Developmental venous anomaly : MR and angiographic features

Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. We describe the imaging findings of this vascular anomaly in different patients and the role of different imaging modalities

Clinical Safety and Performance of GATT-Patch for Hemostasis in Minimal to Moderate Bleeding During Open Liver Surgery

Introduction: Intraoperative blood loss and postoperative hemorrhage affect outcomes after liver resection. GATT-Patch is a new flexible, pliable hemostatic sealant patch comprising fibrous gelatin carrier impregnated with N-hydroxy-succinimide polyoxazoline. We evaluated safety and performance of the GATT-Patch for hemostasis at the liver resection plane. Methods: Adult patients undergoing elective open liver surgery were recruited in three centers. GATT-Patch was used for minimal to moderate bleeding at the liver resection plane. The primary endpoint was hemostasis of the first-treated bleeding site at 3 min versus a prespecified performance goal of 65.4%. Results: Two trial stages were performed: I (n = 8) for initial safety and II (n = 39) as the primary outcome cohort. GATT-Patch was applied in 47 patients on 63 bleeding sites. Median age was 60.0 (range 25-80) years and 70% were male. Most (66%) surgeries were for colorectal cancer metastases. The primary endpoint was met in 38 out of 39 patients (97.4%; 95% confidence interval: 84.6%-99.9%) versus 65.4% (P &lt; 0.001). Of all the 63 bleeding sites, hemostasis was 82.7% at 30, 93.7% at 60, and 96.8% at 180 s. No reoperations for rebleeding or device-related issues occurred. Conclusions:When compared to a performance goal derived from state-of-the-art hemostatic agents, GATT-Patch for the treatment of minimal to moderate bleeding during liver surgery successfully and quickly achieved hemostasis with acceptable safety outcomes. (ClinicalTrials.gov Identifier: NCT04819945).</p

Functional MRI and Diffusion Tensor Imaging of Brain Reorganization After Experimental Stroke

The potential of the adult brain to reorganize after ischemic injury is critical for functional recovery and provides a significant target for therapeutic strategies to promote brain repair. Despite the accumulating evidence of brain plasticity, the interaction and significance of morphological and physiological modifications in post-stroke brain tissue remain mostly unclear. Neuroimaging techniques such as functional MRI (fMRI) and diffusion tensor imaging (DTI) enable in vivo assessment of the spatial and temporal pattern of functional and structural changes inside and outside ischemic lesion areas. This can contribute to the elucidation of critical aspects in post-stroke brain remodeling. Task/stimulus-related fMRI, resting-state fMRI, or pharmacological MRI enables direct or indirect measurement of neuronal activation, functional connectivity, or neurotransmitter system responses, respectively. DTI allows estimation of the structural integrity and connectivity of white matter tracts. Together, these MRI methods provide an unprecedented means to (a) measure longitudinal changes in tissue structure and function close by and remote from ischemic lesion areas, (b) evaluate the organizational profile of neural networks after stroke, and (c) identify degenerative and restorative processes that affect post-stroke functional outcome. Besides, the availability of MRI in clinical institutions as well as research laboratories provides an optimal basis for translational research on stroke recovery. This review gives an overview of the current status and perspectives of fMRI and DTI applications to study brain reorganization in experimental stroke models

Persistent facial swelling and tinnitus complicating septorhinoplasty

Septorhinoplasty (SRP) is commonly performed for correcting nasal bony and cartilaginous deformities. Traumatic arteriovenous fistula (AVF) is often seen at specific anatomic locations and has rarely been associated to SRP. We report such an unusual case where an AVF developed from a terminal branch of the facial artery. After septorhinoplasty a patient reported pulsatile tinnitus, starting one day after surgery. Swelling on the left side of the nasal pyramid was still present two weeks after the procedure. Clinically, a traumatic AVF was suspected which was confirmed by subsequent Doppler ultrasound examination and angiography. The lesion had developed an important venous pouch and arterial contribution was from the internal carotid as well as external carotid system bilaterally. Complete resection was done by external approach

Developmental venous anomaly : MR and angiographic features

Developmental venous anomaly (DVA) is probably the most common anomaly of the intracranial vasculature. DVAs consist of multiple, radially oriented dilated medullary veins that converge into a transcerebral vein. We describe the imaging findings of this vascular anomaly in different patients and the role of different imaging modalities

Platelet-rich plasma in mono-segmental posterior lumbar interbody fusion

INTRODUCTION: The results of platelet-rich plasma (PRP) in spinal fusion applications are limited and controversial. Both beneficial and inhibitory effects have been shown. In this prospective randomised controlled trial, our objective was to assess both the clinical and radiological effect of PRP when added to autograft iliac crest bone in posterior lumbar interbody fusion. METHODS AND MATERIALS: Forty patients were recruited for the study fulfilling strict entry requirements and were randomised with a 1:1 ratio. In each group, one patient was lost to follow-up. Thirtyeight patients completed the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form 36 (SF-36) preoperatively and postoperatively at 3, 6, 12, and 24 months, respectively. CT-scans of the lumbar spine were taken at 3, 6, and 12 months. Posterior stabilisation was achieved with pedicle screws and interbody fusion was aimed at with carbon cages filled with autologous bone. RESULTS: Baseline demographic data (age, sex, smoking history, preoperative outcome measures) showed no relevant difference between groups. For patients who received autograft only, the mean VAS improved by 4.0 points (p < 0.01), mean ODI improved by 32.1 points (p < 0.001), and mean SF-36 showed statistically significant improvement in each of the eight domains and in the physical (p < 0.001) and mental (p < 0.001) component summary measures. For patients who received autograft with PRP, the mean VAS improved by 4.92 points (p < 0.01), mean ODI improved by 30 points (p < 0.001), and mean SF-36 showed statistically significant improvement in six of the eight domains (p < 0.02) and in the physical (p = 0.016) and mental (p < 0.001) component summary measures. The improvement of the VAS score and the physical component summary score was more pronounced in patients who received autograft with PRP. These differences were, however, not statistically significant. CT-scans showed uneventful osseous healing in all but one patient with no difference between groups. CONCLUSION: In this prospective randomised controlled clinical and radiological trial, adding PRP in posterior lumbar interbody fusion did not lead to a substantial improvement or deterioration when compared with autologous bone only. No inhibitory effect of PRP was observed on CT-scans. From a clinical and radiological point of view, the use of PRP seems to be justified in posterior lumbar interbody fusion surgery. From an economical point of view, the expense of using PRP cannot be justified until statistical significance can be reached in a larger study