an effective and safe treatment modality for recurrent hemarthrosis after knee arthroplasty.

  8. Acute paraplegia following embolization of spinal dural arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    HUANG Cheng-guang; QI Xiang-qian; CHEN Huai-rui; L(U) Li-quan; WU Xiao-jun; BAI Ru-lin; LU Yi-cheng

    2011-01-01

    Embolization therapy has been used as the initial treatment for spinal dural arteriovenous fistula (SDAVF) only for certain patients or in certain medical institutions due to its minimal invasiveness, but the recurrence of embolization remains a clinical challenge. The recurrent patient usually exhibits a gradual onset of symptoms and progressive deterioration of neurological function. Developing paraplegia several hours after embolization is commonly seen in patients with venous thrombosis-related complications, for which anticoagulation therapy is often administered. This article reports on a SDAVF patient who had weakness of both lower extremities before embolization and developed complete paraplegia several hours after embolization therapy, later confirmed by angiography as fistula recurrence. The symptoms were relieved gradually after second embolization. The pathophysiology of this patient is also discussed.

  9. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  10. Role of tenecteplase in pulmonary embolism.

    Science.gov (United States)

    Shrivastava, Sameer; Sachdeva, Ankush; Paul, Biswajit

    2009-01-01

    Patients presenting with pulmonary embolism (PE) have a wide spectrum of clinical severity. Although, some patients may present with frank hemodynamic collapse and cardiac arrest, others may present with asymptomatic PE that is discovered incidentally during work up of another condition. Fibrinolytic therapy is an option in the treatment of patients with PE. A rational approach to decide whether to indicate fibrinolytic therapy is based on assessment of benefits that each patient will derive from fibrinolytic therapy weighed against risk of major bleeding and intracranial hemmorage. There is a clear benefit/risk ratio for fibrinolytic therapy in patients with PE who present with cardiac arrest and in those who are hemodynamically unstable from a massive pulmonary embolism. With proper risk assessment selected patients with stable hemodynamics and right ventricular dysfunction may also benefit from fibrinolytic therapy. This article sets out to review the literature on tenecteplase in treatment of patients with PE.

  11. Uterine artery embolization for cervical ectopic pregnancy

    Directory of Open Access Journals (Sweden)

    Qiao Zhou, MD

    2015-12-01

    Full Text Available A 36-year-old woman with 3 prior C-sections is diagnosed with a caesarean scar ectopic pregnancy. Despite receiving intramuscular and transvaginal methotrexate injection 2 months before presentation, the beta human chorionic gonadotropin was recorded to be 73 mIU/mL at the time of encounter. The patient complained of vaginal bleeding with a significant drop in hematocrit from 40% to 33%. Transvaginal ultrasound confirmed retroplacental hemorrhage and because of the patient's desire to retain fertility, interventional radiology was consulted to perform an uterine artery embolization. The uterine artery embolization was successful in achieving hemostasis and resulted in a decrease of betaHCG to 46 on postprocedure day 1 to <1 mIU/mL by postoperative week 3.

  12. Postoperative hypoxemia due to fat embolism

    Directory of Open Access Journals (Sweden)

    Tarun Bhalla

    2011-01-01

    Full Text Available Although the reported incidence of fat embolism syndrome (FES is low (approximately 1%, it is likely that microscopic fat emboli are showered during manipulation of long bone fractures. Even though there continues to be debate regarding the etiology and proposed mechanism responsible for FES, significant systemic manifestations may occur. Treatment is generally symptomatic based on the clinical presentations. We report a 10-year-old girl who developed hypoxemia following treatment of a displaced Salter-Harris type II fracture of the distal tibia. The subsequent evaluation and hospital course pointed to fat embolism as the most likely etiology for the hypoxemia. We discuss the etiology for FES, review the proposed pathophysiological mechanisms responsible for its clinical manifestations, present currently accepted diagnostic criteria, and discuss its treatment.

  13. Controversies in diagnosis of pulmonary embolism.

    Science.gov (United States)

    Stein, Paul D; Sostman, H Dirk; Dalen, James E; Bailey, Dale L; Bajc, Marika; Goldhaber, Samuel Z; Goodman, Lawrence R; Gottschalk, Alexander; Hull, Russell D; Matta, Fadi; Pistolesi, Massimo; Tapson, Victor F; Weg, John G; Wells, Philip S; Woodard, Pamela K

    2011-04-01

    The approach to the diagnosis of acute pulmonary embolism (PE) is under constant revision with advances in technology, noninvasive approaches, and increasing awareness of the risks of ionizing radiation. Optimal approaches in some categories of patients are controversial. Data are insufficient for evidence-based recommendations. Therefore, this survey of investigators in the field was undertaken. Even among experts there were marked differences of opinion regarding the approach to the diagnosis of acute PE. Although CT pulmonary angiography was usually the imaging test of choice, the respondents were keenly aware of the dangers of ionizing radiation. In view of advances in scintigraphic diagnosis since the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) trial, ventilation/perfusion (V/Q) lung scans or perfusion scans alone and single photon emission computed tomography (SPECT) V/Q lung scans are often recommended. The choice depends on the patient's age, gender, and complexity of the findings on the plain chest radiograph.

  14. The researchers developed luminous rabbit

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    <正>Their efforts produced two rabbits out of a litter of eight that went from being a normal, fluffy(蓬松的) white to glowing green in the dark. The rabbits were born at the University of Istanbul as part of a collaboration between scientists from universities in Turkey and Hawaii. The rabbits glow to show that a genetic manipulation technique can work efficiently,

  15. Radiologic findings of cerebral septic embolism

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jee Young; Kim, Sang Joon; Kim Tae Hoon; Kim, Seung Chul; Kim, Jae Seung; Pai, Hyun Joo [Dankook Univ., Seoul (Korea, Republic of). Coll. of Medicine; Kim, Dong Ik [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine; Chang, Kee Hyun [Seoul National Univ. (Korea, Republic of). Coll. of Medicine; Choi, Woo Suk [Kyung Hee Univ., Seoul (Korea, Republic of). Coll. of Medicine

    1998-01-01

    To determine the MR and CT findings which differentiate cerebral septic embolism from thrombotic infarction. Cerebral septic embolism was confirmed by blood culture in six patients and autopsy in two. The number, size, distribution, contrast enhancement, and hemorrhage of the lesions, as seen on MR and CT, were retrospectively analyzed, and four patients were followed up for between one week and seven months. In a total of eight patients, infective endocarditis (n=5) and sepsis (n=3) caused cerebral septic embolism. The number, of lesions was 3 {approx} 7 in six patients, over 10 in one, and innumerable in one: these varied in size from punctate to 6 cm and were distributed in various areas of the brain. Gyral infarction was noted in five patients: non-enhancing patchy lesions involving the basal ganglia or white matter were found in five, tiny isolated nodular or ring-enhancing small lesions involving the cortex and white matter in three, peripheral rim-enhancing large lesions in one, and numerous enhancing nodules disseminated in the cortex in one. Hemorrhage had occurred in six. follow-up studies in four patients showed that initial lesions had enlarged in two and regressed in two: new lesions had appeared in two. Multiple lesions of different sizes and various patterns which include gyral infarction, patchy or nodular lesion in the cortex, white mater of basal ganglia, and isolated small ring-like or nodular enhancement or frequent hemorrhage are findings which could be helpful in the radiologic diagnosis of cerebral septic embolism. (author). 8 refs., 5 figs.

  16. Venous air embolism following insufflation of the urethra.

    Science.gov (United States)

    Vanlinthout, L; Boghaert, A; Thienpont, L

    1986-01-01

    Venous air embolism following urethral inflation only scarcely documented: an extensive search of the literature yielded four papers relating to this subject. We report a new case of venous air embolism due to this uncommon etiology. Careful study revealed some common pathogenetic features with previously reported cases. Some important precautions can diminish the likelihood of gas embolism and reduce its fatal outcome in situations, similar to the kind mentioned.

  17. Carbon dioxide embolism during laparoscopic sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Amir Abu Zikry

    2011-01-01

    Full Text Available Bariatric restrictive and malabsorptive operations are being carried out in most countries laparoscopically. Carbon dioxide or gas embolism has never been reported in obese patients undergoing bariatric surgery. We report a case of carbon dioxide embolism during laparoscopic sleeve gastrectomy (LSG in a young super obese female patient. Early diagnosis and successful management of this complication are discussed. An 18-year-old super obese female patient with enlarged fatty liver underwent LSG under general anesthesia. During initial intra-peritoneal insufflation with CO 2 at high flows through upper left quadrant of the abdomen, she had precipitous fall of end-tidal CO 2 and SaO 2 % accompanied with tachycardia. Early suspicion led to stoppage of further insufflation. Clinical parameters were stabilized after almost 30 min, while the blood gas analysis was restored to normal levels after 1 h. The area of gas entrainment on the damaged liver was recognized by the surgeon and sealed and the surgery was successfully carried out uneventfully. Like any other laparoscopic surgery, carbon dioxide embolism can occur during bariatric laparoscopic surgery also. Caution should be exercised when Veress needle is inserted through upper left quadrant of the abdomen in patients with enlarged liver. A high degree of suspicion and prompt collaboration between the surgeon and anesthetist can lead to complete recovery from this potentially fatal complication.

  18. Pneumatic compression for embolic protection during upper extremity endovascular intervention.

    Science.gov (United States)

    Cassar, Andrew; Barsness, Gregory W; Wysokinski, Waldemar E; Gifford, Shaun M; Bower, Thomas C; Edwards, William D; Gulati, Rajiv

    2014-01-01

    Embolic protection devices are occasionally employed during endovascular interventions to prevent complications caused by embolic debris. However, these devices have imperfect efficacy, confer risk of endovascular trauma, and are expensive. We report a patient with giant cell arteritis and symptomatic axillary artery stenosis, with a perceived elevated risk of distal embolization during endovascular intervention. We describe a straightforward embolic protection technique of brachial pressure cuff inflation during endovascular intervention and aspiration of displaced thrombotic material from the static column of blood. This novel, effective, and cost-free technique could also be employed in other vascular beds during endovascular intervention.

  19. Portal vein embolization induces compensatory hypertrophy of remnant liver

    Institute of Scientific and Technical Information of China (English)

    Jing-Yao Huang; Wei-Zhu Yang; Jian-Jun Li; Na Jiang; Qu-Bin Zheng

    2006-01-01

    AIM: To evaluate the effectiveness and safety of different portal vein branch embolization agents in inducing compensatory hypertrophy of the remnant liver and to offer a theoretic basis for clinical portal vein branch embolization.METHODS: Forty-one adult dogs were included in the experiment and divided into four groups. Five dogs served as a control group, 12 as a gelfoam group, 12as a coil-gelfoam group and 12 as an absolute ethanol group. Left portal vein embolization was performed in each group. The results from the embolization in each group using different embolic agents were compared.The safety of portal vein embolization (PVE) was evaluated by liver function test, computed tomography (CT) and digital subtraction angiography (DSA) of liver and portal veins. Statistical test of variance was performed to analyze the results.RESULTS: Gelfoam used for PVE was inefficient in recanalization of portal vein branch 4 wk after the procedure. The liver volume in groups of coil-gelfoam and absolute ethanol increased 25.1% and 33.18%,respectively. There was no evidence of recanalization of embolized portal vein, hepatic dysfunction, and portal hypertension in coil-gelfoam group and absolute ethanol group.CONCOUSION: Portal vein branch embolization using absolute ethanol and coil-gelfoam could induce atrophy of the embolized lobes and compensatory hypertrophy of the remnant liver. Gelfoam is an inefficient agent.

  20. Interventional neuroradiology of stroke, still not dead

    Institute of Scientific and Technical Information of China (English)

    Vitor; Mendes; Pereira; Karl-Olof; Lvblad

    2013-01-01

    Since the National Institute of Neurological Disorders and Stroke trial,intravenous thrombolysis has been gaining wide acceptance as the modality of treatment for acute embolic stroke,with a current therapeutic window of up to 4.5 h.Both imaging[with either magnetic resonance imaging(MRI)or computed tomography(CT)]and interventional techniques(thrombolysis and/or thrombectomy)have since improved and provided us with additional imaging of the penumbra using CT or MRI and more advanced thrombolysis or thrombectomy strategies that have been embraced in many centers dealing with patients with acute cerebral ischemia.These techniques,however,have come under scrutiny due to their accrued healthcare costs and have been questioned following major recent studies.These studies basically showed that interventional techniques were not superior to the traditional intravenous thrombolysis techniques and that penumbra imaging could not determine what patients would benefit from more aggressive(i.e.,interventional)treatment.We discuss this in the light of the latest developments in both diagnostic and interventional neuroradiology and point out why further studies are needed in order to define the right choices for patients with acute stroke.Indeed,these studies were in part conducted with suboptimal patient recruitment strategies and did not always use the latest interventional techniques available today.So,while these studies may have raised some relevant questions,at the same time,definitive answers have not been given,in our opinion.

  1. Interventional neuroradiology of stroke, still not dead.

    Science.gov (United States)

    Pereira, Vitor Mendes; Lövblad, Karl-Olof

    2013-12-28

    Since the National Institute of Neurological Disorders and Stroke trial, intravenous thrombolysis has been gaining wide acceptance as the modality of treatment for acute embolic stroke, with a current therapeutic window of up to 4.5 h. Both imaging [with either magnetic resonance imaging (MRI) or computed tomography (CT)] and interventional techniques (thrombolysis and/or thrombectomy) have since improved and provided us with additional imaging of the penumbra using CT or MRI and more advanced thrombolysis or thrombectomy strategies that have been embraced in many centers dealing with patients with acute cerebral ischemia. These techniques, however, have come under scrutiny due to their accrued healthcare costs and have been questioned following major recent studies. These studies basically showed that interventional techniques were not superior to the traditional intravenous thrombolysis techniques and that penumbra imaging could not determine what patients would benefit from more aggressive (i.e., interventional) treatment. We discuss this in the light of the latest developments in both diagnostic and interventional neuroradiology and point out why further studies are needed in order to define the right choices for patients with acute stroke. Indeed, these studies were in part conducted with suboptimal patient recruitment strategies and did not always use the latest interventional techniques available today. So, while these studies may have raised some relevant questions, at the same time, definitive answers have not been given, in our opinion.

  2. [Detection of micro-embolic signals: a review of the literature].

    Science.gov (United States)

    Boulon, C; Baud, J-M; Kercret, G; Pichot, O; Poggi, J-N; Saby, J-C; Sprynger, M

    2012-12-01

    The detection of micro-embolic signals (MES), by transcranial Doppler sonography might be useful for risk stratification in patients with symptomatic and asymptomatic carotid or cerebral artery stenosis, dissections, aortic atheroma, interventional procedures, and right to left cardiac shunts. Review of the technique and clinical situations of MES detection. PubMed search from 1990 to 2012. MES were found in 0,19, 48% versus 0,3, and 12% of patients with symptomatic and asymptomatic inferior than 30, 30 to 69, and 70 to 99% carotid stenosis, respectively. MES were related to the risk of recurrent stroke or transient ischemic attack (TIA). In the ACES study, the absolute annual risk of stroke or TIA after 2 years was 7% with vs 3% without MES. In patients with intracranial stenosis, the risk of stroke recurrence was 48% with vs 7% without MES at 13.6 months follow-up. MES were reported in 25% of the symptomatic versus none of the asymptomatic patients with intracranial stenosis. Detection of MES is feasible and reproducible for multicenter studies, using rigourous methodology and long lasting recordings. It may contribute to risk stratification, especially in patients with extra- or intracranial stenosis. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  3. Ultrastructure of Reissner's membrane in the rabbit

    DEFF Research Database (Denmark)

    Qvortrup, K.; Rostgaard, Jørgen; Bretlau, P.

    1994-01-01

    Anatomy, Reissner's membrane, electron microscopy, tubulocisternal endoplasmic reticulum, subsurface cisterns, rabbit......Anatomy, Reissner's membrane, electron microscopy, tubulocisternal endoplasmic reticulum, subsurface cisterns, rabbit...

  4. A Case of Myopathy, Encephalopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome with Intracardiac Thrombus [corrected].

    Science.gov (United States)

    Joo, Jung-Chul; Seol, Myung Do; Yoon, Jin Won; Lee, Young Soo; Kim, Dong-Keun; Choi, Yong Hoon; Ahn, Hyo Seong; Cho, Wook Hyun

    2013-03-01

    Myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a multisystem clinical syndrome manifested by mitochondrial myopathy, encephalopathy, lactic acidosis and recurrent stroke-like episodes. A 27-year-old female with MELAS syndrome presented with cerebral infarction. Echocardiography revealed a thrombus attached to the apex of the hypertrophied left ventricle, with decreased systolic function. The embolism of the intracardiac thrombus might have been the cause of stroke. There should be more consideration given to the increased possibility of intracardiac thrombus formation when a MELAS patient with cardiac involvement is encountered.

  5. Percutaneous N-Butyl cyanoacrylate embolization of a pancreatic pseudoaneurysm after failed attempts of transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ri Hyeon; Yoo, Roh Eul; Kim, Hyo Cheol [Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-10-15

    One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

  6. New anticoagulants in the treatment of stroke:future promise

    Institute of Scientific and Technical Information of China (English)

    Emre Kumral; Tuba Cerraho(g)lu (S)irin

    2013-01-01

    Recent evidence is leading to the replacement of vitamin K antagonists,the efficacy of which in preventing stroke in patients with atrial fibrillation (AF) is well established,with better tolerated and more manageable new anticoagulant drugs,with a lower risk of intracranial bleeding,no clear interactions with food,fewer interactions with medications,and no need for frequent laboratory monitoring and dose adjustments.Among new anticoagulants,dabigatran etexilate is a direct,competitive inhibitor of thrombin.It was evaluated for patients with AF in the RE-LY trial,showing lower rates of stroke and systemic embolism at a dose of 150 mg twice daily with similar rates of major hemorrhage compared with warfarin; and non-inferiority compared with warfarin for the prevention of stroke and systemic embolism at a dose of 110 mg twice daily,with lower rates of major bleeding.Beside dabigatran,oral factor X a inhibitors are also emerging for the prevention of thromboembolic events in AF.Despite the obvious advantages of these new oral anticoagulants over vitamin K antagonists,further information is still needed on how to prioritize the patients deriving the greatest benefit from these novel agents on the basis of patient characteristics or drug pharmacokinetics.There is also a need for assessing their long-term efficacy and safety over decades in the real-world setting.

  7. Upper limb amputation due to a brachial arterial embolism associated with a superior mesenteric arterial embolism: a case report

    Directory of Open Access Journals (Sweden)

    Yamada Tsuyoshi

    2012-07-01

    Full Text Available Abstract Background Acute mesenteric ischemia due to an embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric arterial embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss. Case presentation We present a rare case of a 67-year-old Japanese woman with atrial fibrillation who developed an embolic occlusion of the brachial artery associated with a superior mesenteric arterial embolism. She developed gangrene in her right hand, which had progressed to the point that amputation was necessary by the time the gastrointestinal surgeon had consulted the Department of Orthopedic Surgery. The brachial arterial embolism diagnosis was delayed by the severe abdominal symptoms and shock conditions that followed the emergency enterectomy, resulting in amputation of the upper limb despite anticoagulation therapy. In this case, multiple infarctions of the spleen were also observed, indicating a shower embolism. Conclusions When treating a superior mesenteric arterial embolism in a patient with atrial fibrillation, the possibility of recurrent or multiple arterial thromboembolic events should be considered, even after the procedure is completed.

