bluuebunny/crossref_metadata_2025 huggingface dataset:
Disadvantaged Adolescents in Psychiatric Treatment
Authors: Almqvist Fredrik
Published: January 2017

In a prospective epidemiological study, a cohort of all children born in 1955 in Helsinki have so far been surveyed into their youth. On the basis of the present seven-year follow-up in adolescence, it was observed that the cumulative incidence of public psychiatric treatment is 9.1%. Marital status of the biological parents deviating from normal or the death of a parent as well as a low social status of the father are factors connected with an elevated risk of required psychiatric treatment during youth. The combined effects of such social risk factors are additive. The risk of necessary treatment was observed to be three times greater in young people who exhibited both risk factors during childhood. The results of the study indicate how preventive measures might be directed. At the same time, the need for more detailed studies in the future to allow preventive measures to be directed more accurately than hitherto, at children and families requiring them, is emphasized.
Snowy Roofs—a Potential Hazard
Authors: Eriksson Anders , Björnstig Ulf , Kullenberg Krister
Published: January 2017

An accumulation of injuries and fatal accidents associated with shovelling snow from roofs was observed in the beginning of 1986 in Northern Sweden. Injury mechanisms and injury panorama are analyzed and preventive measures are suggested. Slipping on roofs or ladders, often caused by sliding snow, was a common cause of accident. Five subjects died of suffocation after having been buried under sliding snow. We would like to emphasize the importance of a co-worker when shovelling snow off roofs, of being well anchored by a safety-line and, if using a ladder, taking care that the ladder is well anchored and that the shovelling is not done on an ascent. Special snow conditions should also be noticed.
Is Preoperative Evaluation of the Biliary Tree Necessary in Uncomplicated Gallstone Disease?
Authors: Järhult J.
Published: January 2017

Aim:

To analyse if preoperative radiology is of value in patients with uncomplicated gallstone disease.

Material:

312 patients intended for laparoscopic cholecystectomy were randomly allocated to undergo preoperative radiology (intravenous cholangiography or magnetic resonance cholangiography) or to a control group. Intraoperative cholangiography was not used routinely in either group.

Results:

There was no bile duct injury and no difference in complication frequency between the two groups. The incidence of common bile duct stones was 3,8 % within the first postoperative year with no statistical difference between the two groups.

Conclusions:

Routine preoperative evaluation of the bile tree seems unnecessary before laparoscopic cholecystectomy in patients with uncomplicated gallstone disease.
Cement Augmentation in Fracture Treatment
Authors: Larsson S.
Published: January 2017

Surgical treatment of fractures close to joints, especially in osteoporotic patients, is often associated with problems to obtain adequate strength of the bone-implant construct as well as sufficient purchase for screws in the weak bone. One way to address this increasing problem is through the development of new metal implants specifically designed for fixation of fractures in osteopenic bone. An alternative strategy is to develop methods for augmentation of the weak bone that surrounds the metal implant. In most instances augmentation is achieved by using injectable cement to reinforce the bone. Conventional PMMA provides good strength but due to several drawbacks it has never gained general acceptance for fracture augmentation. More recently several injectable cements based on calcium-phosphate, calcium-sulphate or bioglass has been developed for augmentation of fractures in the extremities as well as for vertebral compressive fractures in the spine. On the basis of biomechanical studies and the clinical experience so far, cement augmentation will enable faster rehabilitation, as the strength of the cement makes it possible to allow full weight-bearing earlier than conventional metal implants alone. More clinical studies are needed in order to refine the surgical technique, develop cement types aimed for fracture treatment and define the most appropriate indications and limitations of augmentation for fracture repair.

The purpose of this article is to review the possible use of augmentation as a technique in the treatment of fractures in the extremities as well as in the spine.
Early Surgeryfor Treatment of Spontaneous Hemopneumothorax
Authors: Homma T. , Sugiyama S. , Kotoh K. , Doki Y. , Tsuda M. , Misaki T.
Published: January 2017

Purpose:

Spontaneous hemopneumothorax (SHP) is a rare life threatening disorder. We retrospectively investigated patients with SHP who were treated with video- assisted thoracic surgery (VATS), and report our results.

Methods:

From January 1993 to July 2006, 239 patients with spontaneous pneumothorax were treated, among whom 11 (4.6%) were diagnosed with SHP.

Results:

All 11 patients had a collapsed lung condition worse than moderate and a chest tube inserted, of whom 10 underwent an emergency operation. The points of hemorrhaging, each of which were in the apical portion of the lung, were easily revealed during VATS, and we were able to distinguish between brisk flow and seepage. Hemostasis was acquired using VATS in all surgery cases, while the other was treated with tube drainage. The single patient who did not undergo surgical treatment had recurrent spontaneous pneumothorax 3 months later.

