1/10. apoptosis of endothelial cells in vessels affected by cerebral vasospasm.BACKGROUND: Cerebral vasospasm after subarachnoid hemorrhage is a prolonged contraction that leads to cerebral ischemia or infarction. Morphological studies of cerebral arteries during vasospasm have shown extensive necrosis of smooth-muscle cells and desquamation and dystrophy of endothelial cells. The mechanism of cellular death is unknown. methods: We report an observation of apoptotic changes in the cerebral arteries of a patient who died after suffering severe cerebral vasospasm caused by aneurysmal rupture. subarachnoid hemorrhage and cerebral vasospasm were confirmed by computed tomography scanning and angiogram. Histological and immunohistological examinations for apoptosis were performed in cerebral arteries. For control, the arteries from another patient, who died of trauma without head injury, were used. RESULTS: Corrugation of the internal elastic lamina and increased amounts of connective tissue was demonstrated by light microscopy. Apoptotic changes, characterized by condensation of chromatin of the nucleus and detachment from the basal membrane, were found on transmission electron microscopy in endothelial cells. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling reaction revealed positive staining of the nuclei of the endothelial cells. CONCLUSIONS: This study demonstrates that apoptosis occurred in the cerebral arteries in a patient who died of cerebral vasospasm. The possible role of apoptosis in cerebral vasospasm is discussed.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/10. Ruptured intracranial aneurysm in an adolescent with Alport's syndrome--a new expression of type IV collagenopathy: case report.BACKGROUND: Aneurysmal subarachnoid hemorrhage is uncommon in the pediatric and adolescent age groups. Collagenopathies, particularly of collagen type iii and IV, have been recognized in the pathogenesis of intracranial (i.c.) aneurysms in recent studies of cerebrovascular immunoreactivity and the molecular architecture of the walls of cerebral blood vessels. Alport's syndrome is a genetic disease characterized by imperfect synthesis of type IV collagen leading to sensorineural hearing loss and hematuria. The hematuria results from an abnormal synthesis of the type IV collagen of the glomerular basement membrane. CASE DESCRIPTION: After a motor vehicle accident, this 14-year-old male driver presented with diffuse subarachnoid hemorrhage confirmed by computerized tomography. Subsequent cerebral angiography revealed a left carotid artery bifurcation aneurysm. A retrospective review of the patient's history disclosed renal biopsy-proven hereditary Alport's syndrome. The patient underwent left pterional craniotomy and clipping of the aneurysm, which had clearly ruptured. CONCLUSIONS: The authors present the first clinical observation of a ruptured cerebral aneurysm in an adolescent male with Alport's syndrome. In this case the type IV collagenopathy of Alport's syndrome may have contributed to the genesis of this adolescent's aneurysm. Intracranial aneurysms may be more common in the population of collagenopathies than previously suspected and non-invasive screening may be appropriate.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
3/10. Ruptured aneurysm associated with partially duplicated posterior communicating artery--case report.A 65-year-old woman presented with a ruptured saccular aneurysm associated with a rare variation of the posterior communicating artery (PcoA), partially duplicated PcoA. The PcoA with this variation forked just distal to the aneurysmal neck, and the two branches independently merged into the posterior cerebral artery. Initial clipping failed to isolate the aneurysm from one of the two branches, so the aneurysmal dome continued to pulsate and bleed. Temporary clipping of the proximal internal carotid artery revealed the fork of the two branches just distal to the aneurysmal neck. A curved Yasargil clip was used to clip the aneurysm and preserve the PcoA and branches. Careful observation of this PcoA variation is needed because the arterial structures may be hidden by the thickened arachnoid membrane.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/10. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome.In median arcuate ligament syndrome, the root of the celiac artery is compressed and narrowed by the median arcuate ligament of the diaphragm during expiration, causing abdominal angina. Aneurysm may be formed in arteries of the pancreas and duodenum due to a chronic increase in blood flow from the superior mesenteric artery into the celiac arterial region. We report a patient saved by embolization with coils of ruptured aneurysm that developed with markedly dilated anterior inferior pancreaticoduodenal artery due to median arcuate ligament syndrome.- - - - - - - - - - ranking = 514.34738108794keywords = ligament (Clic here for more details about this article) |
5/10. Percutaneous and endovascular embolization of ruptured hepatic artery aneurysm.A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic artery aneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.- - - - - - - - - - ranking = 73.478197298276keywords = ligament (Clic here for more details about this article) |
6/10. rupture of the common carotid artery after extracorporeal membrane oxygenation.The use of extracorporeal membrane oxygenation may be life saving but may result in serious complications. We report a rupture of the carotid artery secondary to fungal infection of the cannulation site in a pediatric patient requiring extracorporeal membrane oxygenation while awaiting a heart transplant. Prompt diagnosis and surgery resulted in a favorable outcome.- - - - - - - - - - ranking = 6keywords = membrane (Clic here for more details about this article) |
