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Background To examine published data and assess evidence relating to safety and efficacy of surgical management of symptomatic pineal cysts without hydrocephalus (nhSPC), we performed a systematic review of the literature and meta-analysis. Methods Following the PRISMA guidelines, we searched Pubmed and SCOPUS for all reports with the query ‘Pineal Cyst’ AND ‘Surgery’ as of March 2021, without constraints on study design, publication year or status (PROSPERO_CRD:42,021,242,517). Assessment of 1537 hits identified 26 reports that met inclusion and exclusion criteria. Results All 26 input studies were either case reports or single-centre retrospective cohorts. The majority of outcome data were derived from routine physician-recorded notes. A total of 294 patients with surgically managed nhSPC were identified. Demographics: Mean age was 29 (range: 4–63) with 77% females. Mean cyst size was 15 mm (5–35). Supracerebellar-infratentorial approach was adopted in 90% of cases, occipital-transtentorial in 9%, and was not reported in 1%. Most patients were managed by cyst resection (96%), and the remainder by fenestration. Mean post-operative follow-up was 35 months (0–228). Presentation: Headache was the commonest symptom (87%), followed by visual (54%), nausea/vomit (34%) and vertigo/dizziness (31%). Other symptoms included focal neurology (25%), sleep disturbance (17%), cognitive impairment (16%), loss of consciousness (11%), gait disturbance (11%), fatigue (10%), ‘psychiatric’ (2%) and seizures (1%). Mean number of symptoms reported at presentation was 3 (0–9). Outcomes: Improvement rate was 93% (to minimise reporting bias only consecutive cases from cohort studies were considered, N = 280) and was independent of presentation. Predictors of better outcomes were large cyst size (OR = 5.76; 95% CI: 1.74–19.02) and resection over fenestration (OR = 12.64; 3.07–52.01). Age predicted worse outcomes (OR = 0.95; 0.91–0.99). Overall complication rate was 17% and this was independent of any patient characteristics. Complications with long-term consequences occurred in 10 cases (3.6%): visual disturbance (3), chronic incisional pain (2), sensory disturbance (1), fatigue (1), cervicalgia (1), cerebellar stroke (1) and mortality due to myocardial infarction (1). Conclusions Although the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.

The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.

Drawing upon seven years of police calls for service data (2014-2020), this study examined the effect of the COVID-19 pandemic on calls involving persons with perceived mental illness (PwPMI) using a Bayesian Structural Time Series. The findings revealed that PwPMI calls did not increase immediately after the beginning of the pandemic in March 2020. Instead, a sustained increase in PwPMI calls was identified in August 2020 that later became statistically significant in October 2020. Ultimately, the analysis revealed a 22% increase in PwPMI calls during the COVID-19 pandemic than would have been expected had the pandemic not taken place. The delayed effect of the pandemic on such calls points to a need for policymakers to prioritize widely accessible mental health care that can be deployed early during public health emergencies thus potentially mitigating or eliminating the need for increased police intervention, as was the case here. Supplementary Information: The online version contains supplementary material available at 10.1186/s40163-021-00157-6.

Purpose To explore the incidence of double pituitary adenomas in a tertiary center for pituitary surgery and asses their clinical, imaging and histopathological features. Methods The medical records of the patients operated on for pituitary tumors at the Department of Neurosurgery of Military Institute of Medicine in Warsaw, Poland between the years 2003 and 2018 were retrospectively analyzed. Among the 3270 treated patients, the diagnosis of double pituitary adenoma was established in 22 patients. Clinical, laboratory, detailed histopathological and diagnostics imaging data were collected and analyzed. Results There were 21 cases of synchronous and one case of asynchronous double pituitary adenoma. The main clinical finding was acromegaly (12/22) followed by Cushing’s disease (3/22). The diagnosis of synchronous double pituitary adenoma was suspected in the preoperative MRI in 11 patients. In the remaining patients the diagnosis of contiguous double pituitary adenoma was confirmed in the histopathological examination. There was no predilection for gender and the mean observation time was 74.2 months. In one case of Cushing’s disease the occurrence of double pituitary adenoma led to the initial failure of achieving hormonal remission. One patient presented with double pituitary adenomas as a manifestation of Carney complex. Conclusions Double pituitary adenoma is a rare entity that can pose a significant challenge especially in the setting of Cushing’s disease. Careful inspection of preoperative MRI and diagnostic work-up before transsphenoidal surgery and thorough histopathological microscopic examinations with immunohistochemical staining for all pituitary hormones is essential for establishing the diagnosis of double pituitary adenoma.

