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Vein of Galen aneurysmal malformation in a neonate treated by endovascular surgery--case report.

A male neonate with vein of Galen aneurysmal malformation developed fetal heart failure after a gestation period of 37 weeks. Labor was induced, but a cesarean section had to be performed because of fetal distress. His Apgar scores were 2/8 at birth. The boy required controlled ventilation due to generalized seizure and cyanosis. Neuroimaging revealed vein of Galen aneurysmal malformation with enormous arteriovenous shunt flows. Transarterial embolization was performed on days 4 and 6 to reduce the progressive high-output congestive heart failure. Three large feeders were occluded with interlocking detachable coils, markedly reducing the shunt flow. Although heart failure improved markedly, he died of pulmonary hemorrhage on day 12. Endovascular surgery can improve the prognosis of heart failure in the neonatal period less invasively than other treatment modalities, and may help to minimize ischemic brain damage and thus increase the possibility of normal brain maturation.

Arteriovenous Fistula↗

The transtorcular embolization of vein of Galen aneurysms.

Vein of Galen malformations are a diverse group of deeply located high-flow vascular lesions that are difficult to eradicate with standard surgical techniques. New nonsurgical interventional techniques offer encouraging results as alternative therapeutic choices in these complicated vascular shunts. Use of a new procedure of transtorcular embolization with Gianturco embolic coils is described in three patients harboring vein of Galen aneurysms. Two of the three patients had a satisfactory outcome. This technique is simple and quick, and can produce progressive thrombosis in these high-flow vascular fistulas.

Brain↗

Evaluation, management, and long-term follow up of vein of Galen malformations.

OBJECT: Vein of Galen malformations (VGMs) are extremely rare intracranial lesions. Clinical presentation and management strategies vary significantly in different areas of the world. The authors report their experience in evaluation, management, and long-term follow up of these lesions in India. METHODS: Between October 1983 and June 2003, 25 patients with VGMs were referred to the authors' institution for evaluation and management. Ten children younger than 2 years of age presented with rapidly increasing head size as the chief complaint. Among 11 children 2 years of age or older, the most common presenting symptom was chronic headache. Four patients who presented during adulthood had chronic headache for many years before presentation. Angiographic evaluation of the lesion was performed in 21 patients. Fifteen patients were treated using endovascular techniques. Injection of the embolic material was performed after induction of systemic hypotension when the flow in the fistula was high. Complete occlusion of the arteriovenous shunt could be achieved in two patients with vein of Galen aneurysmal dilation (100% of patients with this type of malformation) and in five of the six patients with the mural type of malformation (83%). Among patients with the choroidal type of malformation, complete obliteration of the shunt could be achieved in three patients. In three patients with high-flow choroidal malformations, embolization carried out in a single sitting resulted in shunt reduction of nearly 90%. These patients received clinical follow up. CONCLUSIONS: The authors' experience in evaluation and management of VGMs reveals that in areas of the world where access to dedicated specialist care is limited, the clinical presentation of VGMs can differ appreciably from the classic descriptions in the literature. Endovascular management of these lesions results in excellent angiographic and clinical results.

Adult↗

Transarterial embolization of vein of Galen malformations: the use of magnetic resonance imaging noninvasive optimal vessel analysis to quantify shunt reduction. Report of two cases.

In patients with vein of Galen malformations, high-flow shunting decreases cerebral perfusion. By reducing or eliminating these shunts, transarterial embolization can improve cerebral perfusion and clinical outcomes. Quantifying pre- and postembolization shunt blood flow may help determine the optimal timing and efficacy of embolization and may provide prognostic information. The authors used magnetic resonance imaging noninvasive optimal vessel analysis as a novel modality to measure volumetric blood flow through vein of Galen malformation shunts in a neonate and an infant before and after transarterial embolization.

Brain↗

Perinatal pseudocoarctation: echocardiographic findings in vein of Galen malformation.

OBJECTIVE: Vein of Galen aneurysmal malformations (VGAMs) are rare congenital malformations thought to develop during weeks 6 to 11 of fetal life. Although they represent less than 1% of all cerebral vascular malformations, they constitute up to 30% of all pediatric vascular malformations. Vein of Galen aneurysmal malformations cause high-output heart failure in the fetus and neonate secondary to the decreased resistance and high blood flow in the lesion. We describe 2 cases, 1 prenatal and 1 postnatal, in which unusual aortic Doppler flow patterns and substantial brachiocephalic vessel dilation contributed to the discovery of a VGAM. METHODS: Echocardiographic findings associated with VGAM malformations in 2 cases are described. RESULTS: Unusual Doppler flow patterns and substantial brachiocephalic vessel dilation were seen in both cases. Pseudocoarctation of the aorta was also noted in both cases. CONCLUSIONS: The echocardiographic findings in fetal and neonatal VGAM may include pseudocoarctation of the aorta. Abnormal fetal cardiac findings should raise the practitioner's suspicion for cerebral malformations and vice versa.

