bluuebunny/crossref_metadata_2025 huggingface dataset:
A Telemedicine Survey among Milan Doctors
Authors: Gaggioli Andrea , di Carlo Simona , Mantovani Fabrizia , Castelnuovo Gianluca , Riva Giuseppe
Published: January 2017

We surveyed physicians' attitudes to the use of telemedicine. A questionnaire was sent to 2987 Italian physicians and 361 responded (12%). The topics covered by the survey were: current telemedicine technology knowledge/ usage level; general attitude towards telemedicine applications; perceived efficacy of telemedicine in enhancing quality of care; and intention to use telemedicine. In all, 83% of respondents had heard about telemedicine. Some doctors considered telemedicine to be of limited interest and many physicians were not convinced that it could improve clinical practice. These beliefs were more common among doctors of higher seniority, probably because they are more reluctant to accept change. To reduce such negative evaluations, better dissemination of information about the state of the art of research and development in telemedicine is needed. A logistic regression model was used to determine which factors influenced the intention to use telemedicine. The final model predicted 80% of the responses correctly.
Organizational Cooperation in Teleradiology
Authors: Aas I H Monrad
Published: January 2017

Teleradiology requires cooperation between participating parties, but it cannot be assumed that such cooperation will work well. A survey was carried out of 12 radiology departments in Norway which used picture archiving and communication systems in connection with teleradiology. Qualitative interviews were carried out with 26 out of 29 resource persons (response rate 90%). The respondents identified 17 issues of importance for cooperation in teleradiology. None of the problems with cooperation seem large enough to prevent effective teleradiology cooperation in future. For organizations planning teleradiology of a larger volume, the cooperation issue is important. It is recommended that managers lead change processes in their organizations where the different issues of importance to cooperation are treated and the right measures are taken to realize the full potential of teleradiology. For telemedicine, it is important that future research includes investigations on cooperation for the different applications.
Telemedicine in the British Antarctic Survey Medical Unit
Authors: Siderfin C D , Haston W , Milne A H
Published: January 2017

The system of telemedical care practised by the British Antarctic Survey has developed over a period of 50 years. It is a system that deals with everyday routine medical problems as well as occasional emergencies. It is tried and tested, but undergoes continual modification. Although the Antarctic stations represent a unique setting, the system has the potential for being adapted to many different situations, wherever there are small groups in remote areas needing medical backup. Initial telemedicine work conducted in the Antarctic has led to projects to improve primary care in Scottish communities some distance from specialist centres. As telecommunication links to the Antarctic stations improve, in future the lessons learnt in UK-based projects can be applied in the Antarctic. The evolutionary process will thus continue.
Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty
Authors: Niemi T. T. , Silvanto M. , Rosenberg P. H.
Published: January 2017

Background and Aims:

Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients.

Material and Methods:

101 patients undergoing primary hip arthroplasty received in random order 4% albumin (n = 48) or HES (average Mw 120 kDa/molar substitution ratio 0.7, n = 53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6–8 %, 12–16 %, 60 % and 100 % blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis.

Results and Conclusions:

Administration of albumin or HES 1200 ml (500–2000 and 500–1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.
No Long-Term Effects of Ultrasound Therapy on Bioabsorbable Screw-Fixed Lateral Malleolar Fracture
Authors: Handolin L. , Kiljunen V. , Arnala I. , Kiuru M. J. , Pajarinen J. , Partio E. K. , Rokkanen P.
Published: January 2017

Background and Aims:

The present study was initiated to evaluate the long-term effects of low-intensity ultrasound therapy on bioabsorbable screw-fixed lateral malleolar fractures, which has not been studied earlier.

Patients and Methods:

The study design was prospective, randomized, double-blinded, and placebo-controlled. Sixteen dislocated lateral malleolar fractures were fixed with one bioabsorbable self-reinforced poly-L-lactide screw. The patients used an ultrasound device 20 minutes daily for six weeks without knowing it was active (eight patients) or inactive (eight patients). The follow-up time was 18 months. The radiological bone morphology was assessed by multidetector computed tomography (MDCT) scans, the bone mineral density by dual-energy X-ray absorptiometry scans, and the clinical outcome by Olerud-Molander scoring and clinical examination of the ankle.

Results:

The MDCT scans revealed that all fractures were fully healed, and no differences were observed in radiological bone morphology at the fracture site. The bone mineral density of the fractured lateral malleolus tended to increase slightly during the 18-month follow-up, the increase being symmetrical in both groups. No differences were observed in the clinical outcome or Olerud-Molander scores.

Conclusions:

The six-week low-intensity ultrasound therapy had no effect on radiological bone morphology, bone mineral density or clinical outcome in bioabsorbable screw-fixed lateral malleolar fractures 18 months after the injury.
Intestinal Microdialysis — Applicability, Reproducibility and Local Tissue Response in a Pig Model
Authors: Emmertsen K. J. , Wara P. , Soerensen F. B. , Stolle L. B.
Published: January 2017

Background and Aims:

Microdialysis has been applied to the intestinal wall for the purpose of monitoring local ischemia. The aim of this study was to investigate the applicability, reproducibility and local response to microdialysis in the intestinal wall.