Conclusion:

It is important to perform surgery for SHP at the appropriate time. VATS was found to be an easily performed and safe procedure for initial treatment in patients with active hemorrhaging and massive blood clotting in the thorax. The long-term outcome of our patients with early surgical indication was excellent and we recommend early surgical treatment for SHP.
The Early Effects of Intramedullary Reaming of the Femur on Bone Mineral Density; an Experimental Study in Pigs
Authors: Husebye E. Ellingsen , Lyberg T. , Madsen J. E. , Nordsletten L. , Røise O.
Published: January 2017

Background and Aims:

Both fracture and fracture treatment affect bone mineral density (BMD). BMD after standard intramedullary reaming of the femoral cavity and after reaming with a reamer-irrigator-aspirator (RIA) system were studied with the hypothesis that the RIA technique would lead to lower BMD levels.

Material and Methods:

Dual-energy X-ray absorptiometry (DXA) was performed on the third day after operation with standard intramedullary nailing technique (n = 6)or RIA technique (n = 7) in intact femora of young Norwegian landrace pigs.

Results and conclusion:

Significantly lower BMD were found in the mid-shaft and total femur after reaming with the RIA technique compared to the non-operated femur. Traditional reaming technique resulted in significantly higher BMD in the distal femur.

Interpretation:

The results of this study indicate that standard reaming increased BMD in the distal femur, suggesting compressive effects on trabecular bone. The RIA technique decreased BMD in the femoral diaphysis and total femur, suggesting removal of trabecular bone. A possible clinical impact of the findings remains to be investigated.
Adenocarcinomas on the Rise — Does it Influence Survival from Oesophageal Cancer?
Authors: Goscinski M. A. , Larsen S. G. , Warloe T. , Stoldt S. , Nesland J. M. , Suo Z. H. , Giercksky K.-E.
Published: January 2017

Background and Aims:

A significant change in the occurrence of oesophageal squamous cell carcinomas (SCCs) in relation to adenocarcinomas (ACs) has been observed in the Norwegian population during the last 20 years (1988–2007). The AC incidence has increased from 5–10% to more than 50% nowadays, while the incidence of SCCs has decreased. Our goal was to evaluate if the change from SCC to AC and the increased effort to control reflux could be reflected in tumour stage, patient demographics and treatment results.

Material and Methods:

We analysed clinical and pathological data from 347 patients with oesophageal AC (n = 189) and SCC (n = 158) treated at The Norwegian Radium Hospital during said period for patient- and tumour characteristics, treatment modalities and survival.

Results:

An oesophageal resection was performed in 169 of 347 patients. The median survival rate for all patients was 15 months, with a 5-year survival rate of 10%. The median survival time for operated and non-operated patients was 25 and 12 months respectively, with the corresponding 5-year survival rate of 13% and 2%. Patients with N0M0 disease operated with free resection margins presented a 5-year survival rate of 28%.

Conclusions:

The change from SCC to AC and the ensuing considerable efforts made in surveillance and treatment of AC did not lead to improved long time survival for our patients.
Can Elevated Serum Tracp-5B Levels Predict Stress Fractures? A Cohort Study
Authors: Ruohola J.-P. S. , Mulari M. , Haataja R. I. , Väänänen H. K. , Pihlajamäki H. K.
Published: January 2017

Background and Aims:

Stress fracture is a common overuse injury in athletes and military conscripts. The reliable diagnosis of stress fractures is often difficult, however, because it is usually based solely on radiographic findings. Biochemical markers of bone resorption reflect bone degradation and may also reflect the rate of bone loss. The aim of the study was to examine whether elevated serum tartrate-resistant acid phosphatase isoform 5b (TRACP-5b) levels reflect enhanced bone remodeling and predict the occurrence of stress fractures in military conscripts.

Material and Methods:

Randomly selected military conscripts [mean age, 19.8 (range 18–28) years; n = 820] were followed for 3 months. Baseline blood samples were drawn upon arrival to the service. Four subsequent samples were obtained from subjects that developed stress fractures and one sample each was obtained from two asymptomatic control subjects for each fracture case.

Results:

Plain radiography was used to diagnose stress fractures in 20 of the 820 conscripts (2.4%). Follow-up data were available for 14 subjects with 21 stress fractures and 28 control subjects. Subjects with proportionally increasing serum TRACP-5b levels had an 8-fold greater probability of stress fracture than controls. No statistically significant difference was detected.

Conclusions:

Although assessing serum TRACP-5b levels appears to be a promising method to predict bone stress injuries, the present study failed to give a conclusive statement of its usefulness as a diagnostic tool.
Children’s rights and social media: Issues and prospects for adoptive families in Italy
Authors: Aroldi Piermarco , Vittadini Nicoletta
Published: January 2017

The worldwide spread of social media is changing the forms and rules of social relations, the boundaries of private and public spheres, and the definition of privacy and its protection. In reflecting on children’s rights in a digital age, the online experiences of adopted children and their families foreground the tension between the right to privacy and protection and children’s right to know about their origins. This article explores the Italian case through a qualitative study of professionals working in private and public foster and adoptive services. It analyses the risks and opportunities presented by social media in the everyday life of adoptive families, with particular attention to children’s rights and recommendations for families and professionals.
The use of conversational co-remembering to corroborate contentious claims
Authors: Bolden Galina B , Mandelbaum Jenny
Published: January 2017

