bluuebunny/crossref_metadata_2025 huggingface dataset:
An Evaluation of Telemedical Support for a Minor Treatment Centre
Authors: Darkins A , Dearden C H , Rocke L G , Martin J B , Sibson L , Wootton R
Published: January 2017

A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During theevaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5–1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been £50,000 per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was £7250, amounting to a saving of some £42,000 per annum.
The Design and Preliminary Evaluation of a Home Electrocardiography and Blood Pressure Monitoring Network
Authors: Bai J , Zhang Y , Dai B , Zhu Z , Cui Z , Lin J , Zhang J , Zhang P , Shen D , Yao S , Cu S , Ye D
Published: January 2017

A home electrocardiography (ECG) and blood pressure (BP) monitoring network was established in Beijing. The network consisted of three parts: (1) the home ECG and BP monitoring devices; (2) the monitoring centre at the hospital; and (3) the data communication network, for which we chose the public telephone network. The system was tested in our university hospital for two months with 30 patients and six normal volunteers. A preliminary evaluation by the users indicated that the system was acceptable in terms of its efficiency and effectiveness. This paper describes the system design, the preliminary testing procedure, and results.
Postoperative Wound Complications after Internal Fixation of Closed Calcaneal Fractures: A Retrospective Analysis of 126 Consecutive Patients with 148 Fractures
Authors: Koski A. , Kuokkanen H. , Tukiainen E.
Published: January 2017

Aim:

The aim of the study was to analyse the number of soft-tissue complications after internal fixation of calcaneal fractures and to evaluate risk factors leading to these complications.

Material:

A retrospective analysis of 126 consecutive patients with 148 operatively treated calcaneal fractures was performed. Only primarily closed fractures were included in the study.

Results:

Wound healing was problematic in 35 cases (24 per cent). The wound was infected in 23 cases (16 per cent) and a wound edge necrosis was observed in 12 cases (8 per cent). The soft tissue complication needed operative treatment in 20 cases (14 per cent). The complications did not lead to amputations in any case. In the end of the follow up all wounds had healed.

Conclusions:

The statistical analysis identified a longer delay in surgery and longer operation time to be positive risk factors for wound complications.
The Future of Imaging in the Management of Abdominal Aortic Aneurysm
Authors: Nyman R. , Eriksson M.-O.
Published: January 2017

The development of endovascular techniques depends on the concomitant development of imaging techniques. Imaging with ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MR) is evolving at rapid pace. Angiography has largely been replaced by these techniques as a diagnostic tool in the clinical setting. New methods, e.g., rotational angiography and intravascular ultrasound, will play an important role in endovascular treatment of vascular disease. It is necessary to have easy access to ultrasonography, CT and MR images in future hybrid angiographic/surgical suites and the operator must be able to do advanced immediate reconstructions in a sterile environment. The combined use of advanced imaging, open and endovascular techniques will further improve the treatment of vascular disease in the future.
The Durability of Evar — What are the Evidence and Implications on Follow-Up?
Authors: Lange C. , Aasland J. K. , Ødegård A. , Myhre H. O.
Published: January 2017

Background and Aims:

To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness.

Material and Methods:

263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program.

Results:

There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well.

Conclusions:

Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
Cholecystectomy for Acute Gallstone Pancreatitis: Early Vs Delayed Approach
Authors: Wilson C. T. , de Moya M. A.
Published: January 2017

Background and Aims:

The management of gallstone pancreatitis, in particular timing of cholecystectomy, has evolved substantially over the last decade. The trend has been toward earlier cholecystectomy. We review current literature regarding the timing of cholecystectomy in the context of gallstone pancreatitis.

Materials and Methods:

The authors performed a literature search in PubMed for relevant articles in the English language with greatest weight given to prospective trials compared to observational studies and previous reviews.