  8. Dabigatran and other oral antithrombotic agents for the prevention of stroke in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Testai F

    2011-06-01

    Full Text Available Fernando D Testai, Venkatesh AiyagariSection of Neurological Critical Care and Stroke, Department of Neurology and Rehabilitation, Center for Stroke Research, University of Illinois College of Medicine, Chicago, IL, USAAbstract: Atrial fibrillation (AF is considered to be one of the most prevalent abnormal heart rhythm disorders and a leading cause of cerebral ischemia. The risk of stroke in AF is associated with vascular risk factors including advancing age, hypertension, congestive heart disease, diabetes mellitus, vascular disease, and prior history of stroke or transient ischemic attack. The classic management of patients with AF at risk of suffering stroke includes the use of warfarin. The use of this medication in clinical practice is, however, limited owing to its narrow therapeutic window, multiple drug and food interactions, prolonged half-life, and the need for periodic anticoagulation monitoring. Recently, newer oral anticoagulants with better pharmacokinetic and pharmacodynamic profiles have been developed and compared to warfarin in phase III trials for the prevention of stroke and systemic embolism in patients with AF. Dabigatran stands out from these studies as a safe and efficacious alternative to warfarin for treating patients with AF at risk of stroke. In this article we review classic and novel approaches for stroke prevention in AF with special emphasis on dabigatran.Keywords: oral anticoagulants, vitamin K antagonists, antiplatelet agents, stroke prevention, atrial fibrillation

  9. Arterial embolization hyperthermia using As2O3 nanoparticles in VX2 carcinoma-induced liver tumors.

    Directory of Open Access Journals (Sweden)

    Hui Yu

    Full Text Available BACKGROUND: Combination therapy for arterial embolization hyperthermia (AEH with arsenic trioxide (As(2O(3 nanoparticles (ATONs is a novel treatment for solid malignancies. This study was performed to evaluate the feasibility and therapeutic effect of AEH with As(2O(3 nanoparticles in a rabbit liver cancer model. The protocol was approved by our institutional animal use committee. METHODOLOGY/PRINCIPAL FINDINGS: In total, 60 VX(2 liver-tumor-bearing rabbits were randomly assigned to five groups (n = 12/group and received AEH with ATONs (Group 1, hepatic arterial embolization with ATONs (Group 2, lipiodol (Group 3, or saline (Group 4, on day 14 after tumor implantation. Twelve rabbits that received AEH with ATONs were prepared for temperature measurements, and were defined as Group 5. Computed tomography was used to measure the tumors' longest dimension, and evaluation was performed according to the Response Evaluation Criteria in Solid Tumors. Hepatic toxicity, tumor necrosis rate, vascular endothelial growth factor level, and microvessel density were determined. Survival rates were measured using the Kaplan-Meier method. The therapeutic temperature (42.5°C was obtained in Group 5. Hepatotoxicity reactions occurred but were transient in all groups. Tumor growth was delayed and survival was prolonged in Group 1 (treated with AEH and ATONs. Plasma and tumor vascular endothelial growth factor and microvessel density were significantly inhibited in Group 1, while tumor necrosis rates were markedly enhanced compared with those in the control groups. CONCLUSIONS: ATON-based AEH is a safe and effective treatment that can be targeted at liver tumors using the dual effects of hyperthermia and chemotherapy. This therapy can delay tumor growth and noticeably inhibit tumor angiogenesis.

  10. Neurogenesis in Stroke Recovery.

    Science.gov (United States)

    Koh, Seong-Ho; Park, Hyun-Hee

    2017-02-01

    Stroke, resulting from limited blood flow to the brain, is one of the most important causes of morbidity and mortality worldwide. Stroke is classified as ischemic, due to lack of blood flow, or hemorrhagic, due to bleeding. Because 87 % of strokes are classified as ischemic, this type will be the predominant focus of this review. Except for thrombolytic therapy, there is no established treatment to reduce the neurological deficits caused by ischemic stroke. Therefore, it is necessary to develop new therapeutic strategies designed to improve neurological functions after ischemic stroke. Recently, therapies to enhance neurogenesis after ischemic stroke have been investigated. However, these approaches have not led to successful clinical outcomes. This review addresses the pathophysiology of stroke, neurogenesis after stroke, and how to stimulate these processes based on the current literature. Finally, ongoing clinical trials to improve neurological functions after stroke by enhancing neurogenesis are discussed in this review.

  11. Onset Time of Ischemic Events and Antiplatelet Therapy after Intracranial Stent-assisted Coil Embolization.

    Science.gov (United States)

    Matsumoto, Yoshihisa; Nakai, Kanji; Tsutsumi, Masanori; Iko, Minoru; Nii, Kouhei; Narita, Sumito; Eto, Ayumu; Mitsutake, Takahumi; Aikawa, Hiroshi; Kazekawa, Kiyoshi

    2014-04-01

    Stent-assisted coil embolization is effective for intracranial aneurysms, especially wide-necked aneurysms; however, the optimal antiplatelet regimens for ischemic events that develop after coil embolization have not yet been established. We aimed to determine the onset time of such postoperative ischemic events and the relationship between these events and antiplatelet therapy. We performed coil embolization using a vascular reconstruction stent for 43 cases of intracranial aneurysms and evaluated the incidence of postoperative ischemic events in these cases. Nine patients showed postoperative ischemic events during the follow-up period (13 ± 7 months). Two patients developed cerebral infarction within 24 hours. Five patients developed transient ischemic attack within 40 days while they were receiving dual antiplatelet therapy. In addition, 1 patient showed cerebral infarction 143 days postoperatively during single antiplatelet therapy, and a case of transient visual disturbance was reported 191 days postoperatively (49 days after antiplatelet therapy had been discontinued). We increased the number of antiplatelet agents in 4 of these patients. The other 5 patients were under strict observation with dual antiplatelet therapy. All these patients were shifted to single antiplatelet therapy 3-13 months postoperatively. No recurrence of ischemic events was noted. Postoperative ischemic events are most likely to occur within 40 days postoperatively. For patients with postoperative ischemic events, additional ischemic events can be prevented by increasing the number of antiplatelet agents; subsequently, they can be shifted to single antiplatelet therapy after the risk of recurrence has decreased. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. The Year of the Rabbit

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Every year of the Chinese lunar calendar corresponds with an animal. The rat,ox, tiger, rabbit, dragon, snake, horse,sheep, monkey, rooster, dog and pig make up the Chinese zodiac, which repeats in a12-year cycle. This year’s Chinese NewYear rings in the Year of the Rabbit.

  13. Welfare assessment in pet rabbits

    NARCIS (Netherlands)

    Schepers, F.; Koene, P.; Beerda, B.

    2009-01-01

    One million pet rabbits are kept in The Netherlands, but there are no data available on their behaviour and welfare. This study seeks to assess the welfare of pet rabbits in Dutch households and is a first step in the development of a welfare assessment system. In an internet survey, housing

  14. INFECTIOUS MYXOMATOSIS OF RABBITS

    Science.gov (United States)

    Rivers, T. M.

    1930-01-01

    The virus of infectious myxomatosis of rabbits (Sanarelli) induces multiple lesions in the skin, lymph glands, tunica vaginalis,epididymis, testicle, spleen, and lungs. Growth and destruction of cells in the epidermis overlying the myxomatous masses leads to the formation of vesicles. Cytoplasmic inclusions are found in affected epidermal cells. Occasionally, similar inclusions are seen in other involved epithelial cells. The nature of the inclusions is an open question. In the myxomatous masses situated in the subcutaneous and other tissues, evidences of alteration and growth of certain cells are observed. PMID:19869741

  15. The White Rabbit project

    CERN Document Server

    Serrano, J; Gousiou, E; van der Bij, E; Wlostowski, T; Daniluk, G; Lipinski, M

    2013-01-01

    White Rabbit (WR) is a multi-laboratory, multi- company collaboration for the development of a new Ethernet-based technology which ensures sub-nanosecond synchronisation and deterministic data transfer. The project uses an open source paradigm for the development of its hardware, gateware and software components. This article provides an introduction to the technical choices and an explanation of the basic principles underlying WR. It then describes some possible applications and the current status of the project. Finally, it provides insight on current developments and future plans.

  16. Stroke and High Blood Pressure

    Science.gov (United States)

    ... More How High Blood Pressure Can Lead to Stroke Updated:Dec 2,2016 Stroke and high blood ... Changes That Matter • Find Tools & Resources Show Your Stroke Support! Show your stroke support with our new ...

  17. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  18. Use of Micropatterned Thin Film Nitinol in Carotid Stents to Augment Embolic Protection

    Directory of Open Access Journals (Sweden)

    Mahdis Shayan

    2016-12-01

    Full Text Available Stenting is an alternative to endarterectomy for the treatment of carotid artery stenosis. However, stenting is associated with a higher risk of procedural stroke secondary to distal thromboembolism. Hybrid stents with a micromesh layer have been proposed to address this complication. We developed a micropatterned thin film nitinol (M-TFN covered stent designed to prevent thromboembolism during carotid intervention. This innovation may obviate the need or work synergistically with embolic protection devices. The proposed double layered stent is low-profile, thromboresistant, and covered with a M-TFN that can be fabricated with fenestrations of varying geometries and sizes. The M-TFN was created in multiple geometries, dimensions, and porosities by sputter deposition. The efficiency of various M-TFN to capture embolic particles was evaluated in different atherosclerotic carotid stenotic conditions through in vitro tests. The covered stent prevented emboli dislodgement in the range of 70%–96% during 30 min duration tests. In vitro vascular cell growth study results showed that endothelial cell elongation, alignment and growth behaviour silhouettes significantly enhance, specifically on the diamond-shape M-TFN, with the dimensions of 145 µm × 20 µm and a porosity of 32%. Future studies will require in vivo testing. Our results demonstrate that M-TFN has a promising potential for carotid artery stenting.

  19. Use of Micropatterned Thin Film Nitinol in Carotid Stents to Augment Embolic Protection

    Science.gov (United States)

    Shayan, Mahdis; Jankowitz, Brian T.; Shridhar, Puneeth; Chun, Youngjae

    2016-01-01

    Stenting is an alternative to endarterectomy for the treatment of carotid artery stenosis. However, stenting is associated with a higher risk of procedural stroke secondary to distal thromboembolism. Hybrid stents with a micromesh layer have been proposed to address this complication. We developed a micropatterned thin film nitinol (M-TFN) covered stent designed to prevent thromboembolism during carotid intervention. This innovation may obviate the need or work synergistically with embolic protection devices. The proposed double layered stent is low-profile, thromboresistant, and covered with a M-TFN that can be fabricated with fenestrations of varying geometries and sizes. The M-TFN was created in multiple geometries, dimensions, and porosities by sputter deposition. The efficiency of various M-TFN to capture embolic particles was evaluated in different atherosclerotic carotid stenotic conditions through in vitro tests. The covered stent prevented emboli dislodgement in the range of 70%–96% during 30 min duration tests. In vitro vascular cell growth study results showed that endothelial cell elongation, alignment and growth behaviour silhouettes significantly enhance, specifically on the diamond-shape M-TFN, with the dimensions of 145 µm × 20 µm and a porosity of 32%. Future studies will require in vivo testing. Our results demonstrate that M-TFN has a promising potential for carotid artery stenting. PMID:27983574

  20. [Stroke and aging].

    Science.gov (United States)

    Ly, J; Maquet, P

    2014-01-01

    Stroke risk increases with aging and one third of ischemic strokes occurs in very elderly (> or = 80 years). These are responsible of two thirds of the overall stroke-related morbi-mortality. Stroke in very elderly differs from younger individuals by sex ratio (more women), risk factors (more atrial fibrillation and hypertension) and usually a worse functional outcome. Very elderly are likely to benefit from stroke unit care and early revascularisation treatments although they have historically been excluded from this urgent management. These issues are likely to worsen in the future with the increasing impact of stroke on our aging societies.

  1. Delayed extrusion of embolic coils into the airway after embolization of an external carotid artery pseudoaneurysm.

    Science.gov (United States)

    Wilseck, Zachary; Savastano, Luis; Chaudhary, Neeraj; Pandey, Aditya S; Griauzde, Julius; Sankaran, Sumanna; Wilkinson, D Andrew; Gemmete, Joseph J

    2017-08-29

    Carotid blowout syndrome (CBS) is a known devastating complication of head and neck surgery. The risk of developing CBS increases in the setting of radiation therapy, wound breakdown, or tumor recurrence. Traditionally, the treatment of choice for CBS is surgical ligation of the bleeding artery; however, recently, endovascular occlusion has become a more common option. If a pseudoaneurysm is present, treatment consists of trapping with endovascular coils or occlusion with a liquid embolic agent. Delayed migration of embolization coils into the airway causing acute respiratory distress is a rare occurrence. This report presents a case of a 57-year-old woman who presented to her otolaryngologist after experiencing an episode of acute respiratory distress which resolved when she expectorated embolization coil material from her tracheostomy tube. Three months prior to the episode she underwent coil embolization of an external carotid artery pseudoaneurysm for life-threatening hemorrhage. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Tunable delivery of niflumic acid from resorbable embolization microspheres for uterine fibroid embolization.

    Science.gov (United States)

    Bédouet, Laurent; Moine, Laurence; Servais, Emeline; Beilvert, Anne; Labarre, Denis; Laurent, Alexandre

    2016-09-10

    Uterine arteries embolization (UAE) is a recent technique that aims, by means of particles injected percutaneously, to stifle fibroids (leiomyomas). This treatment is non-invasive, compared with uterine ablation, but generates pelvic pain for a few days. A strategy to reduce the post-embolization pain would be to use calibrated embolization microspheres preloaded with a non-steroidal inflammatory drug (NSAID). In this study, we first compared four drugs, all active at low concentration on cyclooxygenase-2, i.e. ketoprofen, sodium diclofenac, flurbiprofen and niflumic acid (NFA), for their capacity to be loaded on resorbable embolization microspheres (REM) 500-700μm. NFA had the highest capacity of loading (5mg/mL) on resorbable microspheres. Then, we evaluated in vitro the NFA release profiles from REM having various degradation times of one, two or five days. NFA release was biphasic, with an initial burst (about 60% of the loading) followed by a sustained release that correlated significantly to REM's hydrolysis (rho=0.761, pdegradation rate of REM to provide an antalgic effect for a few days after UAE.

  3. The Vulnerability of Vessels Involved in the Role of Embolism and Hypoperfusion in the Mechanisms of Ischemic Cerebrovascular Diseases

    Directory of Open Access Journals (Sweden)

    Yong Peng Yu

    2016-01-01

    Full Text Available Accurate definition and better understanding of the mechanisms of stroke are crucial as this will guide the effective care and therapy. In this paper, we review the previous basic and clinical researches on the causes or mechanisms of ischemic cerebrovascular diseases (ICVD and interpret the correlation between embolism and hypoperfusion based on vascular stenosis and arterial intimal lesions. It was suggested that if there is no embolus (dynamic or in situ emboli, there might be no cerebral infarction. Three kinds of different clinical outcomes of TIA were theoretically interpreted based on its mechanisms. We suppose that there is a correlation between embolism and hypoperfusion, and which mechanisms (hypoperfusion or hypoperfusion induced microemboli playing the dominant role in each type of ICVD depends on the unique background of arterial intimal lesions (the vulnerability of vessels. That is to say, the vulnerability of vessels is involved in the role of embolism and hypoperfusion in the mechanisms of ischemic cerebrovascular diseases. This inference might enrich and provide better understandings for the underlying etiologies of ischemic cerebrovascular events.

  4. A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ou, Ming-Ching; Chuang, Ming-Tsung [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Lin, Xi-Zhang [Department of Internal Medicine, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Tsai, Hong-Ming; Chen, Shu-Yuan [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China); Liu, Yi-Sheng, E-mail: taicheng100704@yahoo.com.tw [Department of Diagnostic Radiology, National Cheng-Kung University Hospital, No. 138 Sheng Li Road, Tainan 704, Taiwan, ROC (China)

    2013-08-15

    Purpose: To evaluate the efficacy of estimating the volume of spleen embolized in partial splenic embolization (PSE) by measuring the diameters of the splenic artery and its branches. Materials and methods: A total of 43 liver cirrhosis patients (mean age, 62.19 ± 9.65 years) with thrombocytopenia were included. Among these, 24 patients underwent a follow-up CT scan which showed a correlation between angiographic estimation and measured embolized splenic volume. Estimated splenic embolization volume was calculated by a method based on diameters of the splenic artery and its branches. The diameters of each of the splenic arteries and branches were measured via 2D angiographic images. Embolization was performed with gelatin sponges. Patients underwent follow-up with serial measurement of blood counts and liver function tests. The actual volume of embolized spleen was determined by computed tomography (CT) measuring the volumes of embolized and non-embolized spleen two months after PSE. Results: PSE was performed without immediate major complications. The mean WBC count significantly increased from 3.81 ± 1.69 × 10{sup 3}/mm{sup 3} before PSE to 8.56 ± 3.14 × 10{sup 3}/mm{sup 3} at 1 week after PSE (P < 0.001). Mean platelet count significantly increased from 62.00 ± 22.62 × 10{sup 3}/mm{sup 3} before PSE to 95.40 ± 46.29 × 10{sup 3}/mm{sup 3} 1 week after PSE (P < 0.001). The measured embolization ratio was positively correlated with estimated embolization ratio (Spearman's rho [ρ] = 0.687, P < 0.001). The mean difference between the actual embolization ratio and the estimated embolization ratio was 16.16 ± 8.96%. Conclusions: The method provides a simple method to quantitatively estimate embolized splenic volume with a correlation of measured embolization ratio to estimated embolization ratio of Spearman's ρ = 0.687.

  5. [Pulmonary embolism in an acute manic patient following physical restraint].

    Science.gov (United States)

    Pirsoul, S; De Backer, L; Schrijvers, D

    2014-01-01

    Immobilisation is a risk factor for the development of deep venous thrombosis and pulmonary embolism. We present a case-study in which a patient developed a pulmonary embolism after being immobilised after a short period while subjected to physical restraint. We discuss the risk factors involved and stress the need for research into the prevention of such incidents.

  6. Diagnosis, management and prognosis of symptomatic and incidental pulmonary embolism

    NARCIS (Netherlands)

    Exter, den P.L.

    2016-01-01

    This thesis describes studies that aimed to evaluate and improve the diagnostic work-up and management of pulmonary embolism. Age-adjusted D-dimer testing was found to be an effective and safe strategy to reduce the need for CT-imaging in elderly patients with clinically suspected pulmonary embolism

  7. Selective embolization in the treatment of intractable epistaxis

    DEFF Research Database (Denmark)

    Andersen, Pia Juul; Kjeldsen, Anette Drøhse; Nepper-Rasmussen, Jørgen

    2005-01-01

    CONCLUSIONS: In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. OBJECTIVE: Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the b...

  8. Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor

    Science.gov (United States)

    Hashemi, Nafiseh; Ling, Jeanie D.; Soparkar, Charles; Sami, Mirwat; Ellezam, Benjamin; Klucznik, Richard; Lee, Andrew G.; Chévez-Barrios, Patricia

    2015-01-01

    Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT. PMID:27171911

  9. Incidence of Pleural Effusion in Patients with Pulmonary Embolism

    Institute of Scientific and Technical Information of China (English)

    Min Liu; Ai Cui; Zhen-Guo Zhai; Xiao-Juan Guo; Man Li; Lei-Lei Teng; Li-Li Xu

    2015-01-01

    Background:No data on the incidence of pleural effusion (PE) in Chinese patients with pulmonary embolism are available to date.The aim of the current study was to investigate the frequency of PE in a Chinese population of patients with pulmonary embolism.Methods:This was a retrospective observational single-center study.All data of computed tomography pulmonary angiography (CTPA)performed over 6-year period on adult patients with clinically suspected pulmonary embolism were analyzed.Results:From January 2008 until December 2013,PE was identified in 423 of 3141 patients (13.5%) with clinically suspected pulmonary embolism who underwent CTPA.The incidence of PE in patients with pulmonary embolism (19.9%) was significantly higher than in those without embolism (9.4%) (P < 0.001).Majority of PEs in pulmonary embolism patients were small to moderate and were unilateral.The locations of emboli and the numbers of arteries involved,CT pulmonary obstruction index,and parenchymal abnormalities at CT were not associated with the development of PE.Conclusions:PEs are present in about one fifth of a Chinese population of patients with pulmonary embolism,which are usually small,unilateral,and unsuitable for diagnostic thoracentesis.

  10. MASSIVE PULMONARY EMBOLISM IN OLDER PATIENT: SURVIVAL DESPITE STATISTIC DATA

    Directory of Open Access Journals (Sweden)

    O. S. Makharynska

    2017-06-01

    Full Text Available Massive pulmonary thromboembolism is presented in this article on example of clinical case. Clinical investigation, prognosis evaluation tools, diagnosis and acute phase treatment along with prevention of recurrent episode of pulmonary embolism presented. Observed and described clinical case of pulmonary embolism in older patient, when patient was mistakenly diagnosed in emergency department as acute coronary syndrome patient.

  11. Prognostic factors in bronchial arterial embolization for hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-07-15

    To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.

  12. Embolization to treat pelvic congestion syndrome and vulval varicose veins.

    NARCIS (Netherlands)

    Vleuten, C.J.M. van der; Kempen, J.A.L. van; Schultze Kool, L.J.