Adult↗

Galen-In-Use: an EU Project applied to the development of a new national coding system for surgical procedures: NCAM.

GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centre co-operating within the European Federation of Coding Centre (EFCC) to create a multilingual knowledge repository for multicultural Europe. NCAM (Nomenclature Commune des Actes Médicaux) is the new French multipurpose coding system for surgical procedures. The labels are processed from the intermediate dissections to the Grail representation and the natural language generation by the electronically related Medical Informatics research centres network of Saint Etienne, Manchester, Geneva and Nijmegen. The national coding centre is able to retrieve the initial labels with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.

Electronic Data Processing↗

[Vein of Galen aneurysmal malformation: multi-staged feeder clipping in two neonatal cases with intractable heart failure].

The authors reported the surgical experience of two cases of vein of Galen aneurysmal malformation in the newborn, whose congestive high-output cardiac failure was intractable. Along with the intensive care to clinical manifestations of the heart failure, multi-staged feeder clipping was carried out to decrease the high-flow shunt of the malformation. As stages going on, heart failure was relieved gradually and cathecolamines were weaned. Although certain retardation became apparent in both cases, they are showing satisfactory development in the long-term follow up. By the recent advancement of the embolization technique, the embolization appears to have already taken place the treatment of choice for this malformation. According to the neonatal evaluation score of Lasjaunias, the embolization would no longer be recommendation in neonates, whose general condition scored less than eight points. The authors believe, based on our two cases, that multi-staged feeder clipping is one of the effective modality of treatment in neonates of the vein of Galen aneurysmal malformation with severe multiorgan failure.

Cardiac Output, High↗

Galen-In-Use: using artificial intelligence terminology tools to improve the linguistic coherence of a national coding system for surgical procedures.

GALEN has developed a language independent common reference model based on a medically oriented ontology and practical tools and techniques for managing healthcare terminology including natural language processing. GALEN-IN-USE is the current phase which applied the modelling and the tools to the development or the updating of coding systems for surgical procedures in different national coding centers co-operating within the European Federation of Coding Centre (EFCC) to create a language independent knowledge repository for multicultural Europe. We used an integrated set of artificial intelligence terminology tools named CLAssification Manager workbench to process French professional medical language rubrics into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation we generate controlled French natural language. The French national coding centre is then able to retrieve the initial professional rubrics with different categories of concepts, to compare the professional language proposed by expert clinicians to the French generated controlled vocabulary and to finalize the linguistic labels of the coding system in relation with the meanings of the conceptual system structure.

Artificial Intelligence↗

Aggregation and reclassification--assessment of GALEN methods in the domain of thoracic surgery.

This paper reports on the experiences from evaluation of GALEN methods for mapping of follow-up categories in the domain of thoracic surgery to an existing classification of surgical procedures. The mapping of the aggregated levels or groups of thoracic procedures presents a genuine problem in relation to strict hierarchical classifications, since the follow-up categories not necessarily fit in the pre-set structure of the classification. The paper reports on the experiences from modelling of the traditional classification as well as modelling of the follow-up categories, together with an analysis of results with a discussion of opportunities and potential problems and pitfalls when applying GALEN models and tools.

Humans↗

Galen: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.

GALEN has developed a new generation of terminology tools based on a language independent concept reference model using a compositional formalism allowing computer processing and multiple reuses. During the 4th framework program project Galen-In-Use we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures (CCAM) in France. On one hand we contributed to a language independent knowledge repository for multicultural Europe. On the other hand we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW to process French professional medical language rubrics produced by the national colleges of surgeons into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation on one hand we generate controlled French natural language to support the finalization of the linguistic labels in relation with the meanings of the conceptual system structure. On the other hand the classification manager of third generation proves to be very powerful to retrieve the initial professional rubrics with different categories of concepts within a semantic network.

Abstracting and Indexing↗

Vein of Galen aneurysmal malformation. Different clinical expressiveness. Three case reports.

The vein of Galen aneurysmal malformation (VGAM) is a rare cerebro-vascular disorder in neonates. It is characterized by an abnormal direct communication between one or several cerebral arteries and the vein of Galen. It may appear in the neonatal period or afterwards. Three cases of patients affected by VGAM with different clinical expression are presented. Two of them were treated successfully with endovascular embolization. It was not possible to provide the same treatment to the third patient for an intractable congestive heart failure already existing when VGAM was diagnosed.

