Surgical treatment of unruptured dissecting intracranial aneurysms of vertebral - posterior inferior cerebellar artery region and review of the literature.

Surgical treatment of unruptured dissecting intracranial aneurysms of vertebral - posterior inferior cerebellar artery region and review of the literature.

J Neurosurg Sci. 2016 Apr 28;

Authors: Balik V, Yamada Y, Talari S, Yamashiro K, Rile W, Suyama D, Kawase T, Takagi K, Takizawa K, Kato Y

Abstract
AIM: A lack of published surgical experience and higher symptomatic recurrence than previously recognized prompted the authors to present their experience with the surgical treatment of unruptured intracranial dissecting aneurysms (UIDAs).
METHODS: Hospital records, neuroimaging studies, operative reports, and follow-up records were retrospectively reviewed. Four patients with vertebral - posterior inferior cerebellar artery (VA-PICA) UIDAs surgically treated between September 2014 and September 2015 were included in the study along with a review of the literature.
RESULTS: There were 3 men and 1 woman in the studied group, their age ranging from 42 to 66 years. Three presented with chronic headache, and in one the dissecting aneurysm was detected incidentally. All patients underwent surgical exploration of the lesion with proximal clipping of the parent artery through a far-lateral suboccipital craniotomy with or without partial condylar resection. In two patients (Cases 1 and 4) an occipital artery (OA)-PICA bypass was performed. Case 1 had a nasal cerebrospinal fluid (CSF) leak and loss of sweet taste postoperatively. The CSF leak was successfully treated conservatively and loss of sweet taste gradually improved. All patients reached a modified Rankin scale of 0-1 at discharge. The follow-up period ranged from 1 to 28 weeks with a mean of 17 weeks. No hemorrhagic or ischemic complications were observed during the follow-up period.
CONCLUSION: The surgical treatment of VA-PICA UIDAs has acceptable risk regarding perioperative mortality and morbidity. The incidence of aneurysmal recurrence or the need for retreatment seems to be less than that associated with anticoagulation/antiplatelet therapy or endovascular treatment.

PMID: 27124175 [PubMed - as supplied by publisher]

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Reconstruction of the Base of Skull Defect-Lessons Learned over 25 Combined Years.

Reconstruction of the Base of Skull Defect-Lessons Learned over 25 Combined Years.

J Neurol Surg B Skull Base. 2016 Apr;77(2):161-8

Authors: Rowe D, Emmett J

Abstract
With an increased understanding of the pathological processes involved in perinerual spread, surgery has come to play a greater role in its management. As skull base techniques have been refined, the reconstructive surgeon has been presented with increasingly complex and voluminous defects requiring repair. To enable such surgery to have acceptable outcomes, attention to form and function is paramount. This article describes the methods of repair, which have evolved over the last 25 years of practice, and that we find to be both reliable and durable. Our accumulated experience is presented as a treatment algorithm, which will aid the skull base reconstructive surgeon to achieve success for the wide variety of defects encountered with these patients.

PMID: 27123392 [PubMed]

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Development and validation of a smartphone-based digits-in-noise hearing test in South African English.

Development and validation of a smartphone-based digits-in-noise hearing test in South African English.

Int J Audiol. 2016 Apr 28;:1-7

Authors: Potgieter JM, Swanepoel W, Myburgh HC, Hopper TC, Smits C

Abstract
OBJECTIVE: The objective of this study was to develop and validate a smartphone-based digits-in-noise hearing test for South African English.
DESIGN: Single digits (0-9) were recorded and spoken by a first language English female speaker. Level corrections were applied to create a set of homogeneous digits with steep speech recognition functions. A smartphone application was created to utilize 120 digit-triplets in noise as test material. An adaptive test procedure determined the speech reception threshold (SRT). Experiments were performed to determine headphones effects on the SRT and to establish normative data.
STUDY SAMPLE: Participants consisted of 40 normal-hearing subjects with thresholds ≤15 dB across the frequency spectrum (250-8000 Hz) and 186 subjects with normal-hearing in both ears, or normal-hearing in the better ear.
RESULTS: The results show steep speech recognition functions with a slope of 20%/dB for digit-triplets presented in noise using the smartphone application. The results of five headphone types indicate that the smartphone-based hearing test is reliable and can be conducted using standard Android smartphone headphones or clinical headphones.
CONCLUSION: A digits-in-noise hearing test was developed and validated for South Africa. The mean SRT and speech recognition functions correspond to previous developed telephone-based digits-in-noise tests.

