Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel-anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.

• Klíčová slova
• acute stroke, endovascular therapy, moyamoya,
• MeSH
• digitální subtrakční angiografie metody   MeSH
• endovaskulární výkony * metody   MeSH
• intrakraniální aneurysma terapie   komplikace   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• moyamoya nemoc * komplikace   terapie   MeSH
• počítačová rentgenová tomografie MeSH
• prasklé aneurysma * terapie   komplikace   MeSH
• terapeutická embolizace metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE: Intracranial aneurysm (IA) rupture results in one of the most severe forms of stroke, with severe neurological sequelae. Inflammation appears to drive aneurysm formation and progression with macrophages playing a key role in this process. However, less is known about their involvement in aneurysm rupture. This study is aimed at demonstrating how relationship between the M1 (pro-inflammatory) and M2 (reparative) macrophage subtypes affect an aneurysm's structure resulting in its rupture. METHODS: Forty-one saccular aneurysm wall samples were collected during surgery including 13 ruptured and 28 unruptured aneurysm sacs. Structural changes were evaluated using histological staining. Macrophages in the aneurysm wall were quantified and defined as M1 and M2 using HLA-DR and CD163 antibodies. Aneurysm samples were divided into four groups according to the structural changes and the M2/1 ratio. Data were analyzed using the Mann-Whitney U test. RESULTS: This study has demonstrated an association between the severity of structural changes of an aneurysm with inflammatory cell infiltration within its wall and subsequent aneurysm rupture. More severe morphological changes and a significantly higher number of inflammatory cells were observed in ruptured IAs (p < 0.001). There was a prevalence of M2 macrophage subtypes within the wall of ruptured aneurysms (p < 0.001). A subgroup of unruptured IAs with morphological and inflammatory changes similar to ruptured IAs was observed. The common feature of this subgroup was the presence of an intraluminal thrombus. CONCLUSIONS: The degree of inflammatory cell infiltration associated with a shift in macrophage phenotype towards M2 macrophages could play an important role in structural changes of the aneurysm wall leading to its rupture.

• Klíčová slova
• Brain aneurysm, Inflammation, Intracranial aneurysm, Macrophage polarization, Subarachnoid hemorrhage,
• MeSH
• intrakraniální aneurysma * komplikace   patologie   MeSH
• lidé MeSH
• makrofágy * patologie   MeSH
• prasklé aneurysma * komplikace   patologie   MeSH
• trombóza komplikace   MeSH
• zánět komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: Arterial aneurysms of the pancreaticoduodenal arcade (PDA) represent approximately 2% of all aneurysms of visceral arteries. Despite a low incidence, this group of aneurysms is clinically significant due to its high risk of rupture. CASE REPORT: A 45 years old patient presented with a pancreaticoduodenal arcade aneurysm rupture along with a tight stenosis at the origin of the coeliac trunk. Retrograde blood flow from the superior mesenteric artery (SMA) to the hepatic artery (HA) via PDA limited our therapeutic options due to the necessity to maintain liver perfusion. The patient was indicated for an interventional radiology procedure, which consisted of percutaneous transluminal angioplasty (PTA) with stent placement at the origin of the coeliac trunk and subsequent transarterial embolisation (TAE) - trapping of the aneurysm using coils. Due to clinical signs of the intra-abdominal compartment syndrome, within 24 hours of the radiological treatment, the patient was indicated for surgical revision (laparotomy). During the surgery, no signs of active bleeding were found; coagula were evacuated from the abdominal cavity (800 ml) and laparostomy was performed with a temporary closure using a grid. Final closure of the abdominal cavity was performed on postoperative day 20 from the initial procedure. Follow-up abdominal CT performed 22 months after TAE showed no recurrence of the aneurysm. CONCLUSION: Aneurysm rupture represents a serious case of acute abdomen which requires urgent treatment. The preferred method of treatment for ruptured PDA aneurysms is the endovascular intervention using TAE, which is associated with lower morbidity and mortality than the surgical intervention. Concurrent coeliac trunk stenosis requires consideration given the need to maintain sufficient liver perfusion after TAE of the PDA aneurysm, acting up to this point as a collateral circulation of the liver. The choice of the therapeutic approach should be individualised taking into account the above mentioned recommendations.