Cerebral Angiography↗

Hemorrhagic complications in vein of Galen malformations.

The authors report on a series of spontaneous intracranial hemorrhages associated with vein of Galen aneurysmal malformations (VGAMs). Thirty-four children with VGAMs have been treated at this institution since 1986. Eight children (24%) harbored the mural-type malformation, and 26 (76%) had the choroidal-type lesion. Two children (25%) with mural lesions and 1 (4%) with a choroidal lesion suffered hemorrhagic complications. Two presented with acute intracranial hemorrhage. A third child developed acute intracranial hemorrhage due to delayed dural sinus thrombosis after endovascular treatment of his choroidal-type VGAM. The subjects ranged in age from 13 days to 17 months at the time of presentation. Each patient underwent rapid radiological evaluation and treatment with endovascular surgery. Post-procedural arteriography demonstrated complete occlusion of the malformation in each patient. For the 3 patients with hemorrhage, follow-up has taken place over 49-, 107-, and 43-month intervals, respectively. Vein of Galen aneurysmal malformations can present with acute intracranial hemorrhage or develop delayed intracranial hemorrhage but respond to treatment using standard endovascular techniques. The presence of hemorrhage does not de facto portend a poor prognosis.

Cerebral Angiography↗

GALEN-IN-USE: application in Greek and influences on education.

GALEN-IN-USE is a European project that aims to promote greater European harmonization and to overcome the problems encountered in using traditional coding and classification systems. This paper presents the work done by the Greek Centre of Medical Informatics and Terminology, as a collaborating centre of GALEN-IN-USE(GIU), in order to apply GIU's tools to Greek Health Care System as well as the affect of this application in education.

Classification↗

Assessment of the GALEN methodology on holistic classifications for professions allied to medicine.

In the field of health care terminology it has proven to be difficult, but not impossible, to build a formal Reference Model (knowledge-model) for medical terminology. The intuition is that it is even more difficult to build such a reference model for the so called â holistic' classification schemes as used by Nursing and Allied Health Care Professionals. There is a growing perceived need for formal reference models for specific professional groups. These reference models are used in many different ways, such as for building, maintaining and manipulating classification schemes. This paper focuses on the usability of the GALEN methodology for the formalisation of the Dutch Classification of Pain (NCP) as an example of such a â holistic classification'. The first results of this exploration show that the GALEN methodology is very useful for analysing and understanding a' holistic classification'. A high number of necessary concepts from the NCP already exist within the OpenGalen Common Reference Model-2 (OCRM2). A substantial number of concepts from the NCP do not yet exist in the OCRM2 or are underspecified. Additional modelling of the OCRM2 has to be performed, to enrich the expressivity of the model.

Allied Health Occupations↗

[The scientific conceptualization of the female being. Metaphoric use in Galen's writings].

This article, a gender study of the writings of Galen, aims to investigate the reasons for the sustained claims of the inferiority of feminine nature with respect to masculine nature. We offer a reconstruction of the social values held by Galen, which conferred to him an androcentric model of knowledge that differed from the other scientific forms in existence at that time. We show that descriptions of the female organism are assiduously associated with maleness or nature, which we interpret as a metaphorical and exemplifying use for the transmission of ethical norms, and the credibility of the doctrine.

Female↗

Galen ad multos annos.

This paper focuses on demonstrating the weakness of the traditional date for Galen's death. It shows that there are good grounds from both within the Galenic Corpus and outside it for thinking that he lived at least until he was eighty. Information from Byzantine and Arab scholars from the sixth century onwards suggests that he had died in the reign of Caracalla, perhaps in 216.

History, Ancient↗

[Nicotinic acid blood levels after application of xanthinolnicotinate in a new galenic retard preparation].

Nicotinic acid blood level determinations were carried out in 30 male test subjects following application of xantinol-nicotinate in a new galenic retard preparation. The investigations showed that there is a continuous absorption of the agent--lasting for a longer period--with a maximum of blood level values between the 5th and 7th hour. In comparative studies with non-retarded xantinol-nicotinate the peak of concentration is already reached 1 h after application. The use of pharmacokinetic methods showed that by the retardation of xantinol-nicotinate there are no losses of absorption of nicotinic acid--as compared with the non-retarded forms. By the special galenic properties of the new retard form therapeutically effective nicotinic acid blood levels lasting for more than 8 h with an ascertained biological availability are attained.

Adenosine Triphosphate↗

Aneurysm of the vein of galen in neonates: report of four cases.

In neonates, aneurysm of the vein of Galen often masquerades as cyanotic congenital heart disease. We report 4 cases of neonates presenting with malformation of the vein of Galen at our insititution. An increased awareness of this entity seems warranted.

Cerebral Veins↗