Thesis (B.S.)--University of Missouri, School of Mines and Metallurgy, 1901. / The entire thesis text is included in file. Typescript. Illustrated by authors. Title from title screen of thesis/dissertation PDF file (viewed October 28, 2008)

Introdução: As malformações arteriovenosas são lesões congênitas caracterizadas por uma rede capilar malformada (nidus) que comunica o sistema arterial e venoso em um mecanismo de shunt arteriovenoso não irrigando tecido normal. Devido ao shunt arteriovenoso as MAVs apresentam alto fluxo sanguíneo, podem ser assintomáticas ou sintomáticas dependendo de sua localização. O tratamento das MAV busca a exclusão circulatória completa do nidus o que pode ser alcançado por meio de ressecção cirúrgica, radiocirurgia ou embolização endovascular. Objetivo: descrição técnica de uma série de dois casos de MAVs de localização periférica (fora do sistema nervoso central), que foram tratadas através da embolização com uso de cateter-balão de duplo lúmen. Materiais e métodos: Trata-se de estudo retrospectivo que avaliou os pacientes submetidos a embolização com cateter-balão de duplo lúmen para o tratamento das MAVs periféricas pelo Setor de Radiologia Intervencionista do HCFMRP-USP. Resultados: Os achados encontrados foram consistentes com a literatura atual demonstrando altas taxas de sucesso técnico e clínico, sem complicações inerentes ao procedimento. Conclusão: O uso destes dispositivos se mostrou mais eficaz em obliterar completamente o nidus deste tipo de lesão, além de reduzir o tempo de procedimento, a exposição à fluoroscopia. Neste estudo foi obtida a exclusão angiográfica completa das MAV em uma única sessão de embolização e não foram descritas complicações relacionadas ao tratamento. / Introduction: Arteriovenous malformations are congenital lesions characterized by a malformed capillary network (nidus) that communicates the arterial and venous system in an arteriovenous shunt mechanism and does not irrigate normal tissue. Due to the arteriovenous shunt AVMs present high blood flow, they may be asymptomatic or symptomatic depending on their location. The AVM treatment seeks the complete circulatory exclusion of the nidus which can be achieved by means of surgical resection, radiosurgery or endovascular embolization. Objectives: A technical description of a series of two cases of peripheral AVMs that were treated through embolization using a dual-lumen balloon catheter. Materials and methods: This is a retrospective study that evaluated patients undergoing embolization with a double-lumen balloon catheter for the treatment of peripheral AVMs by the Interventional Radiology Sector of HCFMRP-USP. Results: The findings were consistent with the current literature demonstrating high rates of technical and clinical success, without complications inherent to the procedure. Conclusion: The use of these devices has been shown to be more effective in completely obliterating the nidus of this type of lesion, in addition to reducing the procedure time, exposure to fluoroscopy. In this study complete angiographic exclusion of AVM was obtained in a single embolization session and no complications related to treatment were described.

Introdução: A alta incidência de oclusão incompleta e recanalização dos aneurismas intracranianos de colo largo tratados por via endovascular levaram ao desenvolvimento de novas técnicas, entre elas o uso do Onyx ®. Objetivos: avaliar a eficiência do agente embólico líquido Onyx® em produzir oclusão completa dos aneurismas intracranianos de colo largo e avaliar a estabilidade do tratamento aos 6 meses e aos 18 meses, por meio de controles angiográficos. Casuística e métodos: Esta tese foi realizada na Seção de Neuroradiologia Intervencionista da Med Imagem, do Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, através da revisão de dados clínicos e radiológicos de 69 pacientes tratados pelo autor, com 84 aneurismas intracranianos de colo largo no período de julho de 2002 a fevereiro de 2006. Dez pacientes eram do sexo masculino e 59 do sexo feminino, com idade variando de 24 anos a 86 anos (mediana de 52 anos). Todos os aneurismas tinham origem lateral à artéria e apresentavam pelo menos um dos critérios usados para definir colo largo - colo maior que 4 mm de diâmetro e relação saco/colo menor que 1,5. Cinqüenta aneurismas eram pequenos, 30 grandes e quatro gigantes (diâmetro máximo menor que 12mm, de 12mm a 25mm e maiores que 25mm, respectivamente). As