• Klíčová slova
• aneurysm of the pancreaticoduodenal artery, rupture, rupture − stenosis of the coeliac trunk,
• MeSH
• arteria coeliaca MeSH
• arteria mesenterica superior MeSH
• hemoperitoneum etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pankreas MeSH
• prasklé aneurysma * komplikace   diagnostické zobrazování   chirurgie   MeSH
• terapeutická embolizace * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

BACKGROUND: Optimal surgical treatment of blood-blister aneurysms (BBA) remains controversial. Some surgeons prefer clipping reconstruction while others favor primary bypass with trapping. OBJECTIVE: To analyze of benefit of double bypass technique to surgical outcomes in patients with ruptured BBA in poor initial neurological condition (PINC). METHODS: Retrospective analysis of clinical, radiological, and surgical data in 9 patients treated between January 2009 and December 2015. Intraoperative middle cerebral artery blood pressure (MCABP) measurement was used for selection of bypass procedure. RESULTS: Seven patients presented with World Federation of Neurosurgical Societies (WFNS) subarachnoid hemorrhage (SAH) score 4 or 5. No pulse pressure in the MCA after internal carotid artery (ICA) clamping was found in 3 patients, although their ACoA or PCoA were well visualized on preoperative angiograms. By contrast, only a minimal drop in MCABP following ICA clamping was detected in two cases, although their collaterals were slim/nonvisualized on imaging. Although angiographic vasospasms were not observed in our patients, two of them experienced cerebral infarction, attributable more to the mass effect and postoperative ICA thrombosis than to SAH-induced vasospasm. There were 2 premature intraoperative ruptures, but no perioperative mortality, aneurysm recurrence, or rebleeding. Five patients with WFNS SAH score 4 or 5 achieved favorable outcomes. CONCLUSION: Early double bypass technique guided by MCABP measurement and combined with trapping (or rarely clipping) seems to be a safe method with excellent long-term outcomes in patients in PINC. This study may thus contribute to the debate on the optimal treatment strategy for BBA.

• Klíčová slova
• Blood-blister aneurysms, Internal carotid artery, Intraoperative middle cerebral artery blood pressure measurement, Low-flow/high-flow bypass, Trapping,
• MeSH
• arteria carotis interna diagnostické zobrazování   chirurgie   MeSH
• dospělí MeSH
• intrakraniální aneurysma komplikace   diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nemoci arterie carotis komplikace   diagnostické zobrazování   chirurgie   MeSH
• nemoci nervového systému diagnostické zobrazování   etiologie   chirurgie   MeSH
• prasklé aneurysma komplikace   diagnostické zobrazování   chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• subarachnoidální krvácení komplikace   diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Hemodynamic parameters play a significant role in the development of cerebral aneurysms. Parameters such as wall shear stress (WSS) or velocity could change in time and may contribute to aneurysm growth and rupture. However, the hemodynamic changes at the rupture location remain unclear because it is difficult to obtain data prior to rupture. We analyzed a case of a ruptured middle cerebral artery (MCA) aneurysm for which we acquired imaging data at three time points, including at rupture. A patient with an observed MCA aneurysm was admitted to the emergency department with clinical symptoms of a subarachnoid hemorrhage. During three-dimensional (3D) digital subtraction angiography (DSA), the aneurysm ruptured again. Imaging data from two visits before rupture and this 3D DSA images at the moment of rupture were acquired, and computational fluid dynamic (CFD) simulations were performed. Results were used to describe the time-dependent changes of the hemodynamic variables associated with rupture. Time-dependent hemodynamic changes at the rupture location were characterized by decreased WSS and flow velocity magnitude. The impingement jet in the dome changed its position in time and the impingement area at follow-up moved near the rupture location. The results suggest that the increased WSS on the dome and increased low wall shear stress area (LSA) and decreased WSS on the daughter bleb with slower flow and slow vortex may be associated with rupture. CFD performed during the follow-up period may be part of diagnostic tools used to determine the risk of aneurysm rupture.