Memory is a central epistemic resource, yet the interactional organization of shared remembering is largely unexplored. Drawing on a large corpus of video- and audio-recorded interactions in English and Russian, we examine a collection of over 50 cases in which participants are engaged in the activity of co-remembering. We show that memory formulations are commonly used as an evidential method to legitimize or support a claim or point of view in contexts of challenges, objections, disagreements, skepticism, resistance and when alternative positions are on the floor. Our study indicates that in deploying memory formulations, interactants rely on the robust character of excavatable shared past experiences to provide an upgraded epistemic claim to support a contentious stance toward an alternative position.
Who Is Influencing Whom? Latino Parent–Child Request Interactions and Product Purchases in Food Retail Environments
Authors: Castro Iana A. , Calderon Joanna , Ayala Guadalupe X.
Published: January 2017

This study examines Latino parent–child interactions about foods and beverages requested in food retail environments in San Diego, CA. It seeks to extend our understanding of parent–child request interactions and purchases by studying how the number of product request interactions and purchases differ based on four factors that have been understudied in previous parent–child interaction research: parent gender, child gender, product healthfulness, and who initiated the request interaction (parent or child). By unobtrusively observing Latino parent–child dyads for the duration of a brief shopping trip, we found that parent and child gender are related to the number of request interactions initiated by parents and children. For gender-specific child-initiated request interactions, sons initiated more request interactions with fathers while daughters initiated more request interactions with mothers. Most request interactions were for products that were categorized as calorie dense, and a higher percentage of these products were purchased as a result of parent-initiated (vs. child-initiated) request interactions. The results provide important considerations for practitioners and researchers working on improving nutrition and reducing obesity. Assumptions about who is influencing whom in food store request interactions are challenged, requiring more research.
Differences in Quality of Life before Transplantation among Transplant Recipients with Respect to Selected Socioeconomic Variables
Authors: Cetingok Muammer , Hathaway Donna K. , Winsett Rebecca R.
Published: January 2017

Purpose

To examine differences in quality of life before transplantation among transplant recipients with respect to a selected set of socioeconomic variables related to household/housing, family social and health history, and availability and use of community resources.

Methods

An exploratory-descriptive study in a US university's transplant clinic. Sample included 249 kidney, liver, and pancreas transplant recipients aged 18 years or older. Instruments were a socioeconomic data questionnaire, the Sickness Impact Profile, the Adult Self-Image Scale, the Quality of Life Index, and a general quality of life scale. Descriptive statistics and analysis of variance with Bonferroni adjustment were used with a significance level of .05. Effect sizes were estimated.

Results

Quality of life did not differ significantly for any variable except for the use of private insurance combined with public health insurance. Such coverage was associated with significantly better scores on the psychosocial and total dimensions of the Sickness Impact Profile, indicating better health before transplantation.

Conclusion

Researchers must first explore why a mix of private and public health insurance is associated with a higher quality of life and second reexamine whether these results occur at other transplant centers. These results also provide direction for social work professionals as they counsel patients in an attempt to help patients achieve a better psychosocial and physical quality of life before transplantation.
Children in Research: Human Subjects Considerations for the Inclusion of Children as Research Participants
Authors: Beigay Teresa M.
Published: January 2017

Health researchers are becoming increasingly aware of the need to include children as participants (subjects) in studies, both to improve the generalizability of findings of research and to benefit children in terms of medical care. However, because institutional review boards examine proposed research involving children very carefully, researchers often are hesitant to involve children in studies. This article discusses regulatory issues with regard to children in research, outlines specific issues of concern to institutional review boards, and provides guidelines for researchers examining children's health issues.
Do People Accept Brain Death as Death? A Study in Brazil
Authors: Tessmer Chiara Scaglioni , Silva André Rodrigues da , Barcellos Franklin Correa , Araujo Cora Luiza , Costa Juvenal Dias da , Böhlke Maristela
Published: January 2017

Background

Although the term brain death has been clinically and legally accepted as a death criterion, few data are published about public attitudes and beliefs concerning this topic.

Objectives

To examine public understanding of brain death and how the term brain death affects decisions about organ donation.

Methods

Population-based cross-sectional study, with individuals aged 20 years or older in the urban area of Pelotas, State of Rio Grande do Sul, Brazil. The instrument used was a structured questionnaire, completed in individual interviews. χ2 and t test were used in the univariate and logistic regression in multivariate analysis.

Results

Of 3159 participants, 80.1% would authorize organ donation from a relative who had previously declared a willingness to do so. However, when the words “brain death” were used as death, only 63% would authorize organ donation. When the subject had not been discussed, only a third of the participants would authorize the donation of a relative's organs.