7/10. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management.OBJECTIVE: We report a ruptured aneurysm of the pancreaticoduodenal arteries without acute or chronic pancreatitis but associated with a median arcuate ligament division that compressed the celiac trunk, an exceptional event, thus far described in only 11 patients. We also conducted a targeted review to seek information about clinical presentation, to hasten diagnosis and assist in therapeutic management. methods: A 54-year-old man with retroperitoneal hemorrhage associated with an arcuate ligament division, documented on computed tomographic scans, underwent diagnostic arteriography and embolization to treat the bleeding aneurysm. In a second elective operation the causative arcuate ligament was sectioned to decompress the celiac artery, to prevent aneurysm recurrence. RESULTS: Embolization stopped the aneurysmal bleeding, and arteriograms showed that surgical sectioning resolved the celiac trunk stenosis. At 1-year follow-up the patient had no signs of complications or recurrence of disease. CONCLUSION: Ruptured aneurysm of the pancreaticoduodenal arteries associated with stenosis of the celiac trunk is a surgical emergency. Although a literature review disclosed no significant difference between outcomes after open surgery and radiologic arterial embolization, our experience in this case suggests immediate embolization during arteriography as the most effective treatment. Later, to prevent recurrence, the arcuate ligament should be surgically sectioned and the celiac artery stenosis treated.- - - - - - - - - - ranking = 293.91278919311keywords = ligament (Clic here for more details about this article) |
8/10. Thoracic aortic pseudoaneurysm after spine trauma in ankylosing spondylitis. Case report.Ankylosing spondylitis (AS) is a rheumatic disease characterized by consolidation of the articulating surfaces and inflammation of the vertebral column. Because of its associated spine stiffness and secondary osteoporosis, patients with this disorder are at increased risk of vertebral fractures. Ankylosing spondylitis presents a significant challenge to spine surgeons because of its complex effects on the spine, extraarticular organ manifestations, and potential neurological and functional sequelae. Traumatic thoracic and lumbar spine injuries in this patient population may be associated with injury to the aorta either due to direct mechanical trauma or to blunt forces associated with the spine fracture. This complication and association is thought to be the result of pathophysiological changes that cause the aorta to become firmly adherent to the anterior longitudinal ligament. The authors present a case of AS in a patient with a thoracic spine fracture and in whom a delayed thoracic aortic pseudoaneurysm ruptured. To the best of the authors' knowledge, only five cases of this complex condition have been reported since 1980. Recognition of the potential for aortic injury in patients with AS should prompt early investigation of the aorta in cases involving numerous fractures and assist in surgical planning to avoid this lethal injury.- - - - - - - - - - ranking = 73.478197298276keywords = ligament (Clic here for more details about this article) |
9/10. Case of recurrent macular haemorrhage after removal of a sub-internal limiting membrane haematoma secondary to retinal artery macroaneurysm.The authors report the case of an 80-year-old man with sub-internal limiting membrane haematoma secondary to retinal artery macroaneurysm in the right eye. Corrected visual acuity was 6/60 in the right eye. Vitreous surgery was performed. The internal limiting membrane over the haematoma was removed by pulling with a soft-tipped extrusion cannula, and then the haematoma was removed with a vitreous cutter. One month post surgery vision had improved to 6/9. Two months post surgery, however, the same macroaneurysm ruptured again, and vision decreased to 6/60. Clinicians should be aware that recurrent macular haemorrhage may occur after removal of sub-internal limiting membrane haematoma secondary to macroaneurysm.- - - - - - - - - - ranking = 7keywords = membrane (Clic here for more details about this article) |
10/10. Nd:YAG laser photodisruption for preretinal hemorrhage due to retinal macroaneurysm.PURPOSE: To document the clinical course of Nd:YAG laser photodisruption for eyes with preretinal hemorrhage following rupture of a retinal macroaneurysm. methods: We reviewed six eyes of five patients with preretinal hemorrhage due to retinal macroaneurysm that received Nd:YAG laser photodisruption. Nd:YAG laser created a focal opening in the anterior surface of the preretinal hemorrhage, permitting the blood to enter the vitreous cavity where it would be absorbed more rapidly. RESULTS: Three eyes showed both subhyaloid hemorrhage, which was resorbed without treatment within 2 months, and hemorrhagic detachment of the internal limiting membrane (ILM), which required Nd:YAG laser photodisruption. All eyes showed disappearance of the preretinal hemorrhage and improvement of vision within 1 week of Nd:YAG laser photodisruption. Visual recovery was less prominent in eyes associated with subretinal macular hemorrhage. CONCLUSION: Preretinal hemorrhage due to a ruptured retinal macroaneurysm could be dispersed into the vitreous cavity with Nd:YAG laser photodisruption. It should be considered in the decision of Nd:YAG laser photodisruption that the visual increment may be limited in eyes that also have subretinal hemorrhage in the macula and that the hemorrhage beneath the ILM tends to remain longer than the subhyaloid hemorrhage.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
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