Unruptured intracranial aneurysms (UIAs) represent a major public health issue due to their unpredictable natural history. Whether to actively treat them or to maintain them under observation remains a hotly disputed topic. In this chapter, we present a review of the literature regarding the history of clipping and its use in UIAs, as well as the experience of our senior author in this field. We performed an extensive Medline and Google Academic search of the relevant literature. We have also made a retrospective analysis on patients harboring UIAs and multiple intracranial aneurysms (MIAs) clipped by the senior author between 1997 and 2017. About 89 patients had solitary UIAs, alongside 101 with MIAs possessing 257 individual aneurysms in total. All UIA patients were discharged with a favorable neurological outcome and no mortality. Concerning MIAs, the majority of cases had 2 aneurysms, the highest number being 6. And, 61 patients from this group had a favorable outcome. In the hands of experienced vascular neurosurgeons, clipping remains a safe option for both UIAs and MIAs. This procedure offers a long-lasting protection from aneurysmal rupture. In the future, new clip technologies and intraprocedural methods of verifying vessel patency and aneurysmal occlusion may further enhance postoperative results.
Part of the book: New Insight into Cerebrovascular Diseases
Despite its frequency, psoriasis is still a difficult pathology to manage, in no small part due to the wide number of therapeutic choices available. These range from topical medicine to systemic drugs to more targeted agents such as biological therapies. All medical personnel involved in the treatment of psoriasis patients should be aware of these methods and apply them accordingly. Even though all patients may benefit from specific treatment options, these differ in regard to posology, monitoring, interactions and contraindications. Moreover, due to the adverse effects and drug interactions of some of these agents, not all patients are suitable candidates for each of therapies discussed. Therefore, nurses, trainees, general practitioners and dermatologists must carefully select the most appropriate therapy based on the characteristics of each patient, severity of the pathology, comorbidities and coexistent medications. This review aims to offer an updated, pragmatic insight into the modern management of patients with moderate-to-severe psoriasis.
Part of the book: Healthcare Access