PURPOSE: To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. MATERIALS AND METHODS: Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. RESULTS: The incidence of AVN of the femoral head was 5.9 %(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6 -12 months: 10, between 12 -24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. CONCLUSION: The incidence of AVN of the femoral head after renal transplantation was 5.9 %. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than in the rejection group, and these may thus be pre-disposing factors for AVN. In patients with these risk factors, even though plain radiographic findings are normal, MRI is necessary if AVN is to be diagnosed during its early stages.
Bone Diseases, Metabolic ; Causality ; Diagnosis ; Head* ; Hip ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Risk Factors

OBJECTIVE: This retrospective study presents our experience with respect to the clinical and angiographic outcomes of patients treated with stent-assisted coil embolization using Solitaire(TM) AB stents. MATERIALS AND METHODS: From March 2011 to December 2014, 50 patients with 55 wide-necked and/or complex intracranial aneurysms were evaluated. Four patients presented with an acute subarachnoid hemorrhage. Stent deployment was performed with a standard coiling procedure in 49 aneurysms. Three patients underwent bailout stenting, 2 patients were treated by temporary stenting and one patient was treated only by stenting without coiling for dissecting aneurysm. RESULTS: Successful placement of the Solitaire AB stent was achieved in all the cases. Based on the postprocedural angiographic results, a Raymond 1 was obtained in 32 (59%) of 54 aneurysms, excluded by one case of dissecting aneurysm, and a Raymond 2 in 13 (24%), and a Raymond 3 in 9 (17%). There was one thromboembolic (2%) and three hemorrhagic complications (6%). However, procedure-related morbidity or mortality was not found. Annual follow-up angiographic results from the embolization were obtained in 40 (74.1%) of 54 cases. These results were represented as Raymond 1 in 27 (67.5%), class 2 in 9 (22.5%), and class 3 in 4 (10%) cases. Angiographic improvement associated with progressive thrombosis of the aneurysm was obtained in 10 aneurysms. Four aneurysms were recanalized without requiring additional treatment. In-stent stenosis was found in one aneurysm, but stent migration was not seen on follow-up angiography. CONCLUSION: Stent-assisted coil embolization using the Solitaire AB stent for treating wide-necked and/or complex intracranial aneurysms was found to be safe and effective immediately post-embolization and after follow-up. Long-term follow-up will be required to identify the effect of the Solitaire AB stent on recanalization rates.
Aneurysm ; Aneurysm, Dissecting ; Angiography ; Constriction, Pathologic ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Mortality ; Retrospective Studies ; Stents ; Subarachnoid Hemorrhage ; Thrombosis

OBJECTIVE: Based on the use of Nano(TM) coils, we retrospectively compared the proportion of the coils (< or = 1.5 mm) and packing density in two patient groups with small cerebral aneurysms (< 4 mm diameter) who were treated with or without Nano(TM) coils. MATERIALS AND METHODS: Between January 2012 and November 2013, in 548 cerebral aneurysms treated by endovascular coiling, 143 patients with 148 small cerebral aneurysms underwent endovascular coiling. After March 2013, coiling with Nano(TM) coils was performed on 45 small cerebral aneurysms (30.4%). RESULTS: There were no significant differences in the size and locations of the cerebral aneurysms, the age of the patients, and the procedural modalities between the two groups. The proportion of the coil (< or = 1.5 mm) of the group treated with Nano(TM) coils (53.6%) was higher than the proportion of the coil (< or = 1.5 mm) of the group treated without Nano(TM) coils (14.7%) with statistical significance (p < 0.001). The packing density of the group treated with Nano(TM) coils (31.3 +/- 9.69%) was higher than the packing density of the group treated without Nano(TM) coils (29.49 +/- 7.84%), although the difference was not significant. Procedural complications developed in 3 lesions (2 thromboembolisms and 1 carotid dissection) (2.0%). Treatment-related transient neurological deficits due to thromboembolism developed in 1 lesion, which had not been treated with Nano(TM) coils. There was no treatment-related permanent morbidity or mortality in either of the groups. CONCLUSION: In our series, the small cerebral aneurysms treated with Nano(TM) coils showed more packing density with no additive procedural risk or difficulty.
Humans ; Intracranial Aneurysm* ; Mortality ; Retrospective Studies ; Thromboembolism

Angiolipomas are usually found in the soft tissues of the extremity, trunk, or neck. Spinal angiolipomas are rare, accounting for between 0.14% and 1.2% of spinal axis tumors, and the majority are extradural. We report a case of surgically proven extradural spinal angiolipoma with a high vascular content and involving the thoracic level.
Angiolipoma* ; Axis, Cervical Vertebra ; Extremities ; Neck

A giant serpentine aneurysm (GSA) in the anterior cerebral artery (ACA) poses a technical challenge in treatment given its large size, unique neck, and dependent distal vessels. Here we report the case of a GSA in the ACA successfully treated with a combined surgical and endovascular approach. A 54-year-old woman presented with dull headache. On brain computed tomography (CT), a large mass (7 cm × 5 cm × 5 cm) was identified in the left frontal lobe. Cerebral angiography revealed a GSA in the left ACA. Bypass surgery of the distal ACA was performed, followed byocclusion of the entry channel via an endovascular approach. Follow-up CT performed 5 days after treatment revealed disappearance of the vascular channel and peripheral rim enhancement. Follow-up imaging studies performed 7 months after treatment revealed gradual reduction of the mass effect and patency of bypass flow. No complications were noted over a period of 1 year after surgery.
Aneurysm* ; Anterior Cerebral Artery* ; Brain ; Cerebral Angiography ; Cerebral Revascularization ; Female ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Neck