Participants and those assessing outcomes were masked to allocation. Analysis was by modified intention to treat (excluding missing data). Primary outcome was a composite of angiographic and clinical outcomes at 18-month follow-up. We also did prespecified subgroup analyses of characteristics likely to be relevant to angiographic

outcome. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN30531382.

Findings 249 patients were allocated to the hydrogel coil group and 250 to the control group. In 44 of 467 patients for whom an 18-month composite primary outcome was unavailable, 6-month angiographic results were used. 70 (28%) patients in the hydrogel group and 90 (36%) control patients had an adverse composite primary outcome, giving an absolute reduction in the proportion of adverse composite Blasticidin S primary outcomes with hydrogel of 7.0% (95% CI -1.6 to 15.5), odds ratio (OR) 0.73 (0.49-1.1, p=0.13). CP673451 cost In a prespecified

subgroup analysis in recently ruptured aneurysms, there were more adverse composite primary outcomes in the control group than in the hydrogel group OR 2.08 (1.24-3.46, p=0.014). There were 8.6% fewer major angiographic recurrences in patients allocated to hydrogel coils OR 0.7 (0.4-1.0, p=0.049). There were five cases of unexplained hydrocephalus in not-recently-ruptured aneurysms in the hydrogel coil group and one case in the control group.

Interpretation Whether use of hydrogel coils reduces late aneurysm rupture or improves long-term clinical outcome is not dear, but our results indicate that their use lowers major recurrence.”
“BACKGROUND: Retraction injury might explain the soft tissue complications seen after anterior cervical surgery. A novel retractor system (Seex retractor system [SRS]) that uses a principle of bone fixation with rotation

has been shown to reduce retraction pressure in a cadaveric model of anterior cervical decompression and fusion.

OBJECTIVE: To compare the conventional Cloward-style retractor (CRS) with the SRS in a prospective randomized clinical trial.

METHODS: After ethics and study registration (ACTRN 12608000430336), eligible patients were randomized to either the CRS or SRS before DAPT research buy 1- or 2-level anterior cervical decompression and fusion. The pressure beneath the medial retractor blade was recorded with a thin pressure transducer strip. Postoperative sore throat, dysphagia, and dysphonia were assessed after 1, 7, and 28 days.

RESULTS: Twenty-six patients were randomized. There were no serious complications. Complication rates were low with a trend favoring SRS that was not statistically different. Average retraction pressure with SRS was 1.9 mm Hg and with CRS was 5.6 mm Hg (P < .001 on F test; P = .002 on 2-tailed t test). Mean average peak retraction pressure with the SRS was 3.4 mm Hg and with the CRS was 20 mm Hg (P < .001 on F test; P = .005 on 2-tailed t test).