Introduction: There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods: The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results: 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman's rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat (r = 0.59, p < 0.05), as well as the volume of contrast used (r = 0.77, p < 0.05). Infratentorial (r = 0.53, p < 0.05) and right-sided (r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome (r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows (p = 0.459) and largest outflow diameter (p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died - one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation- related complications. Conclusions: To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial.

Due to an increase in interactions between the police and persons with perceived mental illness (PwPMI), police services have begun deploying specialized crisis responses to more adequately address...

To examine the utility of a patient-level information video as part of the contraception consultation visit. Specifically, to assess the impact of the video on women's contraception choice, and, further, to assess patient and provider acceptability of incorporating the video into the patient visit.A pre-post study design was used to assess the impact on patients' contraceptive choices and knowledge. Participants (n = 49) answered questions regarding contraceptive preferences and knowledge of long-acting reversible contraception (LARC), then watched a 12-minute patient-level counselling video that presented evidence-based information about contraception in descending order of effectiveness. Clinicians (n = 39) also viewed the video and completed a survey. A retrospective chart review of 100 contraception visits was completed.Patient preference for IUDs increased significantly, whereas condoms decreased pre-to-post video (hormonal: 8.2% to 20.4%; copper: 0% to 16%; condoms: 32.7% to 18%, P 0.05). Although 74.4% of clinicians believed that the hormonal IUD was the "ideal" form of contraception when no contraindications were present, 95% stated that the oral contraceptive pill was most often prescribed, and a chart review revealed that the oral contraceptive pill was discussed at 88% of contraceptive counselling visits. Both patients and clinicians found the video useful and acceptable.A patient-level contraceptive information video improved interest in LARC. Both patients and clinicians viewed the video as an acceptable addition to the contraceptive counselling visit.

Background Surgical treatment of retrochiasmatic craniopharyngiomas is associated with higher rates of complications, mortality, failure of complete removal, and recurrence compared with craniopharyngiomas located elsewhere. These tumors lie behind the optic chiasm and when large can extend upward into the third ventricle and downward along the brain stem, making their adequate exposure challenging. Most of the proposed techniques either use a translamina terminalis route or require wide bony exposures. In this study, we assessed the feasibility of a subtemporal approach for achieving gross total resection of retrochiasmatic craniopharyngiomas. Methods Thirty patients with retrochiasmatic craniopharyngioma underwent surgery via a subtemporal approach. The technique and surgical and preoperative and postoperative endocrinologic outcomes are described in detail. Results Gross total resection was achieved in all cases. The average tumor volume was 7.59 mL. The average postsurgical observation time was 73.8 months. During this time, 3 recurrences were observed (10.7%). The perioperative mortality was 6.6%. The pituitary stalk was preserved in 13 cases. Partial preservation of the pituitary stalk did not offer any advantage in terms of pituitary function. No postoperative vision worsening or new fixed neurologic deficits were observed. Among the 22 patients with preoperative vision impairment, 18 reported a significant improvement. The most common abnormalities within the temporal lobe on the side of the exposure seen on control magnetic resonance imaging were mild temporal horn enlargement (13 cases) and T2 hyperintensity (7 cases). Conclusions A subtemporal approach can be an attractive alternative approach to accessing retrochiasmatic craniopharyngiomas. Outcomes are comparable to those associated with other widely used and time-consuming exposures.

The problem of data imbalance remains one of the most widespread challenges of the contemporary machine learning, affecting most of the real datasets. It is especially ubiquitous in the medical domain, in which some of the classes used during classification can be naturally under-represented. At the same time it can significantly affect the classification performance of most standard algorithms, such as convolutional neural networks. One of the approaches for dealing with data imbalance is artificially reducing the number of objects from the over-represented class, an approach called undersampling. In this paper we present a novel undersampling technique, Radial-Based Undersampling (RBU), and apply it to the classification of breast cancer histopathological images. The results of the conducted experimental analysis not only indicate the usefulness of the RBU algorithm in that task, but also shed light on some of the drawbacks of that method, which could potentially be used in the future to improve upon the proposed algorithm.