    2012-01-01

    OBJECTIVE: To evaluate the efficacy of embolization for treating the symptoms of pelvic congestion syndrome (PCS). METHODS: Twenty-one women with PCS who were treated with embolization at Radboud University Nijmegen Medical Centre between 2003 and 2008 were sent a questionnaire about their symptoms

  13. Embolization with the Amplatzer Vascular Plug in TIPS patients

    NARCIS (Netherlands)

    P.M.T. Pattynama (Peter); A. Wils (Alexandra); E. van der Linden (Edwin); L.C. van Dijk (Lukas)

    2007-01-01

    textabstractVessel embolization can be a valuable adjunct procedure in transjugular intrahepatic portosystemic shunt (TIPS). During the creation of a TIPS, embolization of portal vein collaterals supplying esophageal varices may lower the risk of secondary rebleeding. And after creation of a TIPS, c

  14. Traumatic brachiocephalic pseudoaneurysm presenting with delayed stroke: case report

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, A.; Gueckel, F. [Department of Radiology, University Hospital Mannheim, Medical Faculty of University Heidelberg (Germany); Meairs, S.; Cornelius, A.; Schwartz, A. [Department of Neurology, University Hospital Mannheim, Medical Faculty of University Heidelberg (Germany)

    2000-10-01

    We report a traumatic pseudoaneurysm of the internal carotid artery bifurcation and subclavian artery with recurrent strokes events in a 19-year-old man. He was admitted with an acute left hemiparesis. His history revealed a similar episode 1 year and a major car accident 3 years previously. Contrast enhanced MR angiography confirmed colour Doppler sonographic findings of a carotid and subclavian artery pseudoaneurysm presumably resulting from seat-belt trauma. The pseudoaneurysm, containing thrombus, was thought to be the source of artery-to-artery embolism. (orig.)

  15. Maternal death due to non-traumatic fat embolism.

    Science.gov (United States)

    Karayel, Ferah; Arican, Nadir; Kavas, Gamze; Turan, Arzu Akcay; Pakis, Isil

    2005-09-01

    The aim of this report is to document a case of non-traumatic fat embolism (NTFE) and to address the need for considerition of fat embolism in suspicious deaths resulting from respiratory distress in the postpartum period. A 28-years-old woman autopsied at the Morgue Department of the Council of Forensic Medicine is included to the study. This female became unconscious and developed respiratory distress 4 h after delivery, and this was followed by respiratory arrest. External examination revealed resuscitation marks and normal postmortem changes. Light microscopy revealed massive fat embolization involving most of the alveolar capillaries on several sections. Only in one particular area was a bone marrow embolus. Pathological diagnosis of the lung was diffuse pulmonary fat embolism. There was no evidence of other organ involvement with emboli. Other visceral organs showed no striking findings other than mild congestion. The cause of death was considered to be respiratory insufficiency resulting from severe fat embolism of the lungs.

  16. The role of embolization in palliative care.

    Science.gov (United States)

    Broadley, K E; Kurowska, A; Dick, R; Platts, A; Tookman, A

    1995-10-01

    Transcatheter arterial embolization (TCAE) is a well recognized radiological technique that has been used for over 25 years. It is a method of diminishing blood flow through selected vessels by inserting haemostatic material under angiographic control. The procedure is performed under local anaesthetic through a femoral or, occasionally, an axillary approach. We present our experience of the use of TCAE in the management of pain and haemorrhage in three hospice inpatients in whom other options had been exhausted. The use of TCAE as a technique for the palliation of these symptoms in the hospice setting is discussed.

  17. A rat model for embolic encephalitis

    DEFF Research Database (Denmark)

    Astrup, Lærke Boye; Agerholm, Jørgen Steen; Aalbæk, Bent

    2011-01-01

    µl thrombin (2.5 IU/ml) in a catheter until coagulated. A sterile fibrin-clot of 5 mm was selected for embolization and injected via the ECA catheter. The common carotid artery was clamped during injection thereby directing the embolus via the internal carotid artery to the brain. The clot...... gain access to the brain by the circulation and, no foreign materials other than bacteria are implated in the brain. This ensures high face-validity and high construct-validity of the model for three reasons: 1) Cerebral infarction by thrombosis or disseminated intravascular coagulation is a key...

  18. Aspergillus coronary embolization causing acute myocardial infarction.

    Science.gov (United States)

    Laszewski, M; Trigg, M; de Alarcon, P; Giller, R

    1988-05-01

    An increased frequency of disseminated aspergillosis has been observed in the last decade, mostly occurring in immunocompromised patients including the bone marrow transplant population. Cardiac involvement by Aspergillus remains rare. We report the clinical and postmortem findings of an unusual case of Aspergillus pancarditis in a 7-year-old bone marrow transplant patient with Aspergillus embolization to the coronary arteries leading to a massive acute myocardial infarction. This case suggests that myocardial injury secondary to disseminated aspergillosis should be included in the differential diagnosis of chest pain in the immunocompromised pediatric patient.

  19. Cardiogenic embolism producing crescendo transient ischemic attacks.

    Science.gov (United States)

    Geraghty, Patrick J; Oak, Jack; Choi, Eric T

    2005-09-01

    Lateralizing, repetitive transient ischemic attacks are characteristic of symptomatic carotid bifurcation atherosclerotic plaques. We report a case in which a cardiogenic embolus, after lodging at the left carotid bifurcation, produced crescendo episodes of expressive aphasia and mild right upper extremity weakness. Complete neurological recovery was achieved following emergent carotid embolectomy and endarterectomy. This case demonstrates that the laminar nature of internal carotid blood flow may result in the localization of embolic events to a single region of the cerebral vasculature, regardless of the source lesion in the carotid artery. The role of endoluminal techniques in the diagnosis and management of such lesions is discussed.

  20. Patent foramen ovale and cryptogenic stroke: the hole story.

    Science.gov (United States)

    Furlan, Anthony J; Jauss, Marek

    2013-09-01

    Despite 3 recent randomized clinical trials, the management of patients with cryptogenic stroke and patent foramen ovale remains unsettled. The primary results of Evaluation of the STARFlex Septal Closure System in Patients with a Stroke and/or Transient Ischemic Attack due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale (CLOSURE), Percutaneous Closure of Patent Foramen Ovale in Cryptogenic Stroke (PC), and Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) were the same; the intent to treat analysis for the primary end point in all 3 trials failed to demonstrate superiority of device closure compared with medical therapy. CLOSURE put the brakes on indiscriminate device closure of patent foramen ovales in patients with cryptogenic stroke or transient ischemic attack. RESPECT suggested, but did not prove, that highly selected patients without vascular risk factors, with a cortical infarct on baseline magnetic resonance imaging and a substantial patent foramen ovale shunt may benefit from the Amplatzer device during a multiple-year period. In the absence of definitive clinical trial results, the precise definition of which patient subgroups should be considered for patent foramen ovale device closure should be agreed to by the stakeholder societies and the Food and Drug Administration.

  1. Cerebrolysin enhances neurogenesis in the ischemic brain and improves functional outcome after stroke

    OpenAIRE

    Zhang, Chunling; Chopp, Michael; Cui, Yisheng; Wang, Lei; Zhang, Ruilan; Li ZHANG; Lu, Mei; Szalad, Alexandra; Doppler, Edith; Hitzl, Monika; Zhang, Zheng Gang

    2010-01-01

    Cerebrolysin is a peptide preparation mimicking the action of neurotrophic factors and has beneficial effects on neurodegenerative diseases and stroke. The present study investigated the effect of Cerebrolysin on neurogenesis in a rat model of embolic middle cerebral artery occlusion (MCAo). Treatment with Cerebrolysin at doses of 2.5 and 5 ml/kg significantly increased the number of bromodeoxyuridine positive (BrdU+) subventricular zone (SVZ) neural progenitor cells and doublecortin (DCX) im...

  2. Circle of Willis variation in a complex stroke presentation: a case report

    Directory of Open Access Journals (Sweden)

    Young Carolyn A

    2006-03-01

    Full Text Available Abstract Background The impact of circle of Willis anatomical variation upon the presentation of stroke is probably underrecognised. Case presentation A 63-year-old right-handed woman developed a left hemiparesis and right leg weakness sequentially following a road traffic accident (RTA. Despite initial concern about the possibility of cervical spinal cord injury, the final diagnosis was bilateral artery-to-artery embolic cerebral infarction with dominant right internal carotid artery. Conclusion The case illustrates the complex presentation of stroke as a pseudo-cervical cord lesion and the impact of circle of Willis anatomical variation upon the expression of large vessel cerebrovascular disease.

  3. Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

    Directory of Open Access Journals (Sweden)

    Nicole Marschner-Preuth

    2013-01-01

    Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

  4. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  5. Intravenous thrombolysis in a patient with left atrial myxoma with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Girish Baburao Kulkarni

    2014-01-01

    Full Text Available Intravenous thrombolysis (IVT is an accepted therapy in patients with acute ischemic stroke presenting within 3-4.5 hours of symptom onset. Selection of the patient for thrombolysis depends on the careful assessment for the risk of post thrombolysis symptomatic haemorrhage (6.2-8.9% which may be fatal. Atrial myxomas which are the commonest tumors of the heart are associated with stroke due to tumor/clot embolism. There are very few case reports of IVT and its outcome in patients with atrial myxoma with stroke. Some have reported successful thrombolysis, while others have reported intracerebral bleeding. In this report we describe our experience of IVT in atrial myxoma patient with ischemic stroke and review the relevant literature.

  6. Preoperative embolization of primary bone tumors: A case control study

    Science.gov (United States)

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand

    2016-01-01

    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  7. Pulmonary cement embolization after vertebroplasty, an uncommon presentation of pulmonary embolism: A case report and literature review

    Science.gov (United States)

    Sinha, Nishant; Padegal, Vivek; Satyanarayana, Satish; Santosh, Hassan Krishnamurthy

    2015-01-01

    Pulmonary Cement Embolization (PCE) is a rare complication of vertebroplasty surgery. There is no clear guideline for management of this entity. There is no definite protocol for anticoagulation in PCE. This is a case report of our patient who was diagnosed to have Pulmonary Cement Embolization, which was quite significant involving both lungs. She was successfully managed without long term anticoagulation. PMID:26664167

  8. Heart and Stroke Encyclopedia

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More The Heart and Stroke Encyclopedia Click a letter below to get a ... dozens of cardiovascular terms from our Heart and Stroke Encyclopedia and get links to in-depth information. ...

  9. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  10. Stroke Fact Sheet

    Science.gov (United States)

    ... tells you to. Return to top Does taking birth control pills increase my risk for stroke? Taking birth ... your vagina Return to top Does using the birth control patch increase my risk for stroke? The patch ...

  11. Stroke Connection Magazine

    Science.gov (United States)

    ... reason to live a longer, healthier life. These stroke survivors, caregivers and others share their 'whys'. We'd love ... let us know! Main Menu Survival Journeys For Caregivers Tips and ... Stroke Association. All rights reserved. | Privacy Policy

  12. Perinatal and Childhood Stroke

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-03-01

    Full Text Available The epidemiology, risk factors, outcome and prognosis of perinatal and childhood stroke were reviewed at a workshop sponsored by the National Institute of Neurological Disorders and Stroke in Bethesda, MD, on Sept 18 and 19, 2000.

  13. Dizziness in stroke

    OpenAIRE

    M V Zamergrad

    2015-01-01

    Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness....

  14. Genetics of stroke

    OpenAIRE

    Guo, Jin-Min; Liu, Ai-Jun; Su, Ding-Feng

    2010-01-01

    Stroke is the second most common cause of death and the most common cause of disability in developed countries. Stroke is a multi-factorial disease caused by a combination of environmental and genetic factors. Numerous epidemiologic studies have documented a significant genetic component in the occurrence of strokes. Genes encoding products involved in lipid metabolism, thrombosis, and inflammation are believed to be potential genetic factors for stroke. Although a large group of candidate ge...

  15. Hemoptysis and hemoperitoneum due to metastatic gestational choriocarcinma: bronchial artery embolization and superselective splenic artery embolization: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom; Park, Byung Ho; Yoon, Seong Kuk; Kim, Chan Sung; Lee, Jin Hwa; Oh, Jong Young [Donga University School of Medicine, Pusan (Korea, Republic of); Seong, Chang Kyu; Kim, Yong Joo; Kim, Young Hwan [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2003-01-01

    Gestational choriocarcinoma is easily disseminated hematogenously and its hypervascular nature places the patient at risk of significant hemorrhage both at the sites of metastatic lesion and in the uterus. In addition, its tends to give rise to pseudoaneurysm formation. Treatment of the condition by percutaneous embolization has been reported in several published articles, and hemoperitoneum secondary to rupture of splenic metastasis of gestational choriocarcinoma has also been reported, as has angiographic embolization. Hemoptysis resulting from pulmonary metastasis and treatment by means of embolization of the bronchial artery have not been reported, however. In this article, we describe a case of hemoptysis and hemoperitoneum due to pulmonary and splenic metastasis of gestational choriocarcinoma. Treatment of the condition involved embolization of the bronchial artery and superselective embolization of the splenic artery.

  16. Etiologic Subtypes, Risk Factors, and Outcomes of Acute Ischemic Stroke in Young Patients

    Directory of Open Access Journals (Sweden)

    İnci Şule Özer

    2015-04-01

    Full Text Available Objective: Stroke in people aged less than 45 years is less frequent than in older patients, but has major impacts on both the individual and society. The aim of this study was to determine the etiologic subtypes of acute ischemic stroke in the young. Materials and Methods: We reviewed the hospital records of 619 patients who were admitted with acute ischemic stroke between January 2011 and November 2014. Acute ischemic stroke in the young was defined as patients aged 45 years and under. Demographic data, the National Institutes of Health Stroke Scale (NIHSS scores at admission and detailed investigations aimed at determining etiologic cause were recorded. Etiologic stroke subtypes were determined using the automated Causative Classification System. Modified Rankin Scale (mRS scores were recorded in the follow-up. Results: There were 32 (5.2% young patients with acute ischemic stroke. The rates of hypertension, diabetes mellitus, atrial fibrillation, and coronary artery disease were significantly lower in young patients compared with patients aged more than 45 years (p<0.05. The mean NIHSS score at admission and hospital mortality was significantly lower in patients aged 45 years and under compared with those older than 45 years (p=0.006, p=0.043. Cardioaortic embolism was the most common etiologic stroke subtype in both groups. Other causes were significantly more frequent in the young acute ischemic stroke group compared with the older patients. The median follow-up mRS was significantly lower in patients aged 45 years and under compared with those older than 45 years (p<0.001. Conclusion: Young patients with ischemic stroke have different risk factors, stroke etiology, stroke severity and prognosis compared with patients older than 45 years with the same condition

  17. Post-Stroke Rehabilitation

    Science.gov (United States)

    ... PDF (704 kb) » Spanish Version » Order Materials » Post-Stroke Rehabilitation In the United States more than 700,000 ... best possible long-term outcome. What is post-stroke rehabilitation? Rehabilitation helps stroke survivors relearn skills that are ...

  18. Acute management of vascular air embolism

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2009-01-01

    Full Text Available Vascular air embolism (VAE is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm  above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.

  19. A Rare Case of Stroke Secondary to Iron Deficiency Anemia in a Young Female Patient

    Science.gov (United States)

    Gopalratnam, Kavitha; Sena, Kanaga; Gupta, Manisha

    2017-01-01

    Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age. However, about one-fourth of strokes occur in young adults. Iron deficiency anemia (IDA) has been described as a known cause for strokes in children, but very few case reports describe this association in adults. We describe a 20-year-old female who presented with sudden onset left side weakness. Magnetic Resonance Imaging (MRI) of the brain demonstrated ischemic infarctions. Patient was also found to be severely anemic. Patient had a thorough work-up including Magnetic Resonance Angiography (MRA) of the brain, echocardiogram, and an extensive screen for thrombophilia disorders. This, however, did not demonstrate a clear etiology. As it has been suggested that IDA is a potential cause for stroke, it is possible the stroke in this young patient was attributable to severe IDA. PMID:28348599

  20. Commentary on a GWAS: HDAC9 and the risk for ischaemic stroke

    Directory of Open Access Journals (Sweden)

    Hacke Werner

    2012-07-01

    Full Text Available Abstract Modifiable risk factors like obesity, hypertension, smoking, physical inactivity or atrial fibrillation account for a significant proportion of the risk for ischaemic stroke, but genetic variation is also believed to contribute to the risk, although few genetic risk variants were identified to date. Common clinical subtypes of stroke are caused by cardiac embolism, large artery atherosclerosis and small cerebral vessel disease. Each of these underlying pathologies may have a specific genetic architecture. Previous genome-wide association studies (GWAS showed association of variants near PITX2 and ZFHX3 with atrial fibrillation and stroke. ANRIL (antisense Non-coding RNA in the INK4 Locus (harboring the CDKN2A/B genes variants were related to a variety of vascular diseases (myocardial infarction, aortic and intracranial aneurysm, including ischaemic stroke. Now a recent GWAS published in Nature Genetics confirmed these previous associations, analyzed the specificity of the previous associations with particular stroke subtypes and identified a new association between HDAC9 and large vessel stroke. The findings suggest that well-recognized clinical stroke subtypes correspond to distinct aetiological entities. However, the molecular pathways that are affected by the identified genetic variants are not yet pinpointed, and the observed associations apply only for some, but not all victims of a specific stroke aetiology.

  1. Increased Incidence of Interatrial Block in Younger Adults with Cryptogenic Stroke and Patent Foramen Ovale

    Directory of Open Access Journals (Sweden)

    P.E. Cotter

    2011-04-01

    Full Text Available Background: Stroke is often unexplained in younger adults, although it is often associated with a patent foramen ovale (PFO. The reason for the association is not fully explained, and mechanisms other than paradoxical embolism may be involved. Young stroke patients with PFO have more atrial vulnerability than those without PFO. It is plausible that stretching of the interatrial septum may disrupt the interatrial conduction pathways causing interatrial block (IAB. IAB is associated with atrial fibrillation, dysfunctional left atria and stroke. Methods: Electrocardiogram (ECG characteristics of prospectively recruited young patients (≤55 years of age with unexplained stroke (TOAST and A-S-C-O were compared with control data. All stroke cases underwent bubble contrast transthoracic and transoesophageal echography. IAB was defined as a P-wave duration of ≧110 ms. ECG data were converted to electronic format and analysed in a blind manner. Results: Fifty-five patients and 23 datasets were analysed. Patients with unexplained stroke had longer P-wave duration (p = 0.013 and a greater prevalence of IAB (p = 0.02 than healthy controls. Case status was an independent predictor of P-wave duration in a significant multivariate model. There was a significant increase in the proportion of cases with a PFO with IAB compared with cases without PFO and with controls (p = 0.005. Conclusions: Young patients with unexplained stroke, particularly those with PFO, exhibit abnormal atrial electrical characteristics suggesting atrial arrhythmia or atrial dysfunction as a possible mechanism of stroke.

  2. Oculoscopy in Rabbits and Rodents.

    Science.gov (United States)

    Jekl, Vladimir; Hauptman, Karel; Knotek, Zdenek

    2015-09-01

    Ophthalmic diseases are common in rabbits and rodents. Fast and definitive diagnosis is imperative for successful treatment of ocular diseases. Ophthalmic examination in rabbits and rodents can be challenging. Oculoscopy offers great magnification for the examination of the ocular structures in such animals, including the evaluation of cornea, anterior eye chamber, limbus, iris, lens, and retina. To date, oculoscopy has been described only sporadically and/or under experimental conditions. This article describes the oculoscopy technique, normal and abnormal ocular findings, and the most common eye disorders diagnosed with the aid of endoscopy in rabbits and rodents.

  3. [Advances in the secondary prevention of cardioembolic stroke].

    Science.gov (United States)

    Masjuan, Jaime

    2012-10-01

    Non-valvular atrial fibrillation (NVAF) is the main cause of cardioembolic stroke. Classically, prevention consists of oral antivitamin-K anticoagulants (AVK), which, despite their demonstrated efficacy, continue to be underused due to their numerous drawbacks. Recently, a new generation of oral anticoagulants has been shown to have a better safety profile and greater efficacy than AVK. The studies that have compared rivoraxaban, dabigatran and apixaban with warfarin have also included a substantial proportion of patients who had previously had a stroke. The results of the substudies performed in this population with a high risk of hemorrhagic and embolic events have been consistent with those in the overall populations in these studies. The new anticoagulants are a feasible alternative to AVK in the secondary prevention of ictus in patients with NVAF. When anticoagulant therapy is contraindicated, percutaneous closure of the left atrial appendage could be an alternative.

  4. Intravenous Autologous Bone Marrow Mononuclear Cell Transplantation for Stroke: Phase1/2a Clinical Trial in a Homogeneous Group of Stroke Patients.

