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[Controlled liberation of active principles by means of new galenic formulations].

Drugs inside a conventional galenic form are distributed between specific biological targets and other anatomical tissues. With the aim to obtain a more rational and a better therapeutic, one of the most promising possibilities by using the concept of vectorization: association of an active principle to an appropriate vector with the object to increase its action efficiency and efficacy. By this means, they do not just increase the affinity of the drug to the target but also active principle gets protected from a potentially hostile environment (hydrolytic enzymes, acid pH, etc.). The success in the extension of the applications of the vectorización depends more and more of an appropriate design, for what the fundamental objective of this revision will be the one of presenting the general characteristics and some of the current applications in these new galenic forms.

Drug Carriers↗

The role of Galen in the development and progress of medical sciences.

Early Roman medicine was a mixture of religion and witchcraft, but as time went by, it became more influenced by the Greek medical sciences, which were more developed. The most famous Greek physician during the Roman period was Galen (129-200 AD). In the 4th century A. D. The Byzantine physicians of the Emperor Julian, made the Galenic writings available to ordinary practitioners, and so Greek medicine spread throughout Syria and was carried by the Nestorians into Persia, where it became available to the Islamic World.

Arab World↗

[Aneurysmal malformation of the vein of Galen in adults].

We present an adult male harbouring a vascular malformation, manifested by haemorrhage, which localization, arterial feeders and venous drainage, match the pattern of choroidal type vein of Galen aneurysmal malformations seen in babies, excepting the absence of anterior choroidal arteries participation. A few cases of vein of Galen aneurysmal malformations were already reported in adults, but haemorrhage was never well documented. This haemorrhage may have a pathogenesis similar to those of pial arteriovenous malformations.

Adult↗

Vein of Galen malformation combined with atrial septal defect in a neonate.

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein, whereby the interconnecting capillary network is missing. Such a malformation frequently occurs in the deep midline regions of the brain, and the subsequent increased flow into the draining vein of Galen substantially dilates in an aneurysmal manner. Congenital forms of the aneurysmal dilatation of the vein of Galen (AVG) often lead to death in the neonatal period, predominantly due to cardiac failure caused by the increased venous inflow as a consequence of the intracerebral arteriovenous shunting. In the presented case a male baby suffered from a rare combination of a cerebral AVF and an atrial septal defect (ASD). He was born at week 38 of pregnancy and subsequently developed tachydyspnoe. Ultrasound (US) and CT scans revealed a large bilateral AVF with dilated basal venous sinuses, hydrocephalus and brain atrophy. In the heart, severe right ventricular hypertrophy, patent ductus arteriosus and an ASD were detectable by US. Neurosurgical consultation rejected the possibility of an operative treatment due to size and localization of the lesion and the existing irreversible brain damage. The child died because of cardiac failure 6 days after birth. Autopsy examination in the brain demonstrated a large conglomerate of dilated blood vessels predominantly in the midline and left occipital lobe, edema and hydrocephalus. In the heart, the ASD detected by US proved to be an ostium secundum-type lesion. Histologically, the conglomerate of vessels revealed features of an AVF and matched the characteristics of AVG. Consequences of chronic ischemic brain injury were also present, with ferruginated neurons suggesting intrauterine damage caused by a congenital AVF. Based on data in the literature, we assume that the left-to-right shunt due to increased venous influx into the heart caused not only cardiomegaly, but may have also interfered with the normal development of the atrial septum leading to an ASD, contributing to the rapid progression of the cardiac failure.

Abnormalities, Multiple↗

Vein of Galen aneurysm malformation (VGAM): closing the management loop.

We report a case where an antenatal scan showed a cerebral vessel dilatation consistent with a vein of Galen malformation (VGAM). After delivery the diagnosis was confirmed on MRI scan. The infant's condition was stable in relation to the two important clinical indicators, mainly not in congestive cardiac failure and no hydrocephalus. The vein of Galen assessment score as used in Hopital Bicetre was 20/21. The scoring system is based on a multiorgan assessment including the five parameters cardiac, cerebral, respiratory, hepatic and renal (Table 1). A score of < 8 indicates no treatment, 8-12 means immediate intervention while a score > 12 delays intervention to circa six months of age. At four months the head circumference accelerated with hydroceaphalus on scans and the infant became clinically symptomatic. Urgent embolisation was performed. The procedure uses N-butylcyanoacrylate (NBCA) glue as the embolisation agent, which in this case was inserted through the left posteriomedial choroidal artery. Complete obliteration was achieved. The infant subsequently required insertion of a ventriculoperitoneal shunt for the hydrocephalus component. The infant has had no recurrence. He remains well on objective examination he has mild developmental delay. In summary this case highlights the value of antenatal diagnosis,the VGAM assessment score to determine the optimal time of intervention and the effectiveness of embolisation.