Conclusions

When the term death was substituted with brain death, the willingness to donate decreased by 20%, suggesting that some individuals do not understand or accept the term brain death. Increasing comprehension about the concept of brain death and adopting educational strategies are essential to obtain higher rates of organ donation in developing countries.
Design and Implementation of an Informed Consent Process before Liver Transplantation
Authors: Rosenthal Lori
Published: January 2017

In the past, the content of patient education was designed at the discretion of each individual transplant center and could vary greatly from center to center. Since the 2007 implementation of the guidelines from the Department of Health and Human Services, Centers for Medicare and Medicaid Services, transplant centers have had to standardize the educational material they give to patients while generating an informed consent form to incorporate this required information. This article describes the development and use of an informed consent form and the educational process for potential liver transplant recipients at Columbia University Medical Center in adherence with the new regulations. This informed consent process can be used as a national model.
Effect of Annual Influenza Immunization on Antibody Response in Lung Transplant Patients
Authors: Dopp John M. , Wiegert Nicholas A. , Moran John J. M. , Francois Mary L. , Radford Kelly L. , Thomas Holly , Love Robert B. , Hayney Mary S.
Published: January 2017

Background

Influenza viral infections cause significant morbidity and mortality each season. Lung transplant patients may be at higher risk because of their underlying pathophysiology. Although annual immunization is the standard of care, its efficacy remains largely unproven. Previous studies showed poor antibody response to influenza vaccine in lung transplant patients, but no data on the antibody response in consecutive seasons have been published.

Methods

We studied antibody responses to influenza vaccine in 122 subjects: 66 lung transplant recipients, 28 control subjects, and 28 patients awaiting lung transplantation. We compared antibody response rates to individual viruses contained in influenza vaccines in consecutive years within the 3 groups. Serum antibody concentrations were measured at baseline and 2 to 4 weeks after vaccination by using the hemagglutination inhibition assay. Log-transformed antibody concentrations and incidence of serconversion and seroprotection were calculated.

Results

Median log-transformed antibody responses were similar in consecutive seasons in lung transplant subjects. Incidences of seroprotection and seroconversion did not differ between consecutive seasons in lung transplant recipients.

Conclusions

Antibody responses were similar in consecutively measured years in lung transplant subjects. Annual influenza vaccination in lung transplant subjects produces similar immune responses in 2 consecutive years, indicating that these patients are not at significantly increased risk of vaccine failure.
Patterns and Predictors of Sleep Quality Within the First Year After Lung Transplantation
Authors: Fatigati Angela , Alrawashdeh Mohammad , Zaldonis Jenna , Dabbs Annette DeVito
Published: January 2017

Context:

Sleep quality affects health and self-management in chronic illness. Limited research has examined patterns and predictors of sleep quality and its impact on self-management and health-related quality of life (HRQOL) among lung transplant recipients (LTRs).

Objective:

The aims of this study were to identify the patterns, predictors, and impact of poor sleep quality on self-management behaviors and HRQOL the first year after lung transplantation.

Methods:

Secondary analysis of 75 LTRs who participated in a randomized controlled trial. Pittsburgh Sleep Quality Index (PSQI) was administered at baseline, 2, 6, and 12 months after transplant; 12-month PSQI was dichotomized categorizing good versus poor sleepers. Predictors were measured at the time of transplant; self-management and HRQOL were measured at 12 months. Logistic regression identified predictors of poor sleep. Correlations examined poor sleep quality, self-management behaviors, and HRQOL.

Results:

Sleep quality was relatively stable during the first year, and 24 of the 75 (32%) of the sample met criteria for poor sleep quality at 12 months. The only multivariate predictor of poor sleep was female gender (odds ratio = 3.421; P = .026); the mental component of HRQOL was the only outcome associated with poor sleep ( r = −.348; P < .01).

Conclusion:

Nearly one-third of LTRs reported persistent poor sleep through year 1. More females reported poor sleep quality, and sleep quality was inversely related to mental HRQOL by 12 months. Knowledge of these relationships may help identify LTRs at the greatest risk for poor sleep and guide strategies to promote sleep and optimize HRQOL.
Long-term hydrolytic degradation study on polymer-based embroidered scaffolds for ligament tissue engineering
Authors: Hahn Judith , Breier Annette , Brünig Harald , Heinrich Gert
Published: January 2017

Following anterior cruciate ligament injury, a mechanically stable tissue replacement is required for knee stability and to avoid subsequent damages. Tissue engineering of the anterior cruciate ligament demands a biocompatible scaffold with a controllable degradation profile to provide mechanical support for 3 to 6 months. It has been argued that embroidered textile scaffolds made of polylactic acid and poly(lactic-co-ɛ-caprolactone) fibres are a promising approach for the ligament tissue engineering with an adapted functionalization and cell seeding strategy. Therefore, the hydrolytic degradation behaviour of embroidered scaffolds made of polylactic acid and a combination of polylactic acid and poly(lactic-co-ɛ-caprolactone) fibres was investigated under physiological conditions for 168 days. The changes in the mechanical behaviour, the molecular weights as well as the surface structures were analysed. Sufficient mechanical properties comparable to native anterior cruciate ligament tissue could be demonstrated for scaffolds made of polylactic acid fibres after 6 months under hydrolysis. These results clarify the potential of using embroidered scaffolds for ligament tissue engineering.
Reclaiming a Positive Identity in Chronic Illness through Artistic Occupation
Authors: Reynolds Frances
Published: January 2017