    Science.gov (United States)

    Taguchi, Akihiko; Sakai, Chiaki; Soma, Toshihiro; Kasahara, Yukiko; Stern, David M; Kajimoto, Katsufumi; Ihara, Masafumi; Daimon, Takashi; Yamahara, Kenichi; Doi, Kaori; Kohara, Nobuo; Nishimura, Hiroyuki; Matsuyama, Tomohiro; Naritomi, Hiroaki; Sakai, Nobuyuki; Nagatsuka, Kazuyuki

    2015-10-01

    The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke. Major inclusion criteria included patients with cerebral embolism, age 20-75 years, National Institute of Health Stroke Scale (NIHSS) score displaying improvement of ≤ 5 points during the first 7 days after stroke, and NIHSS score of ≥ 10 on day 7 after stroke. Bone marrow aspiration (25 or 50 mL; N = 6 patients in each case) was performed 7-10 days poststroke, and bone marrow mononuclear cells were administrated intravenously. Mean total transplanted cell numbers were 2.5 × 10(8) and 3.4 × 10(8) cells in the lower and higher dose groups, respectively. No apparent adverse effects of administering bone marrow cells were observed. Compared with the lower dose, patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes. Compared with 1 month after treatment, patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment. In comparison with historical controls, patients receiving cell therapy had significantly better neurologic outcomes. Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible. Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale randomized controlled trials using this approach.

  5. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ali Fani

    2013-05-01

    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  6. Acquire uterine vascular malformation: Clinical outcome of transarterial embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Yang, Seung Boo; Goo, Dong Erk; Kim, Yong Jae; Lee, Jae Myung; Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of)

    2017-02-15

    To evaluate clinical outcomes of transarterial embolization of bilateral uterine arteries (UAE) in patients with acquired uterine vascular malformation (UVM). This retrospective study was performed on the medical records of all 19 patients who underwent transarterial embolization of bilateral UAE for the treatment of symptomatic UVMs from January 2003 to June 2011. Embolization was performed via the unilateral femoral artery approach with a catheter and angiographic techniques. Clinical success was defined as definitive resolution of abnormal vaginal bleeding. Post-procedural complications included all adverse events related to the embolization procedure. A total of 20 procedures were performed in 19 patients. One patient required repeat embolization because of incomplete embolization related to prominent high flow malformation. Clinically, in all patients, bleeding was controlled immediately after embolization. No complications occurred in all patients during the follow up period. In all patients who underwent successful UAE, menstrual cycles were normally restored within 1-2 months. Normal pregnancy with term delivery was observed in two of the 19 cases. Transarterial bilateral UAE is a safe and effective treatment in patients with vaginal bleeding caused by acquired UVM, and it allows the possibility of future pregnancy.

  7. Current perspectives on cardioembolic ischemic stroke in very old patients

    Directory of Open Access Journals (Sweden)

    Arboix A

    2014-12-01

    Full Text Available Adrià Arboix,1 Joan Massons,1 Josefina Alió2 1Division of Cerebrovascular Diseases, Department of Neurology, Hospital Universitari del Sagrat Cor, University of Barcelona, 2Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain Abstract: The oldest old population (>85 years of age represents the faster growing segment of the elderly in developed countries. Cardioembolic infarction (CI accounts for 14%–30% of all cerebral infarcts and is the most severe ischemic stroke subtype with the highest in-hospital mortality. Also, CI is associated with a low frequency of symptom-free patients at hospital discharge and presents a non-negligible risk of early embolic recurrence. Moreover, cardioembolic stroke is the acute cerebrovascular event most commonly found in very old subjects. However, some clinical aspects of the natural course of the disease in very old patients are still poorly defined. The present report presents an updated review of relevant aspects of CI related to clinical manifestations, biological characteristics, prognostic implications, and treatment strategies, which may contribute to improving the quality of care and outcome of acute cardioembolic stroke in very old patients. The most relevant aspects of CI are discussed based on the data published in the literature and the authors' experience in the management of stroke patients, collected from the hospital-based "Sagrat Cor Hospital of Barcelona Stroke Registry". The following aspects are commented on: epidemiologic data and risk factors, clinical characteristics, cardiac workup studies, special cardioembolic clinical features, outcome, thrombolytic therapy, antithrombotic treatment, and indications for future research lines. Cardioembolic stroke is an important topic in the frontier between cardiology and vascular neurology. The impact of CI on the patients' health and quality of life, health care systems, and society

  8. Epigenetics in Stroke Recovery

    Science.gov (United States)

    Kassis, Haifa; Shehadah, Amjad; Chopp, Michael; Zhang, Zheng Gang

    2017-01-01

    Abstract: While the death rate from stroke has continually decreased due to interventions in the hyperacute stage of the disease, long-term disability and institutionalization have become common sequelae in the aftermath of stroke. Therefore, identification of new molecular pathways that could be targeted to improve neurological recovery among survivors of stroke is crucial. Epigenetic mechanisms such as post-translational modifications of histone proteins and microRNAs have recently emerged as key regulators of the enhanced plasticity observed during repair processes after stroke. In this review, we highlight the recent advancements in the evolving field of epigenetics in stroke recovery. PMID:28264471

  9. Psychoneuroimmunology of stroke.

    Science.gov (United States)

    Skinner, Robert; Georgiou, Rachel; Thornton, Peter; Rothwell, Nancy

    2009-05-01

    Stroke is the major cause of disability in the Western world and is the third greatest cause of death, but there are no widely effective treatments to prevent the devastating effects of stroke. Extensive and growing evidence implicates inflammatory and immune processes in the occurrence of stroke and particularly in the subsequent injury. Several inflammatory mediators have been identified in the pathogenesis of stroke including specific cytokines, adhesion molecules, matrix metalloproteinases, and eicosanoids. An early clinical trial suggests that inhibiting interleukin-1 may be of benefit in the treatment of acute stroke.

  10. Spontaneous occlusion of cerebral arteriovenous malformation following partial embolization with Onyx.

    Science.gov (United States)

    Nas, Omer Fatih; Ozturk, Kerem; Gokalp, Gokhan; Hakyemez, Bahattin

    2017-02-01

    Management options for brain arteriovenous malformations (AVMs) are surgery, radiosurgery, and endovascular embolization. The aim of partial embolization in endovascular treatment is to make total resection possible. However, increased risk of bleeding in partial embolization creates some controversies about treatment options. Spontaneous total occlusion of cerebral AVMs following partial obliteration with embolization agents is a rarely seen condition. We present a case with an AVM vanishing from right posterior cerebral artery which spontaneously occluded following partial embolization with Onyx liquid agent.

  11. The cottontail rabbits of Virginia

    Science.gov (United States)

    Llewellyn, L.M.; Handley, C.O.

    1945-01-01

    Five races of cottontail rabbits belonging to three species occur in Virginia. One of them, the Mearns cottontail (Sylvilagus floridanus mearnsi), is reported here for the first time. It occurs in six southwestern counties of the state, while the eastern cottontail (S. f. mallurus) occurs in the remainder of the state with the exception of Smith and Fishermans islands off the eastern coast of Cape Charles, where it is replaced by Hitchens cottontail (S. f. hitchensi). The New England cottontail (S. transitionalis) is found on the higher mountain peaks, above 3000 feet, and the swamp rabbit (S. palustris) occurs in the Dismal Swamp region of southeastern Virginia.....The height of the breeding season for the eastern cottontail in Virginia is March and April, but breeding continues through the entire year except in December and January. The average litter size based on embryo counts was 4.7. The sex ratio of 234 specimens from all parts of the state, taken mostly in the December to February period, was 53 males to 47 females. That of a group of 145 rabbits live-trapped at Blacksburg during February and Marchwas 58 males to 42 females. The figures show that males are more active than females during the winter months, and therefore are more easily taken then....In transplanting cottontails from one section of the state to another, it is recommended that only cottontails of the same race as those originally present in the region being restocked be released there....Tularemia is not a common disease among rabbits in Virginia, but the rabbit ticks are often carriers of the disease and may transmit it to rabbits. Rabbit ticks are also found to be carriers of Rocky Mountain fever and American Q. fever. After the ticks drop off the rabbits to hibernate in the ground, which is likely to occur during mid-winter in Virginia, there is relatively little danger of humans contracting tularemia by contact with rabbits. Present laws in Virginia which prohibit rabbit hunting until the

  12. Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism.

    LENUS (Irish Health Repository)

    Awad, I T

    2012-02-03

    A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.

  13. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  14. Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial

    Science.gov (United States)

    Steinberg, Benjamin A.; Hellkamp, Anne S.; Lokhnygina, Yuliya; Patel, Manesh R.; Breithardt, Günter; Hankey, Graeme J.; Becker, Richard C.; Singer, Daniel E.; Halperin, Jonathan L.; Hacke, Werner; Nessel, Christopher C.; Berkowitz, Scott D.; Mahaffey, Kenneth W.; Fox, Keith A.A.; Califf, Robert M.; Piccini, Jonathan P.

    2015-01-01

    Aim Anticoagulation prophylaxis for stroke is recommended for at-risk patients with either persistent or paroxysmal atrial fibrillation (AF). We compared outcomes in patients with persistent vs. paroxysmal AF receiving oral anticoagulation. Methods and results Patients randomized in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) trial (n = 14 264) were grouped by baseline AF category: paroxysmal or persistent. Multivariable adjustment was performed to compare thrombo-embolic events, bleeding, and death between groups, in high-risk subgroups, and across treatment assignment (rivaroxaban or warfarin). Of 14 062 patients, 11 548 (82%) had persistent AF and 2514 (18%) had paroxysmal AF. Patients with persistent AF were marginally older (73 vs. 72, P = 0.03), less likely female (39 vs. 45%, P < 0.0001), and more likely to have previously used vitamin K antagonists (64 vs. 56%, P < 0.0001) compared with patients with paroxysmal AF. In patients randomized to warfarin, time in therapeutic range was similar (58 vs. 57%, P = 0.94). Patients with persistent AF had higher adjusted rates of stroke or systemic embolism (2.18 vs. 1.73 events per 100-patient-years, P = 0.048) and all-cause mortality (4.78 vs. 3.52, P = 0.006). Rates of major bleeding were similar (3.55 vs. 3.31, P = 0.77). Rates of stroke or systemic embolism in both types of AF did not differ by treatment assignment (rivaroxaban vs. warfarin, Pinteraction = 0.6). Conclusion In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF. PMID:25209598

  15. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2013-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  16. Sleep and Stroke

    Directory of Open Access Journals (Sweden)

    M V Padma Srivastav

    2014-03-01

    Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP

  17. Improving the results of transarterial embolization of type 2 endoleaks with the embolic polymer Onyx

    Directory of Open Access Journals (Sweden)

    Mikolaj Wojtaszek

    2016-12-01

    Full Text Available Introduction : Type 2 endoleaks (T2E occur in 10 to 20% of patients after endovascular abdominal aortic aneurysm repair (EVAR and remain a significant clinical issue. Aim: To evaluate the efficacy and clinical outcomes of transarterial treatment of persistent type II endoleaks after EVAR using the liquid embolic Onyx. Material and methods From February 2012 to August 2015 transarterial T2E embolization was attempted in 22 patients (21 men, median age: 73, range: 62–88 years. Indications for treatment included an increase in the diameter of the aneurysm sac above 5 mm and a persistent endoleak observed for more than 6 months. Mean time from EVAR to endoleak treatment was 43 months (range: 2–125 months. Results: Primary technical success was achieved in 17 (77.3% patients and secondary technical success in 81.8%, with 0% in-hospital mortality. The mean procedure time was 95 ±48 min, with an average fluoroscopy time of 54 ±25 min. The mean amount of Onyx used was 7.5 ±6.6 ml. Clinical success was seen in 17/21 patients with follow-up imaging (80.9%. Mean follow-up time was 17 months (range: 3–38 months. Conclusions : Onyx has been shown to effectively stabilize previous aneurysm growth as a result of the T2E in the majority of our patients. Transarterial embolization of T2E can be significantly improved as compared to previously reported results by using liquid embolic polymers such as Onyx.

  18. Acute arterial embolism of left lower extremity caused by paradoxical embolism in Ebstein's anomaly

    Science.gov (United States)

    LI, Jun-Sheng; Ma, Jie; Yan, Zi-Xing; Cheng, Dong-Ming; Chang, Liang; Zhang, Hai-Chun; Liu, Jiang-Yan

    2017-01-01

    Abstract Introduction: Ebstein's anomaly is a benign and stable congenital heart disease for asymptomatic patients. Despite a low incidence of Ebstein's anomaly (EA), patients’ quality of life can be badly affected by EA without positive surgical intervention. Especially EA is associated with other congenital heart disease, such as the atrial septal defect, patent foramen ovale, and arterial embolism exclude other reasons, it is often considered to be the consequence of paradoxical embolism, and surgical intervention must be conducted. Case report: An 11-year-old girl falling off the bed suffered pain from left lower extremity. Echocardiographic evaluation revealed an EA, severe tricuspid regurgitation, and secundum atrial septal defect. Both left leg amputation and cardiac surgery were conducted after recovery. Under the condition of anesthesia cardiopulmonary bypass extracorporeal circulation, atrial septal defect repair and Cone reconstruction of the tricuspid valve were performed. Patient recovered well and left hospital smoothly. Discussion: EA is a rare and complex congenital cardiac malformation. There are about 80% to 90% of EA patients with combined atrial septal defect and patent foramen ovale. Sudden arterial occlusion is very rare especially in childhood. When thoracic roentgenoscopy, arterial blood gas analysis, coagulation test, and echocardiographic of lower extremity deep venous system are all normal, one should consider the possibility of a paradoxical embolism. If patients have the paradoxical embolism or worsening tricuspid regurgitation, the most suitable therapeutic regimen should be chosen according to patients’ condition. With surgical techniques and methods renewed continuously, cone reconstruction of the tricuspid valve has been confirmed in clinical trials, which can use its own tissues to form not only central bloodstream, but also the coaption between leaflet and leaflet. PMID:28151866

  19. Evaluation of a liquid embolization agent (Onyx) for transcatheter embolization for renal vascular lesions

    Energy Technology Data Exchange (ETDEWEB)

    Rennert, Janine; Herold, T.; Schreyer, A.G.; Jung, E.M.; Mueller-Wille, R.; Zorger, N. [Inst. fuer Roentgendiagnostik, Klinikum der Univ. Regensburg (Germany); Banas, B.; Feuerbach, S. [Medizinische Klinik, Nephrologie, Univ. Regensburg (Germany); Lenhart, M. [Klinik fuer Diagnostische und Interventionelle Radiologie, Sozialstiftung Bamberg (Germany)

    2009-10-15

    Purpose: to evaluate the therapeutic outcome after endovascular treatment of renal vascular lesions using the liquid embolization agent, Onyx. Materials and methods: between 2004 and 2008 nine patients with renal vascular lesions were treated with transcatheter arterial embolization using Onyx. The renal vascular lesions consisted of 4 AV-fistulas, a pseudoaneurysm, bleeding from a single subsegmental artery, diffuse parenchymal bleeding after trauma, septic embolizations and multiple aneurysms in endocarditis. All patients underwent selective angiography of the renal artery. A dimethyl sulfoxide (DMSO)-compatible microcatheter was used and Onyx was injected. The technical and clinical success rate, examination time and procedure-related complications were documented. Results: the overall technical and clinical success rate was 100%. One patient had to be treated twice due to recurrent bleeding after an accidental puncture with a drainage catheter. No loss of viable renal tissue occurred in 4 cases. In 4 patients mild to moderate parenchyma loss was noted. In one patient having diffuse renal bleeding, occlusion of the main renal artery was performed. No procedure-related complications were noted. The mean examination time was 16.17 min when treating with Onyx alone and 60 min when using a combination of Onyx and coils. Within an average follow-up period of 21 months, no recurrent renal bleeding or recurrent AV-fistulas occurred. Conclusion: Onyx is an effective embolization agent for the treatment of renal vascular lesions. It allows controlled and quick application with low complication rates and a short examination time as a standalone agent or in combination with coils. (orig.)

  20. Postcoital Hemorrhage of a Recurrent Seminal Vesicle Cyst Requiring Embolization

    Directory of Open Access Journals (Sweden)

    Eric Royston

    2014-09-01

    Full Text Available Herein is a case of a 23-year-old man with recurrence of a seminal vesicle cyst after percutaneous drainage and laparoscopic excision complicated by hemorrhage requiring embolization. He presented to the emergency department for pain after ejaculation. Computed tomographic scan of his pelvis revealed extravasation of contrast near his cyst and pelvic fluid collection suspicious for a hematoma. The patient had steadily decreasing hemoglobin and hematocrit levels. An interventional radiologist performed an embolization of the left seminal vesicle cystic arteries. Hemoglobin and hematocrit values improved and he was discharged. Hemorrhage resolved with embolization procedure and pain dissipated over the course of follow up care.

  1. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    Directory of Open Access Journals (Sweden)

    Joshua Halpern

    2016-01-01

    Full Text Available There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.

  2. Anterior mediastinal paraganglioma: A case for preoperative embolization

    Directory of Open Access Journals (Sweden)

    Shakir Murtaza

    2012-07-01

    Full Text Available Abstract Background Paraganglioma is a rare but highly vascular tumor of the anterior mediastinum. Surgical resection is a challenge owing to the close proximity to vital structures including the heart, trachea and great vessels. Preoperative embolization has been reported once to facilitate surgical treatment. Case presentation We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications. Conclusion We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.

  3. Systemic arterial air embolism after percutaneous lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Hare, S.S., E-mail: samanjit@btinternet.com [Ottawa Hospital, Ontario (Canada); Gupta, A.; Goncalves, A.T.C.; Souza, C.A.; Matzinger, F.; Seely, J.M. [Ottawa Hospital, Ontario (Canada)

    2011-07-15

    Systemic arterial air embolism is a rarely encountered but much feared complication of percutaneous lung biopsy. We present a comprehensive review of iatrogenic air embolism post-lung biopsy, a complication that is often suboptimally managed. This review was inspired by our own institutional experience and we use this to demonstrate that excellent outcomes from this complication can be seen with prompt treatment using hyperbaric oxygen chamber therapy, after initial patient stabilization has been achieved. Pathophysiology, clinical features, and risk factors are reviewed and misconceptions regards venous versus arterial air embolism are examined. An algorithm is provided for radiologists to ensure suspected patients are appropriately managed with more favourable outcomes.

  4. Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

    Energy Technology Data Exchange (ETDEWEB)

    Sheth, Rahul A. [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States); Feldman, Adam S. [Massachusetts General Hospital, Division of Urology, Department of Surgery (United States); Walker, T. Gregory, E-mail: tgwalker@partners.org [Massachusetts General Hospital, Division of Interventional Radiology, Department of Radiology (United States)

    2015-02-15

    Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

  5. Embolization of a giant pediatric, posttraumatic, skull base internal carotid artery aneurysm with a liquid embolic agent.

    Science.gov (United States)

    Reig, Adam S; Simon, Scott; Mericle, Robert A

    2009-11-01

    Many treatments for posttraumatic, skull base aneurysms have been described. Eight months after an all-terrain-vehicle accident, this 12-year-old girl presented with right-side Horner syndrome caused by a 33 x 19-mm internal carotid artery aneurysm at the C-1 level. We chose to treat the aneurysm with a new liquid embolic agent for wide-necked, side-wall aneurysms (Onyx HD 500). We felt this treatment would result in less morbidity than surgery and was less likely to occlude the parent artery than placement of a covered stent, especially in a smaller artery in a pediatric patient. Liquid embolic agents also appear to be associated with a lower chance of recanalization and lower cost compared with stent-assisted coil embolization. After the patient was treated with loading doses of aspirin, clopidogrel bisulfate, and heparin, 99% of the aneurysm was embolized with 9 cc of the liquid embolic agent. There were no complications, and the patient remained neurologically stable. Follow-up angiography revealed durable aneurysm occlusion after 1 year. The cost of Onyx was less than the cost of coils required for coil embolization of similarly sized intracranial aneurysms at our institution. Liquid embolic agents can provide a safe, efficacious, and cost-effective approach to treatment of select giant, posttraumatic, skull base aneurysms in pediatric patients.

  6. Prophylaxis for venous thrombo-embolism in neurocritical care: a critical appraisal.

    Science.gov (United States)

    Raslan, Ahmed M; Fields, Jeremy D; Bhardwaj, Anish

    2010-04-01

    Venous thrombo-embolism (VTE) is frequently encountered in critically ill neurological and neurosurgical patients admitted to intensive care units. This patient population includes those with brain neoplasm, intracranial hemorrhage, ischemic stroke, subarachnoid hemorrhage, pre- and post-operative patients undergoing neurosurgical procedures and those with traumatic brain injury, and acute spinal cord injury (SCI). There is a wide variability in clinical practice for thromboprophylaxis in these patients, in part due to paucity of data based on randomized clinical trials. Here, we review the current literature on the incidence of VTE in the critically ill neurological and neurosurgical patients as well as appraise available data to support particular practice paradigms for specific subsets of these patients. Data synthesis was conducted via search of Medline, Cochrane databases, and manual review of article bibliographies. Critically ill neurological and neurosurgical patients have higher susceptibility to VTE. Intermittent compression devices with or without anti-thrombotics is generally the method of choice for thromboprophylaxis. Low molecular weight heparin is the method of choice in certain patient subgroups such as those with SCI and ischemic stroke. Inferior vena cava filters may play a role in thromboprophylaxis in selected cases. Without clear guidelines that can be universally applied to this diverse group of patients, prophylaxis for VTE should be tailored to the individual patient with cautious assessment of benefits versus risks. There is a need for higher level evidence to guide VTE prophylaxis in certain subgroups of this patient population.