Materials and Methods:

In 12 pigs two microdialysis probes were inserted into the ileal wall, one in the peritoneal cavity and one in the psoas muscle. Relative recovery was measured for all probes by the no net flux method. Metabolic measurements of glucose, lactate and glycerol were performed over six hours. The ileal wall segments containing the probes were processed for histological examination.

Results:

Large intra- and inter-group differences in the relative recovery were found between all locations. Absolute values of metabolites showed no significant changes during the study period. The lactate in blood was 25–30% of the intra-tissue values. A severe inflammatory reaction was seen in the ileal wall around all probes.

Conclusion:

Measurement of the relative recovery is essential for valid measurements of metabolites when using microdialysis. The inflammatory reaction around the probe in the intestinal wall is likely to affect metabolism and measurements hereof. Therefore intestinal wall microdialysis seems confined to experimental research, and future studies should consider the intra-peritoneal approach.
How to Define an Abdominal Aortic Aneurysm — Influence on Epidemiology and Clinical Practice
Authors: Wanhainen A.
Published: January 2017

Abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta. There is, however, no general agreement on how to define an AAA. The lack of a uniform definition may have consequences on epidemiology and clinical practice. Several proposed definitions of an AAA exist, all based on the diameter of the abdominal aorta. Age, gender, and body size are all associated with the aortic diameter, and may therefore also be of importance when evaluating the aortic diameter. The precision of the measurement and the awareness of imaging shortcomings are also important. In order to demonstrate a true widening of the aorta the relation to adjacent aortic segments must be assessed. To demonstrate an expansion of a potential aneurysm, a follow-up period with repeated assessments is required. Thus, a fixed diameter does not serve as a proper definition of an aneurysm, but rather as a cut-off level for further assessment and/or follow-up.
Non-Operative or Medical Management of Abdominal Aortic Aneurysm
Authors: Powell J. T.
Published: January 2017

Non-operative management of patients with abdominal aortic aneurysm (AAA) is required for several different reasons. Since these patients have an increased risk of cardiovascular death therapy to reduce cardiovascular events is essential. Treatment is in line with the medical management of coronary artery disease including smoking cessation, statins and anti-platelet therapy. Some of these therapies also will slow aneurysm growth, which is a target in the management of patients with small AAA. As yet there is no targeted therapy that reduces aneurysm growth, but there is active research in this area. Medical management also is required to reduce peri-operative risks, stabilise endovascular aneurysm repair and minimise the risk of rupture in those with large AAA unfit for aneurysm repair.
Abdominal Aortic Aneurysm in the Interval 5.0–5.5 CM, Art or Evidence?
Authors: Swedenborg J.
Published: January 2017

The risk of rupture for aneurysms 5–5.5 cm in diameter has not been specifically studied. Two large randomised trials, the United Kingdom Small Aneurysm Trial and the Aneurysm Detection And Management study Trial concluded that immediate surgical repair did not offer any benefit compared to surveillance and surgical repair if the aneurysm reached 5.5 cm or became symptomatic. Despite these findings many indications today suggest that a lower threshold should be used in patients with higher risk for rupture e.g. women or low risk of mortality in connection with AAA repair such as patients in the lower range of ages.
The Most Wanted Trials for Abdominal Aortic Aneurysm Treatment
Authors: Swedenborg J.
Published: January 2017

This overview contains suggestions for two different types of trials, medical treatment of small aneurysms and methods for selection of aneurysms in need of intervention. Questions in need of answers are evaluation of the influence on growth and rupture by medical treatment and parameters other than absolute diameter for selection of patients for open surgical or endovascular intervention. These questions need not necessarily be answered by randomised controlled trials.
Propositions for Refinement of the Hybrid Surgical Technique for Treatment of Thoraco-Abdominal Aortic Aneurysm
Authors: Ljungman C. , Wanhainen A. , Kragsterman B. , Nyman R. , Ericksson L.-G. , Eriksson M. O.
Published: January 2017

Traditional open repair of thoraco-abdominal aortic aneurysms Crawford type II-IV carries a high perioperative risk and mortality. The hybrid technique for combined surgical and endovascular treatment offers an interesting alternative with reduced risk of paraparesis and possibly a reduced mortality rate. Propositions for refinement of this approach are outlined based on a single centre experience.
Evar and Complex Anatomy: An Update on Fenestrated and Branched Stent Grafts
Authors: Malina M. , Resch T. , Sonesson B.
Published: January 2017

Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair (OR). EVAR is preferred by patients due to the reduction of surgical trauma. Approximately 20% of patients have aneurysm neck morphology which is inadequate for a standard stent graft and requires the endograft to cross vital aortic side branches to achieve a seal. This chapter describes the evolution of three types of devices, namely the fenestrated and branched stent grafts as well as the chimney grafts. These stent grafts incorporate vital aortic side branches in the repair, thereby increasing the applicability of EVAR which may improve the overall results.
Sigmoidostomy-Related Parastomal Hernia
Authors: Wik T.-A. , Hjorthaug J. O. B. , Johannessen H.-O. , Johnson E.
Published: January 2017

Background and Aims:

The aim was to examine prevalence and treatment of parastomal hernias in patients with sigmoidostomy.