• Klíčová slova
• Computational fluid dynamics, Flow dynamic, Rupture location, Velocity, Wall shear stress,
• MeSH
• digitální subtrakční angiografie MeSH
• hemodynamika MeSH
• intrakraniální aneurysma komplikace   diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• modely kardiovaskulární MeSH
• prasklé aneurysma komplikace   diagnostické zobrazování   patofyziologie   MeSH
• subarachnoidální krvácení diagnostické zobrazování   etiologie   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH

OBJECTIVE: We present a case of pregnant woman with acute pacreatitis in 38th week comlicated by acute rupture of aneurysm of artery lienalis. DESIGN: Case report. SETTING: Department of Gynaecology and Obstetrics, Faculty Hospital and Palacky University, Olomouc. CASE REPORT: 28-years-old primipara in 38th week of gestation was admitted to our department for acute pancreatitis caused by gallstones. Subsequent conservative treatment was complicated by rupture of aneurysm of lienal artery and haemorrhagic shock. Urgent caesarean section was performed with two subsequent revisions and peroperative 5l of blood loss. Operation was followed by intensive anesthesiology-resuscitate care of ARDS, gradual realimentation and conservative care of acute pancreatitis. Patient was discharged in good condition 20th day. CONCLUSION: Acute pancreatitis is rare in pregnancy. In severe and complicated cases maternal and perinatal morbidity and mortality may be elevated, despite early diagnosis and intensive treatment.

• Klíčová slova
• acute pancreatitis, rupture splenic artery pregnancy.,
• MeSH
• akutní nemoc MeSH
• arteria lienalis * MeSH
• císařský řez MeSH
• dospělí MeSH
• hemoragický šok diagnóza   terapie   MeSH
• komplikace těhotenství diagnóza   terapie   MeSH
• lidé MeSH
• náhlé příhody MeSH
• pankreatitida komplikace   diagnóza   terapie   MeSH
• prasklé aneurysma komplikace   diagnóza   terapie   MeSH
• reoperace MeSH
• těhotenství MeSH
• třetí trimestr těhotenství * MeSH
• žlučové kameny komplikace   diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Spontaneous hemothorax is a well-known yet seldom-reported entity in forensic literature. While trauma-related hemothorax is frequently encountered in a medicolegal setting, non-traumatic and spontaneous hemothorax are relatively uncommon entities. The wide range of causes that can trigger fatal intrathoracic bleeding include thoracic aortic dissection, followed by vascular malformations, various oncological diseases, and connective tissue abnormalities. In rare instances, extramedullary hematopoiesis, ectopic pregnancy, congenital heart defects, amyloidosis, or parasitic diseases may constitute a source of bleeding. This etiological heterogeneity may, as a result, cause diagnostic difficulties during post-mortem elucidation of hemothorax. It should be borne in mind that hemothorax after low-energy trauma does not exclusively indicate traumatic hemorrhage, hence, the non-traumatic origin of bleeding must be taken into consideration. In this paper, we present a systematic review of the relevant literature enriched by the results of our observations to investigate the etiologies and recommendations for the post-mortem diagnosis of spontaneous hemothorax in an attempt to better delineate the possible medicolegal considerations. It is important that forensic pathologist as well as clinicians are aware of the diseases that could potentially give rise to fatal hemothorax.

