Interventional radiology treatments for iatrogenic severe bleeding during percutaneous coronary interventions

Purpose: Interventional cardiology and interventional radiology are separate medical disciplines in which intra-arterial contrast media are used. Interventional cardiology has resigned from many types of treatment techniques that are now used and developed in the field of interventional radiology. In the event of iatrogenic bleeding during coronary interventions, there is an urgent need to use safe and efficient rescue procedures that are as efficient as cardiosurgery but use simpler treatment options. Serious perforations require immediate endovascular interventions. Medical history may reveal risk factors for artery perforation. Medicines, location of artery perforation, and extent of bleeding are directly associated with the prognosis. Most often, arterial perforations are due to inappropriate wire manipulation or use of oversized balloons or cutting balloons. Prolonged, artery-occluding balloon inflation, covered stent implantation, and embolisation with different agents are among the available treatment options for artery ruptures. Material and methods: A retrospective analysis was carried out among selected patients with iatrogenic vascular complications during procedures involving either coronary or non-coronary arteries. Results: Only representative cases were selected and presented in the patient subsection. Conclusions: Artery perforation during cardiac catheterisation can lead to dire consequences. To manage this complication, clinicians need pre-established procedures, adequate resources, and knowledge. Interventional radiology can be used as a salvage therapy in such cases

Adhezivna svojstva dvaju sojeva Lactobacillus i fizikalno-kemijska svojstva njihovih biosurfaktanata

The aim of this study is to describe the adhesive capability of Lactobacillus fermenti 126 and Lactobacillus rhamnosus CCM 1825 as well as to isolate and evaluate the functional properties of their synthesized biosurfactants. Fourier transform infrared spectroscopy shows that both crude biosurfactants contain three components: protein, polysaccharide and phosphate in different ratio. The crude biosurfactants synthesized by Lactobacillus fermenti 126 and Lactobacillus rhamnosus CCM 1825 contain 8 and 9 fractions analyzed by capillary gel electrophoresis. Lactobacillus fermenti 126 and Lactobacillus rhamnosus CCM 1825 strains used in this study synthesize biosurfactants with low effectiveness, critical micelle concentration of 9.0 and 6.0 g/L, and surface tension of (45.1±0.1) and (43.6±0.6) mN/m, respectively. Biosurfactant synthesized by Lactobacillus rhamnosus CCM 1825 demonstrated higher emulsifying and froth-forming activity than that obtained from Lactobacillus fermenti 126, which resulted in better antiadhesive properties. The advantageous adhesive properties of these Lactobacillus strains were confirmed. A positive effect of the impregnation of polystyrene surface with an aqueous solution of biosurfactants on the inhibition of adhesion of Escherichia coli 22, Klebsiella pneumoniae 2 and Pseudomonas aeruginosa W2 to the impregnated surface was found.Svrha je rada bila opisati adhezivna svojstva bakterija Lactobacillus fermenti 126 i Lactobacillus rhamnosus CCM 1825 i iz njih izolirati biosurfaktante, te procijeniti njihova funkcionalna svojstva. Fourierovom transformiranom infracrvenom spektroskopijom utvrđeno je da se oba biosurfaktanta sastoje od tri komponente: protein, polisaharid i fosfat u različitim omjerima. Neobrađeni biosurfaktanti iz Lactobacillus fermenti 126 i Lactobacillus rhamnosus CCM 1825 imaju 8 i 9 frakcija, koje su analizirane kapilarnom gel-elektroforezom. Biosurfaktant iz Lactobacillus fermenti 126 ima malu učinkovitost, kritičnu micelarnu koncentraciju od 9,0 g/L i površinsku napetost od (45,1±0,1) mN/m. Biosurfaktant iz Lactobacillus rhamnosus CCM 1825 također ima malu učinkovitost, kritičnu micelarnu koncentraciju od 6,0 g/L i površinsku napetost od (43,6±0,6) mN/m. Ima bolja emulgirajuća svojstva i svojstva pjenjenja, stoga bolje inhibira adheziju patogenih bakterija. Oba su soja dobro prianjala na podlogu, a impregnacijom površine od polistirena vodenom otopinom biosurfaktanata spriječena je adhezija patogenih bakterija Escherichia coli 22, Klebsiella pneumoniae 2 i Pseudomonas aeruginosa W2 na podlogu

Are type I dural arteriovenous fistulas safe? : single-centre experience of endovascular treatment of dural arteriovenous fistulas

Introduction: There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods: The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results: 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman's rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat (r = 0.59, p < 0.05), as well as the volume of contrast used (r = 0.77, p < 0.05). Infratentorial (r = 0.53, p < 0.05) and right-sided (r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome (r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows (p = 0.459) and largest outflow diameter (p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died - one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation- related complications. Conclusions: To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial

Superior ophthalmic vein and ophthalmic artery in immediate evaluation after endovascular treatment of carotid-cavernous fistulas

