BackgroundThe primary goal of conventional endovascular and microvascular approaches is the clinical and radiological resolution of the symptomatic aneurysm-induced mass effect. This study assessed the volume changes and mass effect reduction due to sac shrinkage after treatment with flow diverter stents (FD) for unruptured cerebral aneurysms.MethodsWe analyzed retrospectively 36 symptomatic aneurysms that were larger or equal to 25 mm in diameter in patients treated at our center from January 2016 to April 2022. Radiological and clinical outcomes were analyzed, including aneurysmal volume changes and resolution of aneurysm-related symptoms.ResultsAt 6 months, 25 aneurysms decreased in size, 2 remained unchanged, and 9 aneurysms demonstrated a post-treatment dimensional increase. At 12 months, 30 aneurysms showed a progressive radiological volume reduction. Either no change or negligible shrinkage was observed in the remaining six aneurysms. At 24 months, 32 aneurysms showed aneurysmal shrinkage by a mean 47% volume loss with respect to baseline. At the last follow-up, all 13 patients who had presented with third cranial nerve palsy showed improvements. Complete reversal of the pretreatment edematous changes was confirmed in all cases. The overall post-treatment complication rate was 8.3%, as 3 patients experienced non-fatal delayed rupture of their aneurysm. There was no mortality in this study.ConclusionFlow diversion could effectively induce progressive aneurysmal shrinkage and resolution of the mass effect associated with giant symptomatic cerebral aneurysms.
Ascites, regardless of its source (hepatic, neoplastic, cardiac or inflammatory), is a clinical indicator of disease progression. In cirrhosis, ascites forms due to portal hypertension and low circulating blood albumin, which leads to so called third spacing. This study compared blood and ascites samples from 20 consecutive and unselected liver cirrhosis patients and 5 cancer patients.Significant correlations were found in cirrhotic ascites between albumin/D-dimer, albumin/ferritin, albumin/total protein, ferritin/Ddimer, total protein/ferritin, and total protein/D-dimer.Three out of five malignant ascites patients had low ascitic total protein values (below 25 g/L), whereas five out of twenty cirrhotic ascites patients had high values above 25 g/L. The protein composition of our oncology patients was likely altered due to treatment.Half of our cirrhotic patients and two cancer patients had high serum ferritin levels. We also observed ascitic ferritin levels up to 100 μg/l in half of the patients and values above the upper reference level for serum (280.00 μg/l) in six of our liver cirrhosis patients. Individual ascites values overlapped in cirrhotic and malignant ascites. D-dimer levels in ascites were 500-1000 times the plasma upper limit of normal (ULN) in three cancer patients and four cirrhosis patients.This study is the first to simultaneously examine ferritin and D-dimer levels in blood and uncomplicated ascites. Abnormal levels of D-dimer and ferritin in ascites, even in the absence of clinical symptoms, may indicate underlying processes in the ascitic peritoneal fluid such as inflammation and fibrinolysis. Additional research may be needed.
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