Adhesives↗

Vein of Galen aneurysm: antenatal diagnosis: a case report.

Aneurysm of vein of Galen is a rare congenital malformation with reported incidence of less than 1% of cerebral vascular malformations. Most cases present in neonatal life with congestive cardiac failure. We report a case of aneurysm of vein of Galen diagnosed in intrauterine life at 36 weeks of gestation. The importance of third trimester Doppler ultrasound is highlighted.

Adult↗

The galenic plague: a breakdown of the imperial pathocoenosis. Pathocoenosis and longue durée.

Is 'pathocoenosis', a notion conceived and a word coined by Mirko Grmek (1969), useful as far as ancient history is concerned? The author is interested in Galenic pathocoenosis, that of doctor Galen and his Emperor Marcus Aurelius (IInd cent. A.D.), when a new 'pestilence' or 'plague' (smallpox?) devastated the whole empire, from Mesopotamia to the Danube at least.

Disease Outbreaks↗

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis.

A case of thrombosed aneurysm of the vein of Galen associated with superior sagittal sinus thrombosis is reported. Clinical course was characterized by multiple intraparenchimatous hemorrhages and hydrocephalus. NMR showed dural sinuses thrombosis better than CT even though cerebral angiography was more effective for the diagnosis. Intracranial hypertension due to hydrocephalus was relieved with a ventriculoperitoneal shunt. The authors suggest that the abnormal hemodynamic patterns due to the drainage of the malformation into the vein of Galen and dural sinuses led to venous occlusion and multiple intracranial hemorrhages.

Cerebral Angiography↗

[Cardiac and cerebral involvement in aneurysms of the ampulla of Galen. Contribution of echography and cerebral Doppler flowmeter in the neonatal period].

An arteriovenous malformation of the vein of Galen was diagnosed using two-dimensional ultrasound and pulsed Doppler method, in a neonate with congestive heart failure. Contrast echocardiography showed right to left atrial and ductal shunting. Sector scans of the brain revealed an echo free intracranial mass with venous flow at the Doppler. Doppler assessment of the main cerebral arteries was also performed. In neonates presenting with severe congestive heart failure of unknown etiology, two-dimensional ultrasonography provides an accurate and rapid diagnosis of a cerebral arteriovenous malformation with aneurysm of the vein of Galen. Ultrasound method may also contribute to improve the comprehension of the physiopathology underlying the clinical findings.

Cerebral Veins↗

[Role of cerebral echography in the diagnosis of aneurysms of the vein of Galen].

Cerebral ultrasound imaging by a transfontanelle approach is now a common investigation during the first year of life. This exploratory procedure is non-invasive, non-irradiating, requires no sedation and can be carried out at the infant's bedside. In addition, the classical apparatus can be completed by deep Doppler allowing deep cerebral vessels to be studied. Three cases are reported of aneurysm of Galen's ampulla detected by ultrasound imaging during the neonatal period. Images demonstrated the presence of an abnormal fluid mass in the region of Galen's ampulla, confirmed as of vascular origin by Doppler, and allowed assessment of degree of subjacent ventricular dilatation and possible secondary ischemic lesions. In massive neonatal forms this exploration may be sufficient since prognosis is poor, but in lesions of moderate size CT scan and angiographic examinations and perhaps MR imaging are required. This technique allows detection of this malformation in the fetus and could therefore influence therapy.

Cerebral Veins↗

[Congestive heart failure in a newborn infant with arteriovenous malformation of the vein of Galen: diagnosis using color-coded Doppler image echography].

Arteriovenous malformations of the vein of Galen are rare disorders that may appear in the newborn period with severe congestive heart failure mimicking many intrinsic cardiac defects. Using combined two-dimensional ultrasound and color-coded blood flow mapping arterio-venous aneurysm of the vein of Galen and congenital atrial septal defect could be diagnosed in an newborn with congestive heart failure. In addition to the presented clinical value of the new two-dimensional color Doppler echography physiological aspects of intracranial arteriovenous fistula in infancy discussed.

Cerebral Veins↗

[Aneurysm of the vein of Galen with neonatal cardiac insufficiency. Success of early neurosurgical treatment].