  7. Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin.

    Science.gov (United States)

    Haeusler, Karl Georg; Wollboldt, Christian; Bentheim, Laura Zu; Herm, Juliane; Jäger, Sebastian; Kunze, Claudia; Eberle, Holger-Carsten; Deluigi, Claudia Christina; Bruder, Oliver; Malsch, Carolin; Heuschmann, Peter U; Endres, Matthias; Audebert, Heinrich J; Morguet, Andreas J; Jensen, Christoph; Fiebach, Jochen B

    2017-05-01

    Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Overall, 102 (99.0%) ischemic stroke patients (median 63 years [interquartile range, 53-72], 24% female, median NIHSS (National Institutes of Health Stroke Scale) score on admission 2 [interquartile range, 1-4]) underwent cvMRI and TEE in hospital; 89 (86.4%) patients completed the cvMRI examination. In 93 cryptogenic stroke patients, a high-risk embolic source was found in 9 (8.7%) patients by cvMRI and in 11 (11.8%) patients by echocardiography, respectively. cvMRI and echocardiography findings were consistent in 80 (86.0%) patients, resulting in a degree of agreement of κ=0.24. In 82 patients with cryptogenic stroke according to routine work-up, including TEE, cvMRI identified stroke etiology in additional 5 (6.1%) patients. Late gadolinium enhancement consistent with previous myocardial infarction was found in 13 (14.6%) out of 89 stroke patients completing cvMRI. Only 2 of these 13 patients had known coronary artery disease. Our study demonstrated that cvMRI was feasible in the vast majority of included patients with acute ischemic stroke. The diagnostic information of cvMRI seems to be complementary to TEE but is not replacing echocardiography after acute ischemic stroke. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01917955. © 2017 American Heart Association, Inc.

  8. Effect of low-molecular-weight heparin and urokinase on pulmonary arteries involved in pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    WU Jun-ping; SUN Xin; WU Qi; DU Zhong-zhen; LI Li; WU Qian; SUN Hong-fen

    2013-01-01

    Background Pulmonary embolism (PE) is a common and often fatal disease.Early after pulmonary thromboembolism,inflammation and associated intimal hyperplasia occur within the pulmonary arteries,similar to what is observed with chronic thromboembolic pulmonary hypertension.This study tested the hypothesis that thrombolytic and anticoagulant agents would have anti-inflammatory effects or inhibit intimal hyperplasia of involved pulmonary arteries.Methods Seventy-two male New Zealand white rabbits were randomly divided into two groups (54 rabbits in the PE group and 18 in the sham group).Experimental PE was induced in 54 rabbits by femoral vein injection of autologous blood clots and confirmed with pulmonary angiography,and other 18 rabbits underwent sham operations.Fifty-four rabbits in the PE group were randomly divided into three groups:a control group (treated with normal saline),a low-molecularweight heparin (LMWH) group (treated with LMWH),and a urokinase (UK) group (treated with UK).Arterial blood gas was analyzed at 2,7,and 28 days (n=6 per time point by random group division),then lung tissues were removed and were analyzed for pro-inflammatory cytokines and chemokines,and were stained for intimal hyperplasia.Results The overall survival of rabbits undergoing PE was 100%.PE distribution detected on digital signal angiography (DSA) and histopathology was shown in 67% of rabbits (36/54) in the bilateral low lobar pulmonary arteries (PAs).The results showed that alveolar-arterial partial pressure of oxygen (PO2) difference (PA-aO2) significantly increased and PO2 decreased in the control group compared with the sham group.Compared with controls,the UK group had a decreased level of PA-aO2 on day 2 (P <0.05),however,there was no significant difference in the LMWH group.Compared with controls,the LMWH group had a decreased level of monocyte chemoattractant protein-1 (MCP-1) in affected tissue and serum samples on days 7 and 28 (P <0.05),and the UK group had

  9. SPECT/CT and pulmonary embolism

    DEFF Research Database (Denmark)

    Mortensen, Jann; Borgwardt, Henrik Gutte

    2014-01-01

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar...... technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had...... the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume...

  10. Metatarsal fracture leading to massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Vikas Rajpurohit

    2017-01-01

    Full Text Available Immobilization and bed rest after fracture and orthopedic surgery are routinely advised protocol. Period of bed rest usually depends on the type of injury and orthopedic procedure, ranging from few days to weeks. The trauma, surgery, and immobilization with other contributing factors can lead to deep vein thrombosis and pulmonary embolism (PE in these patients. Although there is high incidence of PE in such patients, it is difficult to diagnose, primarily because of the variety of nonspecific signs and symptoms. Here, we discuss a case of a 30-year-old female, who had suffered a trivial roadside accident leading to metatarsal bone fracture and later on presented in emergency with seizures, pulmonary edema, and cardiac arrest, after immobilization of just 5 days which was diagnosed to be result of massive PE. Here, we will discuss the pathophysiology, risk factors, and management of massive PE.

  11. Portal vein embolization before major hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Hai Liu; Yong Fu

    2005-01-01

    To discuss the rationale, techniques and the unsolved issues regarding preoperative portal vein embolization (PVE) before major hepatectomy. After a systematic search of Pubmed, we reviewed and retrieved literature related to PVE. Preoperative PVE is an approach that is gaining increasing acceptance in the preoperative treatment of selected patients prior to major hepatic resection. Induction of selective hypertrophy of the nondiseased portion of the liver with PVE in patients with either primary or secondary hepatobiliary, malignancy with small estimated future liver remnants (FLR) may result in fewer complications and shorter hospital stays following resection. Additionally, PVE performed in patients initially considered unsuitable for resection due to lack of sufficient remaining normal parenchyma may add to the pool of candidates for surgical treatment. The results suggest that PVE is recomm-endable in treating the cirrhotic patients before major liver resection.

  12. A rat model for embolic encephalitis

    DEFF Research Database (Denmark)

    Astrup, Lærke Boye; Rasmussen, Rune Skovgaard; Aalbæk, Bent;

    2011-01-01

    -brain-barrier. This provides our model with several advantages: minimized surgical intervention, bacteria gain access to the brain by the circulation and, no foreign materials are implated in the brain. We thereby mirror the human scenario in several ways: 1: Cerebral infarction by thrombosis or disseminated intravascular...... have recently shown that sepsis is a common cause of microabscesses in the brain, and that S. aureus is one of the most common organisms isolated from these abscesses. This raises the question whether the blood-brain barrier truly makes the brain an immune-privileged organ or not. This makes the brain...... it is difficult to obtain tissue for further examination. This puts a hard demand on animal models of brain lesions in sepsis. We hereby present a novel animal model of embolic encephalitis. Our model introduces bacteria by an embolus to an area of brain necrosis and damage to the blood...

  13. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  14. Cancer patients and characteristics of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Hasenberg, U.; Paul, T. [Department of Radiology, University Hospital Essen (Germany); Feuersenger, A. [Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen (Germany); Goyen, M. [Department of Radiology, University Medical Center Hamburg-Eppendorf (Germany); Kroeger, K. [Department of Angiology, University Hospital Essen (Germany)], E-mail: knut.kroeger@uk-essen.de

    2009-03-15

    Objective: To check the hypothesis that cancer patients suffer from extended pulmonary embolism (PE) more frequently than patients without cancer we analysed PEs proved by computed tomography (CT)-imaging. Patients and methods: One hundred and fifty consecutive CT scans at the University Hospital of Essen from March 2002 until December 2004 which proved a definite case of pulmonary embolism were retrospectively reviewed (79 men, 71 women; mean age 57 {+-} 15 years). Underlying disease and blood parameters were included (haemoglobin, haematocrit, fibrinogen and total protein, if determined within 48 h before the CT scans). Results: Patients with malignant disease were older (59 {+-} 12 years vs. 54 {+-} 19 years, p = 0.05) and tend to have a higher rate of central PEs (52% vs. 34%, p = 0.08) than patients without malignancies. The odds of a central PE in cancer patients was about twice as high as in patients without a malignant disease (Odds ratio: 2.08, 95%-confidence interval: 1.06-4.10; age-adjusted Odds ratio 1.88, 95%-confidence interval: 0.92-3.84). Additional adjustment for the clinical information dyspnoea, inhospital patient and clinically expected PE did not deteriorate the odds. Thrombus density determined in patients with central PE only shows a trend towards a lower density in patients with malignant disease (52 {+-} 13 HE vs. 45 {+-} 15 HE, p = 0.13). There is no statistical evidence that thrombus density is related to one of the blood parameters or even blood density measured in the pulmonary artery. Conclusion: Although this is a retrospective study including a small number of patients it shows that cancer patients are at a higher risk for central PE than patients without cancer. Characteristics of the intrapulmonal thrombus in cancer and non-cancer patients seem to be different.

  15. Embolia paradojal inminente Impending paradoxical embolism

    Directory of Open Access Journals (Sweden)

    Miguel A. Veltri

    2006-12-01

    Full Text Available La presencia de un trombo venoso atrapado en un defecto interauricular e insinuándose en las cavidades izquierdas configura una forma extremadamente inusual de enfermedad tromboembólica denominada embolia paradojal inminente. Presentamos el caso de un varón de 71 años, sometido 10 días antes a adenomectomía prostática, que consultó por disnea y mareos. Se le diagnosticó tromboembolismo pulmonar bilateral por tomografía axial computada helicoidal. Se lo anticoaguló con heparina sódica y se le realizó un ecocardiograma transesofágico que mostró un trombo que atravesaba el foramen oval y se alojaba en la aurícula izquierda. No presentaba signos clínicos de embolización sistémica. Se realizó la embolectomía quirúrgica y cierre del defecto auricular. El paciente falleció.An intracardiac thrombus traversing a patent foramen ovale is a very infrequent but potentially catastrophic complication of the thromboembolic disease. It is named "impending paradoxical embolism". We report the case of a 71 year old Caucasian male warded in ten days after a prostatectomy because of bilateral pulmonary embolism. Diagnosis was confirmed by HCT scan and the patient received anticoagulation with heparin. A transesophageal ecocardiogram disclosed a thrombus traversing foramen ovale into the left atrium. Surgical embolectomy was performed, but the patient died shortly after surgery.

  16. Tenecteplase to treat pulmonary embolism in the emergency department.

    Science.gov (United States)

    Kline, Jeffrey A; Hernandez-Nino, Jackeline; Jones, Alan E

    2007-04-01

    Tenecteplase, a mutant form of alteplase, possesses pharmacological properties that might favor its use for emergent fibrinolysis of acute pulmonary embolism. Contemporaneous search of the World's literature reveals 14 humans with acute pulmonary embolism treated with tenecteplase. Here, we summarize those cases and report the presentation features, dosing details and outcomes of eight additional patients with acute pulmonary embolism treated with tenecteplase in an academic emergency department. None of our eight patients had a significant hemorrhagic event after tenecteplase, and the outcomes of all eight appear to be acceptable. Taken together, we submit that the present case report and prior case reports are sufficient to comprise a phase I study of the safety and efficacy of tenecteplase to treat acute pulmonary embolism.

  17. Catheter embolization from implanted venous access devices: case reports.

    Science.gov (United States)

    Carr, M E

    1989-04-01

    Two cases of catheter embolization from implanted venous access devices are reported and the available literature is reviewed. The catheter from an implanted venous access device migrated into the right heart after slippage of the O-ring, which attaches the catheter to the infusion port. The distal 6 cm of an infusion port catheter embolized to the right heart after spontaneous fracture of the catheter at the point where it passed between the clavicle and first rib. Both catheters were removed percutaneously without complication. Risk factors for embolization were apparent on x-ray films with evidence of O-ring slippage in 1 case an obvious kinking of the catheter in the other. Symptoms of embolization included chest discomfort, right upper quadrant pain, and nausea. In 1 case, an extra heart sound, initially thought to be an S3, disappeared when the catheter was removed.

  18. Establishment of an animal model of dural venous sinus embolism

    Institute of Scientific and Technical Information of China (English)

    Peixian Zhang; Chongzhi Zhang; Yi Qin; Quanrui Ma; Jianying Du; Ying Cai

    2008-01-01

    BACKGROUND: The pathological mechanism of secondary brain lesion following an embolism remains unclear. The establishment of an animal model that imitates the clinical pathophysiological processes is crucial to better study this disease during a certain time window.OBJECTIVE: To establish a new animal model of dural venous sinus embolism that is simple, has a high success rate, and emulates the pathophysiological course of clinical disease.DESIGN, TIME AND SETTING: A randomized block design trial was performed at the Department of Anatomy, Ningxia Medical College between March and December 2007.MATERIALS: Fifty-eight healthy, adult, Sprague Dawley rats were used in the present study. Plastic emboli, with a total length of 0.4cm, were self-made. Each plastic embolus had a conical anterior segment; the largest diameter being 0.12cm. The posterior segment became gradually thin and flat, with a width of 0.2cm and length of 0.1cm.METHODS: The fifty-eight rats were randomly divided into three groups: control (n=6), embolism (n=26), and sham-embolism (n=26) groups. In the embolism group, a solid embolus was slowly inserted and fixed into the posterior part of the superior sagittal sinus against the flow of blood. The posterior segment was detained outside the superior sagittal sinus for fixing. In the sham-embolism group, rats were subjected only to sinus sagittalis superior exposure. In the control group, rats received no treatments. In both the embolism and the sham-embolism groups, the rat brains were resected at 6 hours, 1,3, and 5 days post-surgery.MAIN OUTCOME MEASURES: (1) Brain surface appearance in the embolism and sham-embolism groups. (2) Thrombosis in the embolism group. (3) Cerebrospinal fluid content in the above-mentioned two groups.RESULTS: In the embolism group, the model success rate was 92%(24/26). There was visible thrombosis in the superior sagittal sinus. Cerebral edema was noticeable under a microscope. These changes were visible at 6 hours after

  19. Renal aneurysm and arteriovenous fistula; Management with transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Savastano, S.; Feltrin, G.P.; Miotto, D.; Chiesura-Corona, M. (Padua Univ. (Italy). Ist. di Radiologia Padua Univ. (Italy). Ist. di Fisioterapia)

    1990-01-01

    Embolization was performed in six patients with renal artery aneurysms (n=2) and arteriovenous fistulas (AVF) (n=5). The aneurysms were observed in one patient with fibromuscular dysplasia and in another with Ehlers-Danlos syndrome. All the AVFs were intraparenchymal and secondary to iatrogenic trauma. Elective embolization was performed in five patients with good clinical results at follow-up between 1 and 9 years. Because of rupture of the aneurysm emergency embolization was attempted without success in the patient with Ehlers-Danlos syndrome, and nephrectomy was carried out. A postembolization syndrome complicated three procedures in which Gelfoam and polyvinyl alcohol were used; in two of these cases unexpected reflux of the particulate material occurred, resulting in limited undesired ablation of the ipsilateral renal parenchyma. Embolization is the most reliable and effective treatment for intrarenal vascular abnormalities since it minimizes the parenchymal damage. (orig.).

  20. Embolization of spontaneous hemarthrosis post total knee replacement.

    Science.gov (United States)

    Given, M F; Smith, P; Lyon, S M; Robertson, D; Thomson, K R

    2008-01-01

    Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 microm) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

  1. Percutaneous embolization of bony pelvic neoplasms with tissue adhesive

    Energy Technology Data Exchange (ETDEWEB)

    Keller, F.S.; Rosch, J.; Bird, C.B.

    1983-04-01

    Eight patients with tumors of the bony pelvis underwent embolization with isobutyl-2-cyanoacrylate (IBCA). Five patients had primary bone tumors, of which 2 were malignant and 3 were benign; 3 patients had metastases to the bony pelvis from the thyroid gland, kidney, and femur, respectively. Embolization was performed to minimize blood loss during resection of a giant-cell tumor in one patient and insertion of a hip prosthesis in another who had metastatic renal carcinoma. It was also done prior to scheduled surgery in one of the patients with aneurysmal bone cyst, but healing was sufficient to cancel the operation; in the other patient, embolization was the only therapy. Palliative embolization was performed in 4 patients with malignant tumors after other means failed to control pain or slow progression. IBCA appears to be an efficient means of occluding the vessels feeding selected primary bone tumors and metastases.

  2. Sequential strokes in a hyperacute stroke unit.

    Science.gov (United States)

    Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard

    2014-08-01

    Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.

  3. Cardioembolic Sources in Stroke Patients in South of Brazil

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Porcello Marrone

    2014-01-01

    Full Text Available Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5% and coronary artery disease (16%. Hypertension (61.7% and dyslipidemia (43.7% were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation were the main cause of cardioembolism.

  4. Cardioembolic Sources in Stroke Patients in South of Brazil

    Science.gov (United States)

    Porcello Marrone, Luiz Carlos; Farina Brunelli, João Pedro; Lutzky Saute, Ricardo; Henrique Tomasi, Gustavo; Cecchele Madeira, Bianca; Alves Martins, William; Dupont Rohr, Robson; Heck, Ana Paula; Botton, Luiz Ricardo; Martins de Castro, Marilia; Bodanese, Rodrigo; Bodanese, Luiz Carlos; Huf Marrone, Antônio Carlos; Costa da Costa, Jaderson

    2014-01-01

    Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism. PMID:25349734

  5. Hypertension following Therapeutic Arterial Embolization: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Ghansham Biyani

    2014-05-01

    Full Text Available Accelerated hypertension following therapeutic arterial embolization is a rare phenomenon. A patient of left upper limb chronic lymphedema was posted for shoulder disarticulation under general anaesthesia. Coil embolization of the left subclavian artery was done prior to surgery. Following the intervention, patient’s blood pressure increased by more than 30% of the base line value and was managed with antihypertensives for the next 3 hours to get the blood pressure optimised prior to taking the patient for surgery.

  6. Paradoxical Cerebral Fat Embolism in Revision Hip Surgery

    Directory of Open Access Journals (Sweden)

    Nicolás S. Piuzzi

    2014-01-01

    Full Text Available The incidence of clinical fat embolism syndrome (FES is low (<1% whilst fat embolism (FE of marrow fat appears to occur more often (Mellor and Soni (2001. Paradoxical brain FE may occur in patients undergoing hip orthopedic surgery who have an undocumented patent foramen ovale (PFO. We report a case of an eighty-year-old male patient, who underwent a scheduled revision hip surgery suffering a paradoxical cerebral FE.

  7. The White Rabbit Project

    CERN Document Server

    Serrano, J; Cattin, M; Garcia Cota, E; Lewis, J; Moreira, P; Wlostowski, T; Gaderer, G; Loschmidt, P; Dedic, J; Bär, R; Fleck, T; Kreider, M; Prados, C; Rauch, S

    2009-01-01

    Reliable, fast and deterministic transmission of control information in a network is a need formany distributed systems. One example is timing systems, where a reference frequency is used to accurately schedule time-critical messages. TheWhite Rabbit (WR) project is a multi-laboratory and multi-company effort to bring together the best of the data transfer and timing worlds in a completely open design. It takes advantage of the latest developments for improving timing over Ethernet, such as IEEE 1588 (Precision Time Protocol) and Synchronous Ethernet. The presented approach aims for a general purpose, fieldbus-like transmission system, which provides deterministic data and timing (sub-ns accuracy and ps jitter) to around 1000 stations. It automatically compensates for fiber lengths in the order of 10 km. This paper describes the WR design goals and the specification used for the project. It goes on to describe the central component of the WR system structure - the WR switch - with theoretical considerations a...

  8. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  9. The relationship between tumor markers and pulmonary embolism in lung cancer.