Materials and Methods:

In 2009, the medical records of 447 consecutive patients operated with a sigmoidostomy from January 1999 to December 2008 were retrospectiely reviewed. 119 dead patients (26.6%) were excluded because of short follow up (n = 59) and insufficient clinical data (n = 60). 328 patients (73.4%) were followed-up, of whom 210 (64%) alive patients also were scrutinized for presence of parastomal hernia by phone interview. In 2010, 92 out of 153 alive patients (60.1%) without known parastomal hernia also underwent targeted clinical examination in the ambulatory unit.

Results and Conclusion:

Follow up from stoma operation in 328 patients was median 20 (range 1–129) months. 319 patients had an end sigmoidostomy and nine patients had a loop sigmoidostomy. Time to parastomal hernia in 66 patients (20.1%) was median 9 (1–54) months. Fourty four patients (66.7%) reported no symptoms, eight (12.1%) had mild discomfort, six (9.1%) leakage, six (9.1%) pain, and two (3%) episodes of intestinal obstruction. Eleven (16.7%) had a hernia operation, eight with onlay mesh repair complicated with bowel perforation and ventral hernia in one patient. Three with mesh repair (37.5%) developed recurrent parastomal hernia, of whom one had tissue repair and a second recurrence 6 months later. The only patient with initial tissue repair had a recurrent hernia successfully treated with mesh repair. Two patients had their stoma uneventfully reversed. Parastomal hernia rate, mainly treated with mesh repair, was fairly low in this heterogenous patient series.
The Capacity of the Distal Stump of Peripheral Nerve to Receive Growing Axons after Two and Six Months Denervation; An Experimental Study with Rats
Authors: Rönkkö H. , Göransson H. , Siironen P. , Taskinen H.-S. , Vuorinen V. , Röyttä M.
Published: January 2017

Background and Aims:

Peripheral nerve injury may lead to poor recovery outcome in spite of treatment with advanced microsurgical repair techniques. Delayed cross-anastomosis paradigm was used to study the axon grow to the distal nerve stump after denervation separately from the influence of prolonged axotomy in the proximal stump.

Material and Methods:

Left common peroneal nerve of 48 rats was transected and denervated over two or six months. There were two research groups in the study. In the regeneration group (REG) the proximal stump of acutely transected tibial nerve was sutured to denervated distal stump of common peroneal nerve. To our knowledge, this is the first study in which this group was compared to degeneration group (DEG) with both nerve ends denervated over two or six months. This comparison enabled us to study the capacity of denervated distal nerve stump to receive sprouting axons. Axon density in distal nerve stump was calculated after three or six week's follow-up periods.

Results:

There were no differences in the number of axon sprouts in the distal nerve stump between the denervation periods of two and six months. When compared REG and DEG groups, there was trend to higher axon densities in the REG group, although the differences were not statistically significant.

Conclusions:

We conclude that the capacity of distal nerve stump to receive the growing axons from the proximal nerve stump does not decrease significantly between two and six months denervation. Cross-anastomosis paradigm provides a useful tool for detailed study of the nerve transfer procedure.
The Importance of Continuing Education for Transplant Coordination Staff
Authors: Tokalak Ibrahim , Emiroğlu Remzi , Karakayali Hamdi , Bilgin Nevzat , Haberal Mehmet
Published: January 2017

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.
Donation Education for Medical Students: Enhancing the Link between Physicians and Procurement Professionals
Authors: Essman Christian C. , Lebovitz Daniel J.
Published: January 2017

Purpose

Increasing healthcare professionals' knowledge about organ and tissue donation; the national mandates regarding referral compliance; and the effect on donors, donor families, and transplant recipients is a challenging task. Physicians not routinely involved in organ donation or transplantation are some of the most difficult professionals for organ procurement organizations to access. A course for medical students was developed to initiate the transfer of information, comfort, and familiarity with the organ and tissue donation process.

Methods

Discussions with a local medical school revealed that little organized education on organ and tissue donation existed. An elective course was developed consisting of 2-hour lectures, once a week for 6 weeks. Topics included an overview of tissue and organ donation, history and significance of the current crisis, determination of brain death and its role in organ donation, tissue donation, pretransplant and posttransplant processes, ethical issues, and the donor family and recipient experience.