This article presents a qualitative study of women's positive reconstruction of self and identity during chronic illness through engaging in textile artwork. Ten women volunteered to be interviewed about the influence of their artistic occupations on their perceived health, well-being, and identity in chronic illness. This article specifically examines identity-related issues within the narratives, guided by the principles of grounded theory. The thematic analysis revealed that the participants' engagement in art-making during illness gradually contributed to a positive identity as a textile artist. Although emerging after the onset of illness, the artist identity enabled each participant to express continuities with her pre-illness self and values. Participants also regained a positive sense of personal growth, status, achievement, and connection with other women, which all appeared to promote their successful adaptation to ill health. The support of social networks and the wider cultural milieu may have enabled participants to commit themselves to their artwork. The findings suggest that meaningful artistic occupation may provide a source of positive identity for people living with chronic illness, even when they have not engaged regularly in art in their earlier adult lives.
Local and Widely Distributed EEG Activity in Schizophrenia With Prevalence of Negative Symptoms
Authors: Grin-Yatsenko Vera A. , Ponomarev Valery A. , Pronina Marina V. , Poliakov Yury I. , Plotnikova Irina V. , Kropotov Juri D.
Published: January 2017

We evaluated EEG frequency abnormalities in resting state (eyes closed and eyes open) EEG in a group of chronic schizophrenia patients as compared with healthy subjects. The study included 3 methods of analysis of deviation of EEG characteristics: genuine EEG, current source density (CSD), and group independent component (gIC). All 3 methods have shown that the EEG in schizophrenia patients is characterized by enhanced low-frequency (delta and theta) and high-frequency (beta) activity in comparison with the control group. However, the spatial pattern of differences was dependent on the type of method used. Comparative analysis has shown that increased EEG power in schizophrenia patients apparently concerns both widely spatially distributed components and local components of signal. Furthermore, the observed differences in the delta and theta range can be described mainly by the local components, and those in the beta range mostly by spatially widely distributed ones. The possible nature of the widely distributed activity is discussed.
A Case of Spontaneous Acute Subdural Haematoma in Traumatic Carotid-Cavernous Fistula
Authors: Fukui K. , Miyachi S. , Kato M. , Miyazaki M.
Published: January 2017

We report a case of acute subdural haematoma in traumatic carotid-cavernous fistula. The patient had a history of head trauma four years ago. Postoperative study revealed CCF of dominant posterior drainage with giant pseudoaneurysm. Thereafter endovascular treatment using detachable balloons and detachable platinum micro-coils made successful occlusion of the fistula preserving the ICA.
The Arteriovenous Malformation Associated with Major Arterial Occlusion and Moyamoya Vessels: A Cerebral Blood Flow Study
Authors: Numaguchi Y. , Wang H.Z. , Stern A. , Alleyne C.H. , Lunsford L.D.
Published: January 2017

We report 2 patients with arteriovenous malformation (AVM) associated with complete occlusion of the unilateral middle cerebral artery and moyamoya vessels. Xenon CT CBF study demonstrated diffusely decreased CMF in unilateral or bilateral hemispheres with multiple areas of decreased vascular reserve. A significant reduction of AVM size was seen in one patient who received radiosurgery with marked CBF improvement.
Correlation of Prenatal MRI and Autopsy Findings in the Diagnosis of Vein of Galen Arteriovenous Malformation
Authors: Berge J. , Maugey B. , Charles D. , Jimenez M. , Mangione R.
Published: January 2017

We report the case of an arteriovenous malformation (AVM) of the vein of Galen diagnosed in utero at the 34th week of gestation by ultrasound and MRI. Following interdisciplinary advice, the family decided to terminate the pregnancy. This was carried out in the 36th week of gestation. Mascroscopic study of the fetus confirmed the in utero diagnosis: considerable dilatation of the cerebral arteries, the Galen vein and the anteroinferior sinuses. Based on the correlation of pre and post natal examinations, this study highlights the accuracy of in utero MRI, coupled with ultrasound scanning in the diagnosis of an AVM of the Galen vein. It provides specific information on the degree of cerebral impairment. MRI in utero helps in decision-making for pregnancy termination.
Treatment of a Scalp Arteriovenous Malformation by a Combination of Embolization and Surgical Removal
Authors: Oishi H. , Yoshida K. , Tange Y. , Tsuji O. , Sonobe M.
Published: January 2017

