This document discusses a computer modeling study of blood flow, shape, and tissue stress/strain in intracranial aneurysms. It provides background on intracranial aneurysms and the role of hemodynamics in their formation and rupture. It then describes the @neurIST technology which uses computational fluid dynamics to model blood flow and predict wall shear stress, shape measurements, and tissue stress/strain in aneurysms. Live demonstrations are provided of analyses for unstented and stented cases. Validation studies and a study of physical aneurysm characteristics are also briefly discussed.
This document outlines guidelines for defining vulnerable plaques and vulnerable patients from the Association for Eradication of Heart Attack. It discusses how atherosclerotic diseases are not limited to developed countries and are a major cause of death worldwide. Vulnerable plaques, myocardium, and hypercoagulable blood can lead to sudden cardiac death and heart attacks. The document proposes histological and clinical criteria for defining vulnerable plaques and screening methods. It also discusses diagnosing plaque inflammation, thin caps, endothelial dysfunction, and other factors at both the plaque and systemic level.
Iaetsd bone quality assessment using mems accelerometerIaetsd Iaetsd
The document describes a study that developed a low-cost device to assess bone mineral density (BMD) using MEMS accelerometers. The device uses an automated hammer to generate stress waves that propagate through the bone in the leg and are measured by the accelerometers. Data was collected from subjects in different age groups and it was found that the acceleration values measured were higher in subjects over 35 compared to those below 35, indicating deterioration of bone quality with age. The technique provides a non-invasive, inexpensive way to evaluate bone quality and has potential for diagnosing osteoporosis.
The document discusses the natural progression of coronary atherosclerosis over time from normal artery to vulnerable plaque. It also discusses opportunities for intervention by identifying high-risk plaques prior to adverse events like heart attack. Specifically, it may be possible to identify plaques that are likely to develop vulnerability or progress significantly through snapshots of plaque characteristics and physiology at different stages. This could enable preventive approaches by focusing interventions on these high-risk minor obstructions to avert future clinical events.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
"INCIDENCE OF INCIDENTAL FINDINGS ON MRI SPINE AND PATIENT BENEFITS : SEE BE...Earthjournal Publisher
This document discusses a study of 300 patients undergoing MRI of the spine. The researchers found that around 50% of patients had incidental extra-spinal findings. The most common findings were renal cysts, ovarian/uterine cysts, and abnormalities of the kidneys and genitourinary system. Other frequent findings included lesions in the lungs, chest, liver, and brain. Reporting these incidental findings provides valuable clinical information for managing patients. Detecting conditions like kidney tumors early through incidental findings can help avoid long-term health risks. The study concludes it is important for radiologists to include and discuss any significant incidental extra-spinal findings in their reports.
This document describes a comparative study of three methods for treating mandibular fractures: intraosseous wiring, miniplate osteosynthesis, and reconstruction plate with bone graft. 72 patients with isolated mandibular fractures were divided into three groups and treated with one of the three methods. The surgical outcomes were compared between the groups in terms of malocclusion, plate exposure, wound healing, union, and sensory deficits. The results showed that miniplate fixation provided better outcomes compared to wiring. Reconstruction plates with bone grafts were effective for fractures with bone loss or gaps.
This document outlines guidelines for defining vulnerable plaques and vulnerable patients from the Association for Eradication of Heart Attack. It discusses how atherosclerotic diseases are not limited to developed countries and are a major cause of death worldwide. Vulnerable plaques, myocardium, and hypercoagulable blood can lead to sudden cardiac death and heart attacks. The document proposes histological and clinical criteria for defining vulnerable plaques and screening methods. It also discusses diagnosing plaque inflammation, thin caps, endothelial dysfunction, and other factors at both the plaque and systemic level.
Iaetsd bone quality assessment using mems accelerometerIaetsd Iaetsd
The document describes a study that developed a low-cost device to assess bone mineral density (BMD) using MEMS accelerometers. The device uses an automated hammer to generate stress waves that propagate through the bone in the leg and are measured by the accelerometers. Data was collected from subjects in different age groups and it was found that the acceleration values measured were higher in subjects over 35 compared to those below 35, indicating deterioration of bone quality with age. The technique provides a non-invasive, inexpensive way to evaluate bone quality and has potential for diagnosing osteoporosis.
The document discusses the natural progression of coronary atherosclerosis over time from normal artery to vulnerable plaque. It also discusses opportunities for intervention by identifying high-risk plaques prior to adverse events like heart attack. Specifically, it may be possible to identify plaques that are likely to develop vulnerability or progress significantly through snapshots of plaque characteristics and physiology at different stages. This could enable preventive approaches by focusing interventions on these high-risk minor obstructions to avert future clinical events.
Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Pat...CrimsonPublishersOPROJ
Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
"INCIDENCE OF INCIDENTAL FINDINGS ON MRI SPINE AND PATIENT BENEFITS : SEE BE...Earthjournal Publisher
This document discusses a study of 300 patients undergoing MRI of the spine. The researchers found that around 50% of patients had incidental extra-spinal findings. The most common findings were renal cysts, ovarian/uterine cysts, and abnormalities of the kidneys and genitourinary system. Other frequent findings included lesions in the lungs, chest, liver, and brain. Reporting these incidental findings provides valuable clinical information for managing patients. Detecting conditions like kidney tumors early through incidental findings can help avoid long-term health risks. The study concludes it is important for radiologists to include and discuss any significant incidental extra-spinal findings in their reports.
This document describes a comparative study of three methods for treating mandibular fractures: intraosseous wiring, miniplate osteosynthesis, and reconstruction plate with bone graft. 72 patients with isolated mandibular fractures were divided into three groups and treated with one of the three methods. The surgical outcomes were compared between the groups in terms of malocclusion, plate exposure, wound healing, union, and sensory deficits. The results showed that miniplate fixation provided better outcomes compared to wiring. Reconstruction plates with bone grafts were effective for fractures with bone loss or gaps.
