Bilateral traumatic carotid-cavernous fistulae: Strategies for endovascular treatment

BACKGROUND

Most traumatic carotid-cavernous fistula/e (TCCF) are unilateral, and simultaneous bilateral TCCF are uncommon. The purpose of this study was to evaluate the angiographic architecture of bilateral TCCF and report our experience with their endovascular management.

METHOD

Over 15 years, 252 consecutive patients with TCCF were referred to our institute for endovascular treatment. Bilateral TCCF occurred in 5 men and 2 women with a mean age of 31 years. The angiographic architectures of bilateral TCCF were evaluated with cerebral angiography. All patients underwent a single session of transarterial embolisation by using various permanent embolic materials and were followed up clinically or with angiography for a mean of 22 months (range 9-36 months).

FINDINGS

All patients presented with neuro-ophthalmic symptoms and signs. No new instances of cerebrovascular ischemia or intracranial haematoma resulted from bilateral TCCF. All fistulae were associated with partial arterial steal and were successfully occluded by using a detachable balloon and/or a detachable coil with or without a liquid adhesive. Of 14 TCCF, 9 were completely obliterated with preserved flow of the internal carotid artery (ICA). In the other 5 fistulae, the ICA had to be sacrificed to achieve occlusion because the anatomy of the fistula was complex. All fistula related symptoms resolved immediately or gradually during clinical follow up. No clinically significant procedure related neurological complications or recurrent fistulae were observed.

CONCLUSIONS

All bilateral TCCF were associated with a partial arterial steal phenomenon. Single session endovascular treatment using various embolic materials was effective in managing these high-flow fistulae. In all patients, it was possible to preserve one or both ICAs.

Polybenzoxazine as a mold-release agent for nanoimprint lithography

One of the most important tasks remaining to be resolved in nanoimprint lithography is the elimination of the resist sticking to the mold during demolding. Previously, the main approach was to apply a thin layer of fluorinated alkyl silane mold-release agent on the surface on the mold; however, this involves complicated steps and high costs. The low surface free energy material polybenzoxazine provides an efficient mold-release agent for silicon molds that is easier to process, costs less, and has no side reactions.

Effect of Intermolecular Hydrogen Bonding on Low-Surface-Energy Material of Poly(vinylphenol)

We discovered that poly(vinylphenol) (PVPh) possesses an extremely low surface energy (15.7 mJ/m2) after a simple thermal treatment procedure, even lower than that of poly(tetrafluoroethylene) (22.0 mJ/m2) calculated on the basis of the two-liquid geometric method. Infrared analyses indicate that the intermolecular hydrogen bonding of PVPh decreases by converting the hydroxyl group into a free hydroxyl and increasing intramolecular hydrogen bonding after thermal treatment. PVPh results in a lower surface energy because of the decrease of intermolecular hydrogen bonding between hydroxyl groups. In addition, we also compared surface energies of PVPh-co-PS (polystyrene) copolymers (random and block) and their corresponding blends. Again, these random copolymers possess a lower fraction of intermolecular hydrogen bonding and surface energy than the corresponding block copolymers or blends after similar thermal treatment. This finding provides a unique and easy method to prepare a low-surface-energy material through a simple thermal treatment procedure without using fluoro polymers or silicones.

Prediction of Alzheimer's disease in mild cognitive impairment: a prospective study in Taiwan

The relationship between apolipoprotein E (ApoE) and clinical manifestations of mild cognitive impairment (MCI) has not been investigated in non-Caucasian populations. This prospective study was conducted in an ethnic Chinese population to evaluate the correlations of ApoE genotype, cognitive performance, medial temporal structure volumes, and clinical outcome in amnestic MCI. Twenty normal elders, 58 MCI, and 20 mild Alzheimer's disease (AD) patients received neuropsychological, MRI, and ApoE genotype assessments at baseline. Patients with MCI had intermediate cognitive performance and hippocampal volumes between those in normal and AD groups. In each diagnostic group, epsilon4 carriers (E4+) consistently had smaller hippocampal volume than non-carriers (E4-) did. Nineteen MCI subjects (32.7%) converted to AD during the 3-year study period. Compared with MCI non-converters and E4- MCI converters, E4+ MCI converters had the smallest hippocampal volume. However, epsilon4 was not a predictor for AD. Both cognitive performance and hippocampal volume were predictive for progression to AD. However, stepwise Cox regression model integrating both neuropsychological and radiological variables showed that global cognitive performance was the only significant predictor for AD. A poor global cognitive score may be more crucial than a small hippocampal volume in the prediction of AD.

Stable superhydrophobic polybenzoxazine surfaces over a wide pH range

In this study, we report on a simple two-step casting process designed to create a stable superhydrophobic surface. This method possesses the advantages of being both simple and inexpensive as well as utilizing non-fluorine-containing compounds. Most interestingly, we found that the as-prepared surface possesses superhydrophobic properties not only for pure water but also for corrosive water under both acidic and basic conditions. Furthermore, the superhydrophobic polybenzoxazine surfaces had excellent environmental stability with regard to both heating and organic solvent treatment in terms of the contact angle to water.

Percutaneous vertebroplasty for patients with osteoporosis: a one-year follow-up

PURPOSE

To evaluate changes in height and wedge angle of treated vertebral bodies and kyphosis angle 1 year after vertebroplasty.

MATERIAL AND METHODS

We reviewed radiographs of 95 vertebral bodies treated with vertebroplasty in 60 patients with osteoporosis. Only vertebral bodies with imaging evidence of a new fracture or avascular necrosis received vertebroplasty. Images were obtained for evaluation before vertebroplasty (B), within 2 weeks after vertebroplasty (T), and after 1 year (T1).

RESULTS

The mean wedge angle decreased by 5.4 degrees from B to T1. Mean of the anterior, central, and posterior heights of the fractured bodies increased by 12.6%, 9.6%, and 3.1%, respectively, from B to T1. The kyphosis angle improved by 3.2 degrees initially from B to T, but the improvement later disappeared. In 48% of these patients, a new fracture developed after vertebroplasty, and 63% of the fractures were adjacent to a vertebroplasty-treated vertebral body.

CONCLUSION

The increase in height and wedge angle of the vertebral bodies generally lasted at least 1 year. Improvement in kyphosis angles was lost 1 year after vertebroplasty because new fractures occurred in 48% of these patients. Prevention of new fractures after vertebroplasty remains an important task.

Carotid blowout treated by direct percutaneous puncture of internal carotid artery with temporary balloon occlusion

SUMMARY

Direct percutaneous puncture of a cervical carotid pseudoaneurysm for coil placement or acrylic embolization is described for the endovascular management of acute carotid blowout. However, direct puncture of the internal carotid artery (ICA) for the endovascular management of carotid blowout has not been described. We report a difficult case of acute carotid blowout syndrome in a patient who had radiation- induced occlusion of the right common carotid artery with vasculopathy and pseudoaneurysm in the right cervical ICA. Collaterals from the branches of the controlateral external carotid artery (ECA) anastomosed with branches of right ECA supplied the vasculopathy. We performed direct percutaneous puncture of the bulb of the right ICA using a spinal needle and placed fiber coils to occlude antegrade flow of the artery. During the injection of a mixture of N-butyl cyanoacrylate and lipiodol oil for embolization of the remaining carotid bulb, we transiently inflated an occlusion balloon in the controlateral common carotid artery to further arrest antegrade flow in the ICA. The vasculopathy and pseudoaneurysm of the right cervical ICA were successfully embolized, with preservation of the distal branches of the right ICA.