The authors describe a 21-year-old man in whom a large arteriovenous malformation of the scalp was eliminated using a combined interventional, neuroradiological and neurosurgical approach. Embolization was utilized to reduce arterial blood supply to the malformation. Eudragit-E, as a liquid embolic material from a cationic polymer, methyl and butyl methacrylate, and dimethylaminoethyl methacrylate copolymer, was injected through the transarterial route and then by direct percutaneous puncture of the nidus. One week after embolization, the nidus was easily resected with minimal blood loss. A postoperative angiogram showed nearly total extirpation of the nidus as well as complete clinical recovery. Preoperative embolization in this case was a safe and effective ablative technique.
A Challenging Problem
Authors: Kurt A. , Tanrivermiş A. , İpek A. , Tosun Ö. , Gümüş M. , Yazicioğlu K.R. , taş İ.
Published: January 2017

Vertebral pseudoaneurysm and arteriovenous fistulas are very rare and are commonly due to penetrating trauma to craniocervical region. A 20-year-old man was presented with progressive swelling and pulsatile mass on the left side of his face. He had been stabbed two weeks ago on the left side of his face. Doppler Ultrasound revealed large left vertebral pseudoaneursym and arteriovenous fistulisation with the ipsilateral internal jugulat vein. MR Angiography and conventional angiography confirmed arteriovenous fistula between left vertebral artery and ipsilateral internal jugular vein and large pseudoaneurysm formation on vertebral artery. Arteriovenous fistula was closed surgically and embolized with surgicell. But the pseudoaneurysm was treated with endovascular covered stent placement.
Neuroradiological Analysis of 23 Cases of Basilar Artery Fenestration Based on 2280 Cases of MR Angiographies
Authors: Tanaka M. , Kikuchi Y. , Ouchi T.
Published: January 2017

Basilar artery (BA) fenestrations are the most frequently observed variant of the cerebral arteries. We examined the magnetic resonance (MR) angiographic incidence, location, characteristic configuration of BA fenestration and associated vascular disease.

From April 2004 to September 2004, a total of 2280 cranial MR angiographies were performed at our institution. Twenty-three BA fenestrations (1.0%) were detected on MRA. There were 13 males and ten females in this group and mean age was 57.6 years old. Three cases of these fenestration group are suffered with atherothrombic infarction in the territory of vertebro-basilar system. Seven of 23 cases (30%) were associated with intracranial aneurysm. Of those four cases, aneurysms were located at anterior circulation. Of those three cases, the aneurysms were associated with BA fenestration. Since saccular aneurysms are reported to arise frequently at BA fenestration, knowledge and recognition of fenestration are useful and important in the interpretation of cerebral MR angiography.
Endovascular Treatment of Experimental Cerebral Aneurysms Using Thermoreversible Liquid Embolic Agents
Authors: Takao H. , Murayama Y. , Saguchi T. , Ishibashi T. , Ebara M. , Irie K. , Yoshioka H. , Mori Y. , Ohtsubo S. , Viñuela F. , Abe T.
Published: January 2017

We have developed a new embolic agent, thermoreversible gelation polymer (TGP). This polymer is unique in that solidification occurs at body temperature. The utility of this new liquid embolic agent for the treatment of large experimental aneurysms was evaluated angiographically.

TGP remains liquid at temperatures below the sol-gel transition temperature (TT) and becomes gelatinous above the TT. TGP can also be used to slowly deliver biologically active substances such as growth factors or engineered cells. In this study, TGP was mixed with radiopaque material without solvent. Bilateral common carotid arteries of swine (n=5) were used for surgical creation of lateral aneurysms, then 1 aneurysm in each animal was embolized using TGP without any protection device. The remaining untreated aneurysm in each animal was used as a control.

All aneurysms were successfully embolized using TGP. No distal migration of TGP was observed when aneurysms were embolized without using protection devices.

TGP can be safely used to embolize experimental aneurysms. Embolization of aneurysms with a protection device needs to be evaluated. Further modifications such as mechanical stability and use as a drug delivery system will be necessary prior to the clinical application of TGP.
Snare-Assisted Trans-Brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion
Authors: Oowaki H. , Matsuura N , Ishikawa M.
Published: January 2017

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery.

A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion.

Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist.

The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.
Risk of Hemorrhage in Combined Neuroform Stenting and Coil Embolization of Acutely Ruptured Intracranial Aneurysms
Authors: Jankowitz B. , Thomas A.J. , Vora N. , Gupta R. , Levy E. , Yamamoto J. , Kassam A. , Gologorsky Y. , Panapitiya N. , Sandhu E. , Crago E. , Hricik A. , Lee K. , Gallek M. , Jovin T. , Horowitz M.
Published: January 2017

Stenting as adjuvant therapy for the coiling of acutely ruptured aneurysms remains controversial due to the necessity of anticoagulation and antiplatelet medications. We report our experience using the Neuroform stent in the management of 41 aneurysms in 40 patients over a period of three years. For aneurysms whose open surgical risk remains excessive with a morphology that would preclude complete embolization, the risks of stenting may be warranted.
The Potential of Flow Modification in the Treatment of Intracranial Aneurysms
Authors: Szikora I. , Nelson P.K. , Berentei Z. , Kulcsar Z. , Marosfoi M. , Berez A.
Published: January 2017

Background and purpose: To summarize the theoretical background and existing technical achievements of flow modification techniques in the treatment of intracranial aneurysms.

The evolution of the concept of flow modification for aneurysm treatment is overviewed within the published literature on application of stents for aneurysms. The newest achievements using dedicated flow modifying devices is discussed.

Reconstruction of laminar flow within intracranial arteries harboring aneurysms is feasible. Reorientation of flow using dedicated flow modifying devices is a highly effective technique in the treatment of large, broad neck, otherwise untreatable aneurysms.
Cerebral Sinovenous Thrombosis
Authors: Chen Hsian-Min , Chen Clayton Chi-Chang , Tsai Fong Y , Shy Cherng-Gueih , Wu Chen-Hoa , Chen Wen-Shien , Hung Hao-Chun
Published: January 2017

Cerebral sinovenous thrombosis (CSVT) is an uncommon disorder that affects the dural venous sinus and cerebral vein. In our study, thirty-four patients were examined. Pre and/or post contrast-enhanced CT was done in 28 patients. MRI studies were done in 24 patients. 2-D TOF MR venography (MRV) and contrast-enhanced MRV (CEMRV) were done in 19 cases. Digital subtraction angiography (DSA) was done in 18 patients. Sixteen patients received systemic intravenous heparinization, and 12 received endovascular thrombolytic treatment with urokinase combined with anticoagulant therapy.

Neuroimages of CSVT can be acquired by direct visualization of the thrombus within the dural sinus or by parenchymal changes secondary to venous occlusion. As there are some pitfalls to MRI in the diagnosis of CSVT, the combination of MRI and MRV is now the gold standard in the diagnosis of CSVT. Usually, accuracy can be improved by applying 2-D TOF MRV and CE MRV. Furthermore, the source image of MRV is critical in differentiating between normal sinus variations and diseased ones. DSA is the best tool for demonstrating dynamic intracranial circulation in CSVT and mostly is used for endovascular treatment.

Systemic intravenous anticoagulant therapy with heparin is accepted as a first line treatment. Except for clinical manifestations after systemic heparinization, abnormal MR findings of parenchymal change can be used to determine when to initiate thrombolytic treatment. Endovascular therapy can be finished at the ante-grade flow within the dural sinus and continuous anticoagulation is sufficient to facilitate clinical improvement.

Clinical suspicion and excellent neuroimaging are crucial in making the diagnosis of CSVT. Proper management with anticoagulants and/or endovascular thrombolytic therapy is mandatory in preventing propagation of the thrombosis and improving the clinical outcome.
Coil Migration through a Neuroform 3 Stent during Endovascular Coiling
Authors: O'Hare A. , Thornton J. , Brennan P.
Published: January 2017

A 43-year-old woman attended for stent assisted coiling. A Neuroform 30 × 4.5 mm stent had been successfully placed over the left periophthalmic aneurysm. During the coiling the first coil migrated through the crowns in the stent, lodging at the MCA bifurcation. We believe that the coil herniated through the overlying stent due to the carotid siphon curvature and the open cell design. Furthermore the distal markers of the stent impeded coil extraction with a MERCI device.
Percutaneous Intravertebral Body Embolization of a Traumatic Spinal Epidural Arteriovenous Fistula with Secondary Perimedullary Venous Reflux
Authors: Gjertsen Ø. , Nakstad P. HJ. , Pedersen HK , Dahlberg D.
Published: January 2017

Arteriovenous fistulas following vertebral fractures are probably very rare. We present a case with fistulous connection between arteries and veins within the fractured 12th thoracic vertebral body with retrograde venous drainage to perimedullary veins resulting in spinal venous hypertension and a cauda equina like symptomatology.

Pre-treatment 3D CT enabled us to puncture the venous pouch within the vertebra and deposit glue in the vertebral fistula. The procedure led to a complete occlusion of the fistula and relief of pain and neurological symptoms.
Endovascular Occlusion of a Lacerated Primitive Trigeminal Artery during Surgical Resection of Clival Chordoma
Authors: Baltsavias G. , Valavanis A.
Published: January 2017

We describe a case of a persistent primitive trigeminal artery (PPTA) coexistent with a clival chordoma. During surgery of the tumor, the partially incorporated PPTA was inadvertently traumatized and ruptured. The operation was discontinued and the PPTA was endovascularly occluded permitting further safe resection of the tumor.
Myxomatous Aneurysms
Authors: Tamulevičiūtė E. , Taeshineetanakul P. , Terbrugge K. , Krings T.
Published: January 2017

Cardiac myxomas are benign tumors that may lead to neurological manifestations including ischemic stroke, aneurysms or metastases. We describe a patient with multiple intracranial aneurysms who presented with TIA-like symptoms following resection of an atrial myxoma, and review the clinical and imaging features of myxomatous aneurysms as reported in the literature. The most prominent imaging features of myxomatous aneurysms are their multiplicity, fusiform shape and distal location whereas from a clinical point of view they most often present with stroke like symptoms rather than with hemorrhage. These neurological manifestations may occur even after successful and complete surgical removal of the atrial myxoma.
Hydrocephalus Secondary to Hydrodynamic Disequilibrium in an Adult Patient with a Choroidal-Type Arteriovenous Malformation
Authors: Ebinu J.O. , Matouk C.C. , Wallace M.C. , Terbrugge K.G. , Krings T.
Published: January 2017

We describe an adult patient with an unruptured choroidal-type arteriovenous malformation (AVM) associated with progressive hydrocephalus. There was no evidence of mechanical obstruction of the ventricular system by the AVM nidus itself or a draining vein. However significant reflux into periventricular and trans-medullary veins was demonstrated. Following partial targeted embolization of the AVM, no further reflux was observed, the patient's clinical deficits resolved, and the hydrocephalus improved. We suggest a hydrodynamic disorder as a potential pathomechanism of hydrocephalus in this adult patient with an unruptured AVM.
The Management of Very Small/Blister Internal Carotid Artery Aneurysms
Authors: Le Feuvre D.E.J. , Taylor A.G.
Published: January 2017

Blood blister aneuryms are uncommon lesions that have a poor natural history. Because there is no clear aneurysmal sac to treat they remain challenging lesions to manage whether the approach is endovascular or surgical. Although the management of intracranial cerebral aneurysms has changed subsequent to the results published by the ISAT trial, there still exist groups of aneurysms which do not lend themselves to endovascular management. There are recent reports of successful endovascular management using flow diverting approaches but experience is limited and relying on flow change may be insufficient to prevent re-rupture. Surgery when possible offers the advantage of immediate vessel wall reconstruction.
Spontaneous Thrombosis of an Orbital Arteriovenous Malformation Revealing Hereditary Haemorrhagic Telangiectasia (Rendu-Osler-Weber Disease)
Authors: Van Went C. , Ozanne A. , Saliou G. , Dethorey G. , De Monchy I. , Krings T. , Ducreux D. , Labetoulle M.
Published: January 2017

Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic disorder responsible for cutaneous or mucosal telangiectasia and arteriovenous malformations (AVMs). The most frequent locations are lung and brain. In contrast, orbital AVMs are very rare. We describe a case of symptomatic orbital arteriovenous malformation due to spontaneous thrombosis. A 65-year-old woman was referred for chronic right eye proptosis associated with dilation of conjunctival vessels with a jellyfish pattern. Right visual acuity was 20/40 and intraocular pressure was 40 mmHg. Personal and familial history of recurrent epistaxis, associated with multiple telangiectasia within lips and palate, led to the diagnosis of HHT. Magnetic resonance imaging (MRI) completed with cerebral angiography found a giant and occluded AVM within the right orbit. Other AVMs were also found in brain and chest, confirming the diagnosis. Antiglaucomatous eyedrops were added to reduce intraocular pressure and a steroid therapy was begun. Two months later, visual acuity decreased in the right eye, due to a central retinal vein thrombosis. In conclusion, Most brain or pulmonary AVM can be treated by embolization. By contrast, this treatment in case of orbital location can lead to central retinal artery and/or central retinal vein occlusion, which may also appear as a spontaneous complication of the orbital AVM. Therapeutic management of orbital AVM is thus not standardized, and the balance between spontaneous and iatrogenic risk of visual loss has to be taken into account.
Delayed Complication from a Percutaneous Vascular Closure Device following a Neuro-Interventional Procedure
Authors: Khaldi A. , Waldau B. , Skowlund C. , Velat G.J. , Mocco J. , Hoh B. L.
Published: January 2017

Percutaneous vascular closure devices are being increasingly used as alternatives to manual compression for the closure of femoral arteriotomy after endovascular procedures as they appear to reduce time to ambulate, improve patient's comfort, and are implicated with cost saving. However, vascular closure devices have been associated with an increased risk of complications including hematoma formation, local bleeding, arteriovenous fistula formation, pseudoaneurysm and arterial leg ischemia. To our knowledge, if the above complications occur it is usually within the first 30 days after the procedure. None have been reported in a delayed fashion ten months or longer after closure. We describe a 30-year-old man with a history of a giant basilar trunk aneurysm. He was placed on aspirin and clopidogrel prior to the procedure. He had bilateral femoral access with 6 French sheaths. Following the procedure, 6 French Angio-Seals (St. Jude Medical, St. Paul, MN, USA) were used for closure of bilateral femoral arteriotomies. Ten months after the procedure, the patient kicked a metal cart and developed a large right retroperitoneal iliopsoas hematoma. There was no evidence of pseudoaneurysm. The patient was managed conservatively and his serial hematocrit stayed stable. He did not require surgical intervention.

Use of percutaneous vascular closure devices is associated with complications including risk of hematoma, pseudoaneurysm, intravenous fistula, rectal peritoneal hemorrhage, limb ischemia and possible surgical repair. Most complications occur peri-procedure or within 30 days postprocedure. This is the first reported case of a delayed complication at ten months after the initial procedure.

Site-related complications associated with percutaneous vascular closure devices may occur in a delayed fashion, even ten months postprocedure, so should be considered in the management of patients.