Management of patients presenting for various nonspecific complaints without clear neurological abnormalities and with normal ventricular size remains highly controversial. We intended to share our rationale for surgical treatment of patients who show symptoms of transient increase of intracranial pressure owing to the presence of the cyst.We have retrospectively analyzed 28 cases of patients who presented without Parinaud syndrome nor ventricular enlargement and underwent pineal cyst removal in our centre between 2007 and 2015. We analyzed patients' age, sex, symptoms, preoperative cyst size, perioperative course, treatment outcome and neurologic status at discharge and at follow-up visits 4 and 12 months afterwards.Main complaints included paroxysmal headaches, nausea, vomiting, visual disturbances, syncope and transient depression of consciousness. Mean age of patients was 31 years (17-55); there were 24 females and 4 males. Mean cyst diameter was 17 mm (10-26). Decision about surgical treament was based on signs of transient increases of intracranial pressure. All patients underwent complete cyst excision via midline suboccipital craniotomy and infratentorial supracerebellar route. Short-lasting perioperative neurological signs (notably upgaze palsy) were noted in 22 cases and uniformly resolved within the observation period of 12 months.Abnormal neurological findings and ventricular enlargement are not indispensable to justify surgical treatment of pineal cysts. Judicious selection of surgical candidates based predominantly on clinical grounds can lead to excellent operative results.

Background Several studies have shown comparable early efficacy of mechanochemical ablation to endothermal techniques. The goal of this report was to show if early efficacy is maintained at 24 months. Methods This was a two-year analysis on the efficacy of mechanochemical ablation in patients with symptomatic C2 or more advanced chronic venous disease. Patients with reflux in the great saphenous vein involving the sapheno-femoral junction and no previous venous interventions were included. Demographic information, clinical, and procedural data were collected. The occlusion rate of treated veins was assessed with duplex ultrasound. Patient clinical improvement was assessed by Clinical-Etiology-Anatomy-Pathophysiology (CEAP) class and venous clinical severity score. Results Of the initial 126 patients, there were 65 patients with 24 month follow-up. Of these 65 patients, 70% were female, with a mean age of 70 ± 14 years and an average body mass index (BMI) of BMI of 30.5 ± 6. The mean great saphenous vein diameter in the upper thigh was 7.6 mm and the mean treatment length was 39 cm. Adjunctive treatment of the varicosities was performed in 14% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, 95% at 12 months, and 92% at 24 months. There was one patient with complete and four with partial recanalization ranging from 7 to 12 cm (mean length 9 cm). There was significant improvement in CEAP and venous clinical severity score (P Conclusion Early high occlusion rate with mechanochemical ablation is associated with significant clinical improvement which is maintained at 24 months, making it a very good option for the treatment of great saphenous vein incompetence.

Papillary tumor of the pineal region (PTPR) was introduced to the WHO classification in 2007. This rare tumor of little known natural history and unpredictable behavior was described in fewer than 100 cases. Its optimal treatment is not established yet. We report another two cases of PTPR in whom tumors were totally removed via supracerebellar infratentorial approach and both were treated with radiotherapy. In a 37-year-old man the operation was delayed 6 years after the first tumor diagnosis and subsequent shunt placement. He has no complaints 10 years after the onset of the disease. A 45-year-old woman has no complaints 24 months after surgery. Our experience and the data from literature indicate that a total tumor removal is the major prognostic factor.

Point mutation and loss of heterozygosity (LOH) analyses were performed in 12 Polish patients with a classic symptom of NF2 — bilateral vestibular schwannomas (BVS). In 5 patients (41.7%), germline mutations were found in theNF2 gene: 2 previously reported substitutions (c.592C>T and c.52C>T) and 3 novel mutations (c.1001_1002insG, c.1029_1030insCC, c.774_778dupGAATG). In addition, LOH analysis of 30 tumour samples from 10 patients revealed a molecular basis of NF2 in 3 patients (25%) that did not have any germline mutation. The molecular defects in sporadic cases of NF2 are still being discussed.