The vein of Galen malformation is a rarely recognized cause of congestive heart failure in the newborn. This report describes a newborn who developed severe cardiac failure in the second week of life. An aneurysm of the vein of Galen was noted on the computerized tomography scan, confirming the clinical diagnosis of cerebral arteriovenous fistula. The vascular abnormality was well shown by cerebral arteriography. At the age of four weeks, surgery was carried out by clipping the afferent arteries. The patient is non a three years old infant with moderate developmental delay and hypotonia.

Cerebral Veins↗

[Histopathology of the vein of Galen].

Histology of cerebral arteries and veins are reviewed to show variances with extracerebral blood vessels. Muscles fibers even in large cerebral veins are easily overlooked. The thick wall of the vein of Galen grossly and microscopically resembled dura mater fed by microscopic blood vessels and capillaries. The authors reported 4 cases of arteriovenous aneurysms of the great vein of Galen. When compared to the rest of the histological reports on this subject published till now, it is obvious that this new cases bring new facts. First is the presence of an irregular muscle coat in the aneurysmal wall suggesting early hemodynamic troubles. The second and most important data is the association of multiple malformations of the pineal gland, of the vascular elements of the tela choroidea of the third ventricle between which the aneurysm of the great cerebral vein is found. These unusual data suggested complex congenital malformation in the early stages of development.

Cerebral Veins↗

Arteriovenous malformation involving the galenic system. A chance finding in an elderly female.

An elderly female being treated for an unrelated medical condition was found to have an arteriovenous malformation involving the vein of Galen. The florid radiological features are described, including the computed tomogram (CT) appearances. The pathology and usual modes of clinical presentation are reviewed. This patient is the oldest yet described with an arteriovenous malformation involving the Galenic system. It is suggested that the condition is more common in adults than previously thought.

Brain↗

[On the galenical development of a nose spray from N-(2-imidazolin-2-yl)-N-(4-indanyl)amine monohydrochloride (indanazoline) (author's transl)].

An account if given of the aim of the galenical development of the new remedy, indanazolin nose-spray. The description of the quality of the active ingredient N-(2-imidazolin-2-yl)-N-(4-indanyl)amine monohydrochloride (indanazoline, Farial) and the dosage form allows a pharmaceutical evaluation. The descriptions of the organoleptic, physical and chemical properties of the active substance are given in detail. The formulation, the procedures for manufacturing, and the specifications for the packaging materials give some idea of the galenical aspects. The quality of the finished dosage form is defined by means of product specifications relating to the identity, purity, and potency, and is proved by suitably designed stability studies. Finally a detailed summary is made of the analytical methods which were used.

Chemical Phenomena↗

[General characteristics and problems of the galenic aspects of fat emulsions].

The development of a clinically applicable intravenous fat emulsion has a long history. The gain of knowledge about the best lipid and emulsifying system had an intermittent development and led to three generations of distinct fat emulsions. For the evaluation of a fat emulsion it is necessary to compare the results of the same generation only. In the past, many misinterpretations came from mixing the results of different generations. It can be stated that by considering the contraindications, application schedules and basal galenic aspects, only minimal side effects from a parenteral administration of fat emulsions can be seen. Today the most important aspects of parenteral nutrition with fat emulsions are the galenic ones, which are often overlooked. The staining of the liposomes of the fat emulsions with 2% OSO4 make electron microscopic investigations of the liposomes possible after mixing them with carbohydrates, amino acids, electrolytes, vitamins and trace elements. The liposomes of soybean oil emulsions in different "All In One" (AIO) solutions have been under current investigations. The results demonstrated that the liposomes of fresh AIO-solutions carry highly osmiophilic inclusion bodies. Prolonged storage led to further alterations, as change of shape, loss of osmiophility and finally formation of liposomes ghosts. In solutions kept at 4 degrees C those changes developed between the 1st and 2nd month of storage, whereas storage at 22 degrees C was harmless within 48 h only. Therefore, it is recommended that already prepared AIO solutions are kept at 4 degrees C and used as soon as possible.

Carbohydrates↗

Dorsal cyst malformations. Part II. Galenic dysgenesis and its embryological considerations.

In the preceding part, galenic dysgenesis was stated to be a diagnostic hallmark of dorsal cyst malformations. Failed formation of the galenic drainage system conducts the diencephalic drainage laterally into the transverse sinuses as in the embryonal stage, and it is frequently associated with arrested descent of the torcular portion or other anomalies of the dural sinuses. Highly malformed structures of the deep cerebral veins and the dural sinuses seen in this malformation are correctly interpreted in comparison with findings of venous injection studies performed in human fetuses. Pathogenesis of this malformation is also discussed on the basis of embryological studies of the dural sinuses and falcotentorial structures.

Brain↗