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

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

The Influence of Tobacco Smoke on Protein and Metal Levels in the Serum of Women during Pregnancy

<div><p>Background</p><p>Tobacco smoking by pregnant women has a negative effect on fetal development and increases pregnancy risk by changing the oxidative balance and microelements level. Smoking affects the concentration, structure and function of proteins, potentially leading to various negative effects on pregnancy outcomes.</p><p>Methodology/Principal Findings</p><p>The influence of tobacco smoke on key protein fractions in smoking and non-smoking healthy pregnant women was determined by capillary electrophoresis (CE). Concentrations of the proteins α1-antitrypsin, α1-acid glycoprotein, α2-macroglobulin and transferrin were determined by ELISA tests. Total protein concentration was measured by the Biuret method. Smoking status was established by cotinine levels. Cadmium (Cd) and Zinc (Zn) concentrations were determined by flame atomic absorption spectrometry and the Zn/Cd ratio was calculated based on these numbers. Smoking women had a 3.7 times higher level of Cd than non-smoking women. Zn levels decreased during pregnancy for all women. The Zn/Cd ratio was three times lower in smoking women. The differences between the changes in the protein profile for smoking and non-smoking women were noted. Regarding proteins, α1-antitrypsin and α2-macroglobulin levels were lower in the non-smoking group than in the smoking group and correlated with Cd levels (r = -0.968, p = 0.032 for non-smokers; r = −0.835, p = 0.019 for smokers). Zn/Cd ratios correlated negatively with α1-, α2- and β-globulins.</p><p>Conclusions/Significance</p><p>Exposure to tobacco smoke increases the concentration of Cd in the blood of pregnant women and may lead to an elevated risk of pregnancy disorders. During pregnancy alter concentrations of some proteins. The correlation of Cd with proteins suggests that it is one of the causes of protein aberrations.</p></div

Concentration of serum protein fractions in the blood of women during pregnancy.

<p>Concentration of serum protein fractions in the blood of women during pregnancy.</p

Concentration of α1-antitrypsin, α2-macroglobulin, α1-acid glycoprotein and total protein concentration in the serum of women during each trimester of pregnancy.

<p>Concentration of α1-antitrypsin, α2-macroglobulin, α1-acid glycoprotein and total protein concentration in the serum of women during each trimester of pregnancy.</p

Clinical characteristics of and blood metal concentrations in pregnant women.

<p>Clinical characteristics of and blood metal concentrations in pregnant women.</p

Exemplary profiles of the serum proteins of smoking (A) and non-smoking (B) women during pregnancy.

<p>Exemplary profiles of the serum proteins of smoking (A) and non-smoking (B) women during pregnancy.</p

Correlations between the concentrations of total protein, serum proteins, α1-antitrypsin, α1-acid glycoprotein, α2-macroglobulin, transferrin, with the Zn/Cd ratio and cotinine, Cd, and Zn concentrations in pregnant smoking women [n = 10] in the 3rd trimester of pregnancy.

<p>Correlations between the concentrations of total protein, serum proteins, α1-antitrypsin, α1-acid glycoprotein, α2-macroglobulin, transferrin, with the Zn/Cd ratio and cotinine, Cd, and Zn concentrations in pregnant smoking women [n = 10] in the 3rd trimester of pregnancy.</p

Metals concentration (A—cadmium; B—zinc) and Zn/Cd ratio (C) in smoking and non-smoking women during pregnancy.

<p>^{<b>1, 2,3</b>}<b>significant</b> (p < 0.04) for the Zn in the same group to the other trimester (e.g. ¹S group in the 1^st trimester has higher level of Zn than in the 3^rd trimester). <b>*</b>^<b>-</b><b>*** significant</b> (p < 0.02) for the same parameter in the same trimester for different smoking group (e.g. *S group in the 1^st trimester has higher level of Cd than NS group in the same trimester).</p