Aim To evaluate the endocrinological and ophthalmological results of the tuberculum sellae meningioma surgery. MATRRIAL and METHODS: A total of 18 patients diagnosed with tuberculum sellae meningioma received surgical treatment at Neurosurgery Clinic at Military Medical Institute in Warsaw from January 2010 to July 2012. This analyzed group of patients included 15 females and 3 males at a mean age of 50.5 years (ranging from 30 to 73; SD ± 13.4). In the pre-operative and post-operative periods, all patients underwent magnetic resonance imaging of the head according to a uniform protocol, eye examinations with assessment of visual acuity and field of vision, as well as endocrine tests to evaluate the hypothalamic-pituitary axis (including urine specific gravity and osmolality as well as blood cortisol, TSH, fT3, and fT4 levels). All patients underwent surgical treatment of the tumor via unilateral subfrontal craniotomy, achieving macroscopically complete tumor removal (Simpson grade II resection). Results The use of the unilateral subfrontal approach helped improve vision in 88% of the treated patients. Endocrine tests revealed no hypothalamic-pituitary axis dysfunction. The most commonly diagnosed meningiomas of the area were meningothelial (77%) and transitional (12%) meningiomas. Conclusion Surgical treatment of tuberculum sellae meningiomas via the unilateral subfrontal approach is a safe technique with no significant complications. Visual improvement was observed in 88% of the patients who had received this treatment. There were no hormonal disturbances in patients operated via the subfrontal approach either prior to or after the procedure, which suggests that surgical treatment of tuberculum sellae meningiomas has no effect on pituitary endocrine function.

Most cases of periaqueductal tumours were found in children and adolescents, so treatment modalities in adults are not evaluated yet. A case of 40 years old woman with tectal and periaqueductal protoplasmatic astrocytoma grade II with history of headache and episodes of syncope is described. MRI showed triventricular hydrocephalus. After a shunt procedure she was doing well for about 15 months. Then she became somnolent, disoriented, and Parinaud syndrome appeared. The solid tumour was resected microsurgically in one stage. A part of it was removed via the supracerebellar infratentorial approach and tectal plate incision. The remainder of the tumour was removed through the fourth ventricle and the aqueduct which was filled by tumour mass. Postoperatively bilateral ptosis, vertical gaze palsy, slight horizontal gaze limitation and pupilloplegia were the main neurological sequelae. They all almost completely resolved within a year. The patient is doing well two and half years after the surgery. MRI showed patency of the aqueduct and no residual tumour. The authors suggest, that direct surgical attempt at total tumour removal should be considered in cases of periaqueductal and tectal gliomas. They also believe it is the first described case, in whom this type of tumour was totally removed by a combined transtectal and transaqueductal route.

Background There are several endovenous methods to ablate the saphenous vein, all of which require tumescent anesthesia. This report was designed to evaluate the efficacy of a tumescent-free technique using mechanochemical ablation (MOCA). Methods This was a prospective observational multicenter report on the efficacy of MOCA in selected patients with lower extremity chronic venous disease. Demographic information, clinical and procedural data were collected on a customized database. The distribution and extent of venous reflux and the closure rate of the treated veins were assessed with duplex ultrasound. Pain was evaluated during the procedure and postoperatively using an analog scale. The presence and severity of complications were recorded. Patient improvement was assessed by clinical-etiology-anatomy-pathophysiology (CEAP) class and venous clinical severity score (VCSS). Results There were 126 patients that were included at baseline, 81% females, with a mean age of 65.5 ± 14 years. The average BMI was 30.5 ± 6. The mean diameter of the great saphenous vein in the upper thigh was 7.3 mm and the mean treatment length was 38 cm. Adjunctive treatment of the varicosities was performed in 11% of patients during the procedure. Closure rates were 100% at one week, 98% at three months, and 94% at six months. Post-procedure complications included hematoma 1%, ecchymosis 9%, and thrombophlebitis 10%. There were no cases of venous thromboembolism. There was significant improvement in VCSS ( p Conclusion MOCA of the saphenous veins has the advantage of endovenous ablation without tumescent anesthesia, making it an almost pain-free procedure. High occlusion rates with significant clinical improvement can be achieved with this method at short term.

