Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV):Randomised sham controlled clinical trial

Objective To assess whether percutaneous vertebroplasty results in more pain relief than a sham procedure in patients with acute osteoporotic compression fractures of the vertebral body. Design Randomised, double blind, sham controlled clinical trial. Setting Four community hospitals in the Netherlands, 2011-15. Participants 180 participants requiring treatment for acute osteoporotic vertebral compression fractures were randomised to either vertebroplasty (n=91) or a sham procedure (n=89). Interventions Participants received local subcutaneous lidocaine (lignocaine) and bupivacaine at each pedicle. The vertebroplasty group also received cementation, which was simulated in the sham procedure group. Main outcome measures Main outcome measure was mean reduction in visual analogue scale (VAS) scores at one day, one week, and one, three, six, and 12 months. Clinically significant pain relief was defined as a decrease of 1.5 points in VAS scores from baseline. Secondary outcome measures were the differences between groups for changes in the quality of life for osteoporosis and Roland-Morris disability questionnaire scores during 12 months’ follow-up. Results The mean reduction in VAS score was statistically significant in the vertebroplasty and sham procedure groups at all follow-up points after the procedure compared with baseline. The mean difference in VAS scores between groups was 0.20 (95% confidence interval −0.53 to 0.94) at baseline, −0.43 (−1.17 to 0.31) at one day, −0.11 (−0.85 to 0.63) at one week, 0.41 (−0.33 to 1.15) at one month, 0.21 (−0.54 to 0.96) at three months, 0.39 (−0.37 to 1.15) at six months, and 0.45 (−0.37 to 1.24) at 12 months. These changes in VAS scores did not, however, differ statistically significantly between the groups during 12 months’ follow-up. The results for secondary outcomes were not statistically significant. Use of analgesics (non-opioids, weak opioids, strong opioids) decreased statistically significantly in both groups at all time points, with no statistically significant differences between groups. Two adverse events occurred in the vertebroplasty group: one respiratory insufficiency and one vasovagal reaction. Conclusions Percutaneous vertebroplasty did not result in statistically significantly greater pain relief than a sham procedure during 12 months’ follow-up among patients with acute osteoporotic vertebral compression fractures

Hypofysehyperplasie bij primaire hypothyreodïe

Contains fulltext : 26026___.PDF (publisher's version ) (Open Access

Image based hemodynamic modelling of cerebral aneurysms and the determination of the risk of rupture

This paper is about the quantitative prediction of the long term outcome of the endovascular coiling treatment of a patient's cerebral aneurysm. It is generally believed that the local hemodynamic properties of the patient's cerebral arteries are strongly influencing the origin and growth of aneurysms. We describe our approach: modelling the flow in a 3D Rotational Angiography (3DRA) reconstruction of the aneurysms including supplying and draining blood vessels, in combination with simulations and experiments of artificial blood vessel phantom constructs and measurements. The goal is to obtain insight in the observed phenomena to support the diagnostic decision process in order to predict the outcome of the intervention with possible simulation of the flow alternation due to the pertinent intervention

Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results.

Item does not contain fulltex

Coiling of ruptured pericallosal artery aneurysms.

Item does not contain fulltextOBJECTIVE: To assess the technical feasibility of treating ruptured pericallosal artery aneurysms with detachable coils and to evaluate the anatomic and clinical results. METHODS: Over a period of 27 months, 12 patients with a ruptured pericallosal artery aneurysm were treated with detachable coils. A retrospective review was performed to assess the clinical and angiographic results. The three men and nine women had a mean age of 46.6 years (range, 35-75 yr). Seven patients presented in Hunt and Hess Grade II, three in Grade III, and two in Grade IV. Six patients had a concomitant intracerebral hematoma, and four had at least one additional aneurysm. RESULTS: In all 12 patients, the pericallosal aneurysm could be reached with a microcatheter and the coils delivered. No procedure-related complications occurred. Angiography demonstrated that the initial occlusion was complete in 11 aneurysms and near-complete in 1. At follow-up angiography at 6 months, one aneurysm had become partially recanalized owing to coil compaction. At a mean clinical follow-up of 9.2 months, 11 patients had an excellent outcome and one patient had mild hemiparesis and aphasia. CONCLUSION: Coiling of ruptured pericallosal artery aneurysms can be considered an alternative to surgical clipping

Coiling of saccular basilar trunk aneurysms.

Item does not contain fulltex