    Science.gov (United States)

    Xiong, Wei; Zhao, Yunfeng; Xu, Mei; Guo, Jian; Pudasaini, Bigyan; Wu, Xueling; Liu, Jinming

    2017-06-20

    Tumor markers (TMs) and D-Dimer are both hallmarks of severity and prognosis of lung cancer. Tumor markers could be related to pulmonary embolism (PE) in lung cancer. The number of abnormal tumor markers of lung cancer patients with pulmonary embolism (3.9 ± 1.1vs1.6 ± 0.6,P 0.005) was more than that in patients without pulmonary embolism. TMs panel (P trend tumor markers, TMs panel (OR5.98, P Tumor markers were compared between lung cancer patients complicated with pulmonary embolism and those without pulmonary embolism Then the correlation between each tumor marker as well as panel of combined TMs and D-Dimer as well as pulmonary embolism were analyzed for patients with pulmonary embolism. There is a relationship between tumor markers and pulmonary embolism in patients with lung cancer. The panel of combined tumor markers is a valuable diagnostic marker for pulmonary embolism in lung cancer.

  10. Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage.

    Science.gov (United States)

    Wang, Hong Liang; Xu, Chun Yang; Wang, Hong Hui; Xu, Wei

    2015-10-01

    The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery.

  11. Infiltrated Embolization of Meningioma with Dilute Cyanoacrylate Glue

    Science.gov (United States)

    OHNISHI, Hiroyuki; MIYACHI, Shigeru; MURAO, Kenichi; HIRAMATSU, Ryo; TAKAHASHI, Kenkichi; OHNISHI, Hideyuki; KUROIWA, Toshihiko

    2017-01-01

    We describe the efficacy and technical aspects of infiltrated preoperative embolization of meningioma by penetration of very dilute glue. In this method, a 13% n-butyl-cyanoacrylate (NBCA)-lipiodol mixture is injected extremely slowly from the middle meningeal artery (MMA) in a similar manner to plug and push injection of ethylene vinyl alcohol copolymer mixed with tantalum and dimethyl sulfoxide (Onyx®) after the tortuous side feeders are proximally embolized. The glue is infiltrated into small tumor arteries and extends to inaccessible feeders from deep meningeal arteries. Since 2011, we have used this technique in the embolization of 32 cases preoperatively diagnosed with meningioma. Intratumoral embolization was possible in 30 cases (94%), and a greater than 50% reduction in contrast area of contrast-enhanced T1-weighted MR imaging (T1-WI) was achieved in 18 cases (56%). Two cases achieved complete devascularization, showing a remarkable shrinkage in tumor size after embolization. If excessive reflux of embolization and the resulting migration of glue into normal arteries is achieved, this method provides extremely effective devascularization on surgical extirpation. It might also be applicable to surgically untreatable meningiomas as a semi-radical treatment option. PMID:27646010

  12. PORTAL VEIN EMBOLIZATION USING AN ADAPTED HYSTEROSALPINGOGRAPHY CATHETER

    Science.gov (United States)

    STEINBRÜCK, Klaus; ALVES, Jefferson; FERNANDES, Reinaldo; ENNE, Marcelo; PACHECO-MOREIRA, Lúcio Filgueiras

    2014-01-01

    Background Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. Aim To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. Methods Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam® powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. Results An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. Conclusions The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. PMID:25184773

  13. Transarterial embolization for serious renal hemorrhage following renal biopsy.

    Science.gov (United States)

    Zeng, Dan; Liu, Guihua; Sun, Xiangzhou; Zhuang, Wenquan; Zhang, Yuanyuan; Guo, Wenbo; Yang, Jianyong; Chen, Wei

    2013-01-01

    The goal of this study is to evaluate the feasibility and efficacy of percutaneous transarterial embolization for the treatment of serious renal hemorrhage after renal biopsy. Nine patients with renal hemorrhage had frank pain and gross hematuria as main symptoms after renal biopsy. Intrarenal arterial injuries and perinephric hematoma were confirmed by angiography in all cases. The arterial injuries led to two types of renal hemorrhage, Type I: severe renal injure or intrarenal renal artery rupture (n=5), with contrast medium spilling out of the artery and spreading into renal pelvis or kidney capsule in angiography; Type II, pseudo aneurysm or potential risk of intrarenal artery injure (n=4), where contrast medium that spilled out of intraartery was retained in the parenchyma as little spots less than 5 mm in diameter in angiography. Transcatheter superselective intrarenal artery embolization was performed with coils or microcoils (Type I intrarenal artery injure) and polyvinyl alcohol particles (Type II injure). The intrarenal arterial injuries were occluded successfully in all patients. Light or mild back or abdominal pain in the side of the embolized kidney was found in three patients following embolization procedures and disappeared 3 days later. Serum creatinine and perinephric hematoma were stable, and gross hematuresis stopped immediately (n=4) or 3-5 days (n=3) after embolization. In conclusions, transcatheter superselective intrarenal artery embolization as a minimally invasive therapy is safe and effective for treatment of serious renal hemorrhage following percutaneous renal biopsy.

  14. Genetics of ischaemic stroke.

    Science.gov (United States)

    Sharma, Pankaj; Yadav, Sunaina; Meschia, James F

    2013-12-01

    Recent advances in genomics and statistical computation have allowed us to begin addressing the genetic basis of stroke at a molecular level. These advances are at the cusp of making important changes to clinical practice of some monogenic forms of stroke and, in the future, are likely to revolutionise the care provided to these patients. In this review we summarise the state of knowledge in ischaemic stroke genetics particularly in the context of how a practicing clinician can best use this knowledge.

  15. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    2008-01-01

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (

  16. Heart Disease and Stroke Prevention

    Science.gov (United States)

    ... Heart Health and Stroke Heart disease and stroke prevention Related information Learn more about healthy eating and ... top More information on Heart disease and stroke prevention Read more from womenshealth.gov A Lifetime of ...

  17. STROKE PREVENTION IN HYPERTENSIVE PATIENTS

    Directory of Open Access Journals (Sweden)

    S. Y. Martsevich

    2006-01-01

    Full Text Available Importance of the stroke as one of the main reason of population mortality and invalidity is considered. Stroke risk factors including arterial hypertension are described. The main pharmacotherapy ways of primary and secondary stroke prevention are discussed.

  18. Nutrition and stroke

    National Research Council Canada - National Science Library

    Huang, Chen Ya

    2007-01-01

    ..., Homocysteinemia, and alcohol are the most significant modifiable risk factors of stroke. Of these, hypertension, diabetes, smoking, hyperlipidemia, homocysteinemia and alcoholism are obviously affected by lifestyle and nutrition...

  19. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  20. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  1. Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes.

    Science.gov (United States)

    Joundi, Raed A; Rabinstein, Alejandro A; Nikneshan, Davar; Tu, Jack V; Fang, Jiming; Holloway, Robert; Saposnik, Gustavo

    2016-07-01

    Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes. Adjusted survival curves were computed, and hazard ratios for mortality at 30 days and 1 year were determined for cardiac arrest and other major outcomes. Among the 9019 patients with acute ischemic stroke, 352 had cardiac arrest, for an overall incidence of 3.9%. In a sensitivity analysis with palliative patients removed, the incidence of cardiac arrest was 2.5%. Independent predictors of cardiac arrest were as follows: older age, greater stroke severity, preadmission dependence, and a history of diabetes, myocardial infarction, congestive heart failure, and atrial fibrillation. Systemic complications associated with cardiac arrest were as follows: myocardial infarction, pulmonary embolism, sepsis, gastrointestinal hemorrhage, and pneumonia. Patients with cardiac arrest had higher disability at discharge, and a markedly increased 30-day mortality of 82.1% compared with 9.3% without cardiac arrest. Cardiac arrest had a high incidence and was associated with poor outcomes after ischemic stroke, including multiple medical complications and very high mortality. Predictors of cardiac arrest identified in this study could help risk stratify ischemic stroke patients for cardiac investigations and prolonged cardiac monitoring. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  2. Use of preoperative embolization prior to Transplant nephrectomy

    Directory of Open Access Journals (Sweden)

    Carrie Yeast

    2016-02-01

    Full Text Available ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN was 143.9cc compared to 621.4cc in the non-embolized (NETN group (p=0.041. Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer

  3. Teratology studies in the rabbit.

    Science.gov (United States)

    Allais, Linda; Reynaud, Lucie

    2013-01-01

    The rabbit is generally the non-rodent species or second species after the rat recommended by the regulatory authorities and is part of the package of regulatory reproductive studies for the detection of potential embryotoxic and/or teratogenic effects of pharmaceuticals, chemicals, food additives, and other compounds, including vaccines (see Chapters 1-7).Its availability, practicality in housing and in mating as well as its large size makes the rabbit the preferred choice as a non-rodent species. The study protocols are essentially similar to those established for the rat (Chapter 9), with some particularities. The study designs are well defined in guidelines and are relatively standardized between testing laboratories across the world.As for the rat, large litter sizes and extensive background data in the rabbit are valuable criteria for an optimal assessment of in utero development of the embryo or fetus and for the detection of potential external or internal fetal malformations.

  4. Preventable Pediatric Stroke via Vaccination?

    OpenAIRE

    Press, Craig A.; Wainwright, Mark S

    2015-01-01

    Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS) group studied the risk of arterial ischemic stroke (AIS) associated with minor infection and routine childhood vaccinations.

  5. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack;

    2016-01-01

    stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs......Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic...... embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke...

  6. Establishment of a rhesus monkey model of middle cerebral artery ischemia and reperfusion using a microcatheter embolization method

    Institute of Scientific and Technical Information of China (English)

    Jie Yang; Xiaoqi Huang; Hongxia Li; Li Wang; Jingqiu Cheng; Jian Guo; Hongbo Zheng; Muke Zhou; Li He; Wenying Cao; Li Xiao; Jiachuan Duan; Qiyong Gong

    2010-01-01

    Nonhuman primates are closest to humans in terms of lineage,and middle cerebral artery ischemia/reperfusion responses of nonhuman primates are most similar to ischemic stroke in humans.Therefore,nonhuman primates could be utilized to simulate the process of ischemic stroke in the human.Few studies,however,have reported the use of endovascular technology to establish a rhesus monkey stroke model.In the present study,seven adult,male,rhesus monkeys were selected and,following anesthesia,a microcatheter was inserted into one side of the middle cerebral artery via the femoral artery to block blood flow,thereby resulting in middle cerebral artery occlusion.After 2 hours,the microcatheter was withdrawn to restore the middle cerebral artery blood flow and to establish ischemia/reperfusion.Results from angiography and magnetic resonance angiography confirmed occlusion and reopening of the middle cerebral artery.Magnetic resonance imaging revealed the existence of ischemic brain lesions,and neurological examination showed sustained functional deficits following surgery.The rhesus monkey middle cerebral artery ischemia/reperfusion models established by microcatheter embolization had the advantage of non—craniotomy invasion and reproducibility.The scope and degree of ischemic damage using this model was controllable.Therefore,this nonhuman primate model is an ideal model for cerebral ischemia and reperfusion.

  7. [Review] Mary Toft's Rabbit Tale

    OpenAIRE

    Jones, Emrys

    2013-01-01

    Originally broadcast in April 2011 and aired again by BBC Radio 4 this November, Mary Toft’s Rabbit Tale is a radio drama retelling the story of its titular fraudster’s brief notoriety. With a high-profile cast – including singer Will Young as Toft’s husband and Rupert Graves as man-midwife, John Howard – the play explores a number of issues related to the alleged rabbit births of 1726 and their impact on public discourse of the time.

  8. Femoral head blood flow in long-term steroid therapy: study of rabbit model

    Energy Technology Data Exchange (ETDEWEB)

    Wang, G.J.; Hubbard, S.L.; Reger, S.I.; Miller, E.D.; Stamp, W.G.

    1983-12-01

    Using a rabbit model, previous studies showed steroid-induced hyperlipidemia with subsequent fatty embolization of the subchondral arteries and hypertrophy of the marrow fat cells, followed by elevation of femoral head pressure from the normal level of 25 cm to nearly 60 cm H2O after eight weeks of treatment. This has led us to believe that pressure changes lead to decreased blood flow in the femoral head. In our study of 22 New Zealand white adult rabbits, weighing an average of 4.0 kg, 14 received a weekly dose of 12.45 mg of methylprednisolone (Depo-Medrol), and eight served as control. Femoral head blood flow was established using the radioactive microsphere technique. Control and cortisone-treated rabbits had femoral head blood flow measured 6, 8 and 10 weeks after treatment. The average blood flow in the control femoral heads averaged 0.2039 +/- 0.076 ml/min/gm, with no difference in the left side and the right side. In the treated group, the average blood flow at ten weeks was 0.162 +/- 0.039 ml/min/gm on the right and 0.164 +/- 0.037 ml/min/gm on the left, which was significantly different. This is parallel to unpredictable clinical findings in human beings.

  9. Ex-Vivo Characterization of Bioimpedance Spectroscopy of Normal, Ischemic and Hemorrhagic Rabbit Brain Tissue at Frequencies from 10 Hz to 1 MHz

    Science.gov (United States)

    Yang, Lin; Zhang, Ge; Song, Jiali; Dai, Meng; Xu, Canhua; Dong, Xiuzhen; Fu, Feng

    2016-01-01

    Stroke is a severe cerebrovascular disease and is the second greatest cause of death worldwide. Because diagnostic tools (CT and MRI) to detect acute stroke cannot be used until the patient reaches the hospital setting, a portable diagnostic tool is urgently needed. Because biological tissues have different impedance spectra under normal physiological conditions and different pathological states, multi-frequency electrical impedance tomography (MFEIT) can potentially detect stroke. Accurate impedance spectra of normal brain tissue (gray and white matter) and stroke lesions (ischemic and hemorrhagic tissue) are important elements when studying stroke detection with MFEIT. To our knowledge, no study has comprehensively measured the impedance spectra of normal brain tissue and stroke lesions for the whole frequency range of 1 MHz within as short as possible an ex vivo time and using the same animal model. In this study, we established intracerebral hemorrhage and ischemic models in rabbits, then measured and analyzed the impedance spectra of normal brain tissue and stroke lesions ex vivo within 15 min after animal death at 10 Hz to 1 MHz. The results showed that the impedance spectra of stroke lesions significantly differed from those of normal brain tissue; the ratio of change in impedance of ischemic and hemorrhagic tissue with regard to frequency was distinct; and tissue type could be discriminated according to its impedance spectra. These findings further confirm the feasibility of detecting stroke with MFEIT and provide data supporting further study of MFEIT to detect stroke. PMID:27869707

  10. Relevance of surgery after embolization of gastrointestinal and abdominal hemorrhage.

    Science.gov (United States)

    Köhler, Gernot; Koch, Oliver Owen; Antoniou, Stavros A; Mayer, Franz; Lechner, Michael; Pallwein-Prettner, Leo; Emmanuel, Klaus

    2014-09-01

    Gastrointestinal and abdominal bleeding can lead to life-threatening situations. Embolization is considered a feasible and safe treatment option. The relevance of surgery has thus diminished in the past. The aim of the present study was to evaluate the role of surgery in the management of patients after embolization. We performed a retrospective single-center analysis of outcomes after transarterial embolization of acute abdominal and gastrointestinal hemorrhage between January 2009 and December 2012 at the Sisters of Charity Hospital, Linz. Patients were divided into three groups, as follows: upper gastrointestinal bleeding (UGIB), lower gastrointestinal bleeding (LGIB), and abdominal hemorrhage. Fifty-four patients with 55 bleeding events were included. The bleeding source could be localized angiographically in 80 %, and the primary clinical success rate of embolization was 81.8 % (45/55 cases). Early recurrent bleeding (30 days) developed in 3.6 % (2/55). The mean follow-up was 8.4 months, and data were available for 85.2 % (46/54) of the patients. Surgery after embolization was required in 20.4 % of these patients (11/54). Failure to localize the bleeding site was identified as predictive of recurrent bleeding (p = 0.009). More than one embolization effort increased the risk of complications (p = 0.02) and rebleeding (p = 0.07). Surgery still has an important role after embolization in patients with gastrointestinal and abdominal hemorrhage. One of five patients required surgery in cases of early and delayed rebleeding or because of ischemic complications (2/55 both had ischemic damage of the gallbladder) and bleeding consequences.

  11. Enlarged Right Ventricle Without Shock in Acute Pulmonary Embolism: Prognosis

    Science.gov (United States)

    Stein, Paul D.; Beemath, Afzal; Matta, Fadi; Goodman, Lawrence R.; Weg, John G.; Hales, Charles A.; Hull, Russell D.; Leeper, Kenneth V.; Dirk Sostman, H; Woodard, Pamela K.

    2008-01-01

    Background An unsettled issue is use of thrombolytic agents in patients with acute pulmonary embolism who are hemodynamically stable, but have right ventricular enlargement. Purpose To assess in-hospital mortality of hemodynamically stable patients with pulmonary embolism and right ventricular enlargement. Methods Patients were enrolled in the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II). Exclusions included shock, critically ill, ventilatory support, myocardial infarction within 1 month, or ventricular tachycardia or ventricular fibrillation within 24 hours. We evaluated the ratio of the right ventricular minor axis to the left ventricular minor axis measured on transverse images during computed tomographic angiography. Results Among 76 patients with right ventricular enlargement treated with anticoagulants and/or inferior vena cava filters, in–hospital deaths from pulmonary embolism were 0 of 76 (0%) and all-cause mortality was 2 of 76 (2.6%). No septal motion abnormality was observed in 49 (64%), septal flattening in 25 (33%) and septal deviation in 2 (3%). None required ventilatory support, vasopressor therapy, rescue thrombolytic therapy, or catheter embolectomy. There were no in-hospital deaths due to pulmonary embolism. There was no difference in all-cause mortality comparing patients with and without right ventricular enlargement (relative risk = 1.04) Conclusion In-hospital prognosis is good in patients with pulmonary embolism and right ventricular enlargement if not in shock, acutely ill, on ventilatory support, recent myocardial infarction or life threatening arrhythmia. Right ventricular enlargement alone in patients with pulmonary embolism, therefore, does not appear to indicate a poor prognosis or an indication for thrombolytic therapy. PMID:18187071

  12. Interleukin-6 as an early marker for fat embolism

    Directory of Open Access Journals (Sweden)

    Yoga R

    2009-06-01

    Full Text Available Abstract Background Fat Embolism is a complication of long bone fractures, intramedullary fixation and joint arthroplasty. It may progress to fat embolism syndrome, which is rare but involves significant morbidity and can occasionally be fatal. Fat Embolism can be detected at the time of embolization by transoesophageal echocardiography or atrial blood sampling. Later, a combination of clinical signs and symptoms will point towards fat embolism but there is no specific test to confirm the diagnosis. We investigated serum Interleukin-6 (IL-6 as a possible early marker for fat embolism. Methods An animal study was conducted to simulate a hip replacement in 31 adult male Sprague Dawley rats. The procedure was performed under general anesthesia and the animals divided into 3 groups: control, uncemented and cemented. Following surgery and recovery from anaesthesia, the rats allowed to freely mobilize in their cages. Blood was taken before surgery and at 6 hours, 12 hours and 24 hours to measure serum IL-6 levels. The rats were euthanized at 24 hours and lungs removed and stained for fat. The amount of fat seen was then correlated with serum IL-6 levels. Results No rats in the control group had fat emboli. Numerous fat emboli were seen in both the uncemented and cemented implant groups. The interleukin levels were raised in all groups reaching a peak at 12 hours after surgery reaching 100 pg/ml in the control group and around 250 pg/ml in the uncemented and cemented implant groups. The IL-6 levels in the control group were significantly lower than any of the implant groups at 12 and 24 hours. At these time points, the serum IL-6 correlated with the amount of fat seen on lung histology. Conclusion Serum IL-6 is a possible early marker of fat embolism.

  13. Comparison of three different embolic materials for varicocele embolization: retrospective study of tolerance, radiation and recurrence rate

    Science.gov (United States)

    Favard, Nicolas; Moulin, Morgan; Fauque, Patricia; Bertaut, Aurélie; Favelier, Sylvain; Estivalet, Louis; Michel, Frédéric; Cormier, Luc; Sagot, Paul

    2015-01-01

    Background To evaluate pain, radiation and recurrence rates in patients undergoing varicocele embolization with three different embolic materials. Methods Retrospective study of 182 consecutive patients who underwent transcatheter retrograde varicocele embolization from July 2011 to May 2015 with glue (Glubran®2) (group 1, n=63), mechanical agents (coils and/or plugs) (group 2, n=53) or a sclerosing agent (polidocanol) (group 3, n=66). Patients were asked by telephone interview to evaluate pain during embolization and at 1, 7 and 30 days using a quantitative pain scale ranging from 0 to 10. Duration of scopy, kinetic energy released per unit mass (kerma) and dose area product (DAP) were assessed as radiation parameters during embolization procedures. Recurrence rates after treatment were also evaluated. Statistical analyses were performed using parametric and non-parametric tests. Results Patients in the three study groups were comparable for age, clinical indication and embolization side. No difference was noted for significant pain (pain score ≥3) during embolization and at 1, 7 and 30 days after treatment. Discomfort (pain score <3) was more frequent in group 1 than in groups 2 and 3 at 7 days after the procedure (P=0.049). No difference in discomfort was noted during embolization or at 1 and 30 days. Duration of scopy was shorter (P<0.0001) and kerma was lower (P=0.0087) in group 1 than in groups 2 and 3. DAP was lower in group 1 than in group 2 (P=0.04) but no difference was noted between groups 1 and 3, and groups 2 and 3. The recurrence rate at a mean follow-up of 24.4 months (range, 2-53 months) was significantly lower in group 1 than in the two other groups (P=0.032). Conclusions The use of Glubran®2 acrylic glue for varicocele embolization is safe and leads to less radiation and lower recurrence rates than is the case for other embolic materials without any more significant pain. PMID:26807362

  14. Complications and mid-term outcome after percutaneous patent foramen ovale closure in patients with cryptogenic stroke

    Science.gov (United States)

    Luermans, J.G.L.M.; Post, M.C.; Plokker, H.W.M.; ten Berg, J.M.; Suttorp, M.J.