s from the 2012 American Venous Forum Annual Meeting Factors Associated With Recurrence of Varicose Veins After Thermal Ablation: 3-Year Results of the REVATA (Recurrent Veins After Thermal Ablation) Study R.G. Bush1, P. Bush1, J. Flanagan2, R. Fritz3, T. Gueldner4, J. Koziarski5, K. McMullen6, G. Zumbro7, 1Midwest Vein & Laser Center, Centerville, Ohio, 2Delaware Valley Vein Center, Phoenixville, Pa, 3Advanced Vein Center of North Texas, Irving, Tex, 4Wisconsin Vein Center, Manitowoc, Wisc, 5Family Surgical, Battlecreek, Mich, 6Varicose Vein Clinics of Oklahoma, Oklahoma City, Okla, 7Vein Specialists of Augusta, Martinez, Ga Background: Factors contributing to recurrence of varicose veins after thermal ablationarenotwell known.Thegoalof thisprospective,non-randomized, multi-center trial was to determine the site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF) and laser ablation. Methods: Seven centers enrolled patients into the study during a twelve-month period, from January 1st, to December 31st, 2010. All patients underwent previous thermal ablation of the great saphenous vein (GSV), small saphenous vein (SSV) or anterior accessory great saphenous vein (AAGSV). Patients with high ligation of the GSV and/or stripping were excluded from the study. From a specific designed study tool, recurrence was identified as to site, etiology, and primary mode of treatment (RF, laser). Results: 2,380 patients were evaluated during this time frame. A total of 164 patients, (7%), 3 with bilateral limb involvement, had varicose vein recurrence at a mean of 3 years after treatment (range, 9 months to 8 years) This group of 164 patients with varicose vein recurrence were the subjects of this study. 33% were between the age of 51 and 60, median age range was 51-60, and 83% were women. A history of deep venous thrombosis (DVT) was present in 2% of the patients and deep venous insufficiency was present in 17%. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 131, 52 of these patients had either SSV or AAGSV ablation concurrently. Total or partial GSV recanalization occurred in 47 patients (29%). Of these 47 patients, 27 had RF ablation, and 20 had laser thermal ablation. New AAGSV reflux occurred in 40 patients (24%), and new SSV reflux occurred in 24 patients (12%) Primary or associated perforator pathology was present in 64% of patients. Conclusions: Recurrence of varicose veins at 3 years after thermal ablation was 7%. The three most important factors associated with varicose vein recurrence included new or recurrent perforating veins; recanalized GSV and new AAGSV reflux, in decreasing frequency. In this study, patients who underwent RF treatment had a higher rate of GSV recanalization than those who were treated with laser. Cyanoacrylate Glue Great Saphenous Vein Ablation: Preliminary 180Day Follow-Up of a First-In-Man Feasibility Study of a No-Compression-No-Local-Anesthesia Technique J.I. Almeida1, J.J. Javier2, E.G. Mackay3, C. Bautista4, T. Proebstle5, 1Miami Vein Center, Miami, Fla, 2Physicians Regional Vein Center, Naples, Fla, 3Mackay Vein Center, St. Petersburgh, Fla, 4Canela Clinic, La Romana, Dominican Republic, 5University Clinic of Mainz, Mainz, Germany Background: Endovenous thermal ablation is a highly effective technology for the treatment of incompetent great saphenous veins (GSVs). However, the treatment requires painful transcutaneous injection of perivenous anesthetic fluids. Graduated compression hose are required postprocedure to help mitigate the inflammatory side-effects of thermal delivery. This study was conducted to demonstrate the safety and efficacy of the Sapheon Closure System for chemical ablation of duplex proven incompetent great saphenous veins. Methods: Two series of patients were treated (n 8 and n 30 follow-up of 180 and 30 days, respectively). After venous access and placement of a novel delivery system, the vein was sealed with a proprietary cyanoacrylate (CA) formulation. Perivenous tumescent anesthesia and postprocedure compression stockings were omitted. Results: Thirty-eight patients (29 female) with a median age of 51 years (range, 26-77) and an average VCSS score of 6.0 / 2.7 (range, 2-17) received study treatment. Average maximum saphenofemoral junction (SFJ) diameter was 8.0 / 2.2 cm (range, 4.1 12.0) before treatment. The mean length of ablated GSV segments was 33cm (range, 15-52), average treatment duration was 20.3 minutes (range, 11 33). The mean volume of CA delivered was a total of 1.3 ml (range, 0.63 2.25). Immediately postprocedure, and at 24-72 hours, 100% (38 of 38) were closed. At 30 days follow-up 97% (35 of 36) of treated GSV segments were completely closed; one limb had a 1cm segment of incomplete ablation. VCSS scores improved to a mean of 1.9 / 2.1 (range, 0-11; P .001 compared to baseline) at 30 days in 37 patients. Of the eight patients followed for 180 days, average VCSS improved to 1.1 / 1.0 (range, 0 3) Thirty-one of 37 patients reported no pain during the 30 days after treatment; the remaining six were successfully treated with NSAIDs. No significant side effects or complications were observed. Conclusion: Endovenous ablation of incompetent GSVs with a CAbased glue is feasible. Procedure times are short, tumescent anesthesia is unnecessary as are postprocedure compression stockings. Lack of significant side-effects and an initial success rate of 100% with significant, long-standing, improvement of clinical symptoms support further clinical studies. The Long-Term Effect of Foam Sclerotherapy On Chronic Venous Leg Ulcers With Superficial Venous Reflux F.J. Slim, S.R. Kulkarni, L.G. Emerson, C. Davies, R.A. Bulbulia, M.R. Whyman, K.R. Poskitt, Cheltenham General Hospital, Cheltenham, United Kingdom Background: The ESCHAR trial showed that superficial venous surgery and compression in chronic venous ulcers achieved a 24 week healing rate of 65%, 12 month recurrence rate of 12% and 4 year recurrence rate of 31%. Foam sclerotherapy may be an attractive alternative to surgery. The aim of this study is to assess the effect of foam sclerotherapy on ulcer healing and long term recurrence in chronic venous leg ulcers. This is an expanded study of the abstract presented at the Royal Society of Medicine Venous Forum reporting long term recurrence data. Methods: Chronic venous leg ulcers (CEAP 5 and CEAP 6) with superficial venous reflux were treated between March 2006 and August 2011 with ultrasound guided foam sclerotherapy and compression. Venous duplex was performed on all legs before and one week after treatment. 24-week ulcer healing and 1 and 4 year ulcer recurrence rates were analysed using Kaplan-Meier survival analysis. Results: Two hundred and fourteen legs (199 patients) with chronic venous ulcers (CEAP 5: n 173, CEAP 6: n 41) were treated with foam sclerotherapy. Median age was 73 years (range, 29-92, M:F 87:112). Complete occlusion was achieved in 195/214 (91.1%) legs, short segment occlusion in 16/214 (6.5%) legs and 3/214 failed to occlude. One patient suffered nonocclusive DVT diagnosed on duplex scan at 1 week and one presented with an occlusive DVT at 3 weeks following a normal scan at 1 week. One patient developed asymptomatic occlusive DVT at two weeks following a nonocclusive DVT diagnosed on initial 1 week scan. Eighteen patients were lost to follow up (3 moved away and 15 died of unrelated cause). Twenty four week healing rate was 70.7% and 1 and 4 year recurrence rate were 4.7% and 28.1% respectively. Conclusion: Foam sclerotherapy is effective in abolition of superficial venous reflux contributing to favourable ulcer healing and long term recurrence rates. Foam sclerotherapy is an attractive alternative to superficial venous surgery in this group of patients. Occlusion Rate With Foam Sclerotherapy For the Treatment of Greater Saphenous Vein Incompetence: A Multicentric Study of 3170 Cases J.H. Ulloa, Jr, Clinica de Venas, Bogota, Colombia Background: Foam sclerotherapy using direct access under guided ultrasound, has been the method of choice of our group for the treatment of greater saphenous vein (GSV) incompetence for the last 8 years. The practicality of this approach, low costs, no anesthesia requirement and repeatability, has encouraged other groups in Latin America to follow our example. We organized a multicentric international group in order to get mutual feedback to improve our technique and establish the potential hazards we may encounter. Methods: We present a prospective multicentric study where 2674 patients, 3170 limbs, C2-6, Ep,As,Pr, diagnosed with duplex scanning and operated between june 2007 and june 2011. All cases were treated with foam sclerotherapy with no other treatment associated. Lapidium clorhidrate was the sclerosant of choice due to its increased foam stability. Foam was delivered into the vein via a 21-gauge needle just below the knee; an average of 3cc (12cc of foam) per patient was used. Compression stockings (22mmHg) were used in all cases. Follow-up visits were scheduled at the first week, first,3rd,6th and 12th months and included ultrasound surveillance to assess the occlusion of the treated vein. Result: Occlusion of the GSV was achieved in 96.2% of limbs studied and 93.7% remain occluded at 12months after treatment. Among the complications we had three DVT, one of them subclinical. Superficial thrombophlebitis in 17, induration in 390 and dyschromia in 46 cases. We had one major incident: a neumonitis that required ICU hospitalization for 5 days and were successfully discharged. Conclusions: Foam sclerotherapy is a safe method that showed a high occlusion rate. The possibility of adverse effects has to be taken into account in order to minimize risks and be prepared to handle unavoidable complications.