This document summarizes a case report of a rare case of bilateral squamous cell carcinoma of the temporal bones in a 30-year-old male patient who presented with extensive late-stage disease. Imaging showed large lesions destroying bone structure in the right temporal bone and a smaller lesion in the left. Biopsy confirmed squamous cell carcinoma in both ears. The right-sided tumor was deemed unresectable and the patient received palliative radiotherapy, with a poor prognosis. Bilateral temporal bone cancer is exceptionally rare and this represents one of the few reported cases.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
multiple level spondylodiscitis in neurobrucllosis: int jr of medicineSachin Adukia
Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation
A 56-year-old male farmer in India presented with lower back pain and weakness in his legs for 9 weeks. MRI revealed multi-level infective spondylodiscitis and a prevertebral sacral abscess. Blood culture grew Brucella melitensis after 8 days. Treatment was modified to a 12-month triple antibiotic therapy. Spinal brucellosis should be considered for those with back pain in endemic areas, as timely diagnosis and appropriate treatment is important.
Textbook of refractive laser assisted cataract surgery (re lacs)Springer
This document discusses current outcomes of cataract surgery and how femtosecond laser technology may improve results. It summarizes studies on complication rates of manual cataract surgery, such as anterior capsule tears, posterior capsule ruptures, and vitreous loss. Resident surgeons generally have higher complication rates than experienced surgeons. The document also discusses how a precise laser-created capsulorhexis and pre-chopping of the lens with a femtosecond laser may reduce ultrasound time and power, lower complication risks, and improve refractive outcomes after cataract surgery.
Hydatid cyst, caused by echinococcus granulosa, can produce tissue cyst everywhere in body. Skeletal cystic lesion is rare specially in long bones like femur and because of its unusual presentation, its diagnosis may easily be missed, unless be kept in mind. Hydatid disease is a parasitic infestation of the humans that can practically affect any part of the body. It commonly affects liver, lung and muscles. Bone hydatid is less common occurring in only 0.5–2% of cases and humans act as an intermediate host. In the patient evaluated by us, the plain x-ray showed multiple osteolytic lesions along the lower one third of the femur and the upper end of tibia.
Pettine et al treatment of discogenic back pain with autologous bmc inje...Jason Attaman
This study evaluated the safety and effectiveness of treating discogenic back pain by injecting autologous bone marrow concentrate (BMC) directly into damaged discs. Twenty-six patients received injections of their own BMC into one or two painful discs. At two years follow-up, most patients experienced significant reductions in pain and disability, with 81% avoiding back surgery. No complications occurred from the injections. The results provide preliminary evidence that BMC injections may be a safe and effective non-surgical treatment for discogenic back pain.
Anomalous Shapes of Jugular Foramen in Dried Skulls Anatomical Basis of Verne...ijtsrd
Jugular foramen is seen at the base of the skull behind the carotid canal. It transmits 9,10,11 cranial nerves and internal jugular vein. Variations in the shape of the jugular foramen may compress these vital structures. The present study was done to determine the anomalous shapes of jugular foramen in dried skulls. When the dried skulls from the department of Anatomy at a private medical college were observed, two skulls were found to show anomalies in their shapes bilaterally. One skull exhibited a complete partition on left side dividing the foramen into two. Another skull was found to have incomplete partitions to such an extent that they could compress the vital structures passing through them. Vernet’s syndrome a jugular foramen syndrome may be due to inappropriate bone growth leading to partition or anomalous shape of the jugular foramen. The present study demonstrates two dried skulls with anomalous shapes and partition of the jugular foramen. Dr. Neelima. P | Dr. R. Ravi Sunder "Anomalous Shapes of Jugular Foramen in Dried Skulls - Anatomical Basis of Vernet’s Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38638.pdf Paper Url: https://www.ijtsrd.com/medicine/physiology/38638/anomalous-shapes-of-jugular-foramen-in-dried-skulls--anatomical-basis-of-vernet’s-syndrome/dr-neelima-p
This document discusses traumatic brain injury (TBI) and the neurosurgical response at the Cushing Neuroscience Institute. It describes that TBI affects up to 2% of the population annually and requires specialized care. It outlines the process for evaluating and classifying TBI severity (mild, moderate, severe) upon patient arrival based on Glasgow Coma Scale. For moderate and severe TBI, surgical intervention may be needed and is determined by factors like brain swelling/bleeding seen on CT scan. The neurosurgery team is available 24/7 to treat TBI emergencies.
This document discusses the management of mangled extremity injuries. It covers the initial evaluation, assessment of vascular injury, principles of debridement and wound management, considerations for flap coverage vs amputation, and factors that influence functional outcomes. Scoring systems can help guide the decision between amputation and limb salvage, though the final decision requires clinical judgment based on each patient's situation. Complications like infection, non-union, and flap necrosis may still occur despite salvage attempts.
This document provides an overview of in-stent restenosis. It defines in-stent restenosis as the narrowing of a vessel segment at the site of a previously placed stent due to neointimal proliferation. The incidence of in-stent restenosis ranges from 3-20% with drug-eluting stents and 16-44% with bare-metal stents. Predictors of in-stent restenosis include patient characteristics like diabetes, lesion characteristics like length and diameter, and procedural characteristics like incomplete stent expansion. The document discusses the etiology, clinical presentation, assessment, and treatment options for in-stent restenosis.
Vertebra osteoporosis detection based on bone density using Index-Singh stati...TELKOMNIKA JOURNAL
Osteoporosis is a progressive decrease in bone density so that the bones become brittle and broken. Bones are composed of minerals such as calcium and phosphate, so the bones become hard and solid. Many people do not realize that osteoporosis is a silent disease. Therefore, early detection of osteoporosis is very important. Detection of osteoporosis can be done by utilizing x-ray images of the vertebra. In this research the detection of bone density using blended statistical methods and Index-Singh. The x-ray sample used in this research was 50 images of osteoporosis patients. The result of the area calculation yields the highest white pixel is 7,983 pixels and the lowest white pixel is 5,410 pixels. Based on the results of these calculations, a statistical grouping is conducted into 6 Index-Singh. The range of statistical values is 5,410–6,266 pixels grouped into Index-Singh 1, range of data 6,323–6,512 pixels grouped into Index-Singh 2, the data range 6,520-6,747 pixels grouped into Index-Singh 3, data range 6,778-6,998 pixels grouped into Index-Singh 4, data range 7,001-7,219 pixels grouped into Index-Singh 5, and data range 7,338-7,983 pixels grouped into Index-Singh 6. Overall, the results of testing the osteoporosis detection system have been successful and can be used as an early detection system for osteoporosis. This assistance system has a detection accuracy of 76% compared to doctor's justification.
Angiogenesis And Direct Myocardial RevascularizationSungpil Han
This document discusses preclinical animal models for studying angiogenesis as a treatment for ischemic heart disease. It covers several topics: criteria for selecting appropriate animal models; various models used to study myocardial ischemia and infarction in animals; methods of inducing ischemia tested; experience with protein, gene, and cell-based therapies; and noninvasive imaging techniques used to assess treatment effects. The goal is to establish reliable animal models to test angiogenesis-promoting therapies before applying them to human patients with ischemic heart disease.
Angiogenesis And Direct Myocardial Revascularization ChangedSungpil Han
This document discusses preclinical animal models for studying angiogenesis as a treatment for ischemic heart disease. It covers several topics: criteria for selecting appropriate animal models; different models of inducing myocardial ischemia in animals; methods of protein, gene, and cell therapy delivery that have been tested; and noninvasive imaging techniques for assessing angiogenesis effects. While many studies show promise, challenges remain in translating treatments safely and effectively to human patients with advanced disease.
This document provides information on Ewing sarcoma, a rare type of cancer that develops in bone or soft tissue. It discusses the epidemiology, pathology, clinical features, workup including imaging and staging, prognostic factors, management with chemotherapy, surgery and/or radiation therapy, and clinical trials. Ewing sarcoma is most common in children and young adults between ages 10-20. It is characterized by small, blue round cells and specific gene translocations. Treatment involves induction chemotherapy followed by local control with surgery or radiation and maintenance chemotherapy for at least 28-49 weeks. Prognostic factors and long term follow up care are also outlined.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document discusses fractures in patients undergoing hemodialysis. It notes that fractures are a major public health problem for those with end-stage renal disease, as they have a 4-5 times higher risk of fractures than the general population. The document outlines several risk factors that contribute to this risk, including polypharmacy, comorbidities, decreased muscle strength, increased falls, and renal osteodystrophy. It also discusses different types of renal bone disease seen in those with chronic kidney disease like high turnover disease, low turnover disease, osteomalacia, and amyloidosis. Treatment and management focuses on controlling phosphate levels, calcium levels, parathyroid hormone levels, and vitamin D.
Background: The spectrum of pathological bone lesions ranges from inflammatory to neoplastic conditions. Bone tumours are comparatively uncommon among wide array of lesions. The roentgenogram helps in defining exact location of lesion but becomes difficult to differentiate them. They often pose diagnostic problem as they constitute a small portion of diagnostic experience among pathologist.
Objective: To study histopathological spectrum of bone lesions & correlate them with age, gender and site of occurrence.
Results: All bone biopsies from January 2011 to December 2015 received at department of pathology, S.Nijalingappa Medical College, India. Total 121 cases of bone biopsies were analysed. They were decalcified & processed routinely. Out of 121 bone biopsies, 35 (28.9%) cases are non- neoplastic, 77 (63.6%) are neoplastic and 9 (7.4%) were inadequate for evaluation. The incidence of benign lesions are more than malignant with 51(66.2%) and 26(33.7%) cases respectively. Chronic osteomyelitis is the most common non-neoplastic lesion. Giant cell tumor and osteosarcoma are common benign and malignant lesions respectively. Femur is the common bone involved and metaphysis, the commonest site. The maximum numbers of cases are in the age group between 11-30 years with male preponderance.
Conclusion: Though bone lesions are less common, if viewed in perspective of clinico-radiology and histopathology, correct diagnosis can be reached.
Key-words- Bone lesions, Chronic osteomyelitis, Osteosarcoma, Giant cell tumor, Histopathology
An adolescent male football player presented with heel pain that had worsened over a year. Initial conservative treatment provided temporary relief but the pain intensified. Imaging revealed an osteoid osteoma, a benign bone tumor, in the calcaneus. Surgical excision of the tumor completely resolved the athlete's pain. Osteoid osteomas are rare in athletes but should be considered for persistent hindfoot pain atypical of common conditions like tendinitis.
Simulation by Design - A Healthcare FocusDerek Sweeney
This document discusses how simulation can be used in healthcare product design. It begins by introducing ANSYS and its role in simulation. It then discusses how simulation allows for virtual prototyping of medical devices to evaluate designs without physical testing. Specific applications mentioned include modeling electromagnetic implants, drug delivery systems, and modeling biomechanics of implants and natural tissues. The benefits of simulation highlighted are reducing risk through virtual testing, accelerating innovation, improving accuracy over physical testing, and saving time and costs compared to repeated physical prototyping.
Difficult primary hip replacement - Step by Step Guide for THRVaibhav Bagaria
1. The document discusses various techniques for performing total hip arthroplasty in difficult primary cases such as dysplastic hips, ankylosed hips, and hips with fractures or previous failed surgery.
2. Key factors discussed are implant selection, surgical approach, restoration of hip biomechanics, addressing bone defects, and postoperative care to prevent complications.
3. The goal of these surgeries is to restore a biomechanically sound and stable hip joint with the femoral head in a normal center of rotation.
This document summarizes a case report of a rare case of bilateral squamous cell carcinoma of the temporal bones in a 30-year-old male patient who presented with extensive late-stage disease. Imaging showed large lesions destroying bone structure in the right temporal bone and a smaller lesion in the left. Biopsy confirmed squamous cell carcinoma in both ears. The right-sided tumor was deemed unresectable and the patient received palliative radiotherapy, with a poor prognosis. Bilateral temporal bone cancer is exceptionally rare and this represents one of the few reported cases.
Limb Complex Multi system Injury (Mangled Extremity) is one of the most challenging problems in Orthopaedic surgery. Mangled Extremity is a limb with an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). Decision have to be made either amputation + Prosthesis or limb salvage procedure. The decision of Primary Amputation in the acute setting is difficult for the patient, family, & the treating surgical team. The majority of mangled extremities are potentially salvageable for which, in the acute setting, a treatment plan needs to be made.
multiple level spondylodiscitis in neurobrucllosis: int jr of medicineSachin Adukia
Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation
A 56-year-old male farmer in India presented with lower back pain and weakness in his legs for 9 weeks. MRI revealed multi-level infective spondylodiscitis and a prevertebral sacral abscess. Blood culture grew Brucella melitensis after 8 days. Treatment was modified to a 12-month triple antibiotic therapy. Spinal brucellosis should be considered for those with back pain in endemic areas, as timely diagnosis and appropriate treatment is important.
Textbook of refractive laser assisted cataract surgery (re lacs)Springer
This document discusses current outcomes of cataract surgery and how femtosecond laser technology may improve results. It summarizes studies on complication rates of manual cataract surgery, such as anterior capsule tears, posterior capsule ruptures, and vitreous loss. Resident surgeons generally have higher complication rates than experienced surgeons. The document also discusses how a precise laser-created capsulorhexis and pre-chopping of the lens with a femtosecond laser may reduce ultrasound time and power, lower complication risks, and improve refractive outcomes after cataract surgery.
Hydatid cyst, caused by echinococcus granulosa, can produce tissue cyst everywhere in body. Skeletal cystic lesion is rare specially in long bones like femur and because of its unusual presentation, its diagnosis may easily be missed, unless be kept in mind. Hydatid disease is a parasitic infestation of the humans that can practically affect any part of the body. It commonly affects liver, lung and muscles. Bone hydatid is less common occurring in only 0.5–2% of cases and humans act as an intermediate host. In the patient evaluated by us, the plain x-ray showed multiple osteolytic lesions along the lower one third of the femur and the upper end of tibia.
Pettine et al treatment of discogenic back pain with autologous bmc inje...Jason Attaman
This study evaluated the safety and effectiveness of treating discogenic back pain by injecting autologous bone marrow concentrate (BMC) directly into damaged discs. Twenty-six patients received injections of their own BMC into one or two painful discs. At two years follow-up, most patients experienced significant reductions in pain and disability, with 81% avoiding back surgery. No complications occurred from the injections. The results provide preliminary evidence that BMC injections may be a safe and effective non-surgical treatment for discogenic back pain.
Anomalous Shapes of Jugular Foramen in Dried Skulls Anatomical Basis of Verne...ijtsrd
Jugular foramen is seen at the base of the skull behind the carotid canal. It transmits 9,10,11 cranial nerves and internal jugular vein. Variations in the shape of the jugular foramen may compress these vital structures. The present study was done to determine the anomalous shapes of jugular foramen in dried skulls. When the dried skulls from the department of Anatomy at a private medical college were observed, two skulls were found to show anomalies in their shapes bilaterally. One skull exhibited a complete partition on left side dividing the foramen into two. Another skull was found to have incomplete partitions to such an extent that they could compress the vital structures passing through them. Vernet’s syndrome a jugular foramen syndrome may be due to inappropriate bone growth leading to partition or anomalous shape of the jugular foramen. The present study demonstrates two dried skulls with anomalous shapes and partition of the jugular foramen. Dr. Neelima. P | Dr. R. Ravi Sunder "Anomalous Shapes of Jugular Foramen in Dried Skulls - Anatomical Basis of Vernet’s Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-2 , February 2021, URL: https://www.ijtsrd.com/papers/ijtsrd38638.pdf Paper Url: https://www.ijtsrd.com/medicine/physiology/38638/anomalous-shapes-of-jugular-foramen-in-dried-skulls--anatomical-basis-of-vernet’s-syndrome/dr-neelima-p
This document discusses traumatic brain injury (TBI) and the neurosurgical response at the Cushing Neuroscience Institute. It describes that TBI affects up to 2% of the population annually and requires specialized care. It outlines the process for evaluating and classifying TBI severity (mild, moderate, severe) upon patient arrival based on Glasgow Coma Scale. For moderate and severe TBI, surgical intervention may be needed and is determined by factors like brain swelling/bleeding seen on CT scan. The neurosurgery team is available 24/7 to treat TBI emergencies.
This document discusses the management of mangled extremity injuries. It covers the initial evaluation, assessment of vascular injury, principles of debridement and wound management, considerations for flap coverage vs amputation, and factors that influence functional outcomes. Scoring systems can help guide the decision between amputation and limb salvage, though the final decision requires clinical judgment based on each patient's situation. Complications like infection, non-union, and flap necrosis may still occur despite salvage attempts.
This document provides an overview of in-stent restenosis. It defines in-stent restenosis as the narrowing of a vessel segment at the site of a previously placed stent due to neointimal proliferation. The incidence of in-stent restenosis ranges from 3-20% with drug-eluting stents and 16-44% with bare-metal stents. Predictors of in-stent restenosis include patient characteristics like diabetes, lesion characteristics like length and diameter, and procedural characteristics like incomplete stent expansion. The document discusses the etiology, clinical presentation, assessment, and treatment options for in-stent restenosis.
Vertebra osteoporosis detection based on bone density using Index-Singh stati...TELKOMNIKA JOURNAL
Osteoporosis is a progressive decrease in bone density so that the bones become brittle and broken. Bones are composed of minerals such as calcium and phosphate, so the bones become hard and solid. Many people do not realize that osteoporosis is a silent disease. Therefore, early detection of osteoporosis is very important. Detection of osteoporosis can be done by utilizing x-ray images of the vertebra. In this research the detection of bone density using blended statistical methods and Index-Singh. The x-ray sample used in this research was 50 images of osteoporosis patients. The result of the area calculation yields the highest white pixel is 7,983 pixels and the lowest white pixel is 5,410 pixels. Based on the results of these calculations, a statistical grouping is conducted into 6 Index-Singh. The range of statistical values is 5,410–6,266 pixels grouped into Index-Singh 1, range of data 6,323–6,512 pixels grouped into Index-Singh 2, the data range 6,520-6,747 pixels grouped into Index-Singh 3, data range 6,778-6,998 pixels grouped into Index-Singh 4, data range 7,001-7,219 pixels grouped into Index-Singh 5, and data range 7,338-7,983 pixels grouped into Index-Singh 6. Overall, the results of testing the osteoporosis detection system have been successful and can be used as an early detection system for osteoporosis. This assistance system has a detection accuracy of 76% compared to doctor's justification.
Angiogenesis And Direct Myocardial RevascularizationSungpil Han
This document discusses preclinical animal models for studying angiogenesis as a treatment for ischemic heart disease. It covers several topics: criteria for selecting appropriate animal models; various models used to study myocardial ischemia and infarction in animals; methods of inducing ischemia tested; experience with protein, gene, and cell-based therapies; and noninvasive imaging techniques used to assess treatment effects. The goal is to establish reliable animal models to test angiogenesis-promoting therapies before applying them to human patients with ischemic heart disease.
Angiogenesis And Direct Myocardial Revascularization ChangedSungpil Han
This document discusses preclinical animal models for studying angiogenesis as a treatment for ischemic heart disease. It covers several topics: criteria for selecting appropriate animal models; different models of inducing myocardial ischemia in animals; methods of protein, gene, and cell therapy delivery that have been tested; and noninvasive imaging techniques for assessing angiogenesis effects. While many studies show promise, challenges remain in translating treatments safely and effectively to human patients with advanced disease.
This document provides information on Ewing sarcoma, a rare type of cancer that develops in bone or soft tissue. It discusses the epidemiology, pathology, clinical features, workup including imaging and staging, prognostic factors, management with chemotherapy, surgery and/or radiation therapy, and clinical trials. Ewing sarcoma is most common in children and young adults between ages 10-20. It is characterized by small, blue round cells and specific gene translocations. Treatment involves induction chemotherapy followed by local control with surgery or radiation and maintenance chemotherapy for at least 28-49 weeks. Prognostic factors and long term follow up care are also outlined.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.
This document discusses fractures in patients undergoing hemodialysis. It notes that fractures are a major public health problem for those with end-stage renal disease, as they have a 4-5 times higher risk of fractures than the general population. The document outlines several risk factors that contribute to this risk, including polypharmacy, comorbidities, decreased muscle strength, increased falls, and renal osteodystrophy. It also discusses different types of renal bone disease seen in those with chronic kidney disease like high turnover disease, low turnover disease, osteomalacia, and amyloidosis. Treatment and management focuses on controlling phosphate levels, calcium levels, parathyroid hormone levels, and vitamin D.
Background: The spectrum of pathological bone lesions ranges from inflammatory to neoplastic conditions. Bone tumours are comparatively uncommon among wide array of lesions. The roentgenogram helps in defining exact location of lesion but becomes difficult to differentiate them. They often pose diagnostic problem as they constitute a small portion of diagnostic experience among pathologist.
Objective: To study histopathological spectrum of bone lesions & correlate them with age, gender and site of occurrence.
Results: All bone biopsies from January 2011 to December 2015 received at department of pathology, S.Nijalingappa Medical College, India. Total 121 cases of bone biopsies were analysed. They were decalcified & processed routinely. Out of 121 bone biopsies, 35 (28.9%) cases are non- neoplastic, 77 (63.6%) are neoplastic and 9 (7.4%) were inadequate for evaluation. The incidence of benign lesions are more than malignant with 51(66.2%) and 26(33.7%) cases respectively. Chronic osteomyelitis is the most common non-neoplastic lesion. Giant cell tumor and osteosarcoma are common benign and malignant lesions respectively. Femur is the common bone involved and metaphysis, the commonest site. The maximum numbers of cases are in the age group between 11-30 years with male preponderance.
Conclusion: Though bone lesions are less common, if viewed in perspective of clinico-radiology and histopathology, correct diagnosis can be reached.
Key-words- Bone lesions, Chronic osteomyelitis, Osteosarcoma, Giant cell tumor, Histopathology
An adolescent male football player presented with heel pain that had worsened over a year. Initial conservative treatment provided temporary relief but the pain intensified. Imaging revealed an osteoid osteoma, a benign bone tumor, in the calcaneus. Surgical excision of the tumor completely resolved the athlete's pain. Osteoid osteomas are rare in athletes but should be considered for persistent hindfoot pain atypical of common conditions like tendinitis.
Simulation by Design - A Healthcare FocusDerek Sweeney
This document discusses how simulation can be used in healthcare product design. It begins by introducing ANSYS and its role in simulation. It then discusses how simulation allows for virtual prototyping of medical devices to evaluate designs without physical testing. Specific applications mentioned include modeling electromagnetic implants, drug delivery systems, and modeling biomechanics of implants and natural tissues. The benefits of simulation highlighted are reducing risk through virtual testing, accelerating innovation, improving accuracy over physical testing, and saving time and costs compared to repeated physical prototyping.
Difficult primary hip replacement - Step by Step Guide for THRVaibhav Bagaria
1. The document discusses various techniques for performing total hip arthroplasty in difficult primary cases such as dysplastic hips, ankylosed hips, and hips with fractures or previous failed surgery.
2. Key factors discussed are implant selection, surgical approach, restoration of hip biomechanics, addressing bone defects, and postoperative care to prevent complications.
3. The goal of these surgeries is to restore a biomechanically sound and stable hip joint with the femoral head in a normal center of rotation.
This document provides information about total hip replacement surgery. It discusses the history, principles, indications, contraindications, implants, surgical techniques, postoperative nursing management, health education, exercise guidelines, and potential complications. Total hip replacement involves replacing both the acetabulum and femoral head to relieve pain and restore joint function. Postoperative care focuses on preventing dislocation, thromboembolism, and infection while promoting early ambulation and exercise.
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology.
I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
I am presently working in Columbia asia hospitals, Bangalore.
My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology,
Dr Avinash.KM is a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany.
He is presently working in Columbia asia hospitals, Bangalore.
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3. Abnormal blood flow patterns can lead to endothelial cell damage, inflammation, and wall weakening over time through mechanisms such as increased enzyme activity and smooth muscle cell apoptosis.
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The document discusses the development of tissue engineered stents. It notes that stents are now being developed for uses beyond blood vessels, such as in the lungs, gastrointestinal tract, and heart. Early stents caused restenosis due to an inability to regenerate a healthy endothelial layer. Drug-eluting stents were developed to address this but can cause thrombosis if drug therapy is stopped. Newer designs aim to suppress smooth muscle proliferation while promoting endothelial regeneration using materials like nitric oxide donors. Polymer-free stents with microscale surface features also aim to optimize drug delivery and endothelial attachment.
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Computer Modelling of Flow, Shape and Tissue Stress/Strain in Intracranial Aneurysm
1. Computer Modelling of Flow, Shape and Tissue
Stress/Strain in Intracranial Aneurysm
Alberto Marzo, Derek Sweeney, Martin Murphy
2. Demonstration layout
IDAC company background
IAs clinical background
role of haemodynamics in IAs
@neurIST technology
demonstration of unstented case
demonstration of stented case
SBNS study
what next
3. IDAC company background
CAE Consultants, established in 1997
5 Employees
Derek Sweeney
Dr. Paul Fanning
Bob Moore
Barbara Leichtenstern
Dr Alberto Marzo
In collaboration with partners in 3 successful European projects, we have
developed a range of web-enabled simulation applications aimed at Medical Device
Manufacturers and Clinical Researchers
@neurIST (European Project) finished in March 2010. We are now trying to market
the tools developed.
We supported Martin Murphy in his Research work (poster won a best in section
prize at the SBNS meeting)
Purpose of this meeting is to show you what can be done and then explore
possibility of Research projects etc
4. @neurIST
Multidisciplinary European
initiative funded by the EU*
4-year project, budget 17 million €
Neurosurgeons, neuroradiologists,
epidemiologists, engineers, biologi
sts and computer scientists from
32 EU institutions
Industrial, academic and medical
institutions
Aim: improve current management
of intracranial aneurysms
Members of the consortium
5. Clinical background
Aneurysmal SAH major cause of morbidity and mortality with high
rates of case fatality (40-50%) [1,2]
Management of unruptured IAs remains controversial topic in
Neurosurgery
Most aneurysms do not rupture [2], etiological/pathological factors
responsible for rupture remain poorly understood
Morbidity and mortality from operative/endovascular
treatment, prompts need for better management protocol
Evidence from literature suggests an emerging role of
haemodynamics, shape and tissue stress/strain in aneurysmal
pathogenesis [3,4]
(1) Inagawa
Stroke 2001, (2) ISUIA N Eng J Med 1998, (3) Sekhar et al. Neurosurgery 1981, (4) Ujiie et al.
Neurosurgery 1999
6. Role of haemodynamics
Wall Shear Stress (WSS)
WSS definition: frictional tangential force exerted by blood flow on
endothelial layer
Supra- and infra-physiological values of WSS have been
associated to endothelial damage, aneurysm formation and
rupture [1]
normal WSS infra-physiological WSS
(1) Malek et al JAMA 1999
7. Role of haemodynamics
Hemodynamic Intracranial Aneurysm Proposed mechanism(s) References
factors
Initiation Growth Rupture
Dynamic
Wall Shear Stress High Low Low Increased WSS increases the production of Gao et al (2008), Fukuda et al (2000),
(WSS) MMP-13 which in turn leads to vessel wall Meng et al (2007), Shojima et al
damage (2004), Jou et al (2008), Malek et al
(1999), Ujie et al (1999), Boussel et al
Decreased WSS increases iNOS synthesis- (2008),
NO induced damage to vessel wall
Low WSS increases endothelial
proliferation and apoptosis
Oscillatory Shear High/Low High High Degenerative changes in endothelium Mantha et al (2006), Glor et al (2004),
Index (OSI) Goubergrits et al (2008)
Jet of Blood Stream Impingement Impingement Impingement Localized endothelial cell injury Foutrakis et al (1999), Cebral et al
(2005), Cebral et al (2008)
Flow Pattern - - Complex Statistical association Cebral et al (2005), Cebral et al (2008)
Hydrostatic
Pressure High High High Passive yield/ water hammer effect Inci and Spetzler (2000), Morimoto et
al (2002), Steiger et al (1989)
NB: WSS; wall shear stress, MMP-13; matrixmetalloproteneases-13, iNOS; inducible-nitric oxide synthase, NO; nitric oxide, OSI; oscillatory shear index
Singh PK, Marzo A et al Comput Intell Neurosci 2009
8. @neurIST technology
medical image surface reconstruction 1 surface reconstruction 2
Click Here for Video
surface reconstruction 3 computer model flow prediction
Click Here for Video
9. @neurIST technology: CFD
Detailed in-vivo measurements of relevant flow variables in
regions affected are currently impossible
Motivated by its success in other disciplines scientists started
using CFD to predict blood flows in IAs
Sports Engineering
Automotive
Aerospace
11. @neurIST technology:
shape measurements
non-sphericity-index (NSI): quantifies difference between
aneurysm shape and a perfect circumscribed sphere
Aspect ratio: ratio between aneurysm depth and neck max width.
It has been correlated with aneurysm rupture [1]
non-sphericity-index aspect ratio
a
b
(1) Raghavan et al J Neurosurg 2005
12. @neurIST technology:
stress/strain predictions
it is likely that the event of rupture occurs when the tissue stress
or strain exceeds some sustainable level
tissue stress tissue strain
14. Analysis computation
IDAC EASA web-based computing power
@neuFuse files can be uploaded on the web to run analyses
using web-based computing power (IDAC EASA)
user interface file uploading
15. Analysis computation
IDAC EASA web-based computing power
Analysis status can be monitored and results (e.g. tabulated
indices, WSS plots) accessed once analyses are completed
analysis status results post-processing
16. Validation
it is likely that the event of rupture occurs when the tissue stress
or strain exceeds some sustainable level
Virtual Angio Real Angio
Click Here for Video Click Here for Video
18. @neurEndo
Virtual Endovascular Treatment
The stent is represented by a deformable
model expanding into the vascular lumen
The stent deformation is constrained with
information on the stent design (strut
length, angle between struts)
Time consumption: approximately 1 minute
20. Physical Characterisation of Cerebral Aneurysms and
Identification of Factors Suggestive of Imminent Rupture
TM Murphy1,3, A Marzo2, DR Rawluk1, C Bolger1,4
1 Department of Neurosurgery, Beaumont Hospital, Dublin.
2 Department of Cardiovascular Engineering, Royal Hallamshire Hospital, Sheffield
3 Department of Vascular Research Engineering, University College Dublin
4 Department of Neurosciences, Royal College of Surgeons of Ireland, Dublin
21. Updated ISUIA (2003)
<7 <7 7-12 13-24 ≥25
Group 1 Group 2
Cavernous 0 0 0 3% 6.4%
carotid
AC/MC/IC 0 1.5% 2.6% 14.5% 40%
Post-P comm 2.5% 3.4% 14.5% 18.4 % 50%
Wiebers DO et al. Lancet 2003
22. Materials and methods
Retrospective pilot study investigating role of haemodynamic indices in
subarachnoid haemorrhage
10 patients from Beaumont Hospital recruited
Ethical approval
3D rotational acquisitions (3DRA) images were processed with @neuFuse
Case Age Urgency? Location Size
1 59 Elective Basilar 4
2 59 SAH R P Comm 3
3 53 SAH R P Comm 2
4 35 Elective R P Comm 3
5 42 SAH Basilar 10
6 35 SAH R ICA 3
7 66 SAH L P Comm 10
8 67 SAH L P Comm 6
9 57 SAH R P Comm 10
10 60 Elective L P Comm 7
23. Haemodynamic Results
Infra-physiological time-ave Wall Shear Stress (<0.4 Pa)
Case Number Age Ruptured? Location Size Area WSS<0.4Pa (mm2) % WSS<0.4Pa
1 59 Elective Basilar 4 0 0
2 59 SAH R P Comm 3 7.5 11.4
3 53 SAH R P Comm 2 0 0
4 35 Elective R P Comm 3 0 0
5 42 SAH Basilar 10 76.6 59.4
6 35 SAH R ICA 3 0 0
7 66 SAH L P Comm 10 16.9 7.4
8 67 SAH L P Comm 6 4.7 5.6
9 57 SAH R P Comm 10 0 0
10 60 Elective L P Comm 7 0 0
Aneurysm 2 Aneurysm 5 Aneurysm 7
WSS<0.4 Pa
24. Haemodynamic Results
Jet impingement at peak systole
Case Number Age Ruptured/Elective Location Size (mm) Maximum Pressure (mmHg) Area Pressure Elevated (%)
1 59 Elective Basilar 4 100.8 0.2
2 59 SAH R P Comm 3 110.5 0.6
3 53 SAH R P Comm 2 114.3 3.2
4 35 Elective R P Comm 3 118 16.5
5 42 SAH Basilar 10 119.5 0.2
6 35 SAH R ICA 3 109 8
7 66 SAH L P Comm 10 103 2.6
8 67 SAH L P Comm 6 106 6.4
9 57 SAH R P Comm 10 141 3
10 60 Elective L P Comm 7 110.5 52
Aneurysm 4 Aneurysm 5
pressure
jet
25. Haemodynamic Results
Oscillatory Shear Index
Area Elevated OSI
Case Number Age Ruptured/Elective Location Size Maximum OSI
(%)
1 59 Elective Basilar 4 0.32 0.7
2 59 SAH R P Comm 3 0.47 7.7
3 53 SAH R P Comm 2 0.38 4.5
4 35 Elective R P Comm 3 0.28 0.9
5 42 SAH Basilar 10 0.44 4
6 35 SAH R ICA 3 0.48 24.1
7 66 SAH L P Comm 10 0.41 3.4
8 67 SAH L P Comm 6 0.42 1.2
9 57 SAH R P Comm 10 0.44 3.0
10 60 Elective L P Comm 7 0.38 8.9
Aneurysm 5 Aneurysm 6 Aneurysm 7
OSI
26. Morphological Results
Shape indices automatically extracted from @neuFuse
Case Number Age Ruptured/Elective Location Size Aspect Ratio Non-sphericity index Size ratio
1 59 Elective Basilar 4 0.92 0.09 1.5
2 59 SAH R P Comm 3 1.38 0.2 1.71
3 53 SAH R P Comm 2 0.81 0.12 0.86
4 35 Elective R P Comm 3 0.92 0.09 1.63
a
5 42 SAH Basilar 10 2.09 0.29 2.36
6 35 SAH R ICA 3 1.27 0.15 1.25
7 66 SAH L P Comm 10 2.59 0.26 2.49 b
8 67 SAH L P Comm 6 1.83 0.25 1.81
9 57 SAH R P Comm 10 1.88 0.29 3.09
10 60 Elective L P Comm 7 0.87 0.21 0.83
Aneurysm 1 Aneurysm 2 Aneurysm 3 Aneurysm 4 Aneurysm 5
Aneurysm 6 Aneurysm 7 Aneurysm 8 Aneurysm 9 Aneurysm 10
27. Morphological Results
Shape indices automatically extracted from @neuFuse