    2008-01-01

    Background: Percutaneous patent foramen ovale (PFO) closure seems to reduce the risk of recurrent thromboembolism. We report the safety and efficacy of percutaneous PFO closure in our centre. Methods: All patients, >16 years of age, who underwent a percutaneous PFO closure in our centre were included. Reoccurrence of stroke, transient ischaemic attack (TIA) and peripheral thromboembolism were assessed. Periprocedural and midterm complications are reported. Results: Eighty-three consecutive patients (mean age 49±13 years) were included. Indications for PFO closure were cryptogenic stroke (59.0%), TIA (33.7%), peripheral embolism (2.4%) and other (4.8%). For PFO closure, a Cardioseal/Starflex device was used in 63 patients and an Amplatzer PFO occluder device in 20 patients. Stroke recurred in 1.2%, TIA in 3.6%, peripheral embolism in 0% during a mean follow-up of 1.9±1.2 years. Major periprocedural complications occurred in 1.2%. The mid-term complication rate was 2.4% and only consisted of minor complications. During follow-up, a residual right-to-left shunt was present in 5.7% of the patients. No significant difference in outcome, complications or residual shunting could be documented between the two device types. Conclusion: In our centre, the percutaneous closure of a PFO seems to be a safe and effective procedure to prevent recurrence of paradoxical thrombo-embolic events. (Neth Heart J 2008;16:332-6.) PMID:18958256

  15. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....

  16. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  17. Strokes (For Parents)

    Science.gov (United States)

    ... the brain that's affected and the amount of damage the stroke causes. More likely, a parent first notices changes ... rehabilitation and therapy. previous continue Complications The brain damage that occurs during a stroke can cause a number of other problems that ...

  18. GANGGUAN MOOD PADA STROKE

    Directory of Open Access Journals (Sweden)

    Gabriella Tantular

    2015-10-01

    Full Text Available Stroke adalah salah satu sindrom neurologi yang dapat menimbulkan kecacatan dalam kehidupanmanusia. Salah  satu gejala yang dapat  timbul  setelah  seseorang  terkena  stroke adalah gangguanmood. Gangguan mood berhubungan dengan disabilitas fisik, beratnya stroke dan gangguan kognitif.Gangguan mood yang ditemukan pada stroke adalah depresi, gangguan afektif bipolar dan mania.Gambaran  gejala  berhubungan dengan  lesi  anatomis  stroke. Terapi  yang diberikan dapat  berupafarmakologis, psikoterapi, dan rehabilitasi. [MEDICINA 2015;46:33-36].Stroke is one of neurology syndrome that cause disability in human life. One of the symptoms thatappear after stroke was mood disorder. Mood disorder were related to physical disability, severity ofstroke  and  cognitive  dysfunction. Mood  disorder  found  in  stroke was  depression,  affective  bipolardisorder, and mania. Symptoms were associated with anatomical lesion. Treatment for this disorderare pharmacologic treatment, psychotherapy, and rehabilitation. [MEDICINA 2015;46:33-36].

  19. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber

    2014-01-01

    Full Text Available Pulmonary embolism (PE following shoulder arthroscopy is a rare complication. We present a unique case report of a 43-year-old right-hand dominant female who developed a PE 41 days postoperatively with no associated upper or lower extremity DVT. The patient had minimal preoperative and intraoperative risk factors. Additionally, she had no thromboembolic symptoms postoperatively until 41 days following surgery when she developed sudden right-hand swelling, labored breathing, and abdominal pain. A stat pulmonary computed tomography (CT angiogram of the chest revealed an acute PE in the right lower lobe, and subsequent extremity ultrasounds showed no upper or lower extremity deep vein thrombosis. After a thorough review of the literature, we present the first documented isolated PE following shoulder arthroscopy. Although rare, sudden development of an isolated PE is possible, and symptoms such as sudden hand swelling, trouble breathing, and systemic symptoms should be evaluated aggressively with a pulmonary CT angiogram given the fact that an extremity ultrasound may be negative for deep vein thrombosis.

  20. Acute pulmonary embolism: from morphology to function.

    Science.gov (United States)

    Mayo, John; Thakur, Yogesh

    2014-02-01

    This article reviews the current diagnostic strategies for patients with suspected pulmonary embolism (PE) focusing on the current first choice imaging modality, computed tomographic pulmonary angiography (CTPA). Diagnostic strengths and weaknesses and associated cost-effectiveness of the diagnostic pathways will be discussed. The radiation dose risk of these pathways will be described and techniques to minimize dose will be reviewed. Finally the impact of new dual energy applications which have the potential to provide additional functional information will be briefly reviewed. Imaging plays a vital role in the diagnostic pathway for clinically suspected PE. CT has been established as the most robust morphologic imaging tool for the evaluation of patients with suspected PE. This conclusion is based on the high diagnostic utility of CT for the detection of PE and its unique capacity for accurate diagnosis of conditions that can mimic the clinical presentation of PE. Although current cost-effectiveness evaluations have established CT as integral in the PE diagnostic pathway, failure to acknowledge the impact of alternate diagnosis represents a current knowledge gap. The emerging dual energy capacity of current CT scanners offers the potential to evaluate both pulmonary vascular morphology and ventilation perfusion relationships within the lung parenchyma at high spatial resolution. This dual assessment of lung morphology and lung function at low (< 5 millisievert) radiation dose represents a substantial advance in PE imaging.

  1. Perfusion visualization and analysis for pulmonary embolism

    Science.gov (United States)

    Vaz, Michael S.; Kiraly, Atilla P.; Naidich, David P.; Novak, Carol L.

    2005-04-01

    Given the nature of pulmonary embolism (PE), timely and accurate diagnosis is critical. Contrast enhanced high-resolution CT images allow physicians to accurately identify segmental and sub-segmental emboli. However, it is also important to assess the effect of such emboli on the blood flow in the lungs. Expanding upon previous research, we propose a method for 3D visualization of lung perfusion. The proposed method allows users to examine perfusion throughout the entire lung volume at a single glance, with areas of diminished perfusion highlighted so that they are visible independent of the viewing location. This may be particularly valuable for better accuracy in assessing the extent of hemodynamic alterations resulting from pulmonary emboli. The method also facilitates user interaction and may help identify small peripheral sub-segmental emboli otherwise overlooked. 19 patients referred for possible PE were evaluated by CT following the administration of IV contrast media. An experienced thoracic radiologist assessed the 19 datasets with 17 diagnosed as being positive for PE with multiple emboli. Since anomalies in lung perfusion due to PE can alter the distribution of parenchymal densities, we analyzed features collected from histograms of the computed perfusion maps and demonstrate their potential usefulness as a preliminary test to suggest the presence of PE. These histogram features also offer the possibility of distinguishing distinct patterns associated with chronic PE and may even be useful for further characterization of changes in perfusion or overall density resulting from associated conditions such as pneumonia or diffuse lung disease.

  2. Septic Pulmonary Embolism Induced by Dental Infection

    Directory of Open Access Journals (Sweden)

    Watanabe,Yoichi

    2013-08-01

    Full Text Available Dental infection can be an important source for septic pulmonary embolism (SPE, but only a few cases of SPE accompanying dental infection have been reported. The aim of this study was to characterize the clinical features of SPE induced by dental infection. Patients who fulfilled the diagnostic criteria described in the text were recruited in a retrospective fashion. All 9 patients were men, with a median age of 59 years (range:47 to 74 years. Eight patients had chest pain (88.9%, 5 had a preceding toothache (55.6% and 3 had preceding gingival swelling (33.3%. Blood cultures obtained from 7 patients were negative. Periodontitis was found in all of the cases, periapical periodontitis in 5 cases, and gingival abscess in 3 cases. The median duration of hospitalization was 15 days, and symptoms were mild in some cases. In addition to antimicrobial therapy, tooth extraction was performed in 3 cases, tooth scaling in 6. SPE induced by dental infection has prominent clinical characteristics such as male preponderance, chest pain, preceding toothache, and mild clinical course.

  3. Portal vein embolization for hepatocellular carcinoma.

    Science.gov (United States)

    Shindoh, Junichi; D Tzeng, Ching-Wei; Vauthey, Jean-Nicolas

    2012-11-01

    Portal vein embolization (PVE) improves the safety of major hepatectomy through hypertrophy of the future liver remnant (FLR), atrophy of the liver volume to be resected, and improvement in patient selection. Because most patients with hepatocellular carcinoma (HCC) have liver parenchymal injury due to underlying viral hepatitis or alcoholic liver fibrosis/cirrhosis, indication of PVE is relatively complex and sequential procedures, including transarterial chemoembolization, are required to maximize the effect of PVE as well as to minimize tumor progression due to increased arterial flow after PVE. PVE is currently indicated for patients with relatively well-preserved hepatic function [Child-Pugh A and indocyanine green tolerance test (ICG-R15) 40% is the minimal requirement for patients with chronic hepatitis or cirrhosis, and further strict criteria (FLR volume >50%) have been recommended for patients with marginal liver functional reserve (ICG-R15, 10-20%). Recent clinical results have suggested that PVE can be safely performed in patients with HCC and that it contributes to improved survival after major hepatectomy.

  4. SPECT/CT and pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Mortensen, Jann [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); The Faroese National Hospital, Department of Medicine, Torshavn (Faroe Islands); Gutte, Henrik [Copenhagen University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen (Denmark); Herlev Hospital, Copenhagen University Hospital, Department of Radiology, Copenhagen (Denmark); University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark)

    2014-05-15

    Acute pulmonary embolism (PE) is diagnosed either by ventilation/perfusion (V/P) scintigraphy or pulmonary CT angiography (CTPA). In recent years both techniques have improved. Many nuclear medicine centres have adopted the single photon emission CT (SPECT) technique as opposed to the planar technique for diagnosing PE. SPECT has been shown to have fewer indeterminate results and a higher diagnostic value. The latest improvement is the combination of a low-dose CT scan with a V/P SPECT scan in a hybrid tomograph. In a study comparing CTPA, planar scintigraphy and SPECT alone, SPECT/CT had the best diagnostic accuracy for PE. In addition, recent developments in the CTPA technique have made it possible to image the pulmonary arteries of the lungs in one breath-hold. This development is based on the change from a single-detector to multidetector CT technology with an increase in volume coverage per rotation and faster rotation. Furthermore, the dual energy CT technique is a promising modality that can provide functional imaging in combination with anatomical information. Newer high-end CT scanners and SPECT systems are able to visualize smaller subsegmental emboli. However, consensus is lacking regarding the clinical impact and treatment. In the present review, SPECT and SPECT in combination with low-dose CT, CTPA and dual energy CT are discussed in the context of diagnosing PE. (orig.)

  5. Right Heart Thrombi Accompained with Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Mustafa Çörtük

    2015-10-01

    Full Text Available Aim: Right sided heart thrombus (RSHT is rarely seen. It is generally detected during transthoracic echocardiographic (TTE examination or multislice thoracic computed tomographic scanning for pulmonary embolism (PE. Although RSHT and PE secondary to this situation is rare, mortality during the course of process is very high. We aim to aproach right cardiac trombus and determine the results of treatment. Method: In this study 25 patients hospital records were investigated retrospectively. The data obtained consisted of diagnostic methods, presence of shock state, treatments applied and results were assessed. Results: Th present study revealed that the 32% of patients had been admitted to hospital in shock state, hospital mortality rate was 24%, and this mortality rate was not affected by different treatment choices. Conclusion: The exact incidence of RSHT is unknown. It is reported that the probability of seeing a case suffering from RSHT during echocardiographic examination performed to diagnose the PE is 9%. RSHT may cause PE anytime and requires urgent treatment. In our study, we determined that the hospital mortaliy did not change with the type of given treatment and overall mortality was determined as 24%. There are no sufficient studies searching large series on RSHT in literature. Therefore, there is no agreement on treatment tecniques.

  6. D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale.

    Science.gov (United States)

    Kim, Young Dae; Song, Dongbeom; Nam, Hyo Suk; Lee, Kijeong; Yoo, Joonsang; Hong, Geu-Ru; Lee, Hye Sun; Nam, Chung Mo; Heo, Ji Hoe

    2015-08-31

    Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648-17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.

  7. Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring.

    Science.gov (United States)

    Thakkar, Sandeep; Bagarhatta, Rajeev

    2014-01-01

    Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect. Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission. Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke. Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  8. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  9. Stroke risk factors among participants of a world stroke day ...

    African Journals Online (AJOL)

    2015-04-20

    Apr 20, 2015 ... stroke day awareness program in an urban area of Nigeria. Community ... of ischemic stroke was 1.64 in obese versus healthy subjects and 1.22 in .... Acute stroke mortality at Lagos University Teaching Hospital‑A five ... A review of stroke admissions at a tertiary hospital in rural Southwestern. Nigeria.

  10. Stroke and Women

    Directory of Open Access Journals (Sweden)

    Gülçin Benbir

    2013-12-01

    Full Text Available OBJECTIVE: We aimed to investigate the differences in vascular risk factor and etiology of stroke in two sexes. METHODS: We reviewed the medical files of 2798 patients being followed-up in our Stroke Clinic between the years 1996-2011. The stroke subtypes and risk factors were recorded on the basis of clinical data, physical and neurological examinations, and neuroimaging findings. Data were collected in SPSS 11.5 system and Pearson chi-square and Mann-Whitney U tests were used for statistical analysis. RESULTS: Of a total of 2798 patients, 2564 patients (91,6% had ischemic stroke, and 234 of them (8,4% had hemorrhagic stroke. The mean follow-up duration was 50.2+42.7 months. Of whole study population, 1289 patients were women (46%, 1509 of them were men (54%. The analysis of stroke subtypes showed that the most common subtype was stroke of unknown etiology in both sexes. Following this, the most common subtype was atherothrombotic stroke in men, and cardioembolic stroke in women. Coronary heart disease was more common in men, while atrial fibrillation and other rhythm anomalies were more common in women. Smoking and alcohol consumption were more common in men. CONCLUSION: Our study showed that there are major differences in stroke subtypes and vascular risk factors. Better knowledge of these differences, as well as influencing factors, is of crucial value – in addition to the need of hormonal changes, pregnancy and depression to be better identified in women – for both primary and secondary prevention.

  11. Anatomic distribution of embolus at CT pulmonary angiography in patients suspected acute pulmonary embolism

    Institute of Scientific and Technical Information of China (English)

    朱力

    2013-01-01

    Objective To summarize and analyze the morphology and distribution of embolus in patients suspected acute pulmonary embolism. Methods The CT pulmonary angiography(CTPA) imagings of 279 patients suspected acute pulmonary embolism were analyzed retrospectively in

  12. Tenecteplase in the treatment of acute pulmonary thrombo-embolism.

    Science.gov (United States)

    Bhuvaneswaran, J S; Premchand, Rajendra Kumar; Iyengar, S S; Rajeev Khare; Chabra, C B; Padmanabhan, T N C; Sharma, S K; Jain, Alkesh; Pandian, S A; Rajdev, S; Modi, N; Kumar, V

    2011-05-01

    This is a retrospective study documenting the use of tenecteplase in 41 cases of suspected or confirmed pulmonary embolism receiving in-hospital tenecteplase as per weight-adjusted dosing in addition to standard heparin and oral anticoagulant therapy. The presenting symptoms of dyspnoea, chest pain, hemoptysis and syncope were found in 40 (97.56%), 19 (46.34%), 6 (14.63%) and 9 (21.95%) patients, respectively. There was one case of mortality who was a 26 yrs old female of postpartum pulmonary thrombo-embolism with severe hypotension, cyanosis, bilateral crepitations in lungs and pulmonary hypertension. In the 40 survived patients, there was alleviation of dyspnoea and hemoptysis in all patients. Significant reduction in tachycardia (P tenecteplase therapy. Resolution of pulmonary embolism on CT pulmonary angiography was documented in only two patients. No bleeding events or any other adverse events were reported during this study. The present study suggests favourable efficacy of tenecteplase in patients with suspected or confirmed acute pulmonary embolism. Although no major adverse events were noted, a large prospective study on the use of tenecteplase in pulmonary embolism is suggested.

  13. The diagnosis and treatment of paradoxical embolism: a systematic review

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2016-11-01

    Full Text Available One in five adults has patent foramen ovale (PFO, which is typically without symptoms. Because of the low pressure in both atria and the anatomical position of the septum secundum, there is no left-to-right shunting and little right-to-left shunting in the general condition; however, when the right atrial pressure increases, this slit-like flap separates and allows right-to-left shunting. According to the Johnson criteria, simultaneous occurrences of arterial emboli, such as those caused by cerebrovascular accident or pulmonary embolism, demonstrate the presence of paradoxical embolism through a PFO. When a patient presents with multivascular arterial embolism, the clinician should perform a contrast transthoracic echo, a transesophageal (TEE, a real-time three-dimensional TEE, and even an intracardiac echocardiography (ICE in order to differentiate between PFO, flat atrial septal defect (ASD and hybrid defects. The randomized trials that have assessed therapeutic interventions for paradoxical embolism have not produced any clear guidelines as to how best to treat this condition. The classic treatment is surgical embolectomy with exploration of the right chambers and the pulmonary arteries under full cardiopulmonary bypass. Patients with a history of ≥1 paradoxical embolism may be indicated for device PFO closure.

  14. Echocardiographic detection and treatment of intraoperative air embolism.

    Science.gov (United States)

    Sato, S; Toya, S; Ohira, T; Mine, T; Greig, N H

    1986-03-01

    A real-time two-dimensional echocardiogram was used to detect the presence of an air embolism in patients undergoing neurosurgical procedures in the sitting position. The technique could with good sensitivity detect the appearance of a single air bubble intraoperatively, thus allowing early intervention to prevent development of further air emboli. Two types of air embolism could be differentiated; the single-bubble type and the "stormy-bubble" type. The single-bubble type was observed during skin and muscle incisions, craniotomy, and brain lesion excision. Further embolism development was prevented by electrocoagulation and application of bone wax. The stormy-bubble type occurred during dura and muscle incisions and was prevented by electrocoagulation, reflection of the dura, or suturing the affected muscle. The routine use of a Swan-Ganz catheter for removal of air embolism by suction proved effective for the treatment of the stormy-bubble type of air embolism. Masking the operative field with saline-soaked cotton strips was of moderate benefit in the stabilization of the single-bubble type of air influx, but proved to be of little value in controlling the entrance of the stormy-bubble type.

  15. Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

    Energy Technology Data Exchange (ETDEWEB)

    Su, Li-xin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People’s Hospital (China); Jia, Ren-Bing, E-mail: jrb19760517@hotmail.com [Shanghai Jiao Tong University School of Medicine, Department of Ophthalmology, Ninth People’s Hospital (China); Wang, De-Ming, E-mail: wdmdeming@hotmail.com; Lv, Ming-Ming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@aliyun.com [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People’s Hospital (China)

    2015-06-15

    ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

  16. Endothelial cell proliferation in swine experimental aneurysm after coil embolization.

    Directory of Open Access Journals (Sweden)

    Yumiko Mitome-Mishima

    Full Text Available After coil embolization, recanalization in cerebral aneurysms adversely influences long-term prognosis. Proliferation of endothelial cells on the coil surface may reduce the incidence of recanalization and further improve outcomes after coil embolization. We aimed to map the expression of proliferating tissue over the aneurysmal orifice and define the temporal profile of tissue growth in a swine experimental aneurysm model. We compared the outcomes after spontaneous thrombosis with those of coil embolization using histological and morphological techniques. In aneurysms that we not coiled, spontaneous thrombosis was observed, and weak, easily detachable proliferating tissue was evident in the aneurysmal neck. In contrast, in the coil embolization group, histological analysis showed endothelial-like cells lining the aneurysmal opening. Moreover, immunohistochemical and morphological analysis suggested that these cells were immature endothelial cells. Our results indicated the existence of endothelial cell proliferation 1 week after coil embolization and showed immature endothelial cells in septal tissue between the systemic circulation and the aneurysm. These findings suggest that endothelial cells are lead to and proliferate in the former aneurysmal orifice. This is the first examination to evaluate the temporal change of proliferating tissue in a swine experimental aneurysm model.

