Cavernous carotid aneurysms in the era of flow diversion: a need to revisit treatment paradigms

BACKGROUND AND PURPOSE

Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms.

MATERIALS AND METHODS

A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed.

RESULTS

Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively.

CONCLUSIONS

Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.

Evaluation of in vitro antileishmanial activity of curcumin and its derivatives "gallium curcumin, indium curcumin and diacethyle curcumin"

BACKGROUND AND OBJECTIVES

Leishmania parasites are intracellular haemoflagellates that infect macrophages of the skin and viscera to produce diseases in their vertebrates hosts. Antileishmania therapy is based on pentavalent antimony compounds which toxicity of these agents and the persistence of side effects are severe. Curcumin was identified to be responsible for most of the biological effects of turmeric. Turmeric plant extracts (curcumin and other derivatives) have anti-inflammatory, anti-arthritic, antioxidant, anti-microbial, antileishmanial, hepato protective, anti-cancer, anti-ulcer and anti diabetic activity.

MATERIALS AND METHODS

Stock solutions of curcumin, indium curcumin, diacetylcurcumin and Gallium curcumin were made up in DMSO. From the each stock solution serial dilutions were made with phosphate buffered saline and 100 µl of each prepared concentration was added to each well of 96-well micro plate. All tests were performed in triplicate. Negative control only received RPMI-1640 medium with a parasite density of 106 parasites /ml and the positive control contained varying concentrations of standard antileishmania compound, Amphotericine B. MTT solution was prepared as 5 mg/ml in RPMI-1640 and 20 µl of this concentration was added to each well. Antileishmania effects of test agents and control were evaluated by using the MTT assay.

RESULTS

Mean growth inhibition of triplicate for each concentration of test agents and control were measured. The IC50 values for curcumin, gallium curcumin [ga (CUR) 3], indium curcumin [in (CUR)3], Diacethyle Curcumin (DAC ) and Amphotericine B were 38 µg/ml, 32 µg/ml, 26 µg/ml, 52 µg/ml and 20 µg/ml respectively. Indium curcumin [in (CUR) 3] with IC50 values of 26 µg/ml was more effective than other three test agents against Leishmania. Mean growth inhibition of triplicate for Amphotericine B as control drug, was 20 µg/ml.

CONCLUSIONS

Indium curcumin and Gallium curcumin complex showed more antileishmanial activity than curcumin and diacetylcurcumin and could be suitable candidates for further investigations.

Evaluation of in vitro anti-Leishmanial activity of some brown, green and red algae from the Persian Gulf

BACKGROUND AND OBJECTIVES

Leishmaniasis is a protozoan parasitic disease which is transmitted by the female Phlebotomus sand fly and is prevalent in four continents.The first-choice treatment for the leishmaniasis is pentavalent antimonials, which are potentially toxic and often ineffective and use of them exhibit therapeutic failure. These pharmaceutical problems point towards the need to develop novel chemotherapeutic agents. Seaweeds are considered as source of bioactive metabolites characterized by a broad spectrum of biological activities.

MATERIALS AND METHODS

In this experimental study, cold and hot water crude extracts of four species of green, brown and red marine algae "Caulerpa sertularioides, Gracilaria corticata, Gracillaria salicornia and Sargassum oligocystum" collected along the Bushehr coast of the Persian Gulf (southwest of Iran), prepared and their in vitro activities against Leishmania major promastigote were evaluated by using the MTT assay test.

RESULTS

The cold and hot water crude extracts of four algae species exhibited different anti-Leishmanial activities. The minimum inhibitory concentration of hot water extracts calculated as IC50 was as follows: Caulerpa sertularioides (IC50 < or =85 microg/ml), Gracilaria corticata (IC50 < or =38 microg/ml), Gracillaria salicornia (IC50 < or =46 microg/ml) and Sargassum oligocystum (IC(50)9 < or =78 microg/ml, while these values for cold water extracts were (IC50 >125 microg/ml) for Caulerpa Sertularioides (IC50 >65 microg/ml) for Gracilaria corticata (IC50 >74 microg/ml) for Gracilaria salicornia and (IC50 >105 microg/ml) for Sargassum oligocystum, IC50 values for reference drug (Amphotericin B) was (0.16-0.2 microg/ml).

DISCUSSION

According to the results, inhibitory effects of the crude extracts from these four species algae specially hot water crude extracts from "Gracilaria corticata, Gracillaria salicornia and Sargassum oligocystum" are significant and in accordance with other studies that has been done on different algae species. So these results are sufficiently promising to be followed with further studies on isolation and characterization of pure compounds from these algae species as well as in vivo experiments, a work that is already under way in our laboratory.

In vitro study of antibacterial activity of the alga Sargassum oligocystum from the Persian Gulf

BACKGROUND AND OBJECTIVES

With due attention to the development of drug-resistant bacteria, discovering of new antibacterial compounds is needed. Algae produce numerous bioactive substances which may have pharmacological properties such as antibacterial activity. The objective of this investigation was to in vitro study of antibacterial activity of brown alga Sargassum oligocystum collected along the Bushehr coast of Persian Gulf (south west of Iran).

MATERIALS AND METHODS

Hot water extract, cold water extract, and hot glycerin extract were prepared. The effect of the extracts were investigated on Staphylococcus aureus (ATCC 25923), Staphylococcus epidermidis (ATCC 14990), Pseudomonas aeruginosa (ATCC 27853), and Escherichia coli (ATCC 25922).

RESULTS

Hot water extract exhibited antibacterial activity against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa. Cold water extract and hot glycerin extract did not show antibacterial activity on any of the four test bacteria. The minimum inhibitory concentration (MIC) of hot water extract for both Staphylococcus aureus and Staphylococcus epidermidis was 3.175 mg/ml. However, the MIC of this extract for Pseudomonas aeruginosa was 9.556 mg/ml.

DISCUSSION

In this study gram-positive bacteria were more susceptible to hot water extract than gram-negative bacteria. Extract of Sargassum oligocystum could be a candidate for purification and further in vivo studies.

Ocular aspects of myasthenia gravis

Ocular myasthenia gravis is a not uncommon autoimmune disorder causing diplopia, ptosis, and weakness of lid closure. The predilection of myasthenia for the ocular muscles may be related to differences between limb and extraocular muscles in either physiological function or antigenicity. Clinically, ocular myasthenia can mimic any form of pupil-sparing ocular motility disorder. Dynamic abnormalities of myasthenic eye movements may reflect the primary hallmarks of the disease, which are fatigability and variability in strength, or secondary adaptive effects by the central nervous system. Tests to confirm the diagnosis include edrophonium challenge, repetitive nerve stimulation, single-fiber electromyography (EMG) of the frontalis, and assays for antibody directed against the acetylcholine receptor: all are less sensitive for ocular myasthenia than for generalized myasthenia. There is a higher incidence of other autoimmune conditions in myasthenia, notably thymoma and thyroid dysfunction. The differential diagnosis includes other diseases of the neuromuscular junction, such as Lambert-Eaton syndrome and botulism. Treatment consists of symptomatic use of acetylcholinesterase inhibitors and immunosuppression with steroids or azathioprine. Between 50 and 70% of patients with ocular myasthenia will eventually develop generalized disease: there is some retrospective data that steroids or azathioprine may reduce this by about 75%. The role of thymectomy in ocular myasthenia remains unclear.