PMID: 27121117 [PubMed - as supplied by publisher]

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The New Interventional Radiology Pathways

Publication date: Available online 28 April 2016
Source:Academic Radiology
Author(s): Michael Recht, J. Mark McKinney, Anthony M. Alleman, Lisa H. Lowe, James B. Spies
The new interventional radiology (IR) pathways have generated much discussion with articles and editorials pointing out perceived advantages and disadvantages compared to the current pathways. To briefly review, under the new system, there are three pathways to enter IR: the integrated (INT) IR residency, the independent (IND) IR residency, and the early specialization in interventional radiology (ESIR) program. The pathways have been designed to provide maximum flexibility to programs for implementation and to radiology residents for planning their subspecialty training. As a result, there are many potential permutations for these training programs, and understanding the variety of options can be a challenge at first. We offer three potential solutions, based on the different circumstances or requirements a department might face. The first two solutions involve integrated programs created through newly funded and converted diagnostic radiology slots, respectively. The third involves establishing ESIR and IND programs only. Hopefully, the examples provided will be useful for those currently planning for the future of their IR training programs.



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Diastereoselective Three-Component Cascade Reaction to Construct Oxindole-Fused Spirotetrahydro­furochroman Scaffolds for Drug Discovery

Abstract

A one-pot synthesis of new oxindole-fused polycyclic scaffolds is reported. The process involves a three-component [3+2] cycloaddition followed by cyclization through an intramolecular Michael addition. The reaction gives easy access to oxindole-fused spirotetrahydrofurochromans in moderate to good yields with high regio- and diastereoselectivity. These compounds could be useful for for drug discovery. Further modification was achieved by reduction of the nitro group, and intramolecular amide formation to give the corresponding lactams. The resulting heterocyclic products show good inhibitory activity against the enzyme PTP1B in vitro.

A one-pot three-component cascade reaction involving a [3+2] cycloaddition followed by a cyclization through intramolecular Michael addition was used to generate two families of oxindole-fused spirotetrahydrofurochroman polyheterocycles with high regio- and diastereoselectivity. The resulting polycyclic products were found to inhibit the enzyme PTP1B in vitro.

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Baylis–Hillman Acetates in Synthesis: Copper(I)/tert-Butyl Hydroperoxide Promoted One-Pot Oxidative Intramolecular Cyclization Protocol for the Preparation of Pyrrole-Fused Compounds and the Formal Synthesis of (±)-Crispine A

Abstract

A convenient one-pot protocol for the synthesis of benzo-fused and indole-fused indolizines from Baylis–Hillman acetates was developed. This strategy involves CuBr/tert-butyl hydroperoxide promoted oxidation, intramolecular cyclization, and aromatization as key steps. The efficacy of this methodology was demonstrated by the formal synthesis of (±)-crispine A, a biologically active molecule.

A one-pot, four-step strategy involving alkylation, oxidation, intramolecular cyclization, and aromatization is developed for the synthesis of pyrrole-fused tri- and tetracyclic compounds by using Baylis–Hillman acetates as the starting materials. A formal synthesis of biologically active (±)-crispine A is also achieved. EWG = electron-withdrawing group.

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Preservative-free tafluprost/timolol fixed combination: a new opportunity in the treatment of glaucoma.

Preservative-free tafluprost/timolol fixed combination: a new opportunity in the treatment of glaucoma.

Expert Opin Pharmacother. 2016 Apr 28;

Authors: Konstas AG, Holló G

Abstract
INTRODUCTION: Medical therapy of glaucoma aims to maintain the patient's visual function and quality of life. This generally commences with monotherapy, but it is often difficult to reach the predetermined target pressure with this approach. Fixed combinations (FCs) are therefore selected as the next step of the medical therapy algorithm. By employing a prostaglandin/timolol fixed combination (PTFC) the desired target 24-hour intraocular pressure can be reached in many glaucoma patients with the convenience of once-a-day administration and the associated high rate of adherence. Areas covered. The current role and value of FCs in the medical therapy of glaucoma is critically appraised. Special attention is paid to the PTFCs and the emerging role of preservative-free PTFCs. This review summarizes existing information on the efficacy and tolerability of the new preservative-free tafluprost/timolol FC (Taptiqom®). Expert opinion. The preservative-free tafluprost/timolol FC represents a promising stepwise treatment option for those patients whose intraocular pressure is insufficiently controlled with available monotherapy options. This novel FC has the potential to substantially improve glaucoma management and through evolution of the current glaucoma treatment paradigm, to become a core therapeutic option in the future. Nonetheless, future research is needed to better delineate the therapeutic role of current and future preservative-free FCs in glaucoma therapy.

PMID: 27123557 [PubMed - as supplied by publisher]

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