  17. Transcatheter arterial embolization in gastric cancer patients with acute bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Joo; Shin, Ji Hoon; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong-Il; Song, Ho-Young; Sung, Kyu-Bo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea)

    2009-04-15

    The safety and clinical effectiveness of transcatheter arterial embolization for bleeding associated with unresectable gastric cancer was evaluated. Twenty-three patients with bleeding from unresectable gastric cancer underwent transcatheter arterial embolization. Of the 23 patients, eight showed signs of active bleeding, such as contrast extravasation or pseudoaneurysm, seven showed only tumor staining, and the remaining eight patients showed negative angiographic findings. All embolization procedures were successful without procedure-related complications. In all eight active bleeding patients, immediate hemostasis was achieved. The overall clinical success rate was 52% (12/23). Recurrent bleeding within 1 month occurred in one (8%) in 12 patients with initial clinical success. One patient showed partial splenic infarction after embolization of the splenic artery for active bleeding from the short gastric artery. Overall 30-day mortality rate was 43% (10/23). The median overall survival period was 38 days. In patients with bleeding from unresectable gastric cancer, transcatheter arterial embolization was found to be safe and effective for achieving immediate hemostasis for active bleeding. Although the clinical success rate was not high, the recurrent bleeding rate was low at 1 month post procedure. (orig.)

  18. Uterine arterial embolization for uterine leiomyoma: efficacy and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Seon; Lee, Do Yon; Kim, Yong Tae; Park, Ki Hyun; Park, Yong Won; Cho, Jae Sung; Kim, Myung Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of); Won, Je Hwan [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Kang, Byung Chul [Ewha Womans Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-09-01

    To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas. Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdominal discomfort, backache, urinary frequency, etc.) and one was diagnosed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. Nineteen patients were followed up after embolization. Seventeen (89.5 %)reported satisfactory improvement of symptoms and follow-up sonography three months later showed a 58.5 % reduction in mean myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3 %) and fever (23.8 %). Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, enquired.

  19. Embolization for vertebral metastases of follicular thyroid carcinoma.

    Science.gov (United States)

    Smit, J W; Vielvoye, G J; Goslings, B M

    2000-03-01

    The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage and benign or malignant tumors, notably vertebral metastases of renal cell carcinoma. Because this technique is relatively easy to perform and offers immediate relief of symptoms, it is an attractive option for patients with vertebral metastases of thyroid carcinoma with signs of spinal cord compression. In these patients, other treatment modalities like radioactive iodine, external irradiation, or surgery are more cumbersome or less effective in the short term. We describe four patients with metastasized follicular thyroid carcinoma, presenting with neurological symptoms due to vertebral metastases. All patients had undergone total thyroidectomy, ranging from 1 month to 4 yr before embolization. Embolization was combined with iodine-131 therapy when appropriate. Selective catheterization of the arteries feeding the metastases was performed, followed by infusion of polyvinyl alcohol particles (Ivalon). The procedure was technically successful in all patients without adverse effects. In the patients described, embolization resulted in rapid resolution of neurological symptoms, sometimes within hours. The therapeutic effect lasted from months to years. We conclude that embolization of vertebral metastases of follicular thyroid carcinoma is an attractive palliative therapeutic option that may offer rapid relief of symptoms.

  20. Computed tomography of acute pulmonary embolism: state-of-the-art

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Long Jiang; Lu, Guang Ming [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Meinel, Felix G.; McQuiston, Andrew D.; Ravenel, James G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J. [Medical School of Nanjing University, Department of Medical Imaging, Jinling Hospital, Nanjing, Jiangsu (China); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-09-15

    Multidetector computed tomography (CT) plays an important role in the detection, risk stratification and prognosis evaluation of acute pulmonary embolism. This review will discuss the technical improvements for imaging peripheral pulmonary arteries, the methods of assessing pulmonary embolism severity based on CT findings, a multidetector CT technique for pulmonary embolism detection, and lastly, how to avoid overutilization of CT pulmonary angiography and overdiagnosis of pulmonary embolism. (orig.)

  1. Pulmonary artery perforation and coronary air embolism-two fatal outcomes in percutaneous left atrial appendage occlusion.

    Science.gov (United States)

    Zwirner, J; Bayer, R; Hädrich, C; Bollmann, A; Klein, N; Dreßler, J; Ondruschka, B

    2017-01-01

    Percutaneous left atrial appendage (LAA) closure is a routinely performed method to reduce the risk of stroke in patients suffering from atrial fibrillation, when an oral anticoagulation is no longer indicated due to relevant bleeding complications. Currently, the Amplatzer Amulet and the Watchman system are two equally used systems. While there is an acute success rate of more than 95 per cent for this intervention, several minor and major complications such as pericardial effusions, air embolism, vascular lesions in proximity to the heart or even death can occur. Here, we report two cases of very rare fatal outcomes in percutaneous LAA occlusion. Eight hours after deployment of an Amplatzer Amulet a patient died, after the pulmonary trunk was perforated by a hook of the occluder device causing pericardial tamponade. In the second case during final radiological position control of the deployed Watchman occluder air was injected accidentally. The patient immediately died due to coronary air embolism. Forensic autopsies are necessary to solve the cause and manner of death, to evaluate and develop medical devices and to rule out medical malpractice. Thus, a close collaboration of legal medicine and the various cardiologic departments is proposed.

  2. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes happen every year in the United States. You ... some of your risks for heart disease and stroke, but you can manage many of your risks ...

  3. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan; van der Worp, Bart; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.

    2016-01-01

    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  4. Microbiological quality of rabbit meat.

    Science.gov (United States)

    Rodríguez-Calleja, Jose M; Santos, Jesús A; Otero, Andrés; García-López, María-Luisa

    2004-05-01

    World rabbit meat production is estimated to be over 1 million tons, and Spain is the third largest producer. Although rabbit meat is marketed and consumed worldwide, information on microbiological quality is very scarce. Here, we report indicator organisms, spoilage flora, sensory quality, and some physicochemical traits of 24 h postmortem chilled rabbit carcasses and prepackaged rabbit meat stored chilled in air for 0 to 3 days at the retail level. The mean total bacterial count (4.01 +/- 0.48 log CFU/g) for carcasses dressed at a small abattoir by a manual process was significantly lower (P Pseudomonas, lactic acid bacteria, and yeasts. These microorganisms and Brochothrix thermosphacta were dominant on carcasses from the large abattoir. On prepacked hind legs (pH 6.26 +/- 0.18) stored at -1 to +1 degree C (supermarket 1), mean aerobic mesophilic count was 5.87 +/- 1.03 log CFU/g, and the major microbial groups were Pseudomonas, yeasts, lactic acid bacteria, and B. thermosphacta. On prepacked whole carcasses (pH 6.37 +/- 0.18) displayed at -1 to +5 degrees C (supermarket 2), mean aerobic mesophilic count was 6.60 +/- 1.18 and the same microbial groups were dominant. Relative Escherichia coli incidence was supermarket 2 > large abattoir > supermarket 1 > small abattoir. Overall, low numbers of coliforms, Enterobacteriaceae, psychrotrophic clostridia, coagulase-positive staphylococci, and molds were found. Sensory scores, pH values, and L-lactic acid content differentiated fresh carcasses from retail samples. Data obtained suggest that the microflora of chilled rabbit meat are different from those found on the meat of other animals.

  5. RPR test for serological survey of rabbit syphilis in companion rabbits.

    Science.gov (United States)

    Saito, Kumiko; Tagawa, Masayo; Hasegawa, Atsuhiko

    2003-07-01

    Since the RPR (rapid plasma regain) test was found to be useful for the diagnosis of rabbit syphilis, serological survey by this test has been carried out in Japanese companion rabbits. A hundred virgin household rabbits kept alone and without signs and history of syphilis were examined by RPR test from April 2001 to March 2002, in Tokyo, Japan. The test was positive in 35 cases and negative in 65 cases. RPR negative rabbits should be selected for breeding to prevent the spread of rabbit syphilis in companion rabbits in Japan.

  6. Diagnostic imaging of acute pulmonary embolism.

    Science.gov (United States)

    Christiansen, F

    1997-01-01

    The common strategy of combining clinical information, lung scintigraphy and pulmonary angiography in the diagnosis of acute pulmonary embolism (PE), has many limitations in clinical use. The major causes are that pulmonary angiography and lung scintigraphy are not universally available, and that pulmonary angiography is very expensive. The purpose of this thesis was to analyse different aspects of validity in regard to lung scintigraphy, pulmonary angiography, spiral CT, and ultrasound of the legs, with the subsequent intention of discussing new diagnostic strategies. Observer variations in lung scintigraphy interpretation when applying the PIOPED criteria were tested in 2 studies with 2 and 3 observers respectively and expressed as kappa values. The ability to improve agreement in lung scintigraphy interpretation was tested by training 2 observers from different hospitals. The impact of 3 observers' variations in lung scintigraphy interpretation when compared to pulmonary angiography, was tested by comparing the ROC areas of the observers. The value of combining subjectively derived numerical probabilities and the PIOPED categorical probabilities in lung scintigraphy reporting was compared to using the PIOPED categorization only, and this was tested by comparing ROC areas. The sensitivity and specificity of detecting an embolic source in the deep veins of the legs by ultrasound as a sign of PE when lung scintigraphy is inconclusive, was tested by comparison with pulmonary angiography. The sensitivity and specificity of spiral CT, compared to pulmonary angiography, was tested by comparison to pulmonary angiography. The inter- and intra-observer kappa values were in the range of moderate and fair. It was not possible to achieve better kappa values after training. Although observer variations were substantial, the accuracy did not differ significantly between the 3 observers. Incoorporating subjectively derived probabilities into lung scan reporting could not reduce

  7. Dizziness in stroke

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2015-01-01

    Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.

  8. Imaging acute ischemic stroke.

    Science.gov (United States)

    González, R Gilberto; Schwamm, Lee H

    2016-01-01

    Acute ischemic stroke is common and often treatable, but treatment requires reliable information on the state of the brain that may be provided by modern neuroimaging. Critical information includes: the presence of hemorrhage; the site of arterial occlusion; the size of the early infarct "core"; and the size of underperfused, potentially threatened brain parenchyma, commonly referred to as the "penumbra." In this chapter we review the major determinants of outcomes in ischemic stroke patients, and the clinical value of various advanced computed tomography and magnetic resonance imaging methods that may provide key physiologic information in these patients. The focus is on major strokes due to occlusions of large arteries of the anterior circulation, the most common cause of a severe stroke syndrome. The current evidence-based approach to imaging the acute stroke patient at the Massachusetts General Hospital is presented, which is applicable for all stroke types. We conclude with new information on time and stroke evolution that imaging has revealed, and how it may open the possibilities of treating many more patients. © 2016 Elsevier B.V. All rights reserved.

  9. Did Jean-Martin Charcot contribute to stroke?

    Science.gov (United States)

    Bogousslavsky, Julien; Paciaroni, Maurizio

    2010-01-01

    Stroke was never identified as a significant, autonomous field of activity of the emerging school of neurology at La Salpêtrière, which developed after the appointment of Jean-Martin Charcot (1825-1893) during the last days of 1861. However, stroke was already present in Charcot's first paper (1851), which dealt with a case of multiple organ cardiac embolism, including middle cerebral artery infarction, at a time when the studies of Rudolf Virchow on thromboembolism were unknown in France. A few years later, Charcot made a still up-to-date description of vascular intermittent claudication, which had only been reported in the horse. In the 1860s, Charcot and his pupils presented several major works dealing with cerebrovascular disease, including famous studies on miliary aneurysms in cerebral hemorrhage. This work was done with Charles Bouchard, at the time Charcot's 'interne', but who would become one of his 'political' opponents 2 decades later, when in 1892, as president of the 'agrégation' jury, he rejected the professorship application of 4 protégés of Charcot, including Joseph Babinski and Georges Gilles de la Tourette. Further work on cerebrovascular disease by Charcot included histological studies of brain 'softening', paraneoplastic cerebral arterial occlusion and consequences of stroke (e.g. arthropathies, vegetative changes, contractures and abnormal movements). Brain localization, one of Charcot's major neurological topics, was also largely based on stroke case studies. Charcot's work on stroke remains poorly recognized, but it demonstrates his unique skills in stimulating scientific work in younger colleagues, many of whom subsequently became major figures of neurology and psychiatry.

  10. Magnetic resonance imaging of water ascent in embolized xylem vessels of grapevine stem segments

    Science.gov (United States)

    Mingtao Wang; Melvin T. Tyree; Roderick E. Wasylishen

    2013-01-01

    Temporal and spatial information about water refilling of embolized xylem vessels and the rate of water ascent in these vessels is critical for understanding embolism repair in intact living vascular plants. High-resolution 1H magnetic resonance imaging (MRI) experiments have been performed on embolized grapevine stem segments while they were...

  11. Value of embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-xin; SONG Lu; WU Na; LIU Zhen-guo

    2010-01-01

    @@ T° the Editor We are interested in a recent article "Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer: technical aspects" written by GAO et al.1 Ethylene vinyl alcohol copolymer (Onyx) is a novel liquid embolic material used to cure brain arteriovenous malformations. They performed the embolization on 115 patients and they found that the complications of the treatment are scarce.

  12. Neuro-endovascular Embolic Agent for Treatment of a Renal Arteriovenous Fistula

    Directory of Open Access Journals (Sweden)

    Gurpreet Singh

    2016-01-01

    Full Text Available Renal arteriovenous fistula is a known complication following a renal biopsy, and may require catheter based embolization. Distal location of these fistulas in the renal parenchyma in many a case may necessitate non-traditional embolic materials. Liquid embolic agents that allow a controlled delivery may be suitable in this situation, as demonstrated in this case report.

  13. Negative spiral CT in acute pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Nilsson, T.; Olausson, A. [Karolinska Hospital, Stockholm (Sweden). Dept. of Thoracic Radiology; Johnsson, H. [Karolinska Hospital, Stockholm (Sweden). Dept. of Internal Medicine; Nyman, U. [County Hospital, Trelleborg (Sweden). Dept. of Radiology; Aspelin, P. [Huddinge Univ. Hospital (Sweden). Dept. of Radiology

    2002-09-01

    Purpose: To retrospectively evaluate the clinical outcome of non-anticoagulated patients with clinically suspected acute pulmonary embolism (PE) and no symptoms or signs of deep venous thrombosis (DVT) following a negative contrast medium-enhanced spiral CT of the pulmonary arteries (s-CTPA). Material and Methods: During a 24-month period, 739 of 751 patients underwent s-CTPA with acceptable diagnostic quality for clinically suspected acute PE. All patients who had a CT study not positive for PE were followed up with a questionnaire, a telephone interview and review of all medical reports, including autopsies and death certificates for any episodes of venous thromboembolism (VTE) during a 3-month period. Results: PE was diagnosed in 158 patients. Of the remaining 581 patients with a negative s-CTPA, 45 patients were lost to follow-up. 88 patients were excluded because of anticoagulation treatment (cardiac disorder n=32, chronic VTE or acute symptomatic DVT n=31, PE diagnosed at pulmonary angiography n=1, thrombus prophylaxis during diagnostic work-up or other reasons than VTE n=24) and 7 patients undergoing lower extremity venous studies because of symptoms of DVT (all negative). Thus, 441 patients with a negative s-CTPA and no DVT symptoms, venous studies or anticoagulant treatment constituted the follow-up cohort. Four of these patients had proven VTE (all PE) during the 3-month follow-up period. Two of the PE episodes contributed to the patient's death. Conclusion: Patients with clinically suspected acute PE, no symptoms or signs of DVT and a negative single slice s-CTPA using 3-5 mm collimation, may safely be left without anticoagulation treatment unless they are critically ill, have a limited cardiopulmonary reserve and/or if a high clinical suspicion remains.

  14. Diagnosis and Management of Pulmonary Embolism in Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah Broder

    1996-01-01

    Full Text Available Pulmonary embolism in pregnancy is a significant and under-recognized problem. In British Columbia, where there are 46,000 pregnancies per year, it is estimated that there are approximately 160 pulmonary embolisms per year and one maternal death every two years secondary to pulmonary embolism. A complete assessment for suspected pulmonary embolus can be performed without putting the fetus at significant risk from radiation exposure. An algorithm is provided for the workup of pulmonary embolus during pregnancy. Heparin is the drug of choice for anticoagulating pregnant women, initially managing the situation with intravenous heparin and then switching to the subcutaneous route given in a bid or tid regimen, aiming to keep the activated partial thromboplastin time 1.5 to 2 times the control. The risks to both the fetus and the mother from anticoagulation during pregnancy are reviewed.

  15. [Thoracic aortic dissection revealed by systemic cholesterol embolism].

    Science.gov (United States)

    Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

    2006-10-01

    Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

  16. Tentorial artery embolization in tentorial dural arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2006-10-15

    The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

  17. Embolic Doppler ultrasound signal detection via fractional Fourier transform.

    Science.gov (United States)

    Gençer, Merve; Bilgin, Gökhan; Aydın, Nizamettin

    2013-01-01

    Computerized analysis of Doppler ultrasound signals can aid early detection of asymptomatic circulating emboli. For analysis, physicians use informative features extracted from Doppler ultrasound signals. Time -frequency analysis methods are useful tools to exploit the transient like signals such as Embolic signals. Detection of discriminative features would be the first step toward automated analysis of embolic Doppler ultrasound signals. The most problematic part of setting up emboli detection system is to differentiate embolic signals from confusing similar wave-like patterns such as Doppler speckle and artifacts caused by tissue movement, probe tapping, speaking etc. In this study, discrete version of fractional Fourier transform is presented as a solution in the detection of emboli in digitized Doppler ultrasound signals. An accurate set of parameters are extracted using short time Fourier transform and fractional Fourier transform and the results are compared to reveal detection quality. Experimental results prove the efficiency of fractional Fourier transform in which discriminative features becomes more evident.

  18. Pathogenesis, diagnosis and treatment of cerebral fat embolism

    Institute of Scientific and Technical Information of China (English)

    Yihua Zhou; Ying Yuan; Chahua Huang; Lihua Hu; Xiaoshu Cheng

    2015-01-01

    In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate.In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae.For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc.The early diagnosis and comprehensive treatment can improve prognosis.

  19. Hyponatremia in stroke

    Directory of Open Access Journals (Sweden)

    Sheikh Saleem

    2014-01-01

    Full Text Available Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH or cerebral salt wasting syndrome (CSWS. We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l. The data was analysed using Chi-square test using SPSS (Statistical package for social science software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67% had SIADH and 115 (33% had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate.

  20. Hyponatremia in stroke

    Science.gov (United States)

    Saleem, Sheikh; Yousuf, Irfan; Gul, Azhara; Gupta, Satish; Verma, Sawan

    2014-01-01

    Introduction: Hyponatremia is a common electrolyte disorder encountered in patients of neurological disorders which is usually either due to inappropriate secretion of Antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (CSWS). We conducted this study in a tertiary care hospital to determine the incidence and etiology of hyponatremia in patients of stroke admitted in the hospital. Materials and Methods: It was a prospective study done over a period of two years that included established cases of stroke diagnosed on the basis of clinical history, examination and neuroimaging. 1000 stoke patients were evaluated for hyponatremia (serum sodium <130 meq/l). The data was analysed using Chi-square test using SPSS (Statistical package for social science) software. Results: Out of 1000 patients, 353 patients had hyponatremia. Out of this 353 patients, 238 (67%) had SIADH and 115 (33%) had CSWS. SIADH was seen in 83 patients who had ischemic stroke and 155 patients of hemorrhagic stroke. CSWS was found in 38 patients with ischemic stroke and 77 patients with hemorrhagic stroke. Statistical analysis revealed that hyponatremia significantly affects the outcome of stroke especially when it is due to CSWS rather than SIADH. Conclusion: Incidence of hyponatremia in our study population was 35%. In patients of hyponatremia 67% were having SIADH and 33% were having CSWS. Overall hyponatremia affected the outcome of stroke especially when caused by CSWS. Therefore close monitoring of serum sodium must be done in all patients who are admitted with stroke and efforts must be made to determine the cause of hyponatremia, in order to properly manage such patients thereby decreasing the mortality rate. PMID:24753660