• Klíčová slova
• Diagnostics, Etiology, Post-mortem evaluation, Spontaneous hemothorax, Sudden death,
• MeSH
• amyloidóza komplikace   MeSH
• cévní malformace komplikace   MeSH
• disekce aorty komplikace   MeSH
• echinokokóza plic komplikace   MeSH
• Ehlersův-Danlosův syndrom komplikace   MeSH
• endometrióza komplikace   MeSH
• exostózy komplikace   MeSH
• hemotorax etiologie   patologie   MeSH
• kardiopulmonální resuscitace škodlivé účinky   MeSH
• krevní nemoci komplikace   MeSH
• lidé MeSH
• nádory komplikace   MeSH
• nemoci hrudníku komplikace   MeSH
• pneumotorax komplikace   MeSH
• prasklé aneurysma komplikace   MeSH
• soudní patologie MeSH
• vrozené srdeční vady komplikace   MeSH
• žebra MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

Rupture of isolated aneurysm of common iliac artery is a relative seldom finding in vascular surgery. Nowadays are in therapy of this severe conditions used conventional as well as endovascular procedures. Our case report document, that in high risk patients with convenient anatomical conditions endovascular therapy is a safe and effective therapy, that can reduce mortality of these patients.

• MeSH
• arteria iliaca * MeSH
• endovaskulární výkony * MeSH
• hemoragický šok etiologie   MeSH
• lidé MeSH
• prasklé aneurysma komplikace   diagnóza   chirurgie   MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Arosion of peripancreatic arteries in acute or chronic pancreatitis is a rare cause of bleeding into gastrointestinal tract--hemosuccus pancreaticus. Aim of the paper is to show the diagnostic and therapeutic options in this serious clinical stage. METHODS AND RESULTS: We report a case of a patient with chronic pancreatitis who developed acute bleeding into the gastrointestinal tract due to the perforation of a pseudoaneurysm into pancreatic pseudocyst in the area of the pancreatic body. The diagnosis of hemosuccus pancreaticus, established by endoscopy and postcontrast CT examination, was confirmed by angiography. We stopped the acute bleeding from pseudoaneurysm, unusually well supplied by both gastric arteries by embolization of both arteries with metallic coils. CONCLUSIONS: Angiography plays an irreplaceable role in patients with hemosuccus pancreaticus. Our case demonstrates bleeding from pseudoaneurysm supplied by both gastric arteries, whose embolization produced an immediate hemostasis and improvment the patient's condition.

• MeSH
• arterie MeSH
• chronická pankreatitida komplikace   MeSH
• dospělí MeSH
• gastrointestinální krvácení etiologie   terapie   MeSH
• lidé MeSH
• nepravé aneurysma komplikace   diagnostické zobrazování   MeSH
• pankreatická pseudocysta komplikace   MeSH
• prasklé aneurysma komplikace   diagnostické zobrazování   MeSH
• rentgendiagnostika MeSH
• terapeutická embolizace * MeSH
• žaludek krevní zásobení   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The renal arteries aneurysms are relatively rare, however, their rupture has a high mortality rate. The authors present a case-review of a 38-year old female, hospitalized with a pain in the left lumbar region, lasting for 24 hours, which spread into the mesogastrium and the left groin. Upon angiographic examination, the left renal artery aneurysm was detected. Embolization was conducted, aiming to save the kidney, however, it proved unsuccessful and was complicated by a rupture of the aneurysm. Consequently, urgent nephrectomy was completed. Prior to the procedure, massive haemorrhaging from the right groin following angiography, was managed. Relapsing haemorrhaging from the right groin and development of a major retroperitoneal haematoma, complicated the postoperative course and required repetitive postoperative revisions. The accidental finding of a minor aneurysm of the lienal artery, the patient's constitution, her anamnestic data and the complicated course of hospitalization, suggested the systemic connective tissue disorder. Furthermore, the authors discuss contemporary diagnostic and therapeutic approach to the renal arteries aneurysms.

• MeSH
• arteria renalis * MeSH
• dospělí MeSH
• lidé MeSH
• nefrektomie MeSH
• nemoci pojiva komplikace   MeSH
• prasklé aneurysma komplikace   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH