Role of angiography following aneurysm surgery

Journal ArticleThe postoperative angiograms in 66 patients who underwent craniotomy for clipping of 78 cerebral aneurysms were reviewed. Indications for urgent postoperative angiography included neurological deficit or repeat subarachnoid hemorrhage. Routine postoperative angiograms were carried out in the remaining patients. Postoperative angiograms were reviewed to determine the incidence of unexpected findings such as unclipped aneurysms, residual aneurysms, and unforeseen major vessel occlusions. Logistic regression analysis was used to test if the following were factors that predicted an unexpected finding on postoperative angiography: aneurysm site or size; the intraoperative impression that residual aneurysm was left or a major vessel was occluded; intraoperative aneurysm rupture; opening or needle aspiration of the aneurysm after clipping; or development of a new neurological deficit after surgery. Kappa values were calculated to assess the agreement between some of these clinical factors and unexpected angiographic findings. Unexpected residual aneurysms were seen in three (4%) of the 78 occlusions. In addition, three aneurysms were completely unclipped (4%); these three patients were returned to the operating room and had their aneurysms successfully obliterated. There were nine unexpected major vessel occlusions (12%); six of these resulted in disabling stroke and two patients died. Of six major arteries considered to be occluded intraoperatively and shown to be occluded by postoperative angiography, two were associated with cerebral infarction. Logistic regression analysis showed that a new postoperative neurological deficit predicted an unforeseen vessel occlusion on postoperative angiography. Factors could not be identified that predicted unexpected residual aneurysm or unclipped aneurysm. The inability to predict accurately the presence of residual or unclipped aneurysm suggests that all patients should undergo postoperative angiography. Since a new postoperative neurological deficit is one factor predicting unexpected arterial occlusion, intraoperative angiography may be necessary to help reduce the incidence of stroke after aneurysm surgery. With study of more patients or of factors not examined in this series, it may be possible to select cases more accurately for intraoperative or postoperative angiography

Health hints for your horse (1993)

One of the real disappointments of horse ownership is planning a number of horse activities, then finding that your animal is physically incapable or mentally unwilling to engage in them. Horse owners who don't practice "preventive maintenance" may find themselves in this situation. This publication describes illnesses and injuries that horse owners should mindful of

In Reply : Body Mass Index and the Risk of Poor Outcome in Surgically Treated Patients With Good-Grade Aneurysmal Subarachnoid Hemorrhage

Peer reviewe

Blister beetle management in alfalfa

"In Missouri, blister beetles are an infrequent pest of alfalfa. When present in sufficient numbers, however, the consequences can be serious. These insects cause only limited plant damage to alfalfa and soybeans. But when ingested by livestock, especially horses, the animals may become sick and even die. These insects produce a highly toxic drug called cantharidan."--First page.Wayne C. Bailey and Wilbur R. Enns (Department of Entomology), and Wayne E. Loch (Department of Animal Science, College of Agriculture)Revised 1/90/6

Blister beetle management in alfalfa (1993)

In Missouri, blister beetles are an infrequent pest of alfalfa. When present in sufficient numbers, however, the consequences can be serious. These insects cause only limited plant damage to alfalfa and soybeans. Striped blister beetle, Epicauta vittata, and other species of blister beetles, may occur in large numbers within localized areas of soybean and alfalfa fields during July and August. Rapid defoliation can occur, but the real problem with blister beetles is that they produce cantharidin, a toxin which, when ingested by horses, can cause the animals to become sick and possibly die. This publication provides some general information about blister beetles, their effect on livestock, and guidelines for reducing the number of these beetles in alfalfa

Lower entropy bounds and particle number fluctuations in a Fermi sea

We demonstrate, in an elementary manner, that given a partition of the single particle Hilbert space into orthogonal subspaces, a Fermi sea may be factored into pairs of entangled modes, similar to a BCS state. We derive expressions for the entropy and for the particle number fluctuations of a subspace of a fermi sea, at zero and finite temperatures, and relate these by a lower bound on the entropy. As an application we investigate analytically and numerically these quantities for electrons in the lowest Landau level of a quantum Hall sample.Comment: shorter version, typos fixe

Experimental evidence on the relative efficiency of forward contracting and tradable entitlements in water markets

This paper experimentally tests if adding forward trading or tradable entitlements to already commonly used spot trade in water markets improves allocation and production efficiency. We find that forward contracts significantly increase efficiency, while tradable entitlements do not. The advantage of forward contracts increases further after a climate change shock, which reduces the expected total water supply. However, tradable water entitlements are rather more damaging than beneficial. Due to the complexity involved in pricing entitlements they not only fail to increase efficiency, but are often seriously mispriced, which results in concentrated holdings and considerable wealth inequality across market participants.Ralph C. Bayer, Adam Loc

Randomized, open-label, phase 1/2a study to determine the maximum tolerated dose of intraventricular sustained release nimodipine for subarachnoid hemorrhage (NEWTON [Nimodipine Microparticles to Enhance Recovery While Reducing Toxicity After Subarachnoid Hemorrhage])

BACKGROUND AND PURPOSE—: We conducted a randomized, open-label, phase 1/2a, dose-escalation study of intraventricular sustained-release nimodipine (EG-1962) to determine safety, tolerability, pharmacokinetics, and clinical effects in aneurysmal subarachnoid hemorrhage. METHODS—: Subjects with aneurysmal subarachnoid hemorrhage repaired by clipping or coiling were randomized to EG-1962 or enteral nimodipine. Subjects were World Federation of Neurological Surgeons grade 2 to 4 and had an external ventricular drain. Cohorts of 12 subjects received 100 to 1200 mg EG-1962 (9 per cohort) or enteral nimodipine (3 per cohort). The primary objective was to determine the maximum tolerated dose. RESULTS—: Fifty-four subjects in North America were randomized to EG-1962, and 18 subjects were randomized to enteral nimodipine. The maximum tolerated dose was 800 mg. One serious adverse event related to EG-1962 (400 mg) and 2 EG-1962 dose-limiting toxicities were without clinical sequelae. There was no EG-1962-related hypotension compared with 17% (3/18) with enteral nimodipine. Favorable outcome at 90 days on the extended Glasgow outcome scale occurred in 27/45 (60%, 95% confidence interval 46%–74%) EG-1962 subjects (5/9 with 100, 6/9 with 200, 7/9 with 400, 4/9 with 600, and 5/9 with 800 mg) and 5/18 (28%, 95% confidence interval 7%–48%, relative risk reduction of unfavorable outcome; 1.45, 95% confidence interval 1.04–2.03; P=0.027) enteral nimodipine subjects. EG-1962 reduced delayed cerebral ischemia (14/45 [31%] EG-1962 versus 11/18 [61%] enteral nimodipine) and rescue therapy (11/45 [24%] versus 10/18 [56%]). CONCLUSIONS—: EG-1962 was safe and tolerable to 800 mg, and in this, aneurysmal subarachnoid hemorrhage population was associated with reduced delayed cerebral ischemia and rescue therapy. Overall, the rate of favorable clinical outcome was greater in the EG-1962-treated group. CLINICAL TRIAL REGISTRATION—: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01893190