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Aurelia Mihaela Sandu and Mircea Radu Gorgan

Abstract

Background: Giant arteriovenous malformations (AVMs) are congenital lesions, with nidus sizing more than 6 cm. According to Spetzler-Martin scale, grade V AVMs have a nidus larger than 6 cm in diameter, profound venous drainage and are located in eloquent areas.

Method: We report a case of a 39 years old woman, with giant left frontal AVM, grade V Spetzler-Martin, who was admitted for generalized seizures, with onset 32 years ago, refractory to full dose antiepileptic polytherapy, which severely impaired the patient’s quality of life.

Results: The patient underwent surgery and we performed total resection of the AVM. We emphasize on surgical technique, intraoperative difficulties and outcome.

Conclusions: Surgery is the therapy of choice in AVMs, because it provides cure of the lesion, and is the only treatment capable of preventing hemorrhage and controlling seizures. Management in grade V AVMs is challenging, because of their large size, multiple dilated arterial feeders from anterior and posterior circulation and external carotid arteries, high blood flow, vascular steel from the surrounding brain, enlarged draining veins, profound venous drainage and location in eloquent area. Giant AVMs with high flow nidus, causing a great degree of vascular steel in the surrounding brain, with hypoperfusion of normal parenchyma may develop early normal perfusion pressure breakthrough. Total resection in grade V AVMs can be performed with minimal transient morbidity and favorable outcome. Total resection permits control of intractable seizures with reduced dose of antiepileptic therapy.

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Sławomir Szydlik, Justyna Jankowska-Szydlik, Mariusz Kasprzyk, Wojciech Dyszkiewicz, Jarosław Adamczak and Damian Zwaruń

pectus excavatum at longterm follow-up. J Pediatr Surg 1999; 34: 1787-90. The aim of the study was to evaluate lung function among patients who underwent Nuss Procedure. The analysis included spirometric evaluation of the lung function before Nuss Procedure, during perioperative period and after removing steel bars from behind the sternum. Material and methods. The study group involved patients operated on the pectus excavatum in the Department of Thoracic Surgery in Poznań in years 2002-2004. The study group

Open access

Aurelia Mihaela Sandu, Vasile Gheorghe Ciubotaru, Ligia Gabriela Tataranu, Alexandru Tascu, Narcisa Bucur, Angela Neacsu and Mircea Radu Gorgan

Abstract

We performed a retrospective study, including patients operated for brain AVMs between 1999 and 2014, in the Clinic of Neurosurgery, Emergency Clinical Hospital Bagdasar-Arseni, Bucharest. 277 patients underwent surgery for brain AVMs. Mean age was 29.82 years. 195 patients (70.40%) presented with hemorrhage and 86 cases (31.05%) were admitted with seizures. We performed total resection of AVMs in 228 cases (82.31%) and subtotal resection in 49 cases (17.69%). Regarding patients with residual nidus, 16 of them underwent second surgery, 27 stereotactic radiosurgery Gamma Knife, 3 embolization and 3 refused further treatment. Modified Rankin Scale (mRS) improved following surgery (Z = -9.248, p = 0.000). Early complications (0-30 days) were encountered in 84 patients (30.32%). We found the following risk factors for postoperative complications occurrence: motor deficit (p = 0.006), co-morbidities (p = 0.023), higher mRS (p = 0.005), lower Karnofsky score (p = 0.003), lower GCS (p = 0.016), profound nidus (p = 0.001), eloquent aria (p = 0.000), large nidus (p = 0.000), multiple arterial territory (p = 0.000), deep feeding arteries (p = 0.000), higher number of feeding arteries (p = 0.000), deep venous drainage (p = 0.000), multiple draining veins (p = 0.000), higher Spetzler- Martin grade (p = 0.006), high flow (p = 0.000), vascular steel (p = 0.000), associated aneurysms (p = 0.010) and decompressive craniectomy (p = 0.019). Mortality was 6.1%. Microsurgery is the treatment of choice for brain AVMs. Surgical results are excellent, with low morbidity and mortality. Patients with poor surgical results belonged to the group admitted with severe altered general state, state of consciousness, massive hematomas and acute brainstem dysfunction. If part of the nidus cannot be safely surgical resected, stereotactic radiosurgery can provide definitive cure of the lesion.