apresentações clínicas mais comuns foram: achado incidental em 34 pacientes, pós-hemorragia sub aracnóide e recanalização após tratamento com espirais destacáveis em 10. A maioria dos aneurismas era da artéria carótida interna (76 aneurismas). Controles angiográficos foram feitos ao final, aos seis meses e aos 18 meses do tratamento (controles I, II e III respectivamente), sendo analisados principalmente o grau de oclusão (completa ou incompleta), incidência de recanalização e complicações clínicas. Avaliação estatística foi feita pelo método de Kaplan-Meier para o percentual cumulativo de oclusão completa e percentual de recanalização e análise univariada e multivariada dos fatores preditivos de oclusão total imediata e tardia através de regressão logística. Resultados: O índice de oclusão completa foi de 65,5%, 84,6% e de 90,3% para todos os aneurismas, nos controles I, II e III respectivamente. Estes índices foram de 74%, 95,1% e de 95,2% para os aneurismas pequenos e de 53,3%, 70% e de 80% para os aneurismas grandes nos controles I, II e III respectivamente. Oclusão completa ocorreu em 50% dos aneurismas gigantes nos controles I e II, sem haver controle III neste grupo. Recanalização ocorreu em 3 aneurismas (4,6%). O porcentual cumulativo de oclusão completa foi de 97,63% (IC de 95% variando de 95,27 a 100) para os aneurismas pequenos aos 9 meses e de 83,86% (IC de 95% variando de 67,73 a 100) para os aneurismas grandes aos 21 meses. Três pacientes faleceram (4,3%), havendo relação com o procedimento em dois (2,9%). Morbidade permanente ocorreu em cinco pacientes (7,2%), sendo incapacitante em um (1,4%). Conclusões: 1. O uso do Onyx® foi eficiente na oclusão completa dos aneurismas intracranianos de colo largo. 2. O tratamento foi estável nos controles angiográficos aos 6 meses e aos 18 meses. / Introduction: The high rate of incomplete occlusion and intracranial large neck aneurysms recanalization lead to the development of new techniques, including the use of Onyx®. Purpose: to evaluate the efficacy of the liquid embolic system Onyx ® to produce completes occlusion of the intracranial large neck aneurysms and evaluates the stability of the treatment at 6 month and 18 month angiographic control. Materials and Methods: this thesis has been performed at Section of Interventional Neuroradiology of Med Imagem, at the Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, based on a review of clinical and radiological records of 69 patients treated by the author, harboring 84 large neck intracranial aneurysms between July 2002 and February 2006. Ten patients were male and 59 female, with age ranging from 24 to 86 years old. All aneurysms were lateral to the parent vessel and were wide neck (neck > 4 mm and/or domus to neck ratio < 1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to 25 mm) and 4 were giant (> 25 mm). Thirty four aneurysms were incidental, 10 were ruptured and 10 were recanalized after coil treatment and the majority was located in the internal carotid artery (76). Angiographic follow-up was done at the end of the procedure, at six month and at 18 month (controls I, II and III respectively), analyzing the rate of complete occlusion, recanalization and clinical complication. Statically analysis were done by Kaplan-Meier method for cumulative percentage of complete aneurysm occlusion and for recanalization, and univariate and multivariate analysis of predictive factors of immediate and late complete occlusion through logistic regression. Results: Complete aneurysm occlusion was achieved in 65.5% on immediate control, in 84.6% at 6 month, and in 90.3% at 18 month follow-up periods for all aneurysms. This rate was 74%, 95.1% and 95.2% for small and 53.3%, 70% and 80% for large aneurysms at the same follow-up periods. In the giant aneurysm group, two had complete and stable occlusion at six month follow-up angiography. Recanalization was seen in three aneurysms (4,6%). Kaplan Meyer\'s cumulative percentage of complete aneurysm occlusion was 97.63% (CI 95% ranging from 95,27 to 100) for small aneurysms at 9 months and 83.86% (CI 95% ranging from 67,73 to 100) for large aneurysms at 21 months. There were three deaths (4,3%), two procedure-related (2.9%). Overall morbidity was 7.2%, being disabling in one (1,4%). Conclusions: 1. The use of Onyx was efficient in the complete occlusion of wide neck intracranial aneurysms. 2. The treatment was stable at 6 month and 18 month angiographic controls.

