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Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
A CT scan of the brain followed by a lumbar puncture, if the scan is negative, are the mainstay investigations. A lumbar puncture should not be performed in cases of elevated intracranial pressure, hydrocephalus or intracranial mass and it helps to determine the presence of red blood cells and xanthochromia. Cerebral angiography should be performed in patients with a subarachnoid haemorrhage to determine the presence and anatomical features of aneurysmal formation. In cases where cerebral angiography cannot be performed, magnetic resonance angiography and computed tomography angiography should be considered.
Endarterectomy for Asymptomatic Carotid Artery Stenosis
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Study Impact With the publication of ACAS, the prior VA study, and subsequent ACST trial, the relatively common practice of offering carotid endarterectomy (CEA) to patients with “high-grade” asymptomatic carotid stenosis now had level 1 evidence to support that practice. The number of CEAs performed in the United States rapidly exceeded 100,000/year with more than 90% being performed in asymptomatic patients. With development of duplex scanning, more and more patients were being offered CEA using that diagnostic parameter alone. With the development of magnetic resonance angiography (MRA) and computed tomographic angiography (CTA), the list of noninvasive imaging options has widened. Unfortunately, this has led to CEA being overused beyond what was justified based upon ACAS. The threshold carotid stenosis in ACAS was a 60% diameter reducing lesion as documented by contrast angiography. Using duplex scanning, that usually meant that it would need to fall into the category 80%–99% stenosis or a peak systolic velocity of at least 230 cm/sec and an ICA/CC ratio of at least 4. The average clinician who sees a duplex scan report stating that there is a 60%–79% lesion present assumes that this also corresponds to a similar percent stenosis as measured by contrast angiography, when it clearly does not. Likewise, MRA also tends to overread percent stenosis as does CTA.
Standard autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
Although not essential, imaging provides a roadmap to the largest perforators and can lead to faster intraoperative decision-making. Various vascular imaging modalities including duplex Doppler, computed-tomography angiography, and magnetic resonance angiography have been used19 (Figure 22.5.6). However, these are expensive, time-consuming procedures and are not without risk. Computed-tomography angiography specifically exposes the patient to significant radiation doses and carries a carcinogenic risk.20
Place in therapy of anti-IL-17 and 23 in psoriasis according to the severity of comorbidities: a focus on cardiovascular disease and metabolic syndrome
Published in Expert Opinion on Biological Therapy, 2022
Emanuele Trovato, Pietro Rubegni, Francesca Prignano
Along this line, studies demonstrated a protective role of anti-IL-17 mAbs. A recent prospective observational study analyzed 290 patients to characterize coronary arterial plaque before and after biological therapy with anti-TNF, anti-IL-12/23, and anti-IL-17 [14]. Patients were studied with computed tomography angiography (CCTA) in a 52-week follow-up period. The results highlighted a reduction in the extension of coronary and non-calcified plaque after 1 year of treatment with biologics with concomitant significant reduction of the fibro-lipid and of the necrotic part. Reduction in coronary plaque extension was significantly greater with anti-IL-17 than anti-IL-12/23, and non-calcified plaque extension reduction was about 5% with anti-TNF, 12% with anti-IL-17, and 2% with anti-IL-12/23 [15].
Internal maxillary artery to middle cerebral artery bypass for a complex recurrent middle cerebral artery aneurysm: case report and technical considerations
Published in British Journal of Neurosurgery, 2022
Ronan J. Doherty, Daragh Moneley, Paul Brennan, Mohsen Javadpour
Preoperatively the patient underwent computed tomographic angiography (CTA) of the head which was used for intraoperative navigation and localisation of the IMAX (Figure 2). Under general anaesthesia, the patient was positioned supine, with the head in the Mayfield head holder and rotated approximately 45 degrees towards the contralateral side. The previous left frontotemporal incision and pterional craniotomy were reopened. The temporalis muscle was reflected inferiorly and a zygomatic arch osteotomy was performed. Under the operating microscope, a temporal fossa craniectomy was performed consisting of removal of bone of the lateral part of middle cranial fossa floor extending medially as far as a line connecting the foramen rotundum and foramen ovale (Figures 3 and 4). The left IMAX was localised in the infratemporal fossa using a combination of CTA-based neuronavigation and micro-Doppler probe (Mizuho Inc. Tokyo, Japan) (Figure 5). In addition, the deep temporal arteries in the deep aspect of the temporalis muscle were followed proximally to lead to the location of the IMAX.
Association between platelet counts and morbidity and mortality after endovascular repair for type B aortic dissection
Published in Platelets, 2022
Enmin Xie, Jitao Liu, Yuanhui Liu, Yuan Liu, Ling Xue, Ruixin Fan, Nianjin Xie, Huanyu Ding, Binquan Hu, Lyufan Chen, Xinyue Yang, Fan Yang, JianFang Luo
Between January 2010 to December 2017, 992 consecutive patients with TBAD who underwent TEVAR were identified from the prospectively maintained database at Guangdong Provincial People’s Hospital (Guangdong, China). Patients were diagnosed by contrast-enhanced computed tomography angiography (CTA) according to the criteria of Stanford classification [3]. Subjects were excluded for the following reasons: 1) previous aortic surgery; 2) malignant tumor; 3) connective diseases; 4) traumatic aortic dissection; 5) missed pre- or postoperative platelet records; 6) missed pre- or postoperative serum creatinine records; 7) other known causes of preoperative thrombocytopenia, including hypersplenism, idiopathic thrombocytopenic purpura, and myelodysplastic syndrome. The remaining 892 patients were included for a retrospective analysis (Figure. S1). This study was approved and granted an informed consent waiver by the Guangdong Provincial People’s Hospital Ethics Board as it was a retrospective study.