Case Number Age Ruptured/Elective Location Size Aspect Ratio Non-sphericity index Size ratio
1 59 Elective Basilar 4 0.92 0.09 1.5
2 59 SAH R P Comm 3 1.38 0.2 1.71
3 53 SAH R P Comm 2 0.81 0.12 0.86
4 35 Elective R P Comm 3 0.92 0.09 1.63
5 42 SAH Basilar 10 2.09 0.29 2.36
6 35 SAH R ICA 3 1.27 0.15 1.25
7 66 SAH L P Comm 10 2.59 0.26 2.49
8 67 SAH L P Comm 6 1.83 0.25 1.81
9 57 SAH R P Comm 10 1.88 0.29 3.09
10 60 Elective L P Comm 7 0.87 0.21 0.83
Aneurysm 1 Aneurysm 2 Aneurysm 3 Aneurysm 4 Aneurysm 5
Aneurysm 6 Aneurysm 7 Aneurysm 8 Aneurysm 9 Aneurysm 10
30. Results Summary
Accepted “wisdom” Predicted the SAH patients?
Size matters (7mm) 3/7
Proposed indices
Aspect ratio (1.6) 5/7
Size ratio (3) 1/7
WSS 4/7
Oscillatory shear index (0.40) 6/7
Non-sphericity index (0.183) 6/7
The software is easy to use by clinicians
Results were interchangeable with Dr Marzo’s within 5 cases.
45 minutes clinician time + 2-3 hours computation
31. Conclusions
Size is not the best predictor of aneurysm’s rupture
potential
Haemodynamic and shape indices may have greater
influence on rupture potential
Strongest correlations found for Oscillatory Shear Index
and Non-sphericity index
32. Dissemination
The software has been exposed and used by clinicians at several venues with positive
feedback
Feedback was collected and used to improve the software
Location: Boston, USA Location: Bertinoro, Italy
Conference: WFNS 2009 Conference: ICCB 2009
Exposure: Workshop Exposure: Workshop
Participants: 38 Participants: 13 biomedical
neurosurgeons engineers
Feedback: Overall Feedback: Engineering
impression positive, audience community showed great
showed great interest interest and positive
@neurIST feedback
Location: Lisbon, Portugal Location: Nagoya, Japan
Conference: ESMINT 2008 Conference: ICCVS 2009
Exposure: Workshop Exposure: Presentation
Participants: 36 Participants: 50+
neuroradiologists, neurosurgeons
neurosurgeons, engineers Feedback: Audience showed
Feedback: Very positive great enthusiasm
Location: Santiago, Chile Location: Barcelona, Spain
Conference: SILK- Conference: ESMINT 2009
Workshop 2009 Exposure: Workshop
Exposure: Workshop Participants: 104
Participants: 22 neuroradiologists, epidemiolo
Endovascular gists, engineers, neurosurgeo
Neuroradiologists ns
Feedback: Very Feedback: Positive
positive, GUI needs
improvement
Published in Computational Intelligence
and Neuroscience 2009
33. What next?
• We can offer tools and services to support the following activities:
o Research into cerebral aneurysms
o Research into other vascular diseases
o Patient specific CFD study*
• Typical cost for a 100 Case Research Project would be €10,000. This includes
o Initial training in use of software and interpretation of results
o Tailoring of report and output data
o Ongoing support and training
o Use of @neuFuse and @neuEndo software
• Typical cost for a single patient CFD study would be € 400. This includes
o Transient CFD study
o Interactive discussion with clinician on results
o Presentation of results in summary report
• Open Forum
o Feedback
o Interest in further collaboration
o Can we identify a funded research project?
Blue areas area areas of the aneurysm wall exposed to wall shear stress (time-averaged along the cardiac cycle) below 0.4 Pa. This a threshold found to be deleterious for endothelial cells by Malek (see ref before)
Narrow jet and localised pressure elevation (aneurysm 5) correlated with rupture (Cebral AJNR 2005). Interestingly aneurysm 5 has high pressure over a small area (0.2% of aneurysm surface) and is ruptured. Aneurysm 4 shows high pressure too but distributed of a larger area (16.5 % of aneurysm area) and interestingly this is unruptured.
Disturbed/turbulent (high OSI) flow has been associated with endothelial cell disruption. Interestingly in this cohort aneurysms with high OSI (>0.4), i.e. aneurysms 5,6,7,8 are ruptured. On the contrary unruptured aneurysm show a smaller OSI.
Average aspect ratio, non-sphericitiy index, and size ratio is higher in ruptured than unruptured aneurysm. In particular non-sphericity index is quite low (0.09, almost spherical) for elective aneurysms (aneurysm 1 and 4). Whereas the same index is high for SAH aneurysms (e.g. aneurysms 5, 7 ,8, 9)
Average aspect ratio, non-sphericitiy index, and size ratio is higher in ruptured than unruptured aneurysm. In particular non-sphericity index is quite low (0.09, almost spherical) for elective aneurysms (aneurysm 1 and 4). Whereas the same index is high for SAH aneurysms (e.g. aneurysms 5, 7 ,8, 9)