Introdução: A alta incidência de oclusão incompleta e recanalização dos aneurismas intracranianos de colo largo tratados por via endovascular levaram ao desenvolvimento de novas técnicas, entre elas o uso do Onyx ®. Objetivos: avaliar a eficiência do agente embólico líquido Onyx® em produzir oclusão completa dos aneurismas intracranianos de colo largo e avaliar a estabilidade do tratamento aos 6 meses e aos 18 meses, por meio de controles angiográficos. Casuística e métodos: Esta tese foi realizada na Seção de Neuroradiologia Intervencionista da Med Imagem, do Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, através da revisão de dados clínicos e radiológicos de 69 pacientes tratados pelo autor, com 84 aneurismas intracranianos de colo largo no período de julho de 2002 a fevereiro de 2006. Dez pacientes eram do sexo masculino e 59 do sexo feminino, com idade variando de 24 anos a 86 anos (mediana de 52 anos). Todos os aneurismas tinham origem lateral à artéria e apresentavam pelo menos um dos critérios usados para definir colo largo - colo maior que 4 mm de diâmetro e relação saco/colo menor que 1,5. Cinqüenta aneurismas eram pequenos, 30 grandes e quatro gigantes (diâmetro máximo menor que 12mm, de 12mm a 25mm e maiores que 25mm, respectivamente). As apresentações clínicas mais comuns foram: achado incidental em 34 pacientes, pós-hemorragia sub aracnóide e recanalização após tratamento com espirais destacáveis em 10. A maioria dos aneurismas era da artéria carótida interna (76 aneurismas). Controles angiográficos foram feitos ao final, aos seis meses e aos 18 meses do tratamento (controles I, II e III respectivamente), sendo analisados principalmente o grau de oclusão (completa ou incompleta), incidência de recanalização e complicações clínicas. Avaliação estatística foi feita pelo método de Kaplan-Meier para o percentual cumulativo de oclusão completa e percentual de recanalização e análise univariada e multivariada dos fatores preditivos de oclusão total imediata e tardia através de regressão logística. Resultados: O índice de oclusão completa foi de 65,5%, 84,6% e de 90,3% para todos os aneurismas, nos controles I, II e III respectivamente. Estes índices foram de 74%, 95,1% e de 95,2% para os aneurismas pequenos e de 53,3%, 70% e de 80% para os aneurismas grandes nos controles I, II e III respectivamente. Oclusão completa ocorreu em 50% dos aneurismas gigantes nos controles I e II, sem haver controle III neste grupo. Recanalização ocorreu em 3 aneurismas (4,6%). O porcentual cumulativo de oclusão completa foi de 97,63% (IC de 95% variando de 95,27 a 100) para os aneurismas pequenos aos 9 meses e de 83,86% (IC de 95% variando de 67,73 a 100) para os aneurismas grandes aos 21 meses. Três pacientes faleceram (4,3%), havendo relação com o procedimento em dois (2,9%). Morbidade permanente ocorreu em cinco pacientes (7,2%), sendo incapacitante em um (1,4%). Conclusões: 1. O uso do Onyx® foi eficiente na oclusão completa dos aneurismas intracranianos de colo largo. 2. O tratamento foi estável nos controles angiográficos aos 6 meses e aos 18 meses. / Introduction: The high rate of incomplete occlusion and intracranial large neck aneurysms recanalization lead to the development of new techniques, including the use of Onyx®. Purpose: to evaluate the efficacy of the liquid embolic system Onyx ® to produce completes occlusion of the intracranial large neck aneurysms and evaluates the stability of the treatment at 6 month and 18 month angiographic control. Materials and Methods: this thesis has been performed at Section of Interventional Neuroradiology of Med Imagem, at the Hospital São Joaquim da Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, based on a review of clinical and radiological records of 69 patients treated by the author, harboring 84 large neck intracranial aneurysms between July 2002 and February 2006. Ten patients were male and 59 female, with age ranging from 24 to 86 years old. All aneurysms were lateral to the parent vessel and were wide neck (neck > 4 mm and/or domus to neck ratio < 1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to 25 mm) and 4 were giant (> 25 mm). Thirty four aneurysms were incidental, 10 were ruptured and 10 were recanalized after coil treatment and the majority was located in the internal carotid artery (76). Angiographic follow-up was done at the end of the procedure, at six month and at 18 month (controls I, II and III respectively), analyzing the rate of complete occlusion, recanalization and clinical complication. Statically analysis were done by Kaplan-Meier method for cumulative percentage of complete aneurysm occlusion and for recanalization, and univariate and multivariate analysis of predictive factors of immediate and late complete occlusion through logistic regression. Results: Complete aneurysm occlusion was achieved in 65.5% on immediate control, in 84.6% at 6 month, and in 90.3% at 18 month follow-up periods for all aneurysms. This rate was 74%, 95.1% and 95.2% for small and 53.3%, 70% and 80% for large aneurysms at the same follow-up periods. In the giant aneurysm group, two had complete and stable occlusion at six month follow-up angiography. Recanalization was seen in three aneurysms (4,6%). Kaplan Meyer\'s cumulative percentage of complete aneurysm occlusion was 97.63% (CI 95% ranging from 95,27 to 100) for small aneurysms at 9 months and 83.86% (CI 95% ranging from 67,73 to 100) for large aneurysms at 21 months. There were three deaths (4,3%), two procedure-related (2.9%). Overall morbidity was 7.2%, being disabling in one (1,4%). Conclusions: 1. The use of Onyx was efficient in the complete occlusion of wide neck intracranial aneurysms. 2. The treatment was stable at 6 month and 18 month angiographic controls.

