Medeirosfraser9233

At age 14 the patient had his only shunt revision consisting of a new distal catheter being placed adjacent to the old catheter. The patient presented with significant discomfort from the retained original shunt catheter. Using the endoscopic vein harvesting system, the shunt catheter was removed minimally invasively and the patient had complete resolution of his symptomatology. CONCLUSION The endoscopic vein harvesting system used in cardiothoracic surgery is a suitable instrument to remove long segments of a retained ventriculoperitoneal shunt catheter minimally invasively through a small skin incision. To our knowledge this is the first report of minimally invasive removal of a retained ventriculoperitoneal catheter. BACKGROUND Incidental findings such as meningioma are becoming increasingly prevalent. There is no consensus on the optimal management of these patients. The aim of this study was to examine the outcomes of patients diagnosed with an incidental meningioma who were treated with surgery or radiotherapy. METHODS Single-center retrospective cohort study of adult patients diagnosed with an incidental intracranial meningioma (2007-2015). Outcomes recorded were post-intervention morbidity, histopathological diagnosis and treatment response. RESULTS Out of 441 patients, 44 underwent treatment. Median age at intervention was 56.1 years (IQR 49.6-66.5); 35 female and 9 males. The main indication for imaging was headache (25.9%). Median meningioma volume was 4.55 cm3 (IQR 1.91-8.61) and commonest location was convexity (47.7%). Six patients underwent surgery at initial diagnosis. Thirty-eight had intervention (34 surgery and 4 radiotherapy) after a median active monitoring duration of 24 months (IQR 11.8-42.0). Indications for treatment were radiological progression (n=26), symptom development (n=6), and patient preference (n=12). Pathology revealed WHO grade I meningioma in 36 patients and WHO grade II in four. The risk of postoperative surgical and medical morbidity requiring treatment was 25%. Early and late moderate adverse events limiting activities of daily living occurred in 28.6% of patients treated with radiotherapy. Recurrence rate following surgery was 2.5%. All meningiomas regressed or remained radiologically stable following radiotherapy. CONCLUSION The morbidity following treatment of incidental intracranial meningioma is not negligible. Considering most operated tumors are WHO grade I, treatment should be reserved for those manifesting symptoms or demonstrating substantial growth on radiological surveillance. BACKGROUND We analyzed our clinical data retrospectively to determine the risk factors for thromboembolism, especially with unruptured posterior circulation coil embolization. METHODS In total, 53 coil embolization procedures for unruptured posterior circulation aneurysms in 53 patients were included between October 2010 and August 2018. Tanespimycin order Data about risk factors of thromboembolism in the medical records were collected, such as demographics (gender and age), diabetes mellitus (DM), hypertension (HTN), dyslipidemia, smoking, and other underlying diseases. Data about the effect of antiplatelet agents were analyzed with the VerifyNow test. Angiographic data were analyzed to determine aneurysm location and maximum diameter of the aneurysm sac. In addition to these risk factors, relationships between guiding catheter and anatomical variation of posterior circulation were also evaluated by dividing the cohort into 2 groups. RESULTS Thromboembolism was more likely to occur in the 'same-sided group' (81.3% versus 45.9%, P=0.033). Accordingly, multivariate analysis revealed 2 risk factors of thromboembolism (Table 3) same-sided (OR=6.12, 95%, CI=1.369-27.387, P=0.018) and stent deployment (OR=3.90, 95%, CI=1.133-13.466, P=0.031). CONCLUSIONS In case of posterior circulation aneurysm coil embolization, if we place the guiding catheter into the side of the dominant PICA, the risk of thromboembolism within the PICA territory could be higher. Accordingly, if we face this situation, several solutions might be considered, such as changing the antiplatelet strategy and adding an intermediate catheter. OBJECTIVES To compare tooth colour change and participant's satisfaction following home (HB), in-office (IOB) and combined (CB) bleaching treatments. METHODS A group of 105 participants received HB, IOB and CB treatments. HB was performed using custom-made trays and 10 % carbamide peroxide for 14 days. IOB was performed using 37.5 % hydrogen peroxide applied in 3 cycles. CB bleaching treatment involved IOB followed by HB. Tooth colour change was assessed visually (VC-ΔVC) and using a digital spectrophotometry device (ES-ΔeVS). Participant's perception of oral health, smile and straightness and whiteness of teeth were evaluated using self-reported questionnaire. Parameters/responses were evaluated/collected prior bleaching and at recalls. Linear mixed models were used to estimate between- and within-group differences. RESULTS CB resulted in significantly higher shade difference at 15 days recall (ΔVC and ΔeVS, all p ≤ 0.046). At 6 months recall, CB group demonstrated higher ΔeVS compared to IOB (p = 0.018) but who may accept gradual whitening of teeth can be treated effectively using a cost-effective protocol and less concentrated bleaching agents. OBJECTIVES To assess the CAMBRA caries risk assessment tool (CRAT) in terms of its measurement properties reliability, validity and responsiveness to change in caries estimates over time. METHODS Secondary data from the VicGeneration (VicGen) birth cohort study were used. Caries risk status at child age18 months was compared against caries development at 36 and 48 months. Questionnaire data for the 18-month-old children, were used to generate the CRAT item responses. Five examiners assessed the caries risk profile for each 18-month-old child and assigned a risk status. The analytic method was informed by the COnsensus-based Standards for the selection of health Measurement INstruments Checklist. RESULTS Each examiner applied the CAMBRA CRAT to 214 cases from the VicGen study. At 18 months of age, the proportion of low-, moderate- and high-risk children were 17 %, 17 % and 66 %, respectively. Caries prevalence at 36 and 48 months of age was 18 % and 35 %, respectively. Almost perfect reliability (both inter- and intra-reliability) was achieved in caries risk categorisation.