During a 4 1/2-year period, seven patients with delayed onset of an extradural hematoma were seen among 80 consecutively treated cases of extradural hematoma for a frequency of 8.75%. The hematomas were insignificant or not present on initial computerized tomography (CT) scanning. Repeat CT scans within 24 hours of admission showed sizeable hemorrhages. Six hematomas were evacuated, and one was reabsorbed spontaneously. In only one patient did neurological deterioration herald the onset of the extradural hematoma, four patients remained unchanged, and two improved before diagnosis. Intracranial pressure (ICP) was monitored in five patients, four of whom showed intermittent rise in pressure despite preventive treatment. Intracranial hypotension and rapid recovery from peripheral vascular collapse seemed to be contributory factors in the delayed onset of an extradural hematoma. Awareness of this entity, a high degree of vigilance, ICP monitoring, and repeat CT scanning within 24 hours of injury are strongly recommended in these cases, especially after decompression by either surgical or medical means, recovery from shock, or whenever there is evidence of even minimal bleeding under a skull fracture on the initial CT scan.

CT angiography of the carotid arteries in cervical trauma may be used as an accurate decisive tool for a needed surgical intervention. More studies with larger number of patients and comparison with angiography are needed.

Globular single meningiomas are generally regarded as benign tumors that can be completely removed. Nevertheless, after a total macroscopic resection including the insertion zone (Grade 1 operation according to Simpson's classification), the incidence of recurrence ranged from 9% to 14% at the 5-year follow-up review. The authors have shown that single meningiomas represent only the visible predominant growth in the midst of a wide neoplastic field in the dura mater. Regional multiplicity in meningiomas would thus seem to be the rule. With this in mind, the authors propose to divide recurrences after Grade 1 operations into true local and false regional. A local recurrence is defined as a regrowth within the limits of the previous dural flap. Regional recurrence is when new growth develops outside the previous craniotomy site; this should not be considered as a recurrence but as a new primary site. These regional recurrences might explain some unexpected late tumor growth occurring after a Grade 1 operation. Five illustrative cases in which regional recurrence was detected by computerized tomography are presented. The authors also propose to add a supplementary grade to Simpson's surgical grading: Grade 0. This operation would entail a wide resection of the dura around the attachment zone of the meningioma. The authors hope that with a Grade 0 operation the incidence of recurrence might be reduced.

We report on 2 patients with Johanson Blizzard syndrome and review the literature, in an attempt to further characterize the clinical spectrum of this disorder.

Peripheral artery disease is a cardiovascular disease characterized by a narrowing of arteries that supply blood to the extremities, particularly, the legs. When surgical intervention is warranted, the primary approach is balloon angioplasty. Drug coated balloons (DCB) designed to release antimitogenic agents to the site of the blockage are a relatively new product aimed at reducing artery re-narrowing, or restenosis, after intervention. However, first generation DCB utilize mainly direct application of the chemotherapy drug paclitaxel, along with hydrophilic excipients to facilitate uptake into the tissue, and the majority of drug is released from the DCB systemically. We thus designed a drug-eluting nanoparticle delivery system for firm attachment to the balloon surface and only slow release of its entrapped drugs within a fluid environment. We furthermore chose the relatively nontoxic polyphenols resveratrol and quercetin as active agents we've shown reduce smooth muscle cell proliferation and inflammatory cell and platelet activation, all contributing events in restenosis. A polymeric nanoparticle (pNP) system based on poly(lactic-co-glycolic) acid but possessing a positive charge was designed for firm attachment to the balloon matrix, followed by adhesion to the negatively charged bilayer of the vascular wall. As a first step toward testing its biologic properties, drug elution into a simulated blood fluid was determined, as well as the fold enrichment of cells with drug after exposure to the drug-entrapped pNPs compared to drugs only. Cytotoxicity to vascular smooth muscle cells was assessed, along with their biocompatibility, determined as their ability to promote red blood cell lysis. The drug-entrapped pNP system showed excellent biocompatibility with limited cytotoxicity. In addition, the pNPs released the two drugs only very slowly over 10 days. Development of a spray process for delivering the drug-entrapped pNPs to a balloon surface and in vivo testing in small animals appears warranted. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2018.