Blister Aneurysms

Blister aneurysms are rare carotid lesions characterized by a thornlike appearance in combination with prominent fragility. Comprising less than 2% of all intracranial aneurysms, they are considered to be either dissecting or false aneurysms. Etiogenesis remains poorly understood, though atherosclerosis seems to be playing a prominent role. Although many approaches have been tried throughout the years, treatment of blister lesions remains debatable. Both surgical and endovascular modalities can be used, with every technique having though its own limitations and pitfalls. In this context, when confronted with such a lesion, physicians should consider all available alternatives in order to maximize the chances of a good outcome

May 16, 1958

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

Telemetric Monitoring of Intracranial Pressure

Background: We present the application of a modern telemetric method that records and monitors Intracranial Pressure (ICP) over long periods in patients with possible intracranial hypertension. Methods: A telemetric devise (Raumedic, Neurovent P-tel) was surgically implanted in six (6) patients. Three (3) patients with inconclusive diagnosis of idiopathic intracranial hypertension, two (2) patients with possible diagnosis of aqueduct stenosis and one (1) patient with Normal Pressure Hydrocephalus. All patients underwent a 3-day ICP recording within the nursing unit. Two more recordings were obtained over a period of 2-6 months at outpatient base. Results: All patients had an uncomplicated post-operative course. Analysis of the data excluded the diagnosis of idiopathic intracranial hypertension in two patients. Contrary in four patients data confirmed elevated ICP values and subsequently three of them underwent shunts implantation, while one patient refused further neurosurgical treatment. Conclusions: The telemetric device could be safely implanted in selected patients. It could provide long-term ICP recordings, which are necessary to confirm diagnosis and guide to the appropriate treatment

Idiopathic portal hypertension in an "inactive" HBV carrier: a case report

Idiopathic portal hypertension belongs to the group of non-cirrhotic portal hypertension, its etiology is still unknown but its prognosis is excellent. We report a case of 45 year old female with inactive hepatitis B virus (HBV) carrier status and persistently elevated alpha-fetoprotein (AFP), presented with features of portal hypertension and without evidence of cirrhosis or fibrosis on liver biopsy

Early bare-metal stent thrombosis presenting with cardiogenic shock: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although stents have improved the safety and efficacy of percutaneous coronary interventions, coronary stent thrombosis remains a serious complication.</p> <p>Case presentation</p> <p>We present the case of a 64-year-old Caucasian man from Greece, with symptoms and electrocardiographic findings suggestive of acute inferior myocardial infarction, who complained of chest pain and rapidly developed cardiogenic shock 48 hours after primary percutaneous coronary intervention.</p> <p>Conclusion</p> <p>The most common cause of early bare-metal stent thrombosis is stent malapposition. Intravascular ultrasound is the preferred method to recognize predictors of coronary events that are not detected by angiography.</p

Cytoreductive nephrectomy for synchronous metastatic renal cell carcinoma. Is there enough evidence?

Objective: To assess the role of Cytoreductive Nephrectomy for synchronous metastatic Renal Cell Carcinoma patients in the Systemic Therapy era and beyond regarding the Overall Survival, the optimal sequence between Systemic Therapy and Cytoreductive Nephrectomy and prognostic factors. Methods: The systematic review was conducted in accordance with the PRISMA guidelines. Bibliographic search was performed in Medline (PubMed), ClinicalTrials.gov, and Cochrane Library-Cochrane Central Register of Controlled Trials (CENTRAL). Studies included were those indexed from 2005 in an attempt to limit those conducted in the cytokine era. Risk of bias assessment was performed by two authors (K.S and T.L) using the Cochrane Collaborative Risk of Bias tool for randomized trials, the Cochrane Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for nonrandomized studies. Results: Cytoreductive nephrectomy was associated with improved overall survival in all but one of the observational studies. While in all of these studies the unvariable analysis showed improved overall survival in favor of the cytoreductive nephrectomy group in some studies the subgroup analysis showed no benefit. Regarding the optimal sequence, deferred cytoreductive nephrectomy demonstrated better results in more studies than upfront cytoreductive nephrectomy but a advantage was not clearly certain. In the analysis of possible prognostic factors for overall survival with cytoreductive nephrectomy, most common prognostic factors found were age (in 8 studies), tumor histology (in 7 studies), number of metastasis (in 6 studies), and T stage. Conclusions: Cytoreductive nephrectomy can still play an important role in wisely selected patients, although the role of cytoreductive nephrectomy in the new immunotherapy era needs to be defined