Results

A thorough course proposal was presented to the medical school's Chairman of Surgery and Chairman of Transplantation. The proposal was approved for first- and second-year medical students.

Conclusion

Offering medical students a unique and comprehensive course may attract curious students who could become future champions for donation. This type of educational approach may significantly influence future interactions between physicians and organ procurement organizations. If more organ procurement organizations implement this type of program, the medical students' knowledge of donation will not only affect and benefit the local organ procurement organization's service area but other procurement organizations throughout the country as well.
Interventions during Donor Care before Lung Transplantation
Authors: Powner David J. , Hewitt Michael J. , Levine Robert L.
Published: January 2017

Improvement in the ratio of PaO2 to the fraction of inspired oxygen and treatment of pulmonary infections in donors have been cited as important goals for improving lungs before implantation and restoring marginal lungs to the donor pool. Likewise, improving donor PaO2 is often critical for other organs during donor care. The common physiological mechanisms responsible for hypoxemia are ventilation/perfusion mismatching, abnormal oxygen diffusion, and hypoventilation. These mechanisms are discussed and treatment options are considered.
Treatment Goals during Care of Adult Donors That Can Influence Outcomes of Heart Transplantation
Authors: Powner David J.
Published: January 2017

Myocardial dysfunction during care of adult donors can result from injury occurring before hospital admission or during the progression of brain death. Few evidence-based data correlate specific hemodynamic goals during donor care with outcomes of heart transplantation, although many recommendations exist. Spontaneous reversal of early heart damage or correction of poor cardiac performance can yield outcomes equivalent to outcomes in recipients who had ideal donors. Hemodynamic goals developed in the operating room can be applied in intensive care to improve outcomes of transplantation. These goals include maintenance of mean arterial pressure greater than 60 mm Hg, central venous pressure less than 12 mm Hg, cardiac output greater than 3.8 L/min, cardiac index greater than 2.1, and systemic vascular resistance between 800 and 1200 dyne · sec · cm−5. The ejection fraction and other echocardiographic data also provide helpful guidance when determining whether a heart is suitable for transplantation and during therapy. Titration of cardiovascular variables often requires invasive monitoring to ensure that cardiac preload, afterload, and contractility are optimal.
Promoting Organ Donation and Transplantation among South Asians in the United Kingdom: The Role of Social Networks in the South Asian Community
Authors: Randhawa Gurch
Published: January 2017

The percentage of South Asians on the kidney transplant waiting list in the United Kingdom is 3 times their percentage in the general population. Obviously, organ donation and transplantation among South Asians in the United Kingdom needs improvement. In recent years, ethnically targeted campaigns in the mass media have specifically attempted to attract donors from the South Asian communities. A number of pilot studies have been done to evaluate the effectiveness of these initiatives in providing information about organ donation to South Asians. Results indicate that detailed information related to transplantation was learned mainly by people within the community receiving transplants and was transmitted through various informal community networks rather than through the resources provided by the Department of Health. This article provides an overview of who South Asians are and how these community networks were established. Transplant professionals must devise effective strategies to access these community networks, thereby raising the consciousness of transplantation among South Asians in the United Kingdom.
Domino Kidney Transplantation
Authors: Subramaniam Murali , Hamilton David N. H. , Junor Brian J. R.
Published: January 2017

Kidney transplantation has become a victim of its own success. Despite measures to increase the number of donors, success to date has been limited. At the Western Infirmary, we used an organ that had been transplanted earlier. The patient who received that organ has since been followed up for more than 2 years, and no issues have arisen regarding functioning of the graft. Although it does not increase the donor pool, we believe that domino kidney transplantation ought to be considered when the situation merits it.
Giving Back to Donor Families: The “Thank You Letter” Package Insert Project
Authors: Colarusso Cynthia
Published: January 2017

Family members of organ donors receive anonymous information about the transplant recipients. Also, they often receive written communication from the recipients themselves and or the recipient's family members, expressing gratitude for the generous gifts they donated. The feedback received by donor families serves to affirm that their altruistic decision to donate life-saving and life-enhancing gifts has saved or dramatically improved the lives of the recipients. Feedback allows donor families to assign meaning to the donation itself and make some sense of otherwise tragic circumstances. In contrast, family members of bone and soft tissue donors historically have not received the same level of feedback provided to the family members of organ donors. The tissue banking community, as an extension of the procurement community that provides care to tissue donor families, is in a unique position to facilitate meaningful feedback between bone and soft tissue donor families and their recipients. This article explores the use of tissue packaging as a communication portal to solicit and facilitate the needed feedback loop between bone and soft tissue donor families and their recipients.
The Decision to Donate: A Model of Decision Making among Individuals and Families
Authors: Kowalski Robin M. , Payne Holly S.
Published: January 2017