Open access

Dragan Mijakoski, Jordan Minov and Saso Stoleski

Medicine. 2000;37(5):451-458. Sterk PJ, Fabbri LM, Quanjer PhH, et al. Airways Responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party for the Standardization of Lung Function Tests. European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993;6(16):58-83. American Thoracic Society. Guidelines for Metacholine and Exercise Challenge Testing -1999. Am Respir Crit Care Med. 2000

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Jordan Minov, Jovanka Karadzinska-Bislimovska, Kristin Vasilevska, Snezana Risteska-Kuc, Saso Stoleski and Dragan Mijakoski

. Effects of passive smoking on respiratory symptoms, bronchial responsiveness, lung function, and total serum IgE in the European Community Respiratory Health Survey: a crosssectional study. Lancet. 2001; 358: 2103-2109. 27. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows.Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993; 6 (16): 5-40. 28. Global

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Norbert Sławeta, Stanisław Głuszek and Jacek Heciak

chorych. Pol Przegl Chir 2012; 84(9): 437-44. 18. Misołek M, Cecherz K, Namysłowski G, Misiołek H: Ewolucja postępowania operacyjnego w obustronnym porażeniu fałdów głosowych. Otolaryng Pol 2006; 5: 107-11. 19. Harnisch W, Brosch S, Schmidt M, Hagen R: Breathing and voice quality after surgical treatment for bilateral vocal cord paralysis. Arch Otolaryngol Head Neck Surg 2008; 134: 278-84. 20. Quanjer PH, Tammeling GJ, Cotes JE et al.: Lung volumes and forced ventilatory flows. Work Group on Standardization of

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N. Stamenov, G. Tomov, Z. Denkova and I. Dobrev

vitro analysis of mutans streptococci adhesion on esthetic, nickel-titanium, and stainless-steel arch wires. - Angle Orthod 84, 2014, № 4, 680-686. 10. Leonard, A., G. B. Gerber et P. Jacquet. Carcinogenicity, mutagenicity and teratogenicity of nickel. - Mutat Res, 87, 1981, № 1, 1-15. 11. Li, J., H. Katsuhiko, G. Takaharu, Y. Hiromichi, M. Yoichiro et I. Tetsuo. Biofi lm formation of Candida albicans on implant overdenture materials and its removal. - J Dent, 40, 2012, № 8, 686-692. 12. Lie, T. Morphologic Studies on

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Goran Pavlisa, David Ozretic, Marko Rados and Gordana Pavlisa

-54. Yahia AM, Gordon V, Whapham J, Malek A, Steel J, Fessler RD. Complications of Neuroform stent in endovascular treatment of intracranial aneurysms. Neurocrit Care 2008; 8: 19-30. Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. In-stent stenosis as a delayed complication of Neuroform stent-supported coil embolization of an incidental carotid terminus aneurysm. AJNR Am J Neuroradiol 2004; 25: 1764-7. Streefkerk HJN, Wolfs JFC, Sorteberg W, Sorteberg AG, Tulleken CAF. The ELANA technique: constructing a high

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Jakob Liermann, Patrick Naumann, Franco Fortunato, Thomas E. Schmid, Klaus-Josef Weber, Jürgen Debus and Stephanie E. Combs

treatment’s plating efficiency to the single reagent treatment one’s. Dose-response curves were created using the linear-quadratic model. 20 Combination effects were analyzed defining additivity according to Steel and Peckham. 21 For this purpose a dose-response curve was calculated that represents the course of the measured control curve at a pre-effect similar to the single reagent treatment’s effect („theoretical control-curve“). Additive effects were defined as area between the measured control curve and the theoretical one. Supraadditive effects were defined as

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Tanja Marinko, Simona Borstnar, Rok Blagus, Jure Dolenc and Cvetka Bilban-Jakopin

/s) 10.0 (7.82–11.37) 10.0 (8.05–11.8) 0.547 95% CI (-0.10–0.50) CI = confidental interval; E/A = mitral valve annulus ratio of early diastolic and atrial flow velocities; E/E m = ratio between the early diastolic blood flow velocitiy on the mitral valve annulus and early diastolic tissue Doppler velocity at the mitral ring; LA long – left atrial longitudinal diameter; LA tr = left atrial transversal diameter; LV EDD = left ventricular end diastolic diameter; LVEF = left ventricular ejection fraction; LV ESD = left ventricular end systolic