PubMed · 13694906
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M COMEL. [Functional angiological morphology].. https://pubmed.ncbi.nlm.nih.gov/13694906/
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BACKGROUND: Thrombosis of cerebral arteriovenous malformations (AVM) and spinal dural arteriovenous fistulas following hemorrhage rarely have been reported. Rarer still is thrombosis of spinal AVMs following hemorrhage. CASE DESCRIPTION: A 6-year-old boy presented with sudden low back and sciatic pain, bilateral leg weakness, and an intramedullary spinal cord hematoma. Spinal angiography demonstrated dilated feeding arteries without shunting, and no intervention was performed. Over time, these enlarged arteries reduced in caliber, and the patient recovered fully. CONCLUSIONS: The rarity of spinal AVMs and AVM thrombosis make their coincidence in this case unique. Although surgical intervention would have enabled definitive diagnosis of the spinal AVM, it is not mandatory in the absence of arteriovenous shunting. What is mandatory, however, is continued angiographic surveillance, particularly in pediatric patients.
Until now surgical resection was still considered as the only choice of successful treatment of hepatoblastoma. Therefore, successful use of transcatheter arterial chemoembolization (TACE) alone to cure the unresectable hepatoblastoma in an infant was firstly reported. A 6-month-old boy presented with a huge abdominal mass and was found to have a hepatoblastoma of 17.5 cm x 11.5 cm x 10 cm on computed tomography (CT) scan. The serum alpha-fetoprotein (AFP) was elevated to 6250 ng/mL. On the first TACE the main feeding arteries were completely occluded by stainless steel embolization coils. After one month tumor shrinkage was 75%, but a newly formed feeding artery was found and embolized on second TACE. Since the third TACE no newly formed feeding artery was found and 6 courses of intravenous chemotherapy were consolidated. On the last DSA and CT the tumor was completely disappeared and AFP returned to normal. During the follow-up he remained disease-free for 33 months until the present report. TACE may provide an additional promising choice in the treatment of hepatoblastoma.
A significant clinical problem in reconstructive surgery is partial loss of a pedicled flap. To resolve this problem, various methods of vascular augmentation have been developed; "supercharging" is one of those techniques. A new rat flap model was developed for investigation of the supercharging procedure, and the efficacy of the arterial supercharging method was examined. The purpose of this study was to investigate how an arterial supercharging procedure could generate large flap survival areas with different supercharging positions in rats. On the basis of the vascular anatomical features of rats, a circumferential skin flap from the lower abdomen to the back, measuring 4 x 12 cm, was marked. The flap was divided along the dorsal midline. Forty rats were divided into four experimental groups, as follows: group 1 (control), flaps based only on the deep circumflex iliac artery and vein; group 2, flaps supercharged with the ipsilateral superficial inferior epigastric artery; group 3, flaps supercharged with the contralateral superficial inferior epigastric artery; group 4, flaps supercharged with the contralateral deep circumflex iliac artery. On the fourth postoperative day, the flaps were evaluated with measurements of necrosis and survival areas. Microfil (Flow Tech, Inc., Carver, Mass.) was then injected manually throughout the body, and the vascular changes produced by supercharging were angiographically evaluated. Compared with group 1 (control), the flap survival areas were significantly greater in distally supercharged flaps in groups 3 and 4 (mean flap survival, 91.2 +/- 5.2 percent and 90.5 +/- 10.6 percent, respectively; p < 0.001) and in proximally supercharged flaps in group 2 (45.9 +/- 4.1 percent, p < 0.05). Angiographic assessment of the flaps that survived completely revealed marked dilation of the choke veins among the territories and reorientation of dilated veins along the axes of the flaps. This study suggests that distal arterial supercharging (contralateral superficial inferior epigastric artery or contralateral deep circumflex iliac artery) is more effective than proximal arterial supercharging (ipsilateral superficial inferior epigastric artery) in increasing flap survival. Although the rat skin flap may not be analogous to human flaps, distal arterial supercharging might have useful therapeutic potential in increasing flap survival in clinical practice.