Fifty years ago, the first successful kidney transplantation was performed. Since then significant advances in transplantation have been made. Unfortunately, the number of people needing transplants far surpasses the number willing to donate. The literature addresses a plethora of variables influencing whether individuals will become donors themselves or whether family members will donate a loved one's organs. However, to date, no model has examined similarities and differences in the processes by which individuals and families go about making decisions to donate their own or another's organs. In this article, individual and family donation decisions are discussed using Janis' 5-stage model of decision making. We suggest that the weighty nature of donation decisions levels the playing field for decisions made for self and for others. Although the specifics (eg, micro-level) may vary slightly, the processes by which people go about deciding to donate their own organs or those of another individual are similar (eg, macro-level).
Midterm Outcome of Partially Thrombosed Intracranial Aneurysms Treated with Guglielmi Detachable Coils
Authors: Kim S.J. , Choi I.S.
Published: January 2017

We evaluated the results of Guglielmi detachable coil (GDC) treatment in partially thrombosed aneurysms and determined if there is high rate of recanalisation on follow-up.

Among 149 treated aneurysms in 141 patients, 25 CT- or MR-confirmed partially thrombosed aneurysms were selected for evaluation. The features of thrombosed aneurysms and percentage of occlusion were analysed on initial angiograms. Follow-up angiograms, which were available in 18 cases, were evaluated for aneurysm lumen recanalisation. The recanalisation rate was compared with that of non-thrombosed aneurysms treated with GDCs.

Locations of aneurysms were as follows: cavernous carotid ten; ophthalmic four; p- com. two; MCA one; A-com. one; basilar tip four; midbasilar two; PICA one. The size of the aneurysm lumen ranged from 5 to 30 mm (mean 16.8 mm) on angiograms, but on cross sectional images the size of aneurysms ranged from 13 to 70 mm (mean 24.6 mm). The extent of aneurysmal thrombosis ranged from 10 to 90 per cent (mean 46.4 per cent). On initial GDC treatment, total to subtotal occlusion was achieved in 18 cases out of 25 (72%). Of the 18 follow-up angiograms, 14 cases (77.8%) showed recanalisation ranging from 10 to 60 per cent of aneurysm size. Luminal recanalisation was due to migration (10 of 14) or compaction (4 of 14) of coil masses. In two cases, symptoms recurred in association with aneurysm recanalisation, but in no instance was haemorrhage noted. Attempts for retreatment were made in ten cases with success in six. In comparison, 14 (15.9%) out of 88 non-thrombosed cases revealed recanalisation on follow-up angiography.

Midterm follow-up angiograms in partially thrombosed aneurysms treated with GDC revealed a fivefold higher rate of recanalisation than in non-thrombosed cases. Close follow-up is necessary in patients with thrombosed aneurysms treated with GDCs.
Giant Serpentine Aneurysms: Multidisciplinary Management
Authors: Anshun W. , Feng L. , Daming W.
Published: January 2017

Sixty-five cases of intracranial giant serpentine aneurysms (GSAs), including 61 cases reported in the literature and four additional cases presented in this study were reviewed. The clinical presentation, possible causes, natural history, and especially management of GSAs are discussed with emphasis on the need for aggressive intervention and multidisciplinary management.
Disappearance of a Cerebral Arteriovenous Malformation after Partial Endovascular Embolisation
Authors: Mangiafico S. , Cellerini M. , Villa G. , Nistri M. , Ammannati F. , Giordano G.P.
Published: January 2017

The authors report the observation of a patient with a Spetzler-Martin grade 3, symptomatic, sulcal cerebral arteriovenous malformation (cAVM) of the left precuneus that after partial, uncomplicated, endovascular embolisation disappeared at 4, 6 and 12 months follow-up. Discussion focuses on the angioarchitectural remodelling of the cAVM over time according to the latest concepts on AVM development and evolution.
2D Fast Spoiled Gradient Echo (2D-FSPGR) Gd-DTPA Enhanced Dynamic MR Angiography in Cerebral Aneurysms after Treatment with Platinum Detachable Coils
Authors: Hayashi T. , Asai J. , Sugimoto H. , Honda M. , Satoh K. , Nagashima G. , Suzuki R. , Fujimoto T.
Published: January 2017

The purpose of this study is to evaluate the perfusional state of cerebral aneurysms treated by platinum detachable coils using three different techniques of MR angiography (MRA), and to compare the results of each MRA technique. Thirty examinations were investigated in twelve patients. They were three men and nine women, and their average age was 67y.o. They were all treated by platinum detachable coils for cerebral aneurysms. We obtained three different types of MRA on the same day; 2D-FSPGR Gd-DTPA enhanced dynamic MRA, 3D-TOF MRA with and without Gd-DTPA enhancement. On 2D FSPGR enhanced dynamic MRA, we used the first pass arterial phase for judgement that did not overlap the venous phase. In each study, we evaluated parent artery flow, branch artery flow, residual flow in coils, and residual neck. Digital subtraction angiography (DSA) was used as gold standard. On 3D-TOF MRA examinations without enhancement, parent artery flow was correctly identified with an accuracy of 96.7% with DSA confirmation. Branch artery flow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 86.7%. Residual neck was correctly evaluated with an accuracy of 83.3%. On 3D-TOF MRA with enhancement, parent artery flow was correctly identified with an accuracy of 96.7%. Branch artery flow was identified with an accuracy of 91.3%. Flow in the coils was correctly identified with an accuracy of 93.3%. Residual neck was correctly identified with an accuracy of 86.7%. On 2D FSPGR enhanced dynamic MRA, parent artery flow was correctly identified with an accuracy of 100%. Branch artery flow was identified with an accuracy of 94.2%. Flow in the coils was correctly identified with an accuracy of 96.7%. Residual neck was correctly evaluated with an accuracy of 100%. Parent artery flow, branch artery flow, residual flow in coils, and residual necks were seen more accurately with 2D-FSPGR Gd-DTPA enhanced dynamic MRA than 3D-TOF MRA with and without enhancement. With T1 shortening effect of Gd-DT-PA and first pass arterial phase of 2D-FSPGR enhanced dynamic MRA techniques, we could evaluate more accurately the perfusional status of platinum-coil-treated cerebral aneurysms and arteries adjacent to the aneurysms than with non enhanced or enhanced 3D TOF MRA.
Hydroxyapatite Coating of Detachable Coils for Endovascular Occlusion of Experimental Aneurysm
Authors: Shimozuru T. , Kamezawa T. , Kuratsu J. , Sakai N. , Nagata I. , Kishida A. , Akashi M. , Matsusaki M.
Published: January 2017

The purpose of this study was to evaluate the effect of hydroxyapatite (HAp) coating on Guglielmi detachable coils (GDCs) in an experimental aneurysm model. A total of 12 aneurysms were experimentally made in the common carotid arteries of swine using a microsurgical technique. Embolization was done on these aneurysms using standard GDCs and GDCs coated with HAp (GDC-HAp). The animals were then killed 14 days after embolization. The physical properties of coated coils and the development of tissue scarring and coverage the aneurysm's orifice were evaluated microscopically and microscopically. Macroscopically, a scar formation and coverage at the neck of aneurysms were observed in a group with GDC-HAp, while such findings were not seen in a group with GDC. With light microscope, fibroblasts were seen in the neck of the aneurysms in a group using GDC-HAp, whereas only a fibrin-like net was seen in a group using GDC. In a group with GDC-HAp, inflammatory response was more intense in the dome of the aneurysm with faster re-endothelial coverage of the neck of the aneurysm than the ones in a group with GDC. These results indicated that GDC-HAp might create a clinically beneficial biological surface in an experimental aneurysm model.
Development of Active Catheter, Active Guide Wire and Micro Sensor Systems
Authors: Haga Y. , Mineta T. , Totsu K. , Makishi W. , Esashi M.
Published: January 2017

Active catheters and active guide wires which move like a snake have been developed for catheter-based minimally invasive diagnosis and therapy. Communication and control IC chips in the active catheter reduce the number of lead wires for control. The active catheter can be not only bent but also torsioned and extended. An ultra minature fiber-optic pressure sensor, a forward-looking ultrasonic probe and a magnetic position and orientation sensor have been developed for catheters and guide wires. These moving mechanisms and several sensors which are fitted near the tip of the catheter and the guide wire will provide detailed information near the tip and enable delicate and effective catheter intervention.
Computerized Assessment of Carotid Plaque Echogenicity before Stenting
Authors: Takahata H. , Hayashi K. , Kitagawa N. , Kaminogo M. , Koga H. , Shibata S.
Published: January 2017

To assess the ability of transcutaneous ultrasound (US) to identify carotid atherosclerotic plaques at high risk for development of procedural strokes, the authors retrospectively analyzed the plaque echomorphology by means of gray-scale value (GSV). Both transcutaneous and intravascular US demonstrated a similar ability to characterize the atherosclerotic plaques.

A case with embolic complication was proven to have had the lowest GSV in the studied cases.

With computerized assessment of plaque echogenicity, pre-procedural transcutaneous US may be used to predict plaques that are associated with a high risk of distal embolization.
Clinicopathological Investigation of AVMs Embolized with HEMA-MMA
Authors: Aikawa H. , Kazekawa K. , Tanaka A. , Ueno Y. , Nomoto Y.
Published: January 2017

We have recently developed a non-adhesive liquid embolic agent, hydroxyethylmethacrylate methylmethacrylate copolymer (HEMA-MMA), and used it for arteriovenous malformations (AVMs) in the central nervous system. To evaluate the toxicity and usefulness of this agent, we made a clinicopathological study of AVMs that were embolized with it and then excised surgically. This study includes ten cases: nine with pial AVM and one with scalp AVM. In a pathological study, special attention was paid to vascular and perivascular inflammation, angionecrosis, recanalization of the embolized vessels, and foreign body reactions. Inflammation was absent or very mild regardless of the interval between embolization and excision. There was no angionecrosis. Recanalization could be expected to occur in the partially occluded vessel. Foreign body reactions such as infiltration of monocytes or giant cells, and proliferation of fibroblasts or capillaries were also not seen in any case. It was concluded that HEMA-MMA is an excellent embolic material that is easy to handle, less vasotoxic than other agents, and highly his-tocompatible.
Aneurysm of Persistent Primitive Hypoglossal Artery Occluded with Guglielmi Detachable Coils
Authors: Grand M. , Nepper-Rasmussen J.
Published: January 2017

The persistent primitive hypoglossal artery is rare remnant of one of the four embryonal carotid-basilar anastomoses. It is present in 0.02–0.26% of all cerebral angiogram. 14 cases of PHA aneurysms have been reportede in the literature and as far as we know no case in which endovascular embolization was used as a treatment. We present a case with subarachnoid haemorrhage due to aneurysm of persistent primitive hypoglossal artery. The aneurysm was successfully occluded with Guglielmi detachable coils. The SAH resolved and recovery was uneventful.
Adjunct Use of a Self-Expanding Stent for Treatment of Intracranial Stenosis
Authors: Fujimura N. , Yilmaz H. , Abdo G. , Lovblad K. O. , Sztajzel R. , Rüfenacht D. A.
Published: January 2017

We present a case of a patient who received adjunct treatment with a self-expanding stent after balloon dilatation of a symptomatic stenosis of the carotid siphon.

After predilatation, complementary angioplasty with a balloon-expandable stent was abolished due to lack of compliance of the delivery system. Since the vascular anatomy allows for the passage of balloon systems only, the stenosis was further dilated and a self-expanding stent was delivered to avoid the risk of complications related to dissection and vessel recoil. However, problem of in-stent stenosis remains at the long-term follow-up period.
Intra-arterial Embolization in the Treatment of Brain Arteriovenous Malformations
Authors: Campos J. , Biscoito L. , Sequeira P. , Batista A.
Published: January 2017

The crucial question - treat or not a brain arteriovenous malformation - has been the object of many studies, sometimes contradictory. The authors analyse retrospectively, clinically and angiographically, the results of the intra-arterial embolization in the treatment of 106 patients with brain arteriovenous malformation. The endovascular therapy was palliative or curative in 46% of the cases, in 30% of the patients the embolization was pre-surgery and in 18% the intra-arterial occlusion was pre-radiosurgery. In 6% the therapeutic protocol included embolization with surgery and radiosurgery. Cyanocrylate was used in 89% of the cases, and in 10% of the patients the embolic material used was Ethylene - vinyl alcohol copolymer - EVOH (Onyx). In this series 11% of total morbidity occurred - transitory in 8% and settled with permanent neurological deficit in 3% of the patients. The mortality post-embolization was 2% and the total mortality post-embolization and surgery was 3%. Total angiographic exclusion immediately post-embolization was confirmed in 24% of the cases. The mean period for clinical and angiographic follow-up was 38 months. 72 patients - 77% of the cases discharged from hospital showed complete exclusion of the lesion after the different combined therapeutic strategy - embolization, surgery and radiosurgery. New retrospective and long-term prospective studies based on the actual therapeutic protocols and new embolic agents are necessary to be able to evaluate accurately a new therapeutic reality in the brain arteriovenous malformations.
The Characters of Images and Endovascular Embolization for High Risk Cerebral AVM
Authors: Sheng Li , Baomin Li , Jun Wang , Xiangyu Cao , Xiaofang Gu , Liping Guo
Published: January 2017

The high risk cerebral AVM can do great harm to people in case of hemorrhage. The goal of aathis paper is to discuss the characters of images and the technical manipulate of endovascular embolization for high risk cerebral AVM with bleeding. Fifty-six cases of high risk cerebral AVM with bleeding were confirmed by CT?MRI?and approved by whole cerebral DSA. Depended on the nidus of AVM, the superselective endovascular embolization with NBCA or embolization combined with radiological surgery was chosen. The nidus was eliminated for 100% in 36 cases after embolization for 1 to 3 processes. The rebleeding was found in 2 cases with new growth and survival aneurysm in nidus during the following period and treatment with Y-knife, and cured by second embolization. These are the main causes of brain bleeding composed of aneurysm and aneurysm like dilation beside and located at the nidus, fine draining veins, and growth in ventricles. It is the favourable for the preference to eliminate the aneurysm in AVM during embolization to prevent brain from bleeding.
Endovascular Treatment of Cerebral AVM: Our Experience with Onyx
Authors: Pérez-Higueras A. , López R. Rossi , Tapia D. Quiñones
Published: January 2017

We have been using Onyx, a non-adhesive liquid polymer, to treat cerebral AVMs endovascularly since 1999. During this time we have treated 45 consecutive, unselected patients.