Purpose: To validate superior ophthalmic vein (SOV) and ophthalmic artery (OA) usefulness in immediate evaluation of new endovascular approaches to treat carotid-cavernous fistulas (CCFs). Material and methods: A retrospective review of 597 intracerebral malformation embolisations yielded 40 embolisations of CCF in the treatment of 18 patients. Two interventional radiologists performed detailed radiological angiographic assessments. Results: Mean age at initial admission was 58.9 years (SD 18.5 years, range 24-85 years). Patients presented with: chemosis (50%), ocular bruit (50%), exophthalmos (61%), diminished visual acuity (77.8%), headache (16.7%), and intracerebral haemorrhage (5.55%), and 5.55% were asymptomatic. Unilateral fistulas (10-55.5%) showed more diversified venous drainage pattern than bilateral ones (8-44.4%). There were statistically significant differences in post-traumatic and spontaneous CCF regarding age (p = 0.036), type of fistula (p = 0.0008), and presence of pseudoaneurysm (p = 0.036). 77.8% of patients had increased ipsilateral SOV diameter. SOV enlargement was not associated with type of fistula, history of trauma, or degree of exophthalmos. Ipsilateral ophthalmic artery was visible in all patients on both pre- and postprocedural angiography on lateral projection. Pre- and post-procedural SOV diameter was significantly different. Internal carotid artery patency was 100%, while the overall final angiographic or clinical success was 85.7%. We had three cases of peri-procedural complications. Conclusions: We reported changeable dynamics of SOV and OA after endovascular treatment of CCFs and proved the feasibility of coils and Onyx-18 in the treatment thereof

The use of 90Y-PET imaging in evaluation of 90Y-microspheres distribution in the liver: initial results

BACKGROUND: Selective internal radiation therapy (SIRT) with 90Y-microspheres infusion into the hepatic artery is a novel method for palliative treatment of primary and metastatic liver cancer. The post-procedural 90Y dose estimation in the liver is very difficult because direct measurement of b particles is not possible with SPECT/CT. New methods are needed to assess the 90Y-microspheres liver distribution. In the present paper we evaluate the 90Y-PET for these purposes. MATERIALS AND METHODS: A GE Discovery ST PET/CT scanner with a copper ring protected the gantry was used for images acquisition. For SPECT/CT imaging, a GE Infinia VCHWK4 with HEPG collimators was used. The liver 90Y-microspheres (SIR-Spheres, SIRTEX, Australia) dose distribution after selective internal radiotherapy treatment was evaluated in three patients (9 lesions in total). The activity of 90Y-microspheres delivered into the liver ranged from 1.0 GBq to 2.2 GBq. The correlations between liver lesions detected with 90Y-PET, 99mTc-MAA and 90-bremsstrahlung were investigated and compared with CT images obtained before and after the procedure. RESULTS: The mean T/N ratio was 2.7 in 99mTc-MAA, 2.3 in 90Y-bremsstrahlung and 3.6 in 90Y-PET. The mean 90Y absorbed dose in tumor was 133 Gy, 112 Gy, and 187 Gy, respectively. The mean liver tissue radiation was 15.5 Gy. According to RECIST criteria, one PR (mCRC) and two SD were observed (mCRC and PC). Time to progression was 217 and 117 days in two patients with mCRC and 214 days in the patient with PC. CONCLUSIONS: 90Y-PET/CT images give crucial information regarding 90Y-microspheres distribution and dosimetry and may serve as a predictor of efficiency of radioembolisation

New reactivity at the silicon bridge in sila[1]ferrocenophanes

CONCLUSION:The mT/N1 ratio, PAD, and AAD can be used as predictors of tumor response to SIRT treatment, and SPECT/CT imaging can be used for dosimetric assessment of radioembolization

Massage-induced morphological changes of dense connective tissue in rat’s tendon

The aim of the experiment was to determine if possible changes in connective tissue induced by massage could have a positive effect justifing the use of massage in all post-traumatic connective tissue conditions, e.g. tendon injuries. The investigations were performed in a group of 18 Buffalo rats. The rats were divided into two groups (experimental and control). To standardize the massage procedure, it was performed with an algometer probe of 0.5 cm2 with constant pressure force of 1 kG (9,81 N). To analyse the number and diameter of collagen fibrils, two electron micrographs were performed for each rat of the collected segments of tendons of rat tail lateral extensor muscle. After image digitalization and calibration, the measurements were carried out using iTEM 5.0 software. The number of fibrils, their diameter and area were measured in a cross-sectional area. An increase of the number of collagen fibrils was observed in the tendons of massaged animals compared to the control group. Our study demonstrated that massage may cause a beneficial effect on metabolic activity of tendon’s fibroblasts and, in consequence, may be applied for more effective use of massage for the prevention of tendon injury as well as after the injury has occurred. (Folia Histochemica et Cytobiologica 2013, Vol. 51, No. 1, 103–106