Repeating enlargement, recanalisations, and subarachnoid haemorrhages after middle cerebral artery aneurysm embolisation using pCONus stent and coils : a case report

Purpose: Large and wide-necked bifurcation aneurysms remain technically challenging to treat by the endovascular approach. Several endovascular strategies have been established in recent years for treating wide-necked bifurcation aneurysms, such as balloon-assisted coiling, stent-assisted coiling, waffle cone technique (WCT), and intrasaccular flow disruptors. Case report: A 64-year-old woman was diagnosed with three intracranial aneurysms of the right and left middle cerebral artery and right internal carotid artery. She was qualified for endovascular treatment of the left middle cerebral artery (LMCA) aneurysm because it posed the greatest risk of rupture. Due to complicated morphology, a pCONus stent and coils were chosen for treatment. Three months later the right middle cerebral artery aneurysm was embolised and the woman was scheduled for second-stage treatment of the LMCA aneurysm. One week before the planned admission the woman was diagnosed with subarachnoid haemorrhage (SAH) in the region of the previously treated LMCA aneurysm, and the second-stage treatment was conducted with a good result. The woman was discharged in improved condition. Three months later the woman was once again admitted with SAH - an enlarged LMCA aneurysm was observed and immediate third-stage embolisation was performed, but due to complications of SAH the woman eventually died. Conclusions: On the basis of the presented case we would like to emphasise the importance of sufficient initial coil packing and frequent control of neck region of the aneurysm for the long-term stability and safety after pCONusassisted coiling of intracranial aneurysms

Bilateral thalamic stroke after tonsillectomy in patient with collateral extracranial anastomosis : case report

Haemorrhage remains the most frequent and serious complication of tonsillectomy. When bleeding is recurrent, gushing, and ceases spontaneously, pseudoaneurysm of the injured artery in the proximity of the tonsillar bed should be suspected. Haemorrhage related to pseudoaneurysm occurs most commonly in the first 30 days after surgery. It can sometimes be excessive and requires a revision procedure such as external carotid artery (ECA) ligation or embolisation. During those procedures, ECA should be checked for possible anastomoses, otherwise the bleeding may persist despite the intervention. We report an unusual case of a patient with recurrent post-tonsillectomy haemorrhage due to pseudoaneurysm of the facial artery, which persisted after ECA ligation because of the presence of collateral occipital-vertebral anastomosis. Due to the recurrence of bleeding episodes, endovascular treatment was implemented. However, the embolisation was complicated by bilateral thalamic stroke with unclear mechanism. This case highlights the importance of anastomosis between ECA and the vertebrobasilar system, both in recurrence of significant post-tonsillectomy bleeding and in potential thromboembolic complications. Therefore, ECA ligation should always be accompanied by exclusion of possible anastomoses. In cases of non-life-threatening bleeding, embolisation seems to be the proper and more selective therapy

Intra-arterial computed tomography angiography with ultra-low volume of iodine contrast and stent implantation in transplant renal artery stenosis in terms of contrast-induced kidney injury : a preliminary report

Purpose: Traditional digital subtraction angiography is still regarded as the gold standard in the diagnostics of transplant renal artery stenosis (TRAS). However, this procedure requires a high volume of iodine contrast medium for optimal visualisation of the renal artery. The aim of this study was to analyse both the usefulness and the safety of intra-arterial computed tomography angiography (IA-CTA) with ultra-low-volume iodine contrast administration in the diagnostic and therapeutic management of TRAS in patients with impaired renal transplant function. Material and methods: Thirty-three patients with a suspicion of TRAS based on Doppler-ultrasound and clinical setting underwent IA-CTA with ultra-low iodine contrast volume. A special, author-elaborated CTA protocol was used. The volume of 8-18 ml of diluted iodine contrast medium was administered through a catheter with the tip placed 2 cm below the aortic bifurcation. Results: In six patients the CTA examinations revealed TRAS in three configurations: in the anastomosis, in the trunk (critical and high-grade), or in both sections. Stenoses were treated with primary stenting obtaining favourable anatomical outcome. No intervention-related complications were observed. No contrast-induced acute kidney injury was diagnosed in this study. Mean serum creatinine concentration was 2.93 ± 0.89 mg/dl at the baseline and 2.89 ± 1.73 mg/dl and 2.17 ± 0.51 mg/dl after three and seven days from IA-CTA, respectively. Conclusions: Intra-arterial CTA with ultra-low volume of iodine contrast seems to be a safe and reliable diagnostic tool to detect and assess TRAS in the aspect of stent implantation. Application of this imaging modality eliminates the need for a high volume of iodine contrast and thus does not adversely influence renal transplant function

Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Linguistic interference in translation between Polish and Swedish concerning Swedish fundament

Analiza materiału badawczego pod kątem relacji pozycji struktur inicjalnych w zdaniach szwedzkich i polskich względem siebie udowadnia występowanie w procesie przekładu zjawiska interferencji, o czym świadczy globalny, 63-procentowy poziom adekwatności pomiędzy lokalizacją szwedzkich fundamentów i ich polskich odpowiedników.Badania kontrastywne, które w niniejszej pracy stanowią punkt wyjścia dla badań nad procesem przekładu, pozwalają zauważyć, że najdłuższe pod względem liczby wyrazów ekwiwalenty szwedzkich fundamentów zajmują dokładnie te same otwierające pozycje zdań w tekście źródłowym. Na tej podstawie udało się zweryfikować hipotezę zawartą w celu pracy, mianowicie że w translacji to język wyjściowy polski w znacznym stopniu determinuje składnię języka szwedzkiego. Wybrane fragmenty obu tekstów jednoznacznie wskazują na to, że interferencja, będąca wypadkową pracy tłumacza, skutkuje nie jedynie transferem pozycji inicjalnych członów źródłowych. Siła jej oddziaływania prowadzi do podporządkowania tekstu docelowego względem tekstu wyjściowego, co skutkować może nawet stylizowaniem składni zdania docelowego tak, by przywodziła ona na myśl składnię powszechnie występującą w zdaniu źródłowym. Pozwala to otworzyć debatę na temat wpływu jęzka polskiego na fudamenty szwedzkie, a niezaprzeczalnie założyć, że interferencja jest zjawiskiem naturalnym, wpisanym w kontekst kontaktu dwóch języków w umyśle produkującego tekst. Na tej podstawie właśnie można rozpatrywać transfer struktur i prawo interferencji jako narzędzia uniwersalnej polityki tłumaczeniowej, czy innymi słowy uniwersaliów tłumaczeniowych.Nie bezzasadnie eksploruje się różne kierunki oraz kategorie działania interferencji i związanego z nim prawa, ponieważ rozgraniczenie pomiędzy językiem pierwszym i drugim (adekwatnie źródłowym i docelowym) nie musi być oczywiste. Wyniki niniejszych badań wskazują na to, iż interferencja językowa zauważalna była przede wszystkim na poziomie S2 w kierunku S1, przy założeniu, że notacja ta odnosi się kolejno do systemów języków drugiego oraz ojczystego tłumacza.Nie wolno zapominać, że w kontekście podobnych badań, a w szczególności tych posługujących się metodologią korpusową, należy wyraźnie sprecyzować, które struktury przyjmuje się jako wzajemnie ekwiwalentne oraz w jaki sposób ekwiwalencja na płaszczyźnie syntaktycznej rozumiana jest przez badacza. Składnia zdania sugeruje występowanie określonego porządku pomiędzy członami będącymi jego składowymi, dlatego kwestie zrozumienia związków strukturalnych zdań wszystkich porównywanych języków oraz uściślenia definicji ekwiwalencji strukturalnej pomiędzy językami stają się niebagatelnej wagi.This essay concentrates on confrontational methods in translation between Polish and Swedish. The purpose of this study is to investigate the influence of linguistic interference on the character of Swedish fundament in case of a Polish-Swedish translation. The investigation focuses on verifying the hypothesis that the source language (Polish) determines the target language’s (Swedish) syntax.The essay is divided into two parts. The theoretical part addresses the problems posed by contrastive linguistics, the question of a relationship between translation and contrastive linguistics, and descriptions of terms such as interference and fundament. The results based on a language material derived from Maria Renata Mayenowa's literary article "Teoria tekstu a tradycyjne zagadnienia poetyki" and its Swedish translation by Gösta Lavén and Jerzy de Kamiński are presented in the empirical section.Language material was analyzed using two linguistic methods, ie. the one-way comparative method, as well as the inductive method. The first method is used to identify similarities and differences between compared languages. The inductive method is based on analyzing individual cases, which results in formulating more universal conclusions about the types of phenomena. Tertium comparationis that serves as a link between two languages while making a description of a particular language category is translational equivalence.Toury's (1995) law of interference means that while a text is translated, there arises a tendency of reflecting phenomena that are linked to the semantic and syntactic levels of a source language text. The analysis shows that the positioning of fundaments’ equivalents in the source language sentences is the same for the most fundaments in the target language text. The research also proves that the stylistic requirements of the source language determine the organization of the target text by adapting it to the stylistic level of the translated text. Moreover, the analysis carried out in this essay leads to a conclusion that the translator's second language (translation’s source language) is dominant in the translation process. It influences the translation’s target language even though the translator's proficiency in their first language is higher

Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia

Purpose: Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis. Material and methods: Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacrylate glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization. Results: The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 (p < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation (r = 0.8, p < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time – 27.0 vs. 7.2 days (r = 0.66, p < 0.05). Conclusions: Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate

Intraarterial CT angiography using ultra low volume of iodine contrast : own experiences

BACKGROUND: High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages. MATERIAL AND METHODS: Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1-2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6-8 mL of Iodixanol (320 mg/mL) diluted with saline to 18-24 mL was administered at a speed of 4-5 mL/s. RESULTS: Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. CONCLUSIONS: 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy

Background: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. Material/Methods: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm3 (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. Results: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. Conclusions: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV

Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device

International audienceBackground: The use of flow diversion to treat intracranial aneurysms has increased in recent years.Objective: To assess the safety and angiographic efficacy of the p64 flow modulation device.Methods: Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers. The p64 flow modulation device was used to treat anterior circulation aneurysms between December 2015 and January 2019. The primary safety endpoint was the incidence of major stroke or neurologic death at 3-6 months, with the primary efficacy endpoint being complete aneurysm occlusion (Raymond-Roy Occlusion Classification 1) on follow-up angiography.Results: A total of 420 patients met the eligibility criteria and underwent treatment with the p64 flow modulation device (mean age 55±12.0 years, 86.2% female). Mean aneurysm dome width was 6.99±5.28 mm and neck width 4.47±2.28 mm. Mean number of devices implanted per patient was 1.06±0.47, with adjunctive coiling performed in 14.0% of the cases. At the second angiographic follow-up (mean 375±73 days), available for 343 patients (81.7%), complete aneurysm occlusion was seen in 287 (83.7%) patients. Safety data were available for 413 patients (98.3%) at the first follow-up (mean 145±43 days) with a composite morbidity/mortality rate of 2.42% (n=10).Conclusions: Diversion-p64 is the largest prospective study using the p64 flow modulation device. The results of this study demonstrate that the device has a high efficacy and carries a low rate of mortality and permanent morbidity

Mechanical thrombectomy in acute stroke : five years of experience in Poland

Objectives: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250 99 min. 90.3% of the studied patients had MT within 6 h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0–2 - in 31.4% and mRS of 6 in 22% of cases. Conclusion: Our results can help harmonize standards for MT in Poland according to international guideline