From the outset this product brought about a change in our approach to treating this type of lesion because of the different injection behaviour observed for this material compared with the adhesive Histoacryl that had been employed until then.

The object of this article is to assess the results achieved by our team using this new embolic agent, following angiographic and clinical follow-up of cases for a minimum of six months and a maximum of five years (mean: two years).

We propose new categories of cerebral AVM based on the expected behaviour of Onyx within the nidus.

Our appraisal indicates that we have improved our angiographic results, achieving complete occlusion of the malformation in 22% of cases and over 80-% closure in 69% of cases. The morbimortality rate for the procedure was 18%.
“Mirror-Image” Bilateral Giants: Intracavernous Carotid Artery Aneurysms
Authors: Díaz M.B. , Mercado F.C. , Plaghos L.A. Lemme
Published: January 2017

The literature on the incidence of “mirror image” bilateral giant intracavernous aneurysms, their symptoms and their association with other entities is reviewed, with a brief comment on their evolution and treatment.

A case of “mirror image” bilateral giant intracavernous aneurysms in a 76-year-old man who presented a sudden diplopia with pupillary sparing is reported. A CT scan showed parasellar images and dolichomega circle of Willis arteries that enhanced with endovenous contrast. MRI and angiography disclose bilateral aneurysms in detail, associated with an anomalous origin of the left common carotid artery and bilateral renal artery stenosis.
Bilateral Petrous Ridge Dural Arteriovenous Malformations Treated by a Combination of Endovascular Embolization and Surgical Excision
Authors: Seong S.O. , David C. , Choi In Sup
Published: January 2017

We report the first case of bilateral complex petrosal arteriovenous malformations (AVM). The patient was treated by a combination of transarterial embolization and surgical excision on the right-sided AVM, and by transarterial and transvenous embolization on left-sided lesion.
Disappearing Saccular Intracranial Aneurysms: Do They Really Disappear?
Authors: Jayakumar P.N. , Ravishankar S. , Balasubramaya K.S. , Chavan R. , Goyal G.
Published: January 2017

Evolution and natural history of cerebral aneurysms is a dynamic process. Spontaneous regression in size or complete disappearance of an aneurysm is a known phenomenon, more commonly noted in giant intracranial aneurysms. However, reappearance or regrowth of such aneurysms is rare with few anecdotal reports. We report a series of four cases including one giant aneurysm, which either disappeared or regressed on sequential angiograms. Regrowth or reappearance of two of these previously disappeared or regressed aneurysms was noted and endovascularly treated while the other two cases are being followed up. The decision to follow up was crucial considering the nature of the aneurysms to change in morphology under the influence of various hemodynamic factors.
Successful Endovascular Occlusion of a Ruptured Distal Anterior Inferior Cerebellar Artery Aneurysm of the Caudal Trunk: Case Report
Authors: Kang H.-S. , Roh H.G. , Han M.H. , Koh Y.-C.
Published: January 2017

We report a rare case of a ruptured distal anterior inferior cerebellar artery (possibly dissecting) aneurysm of the caudal trunk, successfully treated by endovascular occlusion. A 41-year-old man presented with sudden severe headache and drowsiness.

On the day of ictus, conventional angiography was performed to make the above diagnosis, followed by endovascular occlusion of the sac and the parent artery.

The patient recovered completely without any neurologic deficit after treatment. Endovascular occlusion could be a safe and effective treatment option in a case of a ruptured distal AICA aneurysm of the caudal trunk.
Endovascular Surgery for Ruptured Aneurysms with Vasospasm
Authors: Kurata A. , Suzuki S. , Niki J. , Ozawa H. , Yamada M. , Fujii K. , Kan S. , Kitahara T. , Miyasaka Y. , Ohmomo T.
Published: January 2017

With the existence of vasospasm, it is recommended that direct clipping surgery for a ruptured aneurysm be delayed until its disappearance, but this may be associated with aneurysmal re-rupture resulting in a poor outcome for the patients. Indications for endovascular coil embolization in such cases are discussed.

Since November in 2003, we have applied endovascular coil embolization in 11 consecutive patients with ruptured aneurysms and apparent vasospasm of the parent artery from two to 17 days (average: eight days) after initial subarachnoid hemorrhage. Three patients had aneurysmal re-rupture before treatment, but the other eight had only experienced the one episode of subarachnoid hemorrhage. With one exception, all endovascular procedures could be successfully performed, resulting in complete occlusion of aneurysms and remarkable dilatation of inserted spastic vessels without technical complications or aneurysmal re-rupture.

For the one case of failure because of a tortuous artery, direct clipping surgery was performed after disappearance of vasospasm. Cerebral infarction occurred in four, but only one correlated with the distribution of catheterization, and neurological deficits had completely disappeared three months after the onset. This preliminary report concerning a small number of patients suggests that endovascular coil embolization is not contra-indicated for aneurysms with vasospasm requiring catheterization. A large study for confirmation is now warranted.