The use of mechanical thrombectomy in the treatment of basilar artery occlusion – case report

Occlusion of the basilar artery (BAO) is a rare cause of stroke, making up approximately 1% of all cases. Ischemic stroke within the basilar artery is associated with serious complications and high mortality (75–91%). BAO may occur initially in the form of mild prodromal symptoms with neurological disorders, the consequences of which can lead to death. For these reasons, BAO requires rapid diagnosis and treatment. We report the case of a 26-year-old man who suffered basilar artery occlusion and was treated with endovascular therapy. The patient was disqualified from intra-venous thrombolysis and endovascular treatment due to exceeding the therapeutic time window. Despite this, due to the location of ischemia and age of the patient, it was decided to proceed with a mechanical thrombectomy (TM). Vessel patency was restored using the Solitaire FR stent. Treatment continued with antiplatelet therapy. Despite a significant overshoot of the time window the procedure was successful and complete recanalization was achieved. During hospitalization, significant neurological symptom reductions were observed. There is no accurate data on which method of treatment of ischemic stroke is best for BAO. Expectations about the effectiveness of endovascular techniques are high

Biliary duct obstruction treatment with aid of percutaneous transhepatic biliary drainage

AbstractIntroductionPercutaneous Transhepatic Biliary Drainage (PTBD) is a procedure indicated in patients with non-operative lesions, when endoscopic application of prosthesis is impossible due to anatomic reasons, complications or severe general condition of patient. Most often it is a palliative procedure, aiming for live-quality improvement, although not altering prognosis of basic disease.AimThis study presents own experience in biliary drainage with the aid of percutaneous transhepatic method and simultaneous assessment of method effectiveness and safety. The aim was to assess outcomes and complications of PTBD in a large group of patients.Materials and methodIn time period 2007–2014, 167 patients hospitalized in Radiodiagnostics and Radiology Department of Clinical Hospital, were investigated retrospectively. PTBD procedure was applied to patients with biliary tract obstruction. In total 186 procedures of percutaneous drainage were applied. Average age of patients was 63.6years. Bilirubin, alkaline phosphatase and gamma-glutamyl transferase were measured before and after procedure. All data were analyzed statistically.ResultsIn examined group percutaneous drainage was successful in 90.7% interventions. In 8.1% procedures drainage application was ineffective. The most common complication during procedure was hemobilia (3.2%) and the long term complication was drain dislocation (2.7%). The mean bilirubin levels declined from 397.06μmol/l before drainage to 297.88μmol/l after drainage (p<0.05).ConclusionsPTBD is an effective method of biliary tract decompression and it is an important alternative to endoscopic drainage. This method is indicated in patients with neoplastic obstruction of biliary tract with low expected survival rate and thus is a palliative procedure

Endovascular treatment of acute ischemic stroke – Own experience

Objective Presentation of the own experience in the treatment of ischemic stroke using endovascular methods of simultaneous evaluation of their effectiveness and safety. Materials and methods The retrospective study involved a group of 18 patients hospitalized in 2005–2012 who were treated with intraarterial thrombolysis and mechanical thrombectomy. Overall there were 24 procedures performed. The investigated group consisted of seven (38.89%) women and 11 (61.11%) men. The average age of the patients was 60 years (SD±17, median – 60 years). Results In 62.50% of cases (n=15) the effect of revascularization has been achieved and another 12.50% of cases (n=3) recanalization was achieved only partially. Only in 25% of procedures (n=6) failed to achieve recanalization of the artery (TICI≤1). The highest percentage of recanalized arteries were obtained by following the procedure of thrombolysis targeted – 69.24% (TICI≥2b). In the case of mechanical thrombectomy total patency (TICI≥2b) was 54.55%. The average duration of treatment (operation) is 157min. After 30 days successful result of the neurological status was achieved in 57.14% of patients (n=8). Full return to independent functioning as defined within 3 months after the surgery (mRS≤2) reached 57.14% of patients (n=8). Conclusion Studies suggest that endovascular techniques are effective and safe in the treatment of ischemic stroke. Greater efficiency is characterized by intraarterial thrombolysis. Patients who were treated endovascular improved significantly

Badanie różnic w zdolności konwergencji gałek ocznych u osób po zabiegu fakoemulsyfikacji oraz u osób z własną soczewką

INTRODUCTION: The aim of this study was to determine whether convergence varies with age and pseudophakia. MATERIAL AND METHODS: 86 patients, aged 21–85 (average age: 62.7) years were included in the study group: 39 patients with binocular pseudophakia and 41 with their own lens, as well as 68 people with their own lens, at the age of 19–25 (average 22.1) years. Examinations were carried out at distances of 50 and 10 cm, and for distant vision. Interpupillary distance measurements were used to calculate the difference of convergence capabilities. The exami-nation results of phakic and pseudophakic eyes were compared. RESULTS: The mean convergence of the pseudophakic patients was 3.52 mm (± 0.42 mm), in the patients with their own lens: 3.46 (± 0.74 mm). No statistically significant differences between the groups were found. No statistically significant difference was found in the mean convergence between the two groups of patients aged 19–25 (group 1) and over 65 years (group 2), either. The average value of convergence in group 1 was 3.47 mm (3.84–2.93 mm). Ho-wever, in the second group the values were 3.46 mm (3.96–2.48 mm). There was no evidence of statistical differences in the average value of convergence in both groups for distances of 50 cm and 10 cm. CONCLUSIONS: Convergence does not depend on age. Presbyopia does not lead to a loss of convergence in phakic or pseudophakic eyes.WSTĘP: Celem badania było stwierdzenie, czy konwergencja zależy od wieku i pseudofakii. MATERIAŁ I METODY: Do grupy badanej włączono 86 pacjentów w wieku 21–85 lat (średnia: 62,7): 39 pacjentów z obuoczną pseudofakią, 41 z własną soczewką oraz 68 osób z własną soczewką w wieku 19–25 lat (średnia 22,1). Badanie zostało wykonane w odległości 50 i 10 cm oraz dla spojrzenia w dal. Wykorzystując uzyskane pomiary rozstawu źrenic, obliczono różnicę zdolności konwergencji oraz porównano obie grupy badanych. WYNIKI: Średnia wartość konwergencji u pacjentów z pseudofakią wyniosła 3,52 mm (± 0,42 mm), a w grupie pacjentów z własną soczewką 3,46 mm (± 0,74 mm). Na podstawie przeprowadzanych analiz nie stwierdzono istotnych statystycznie różnic pod względem średniej konwergencji pomiędzy grupami pacjentów w wieku od 19 do 25 lat (grupa 1.) i powyżej 65 lat (grupa 2). Średnia wartość konwergencji w grupie 1. wynosiła 3,47 mm (maksymalna 3,84 mm, minimalna 2,93 mm). Natomiast w grupie 2 – 3,46 mm (maksymalna 3,96 mm, minimalna 2,48 mm). Średnia wartość konwergencji przy patrzeniu na przedmiot znajdujący się w odległości 50 cm i 10 cm różniła się istotnie statystycznie pomiędzy badanymi grupami. WNIOSKI: Dane z uzyskanych analiz statycznych pozwalają stwierdzić, że konwergencja nie zależy od wieku oraz starczowzroczność, nie prowadzi do utraty zdolności konwergencji w oczach fakijnych i pseudofakijnych