CAS: which stent for which lesion

Current carotid stent designs and their attributes like scaffolding to reduce plaque prolapses and embolization, flexibility, adaptability and conformability to the vessel vary largely. Knowing that differences in behaviour due to stent design exist, especially due to the open cell design (which show high flexibility and therefore adaptability to the vessel but allows in theory easy particle penetration due to open structure) and closed cell designs (which show low flexibility and therefore low adaptability to the vessel but show high resistance to particle penetration due to closed cell design and high scaffolding), physicians have to be aware of these differences when planning carotid artery stenting procedures. The individual characteristics of each stent device may make it an attractive choice in one circumstance but render it less desirable in other situations; in approximately 75% of all procedures, all types of stents will achieve similar outcomes, making adequate device selection unnecessary; for the remaining quarter, careful preoperative screening is mandatory. The aim of this article was to review different stents with regard to latest designs intended for carotid stenting with regard to topics as mentioned above highlighting latest developments in specific designs especially developed for carotid lesion treatment.

[Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident]

We present a rare case of a combined dislocated odontoid dens fracture type II (Anderson/D'Alonzo) and rotational atlantoaxial luxation in a 15-year-old girl who was involved in a riding accident.She fell off her horse after it had stopped suddenly, losing consciousness for a few minutes. At presentation in the hospital, she had no complaints other than limited, painful neck movement. Radiologically, a posterior dislocation of an odontoid type II fracture (Anderson/D'Alonzo) was found. Computed tomography reconstruction demonstrated a rotational, hooklike fixed luxation of the left atlantoaxial facet joint. Manual repositioning after application of a cervical collar failed. Therefore, operative treatment was indicated for this highly unstable fracture. Posterior transarticular atlantoaxial screw fixation according to Magerl was performed; an iliac corticocancellous bone graft was harvested and shaped to conform to the posterior processes of C1 and C2. Additionally a hook-claw atlas fixation of C1 was done.To our knowledge, this is the first case of adolescent atlantoaxial cervical spine trauma in combination with an odontoid fracture and fixed rotational luxation reported in literature.

[Biliary, renal and fecal elimination and distribution of gold after a single oral administration of auranofin, quantified by the instrumental neutron activation analysis method]

Three days after cholecystectomy, seven patients received a single dose of auranofin (5 tablets Ridaura = 4.35 mg gold). At defined time points thereafter the gold content in samples of blood, plasma, urine, bile, and feces was determined by instrumental neutron activation analysis (INAA). Maxima of the mean gold concentrations in blood (140 +/- 42 ng/ml) and plasma (173 +/- 54 ng/ml) are found 2 h after oral administration of the antirheumatic agent, after 16 h in urine (43 +/- 28 ng/ml) and bile (65 +/- 50 ng/ml), and after 24 h in erythrocytes (greater than 200 ng/ml). The mean terminal half-lives are 7.6 days (blood), 15 days (plasma), 5 days (erythrocytes), and 6.5 days (bile). The cumulative biliary gold excretion within 8 days after the administration of auranofin was 1.6%, compared with 4% and 40% for renal and fecal elimination, respectively. The gold concentration in plasma is always higher than that in bile. There is a close correlation between the areas under the concentration curves (AUC) in bile and plasma (r = 0.864).