Les agents d'embolisation liquides utilisés dans le traitement endovasculaire ont de nombreuses limitations. Des polymères, tels que l’Onyx et les cyanoacrylates sont disponibles. L’alcool est un agent puissant, mais non radio-opaque. Les cyanoacrylates entrainent une réaction inflammatoire significative. Leur polymérisation rapide est responsable d’un comportement mal prévisible.Il existe une possibilité de traitement incomplet.L’Onyx est efficace pour le traitement des MAV.Une pénétration plus distale est obtenue avec l’alcool, mais associée à un risque de migration systémique. Nous avons évalué les propriétés d'un nouvel agent embolique (Alconyx) composé d'un mélange d'alcool et d'Onyx. Cet agent devrait cumuler les avantages respectifs de l'alcool et de l'onyx avec une visualisation adéquate sous fluoroscopie, une meilleure pénétration distale que l'Onyx seul et moins de toxicité systémique liée à la réduction de quantité d’alcool injecté. Divers mélanges ont été testés avec différentes concentrations d'Onyx 18 et d’alcool absolu. Alconyx 25 (75% Onyx 18; 25% d'éthanol) est la formulation la plus prometteuse. Nous avons démontré sa facilité d'injection in vivo, sa nature cohésive sans fragmentation ainsi que sa bonne visualisation sous fluoroscopie. En raison de sa moindre viscosité démontrée in vitro, Alconyx a été capable de pénétrer profondément dans le lit artériel.. L'occlusion proximale par Alconyx 25 devrait permettre d'améliorer le contact entre l'éthanol et la paroi vasculaire et donc augmenter son pouvoir sclérosant et limiter son passage systémique. Les propriétés occlusives d’Alconyx 25 sont similaires à celle de l’Onyx 18 sous haute pression in vitro. / Commercially available liquid embolization agents used in endovascular treatment have many limitations. Polymeric agents as Onyx and cyanoacrylate are available. Ethanol also is a potent sclero-embolic agent. Cyanoacrylates are effective liquid embolic agents, however, their rapid polymerization makes their behaviour unpredictable with possibility of incomplete treatment. These properties render their use challenging.Onyx is easy to use. However, in very small arterial niduses, Onyx, is unable to penetrate deeply. Deep penetration is obtained with ethanol, associated with risk of systemic migration.Poor visualization of ethanol under fluoroscopy is major drawback. Mixing Onyx with ethanol had never been described in the literature till now. In this work, various mixtures have been tested with different concentrations of Onyx 18 and absolute ethanol. Alconyx 25 (75% Onyx 18; 25% ethanol) seems to be a promising product. We proved its ease of injection in vivo and in vitro, its cohesive nature showing no fragmentation or interruption of the injected column as well as its good visualization under fluoroscopy. It was able to penetrate deeply in the arterial bed. The occlusive properties of Alconyx 25 were rated as good as Onyx 18 under high pressure in vitro. Further investigation is needed to better understand the behavior of ethanol in the suspension and its effect on tissues compared to Onyx diluted simply with an equivalent amount of DMSO. Studies on other commercially available concentrations of Onyx would certainly be interesting.

The aim of the thesis was to create an architectural study of the new synagogue in Opava. Similarly to many other towns and cities, the former synagogue was burned during Kristallnacht, the ruins were completely demolished and taken away. Nowadays there are no buildings on the site, except the former Rabbi’s house. Basic idea was in preserving the park character of the site by insertion of a non-arrogant low cuboid volume in the neighbourhood of apartment buildings from the first half of the 20th century. Designed form benefits from the character of the site while humbly avoiding construction on the actual place where the burnt synagogue stood. This creates an elegant, low object, whose two dominant ceiling slabs are filled with glass in between so it preserves a part of the park’s existing transparency and let the interior freely connect with exterior, also thanks to large sliding windows. In the center of the block is situated three sides closed atrium, which surrounds the new synagogue, into whose interior delicate scattered sunlight penetrates through the translucent onyx stone walls.