15 cases of intracerebellar haematomas [11 spontaneous, 2 traumatic and 2 unclear] were presented. Hypertension was thought to be a main risk factor in 91% in 11 of the spontaneous cases. 11 cases were treated medically. They were usually conscious, scoring not less than 13 in GCS with subacute or chronic picture of illness and harbouring small haematomas below 3 cm in diameter situated almost always in the hemisphere and with no signs of ventricular dilation. Mortality in medically treated patients was 9% [1 case]. The remainder were discharged in good state, usually with no or only slight neurological deficit. Complete haematoma absorption took about 14 days. There were no signs of delayed hydrocephalus in subsequent CT scans. When the haematoma was large, more than 3 cm in diameter, located usually in the vermis or in the vermis and cerebellar hemisphere, sometimes with ventricular involvement, the clinical presentation was acute and required CT diagnosis and surgical evacuation without delay due to low and deteriorating conscious level. Postoperative mortality was 25%, but delayed mortality was 100%. Vertebral angiography was performed in all cases of spontaneous haemorrhage and was normal in 54%, revealed atheromatous changes in 36% and the signs of cerebellar haematoma in only 10%. Arteriovenous malformations were excluded from this study. The authors believe, that the benign course of intracerebellar haematomas is more frequent than it was considered previously and needs no surgical treatment in many cases.

A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. Voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication.

Skin tests of nonspecific antigens (immunoskin test Sevac) were performed on patients suffering from intracranial aneurysms, scheduled for surgical clipping. It was found that high antibody titre correlated well with the severity and progress of neurological deficit developing after surgery. This deficit was absent in patients who exhibited low antibody titre in response to the skin test before surgery. These results indicate that the immunological processes may play a role in the development of neurological deficit after neurosurgical procedures. Thus the skin test employed may have prognostic value in predicting neurological deficit following intracranial aneurysm surgery.

The experiment was carried out on 27 sheep with traumatic-haemorrhagic shock caused by a gunshot wound produced using high-velocity missiles from the HM16 rifle. Sixty minutes after injury treatment with blood-replacing fluids was started. In Group I Ringer's solution with sodium lactate pH 8.2 was infused, Group II received Ringer's solution with sodium lactate pH 6.5, and Group III was given Ringer's solution alone. Volume of the infused fluid exceeded threefold the volume of lost blood. During and after fluid replacement blood samples were drawn for biochemical investigations and haemodynamic disturbances were carefully observed. In conclusion, we can say that Ringer's solution filled the vascular bed and improved tissue perfusion, but it failed to correct metabolic and acid-base equilibrium disturbances to such a degree and for as long a long time as did Ringer's solution with lactate.

A method of checking the alignment of the light field with the x-ray field on variable-aperture radiographic collimators is described. Of 133 collimators tested by this method, 12% failed to meet the alignment requirements recommended by the NCRP.