Results:

The literature search yielded 59 articles discussing cholecystectomy in the context of gallstone pancreatitis. Most were retrospective studies or reviews, but there were nine prospective observational studies and two randomized control trials. For mild gallstone pancreatitis, laparoscopic cholecystectomy within 48 hours of presentation (without normalization of pancreatic enzymes or absence of abdominal pain) has been shown to shorten hospital stay without increased morbidity or mortality. Routine preoperative ERCP is unnecessary for patients with mild disease. For more severe disease, timing of cholecystectomy is governed by clinical status. Interval cholecystectomy (>2 weeks after index admission) can be safely done with low risk of recurrence if the patient has had ERCP and sphincterotomy at index admission.

Conclusion:

Patients with mild gallstone pancreatitis should have cholecystectomy during index admission within 48 hours of arrival, but patients with more severe disease will require cholecystectomy at a later time, depending on the clinical circumstances. Sphincterotomy should be done as soon as possible if cholecystectomy is not feasible early in course.
A Clinical Study on the Resection of Breast Fibroadenoma Using Two Types of Incision
Authors: Liu X.-F. , Zhang J.-X. , Zhou Q. , Chen F. , Shao Z.-M. , Lu C.
Published: January 2017

Background and Aims:

Breast fibroadenoma (FA) is traditionally managed by FA excision through an overlying incision (FETOI). FA excision through a periareolar incision (FETPI) has been developed, paying special attention to incision location to preserve cosmesis. The purpose of this article is to discuss the FETPI technique.

Methods:

The clinical data of 76 patients who underwent FETPI (98 FAs, group A) and 82 patients who underwent FETOI (122 FAs, group B) were retrospectively analyzed in this non-randomized study. Early postoperative complications, nipple sensation loss, and cosmetic results were compared between the two groups. The techniques, indications, and special considerations of the FETPI technique were described and identified.

Results:

The FETPI technique was associated with more early postoperative complications (7/76 vs. 2/82, p = 0.067) and more nipple sensation losses (15/76 vs. 7/82, p = 0.042) than those of the FETOI technique. Cosmetic assessment at 6 months demonstrated statistically more excellent/good results in group A than in group B (62/76 vs. 50/82, p = 0.004).

Conclusion:

The FETPI technique yields superior cosmetic results with minor postoperative complications.
Results of a Surgical Resection for Patients with Thymic Carcinoma
Authors: Yasuda M. , Hanagiri T. , Oka S. , Uramoto H. , Takenoyama M. , Yasumoto K.
Published: January 2017

Objectives:

This study investigated the clinical features of patients with complete resection of thymic carcinoma.

Patients and Methods:

The clinical records from 11 patients who underwent a complete resection of thymic carcinoma were retrospectively reviewed.

Results:

Twelve of 22 patients underwent a resection (a complete resection in 11 and an incomplete in 1). Six of the 11 patients with complete had confirmed recurrent tumors. The 5-year survival rate was 45.4%, and the median survival time was 50.6 months. The patients who underwent complete resection showed significantly better prognosis than cases with incomplete resection and inoperable cases ( p = 0.048). Three of the 6 patients had a recurrence within 1 year. Frequent sites of recurrence were the pleura, pericardium, and lung.

Conclusions:

A complete resection improved the prognosis of thymic carcinoma. Further prospective studies regarding postoperative adjuvant therapy are necessary to prevent local recurrence after a surgical resection for thymic carcinoma.
Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run
Authors: Giordano S. , Kääriäinen M. , Alavaikko J. , Kaistila T. , Kuokkanen H.
Published: January 2017

Background:

The latissimus dorsi (LD) muscle or myocutaneous flap is one of the most commonly used flaps and is believed to result in minimal donor-side morbidity. The impact on shoulder function from LD removal is important due to the common nature of this procedure. Previous studies have been performed after relatively short follow-up time and mostly after breast reconstruction. The purpose of this study was to objectively evaluate shoulder function years after latissimus dorsi muscle free flap operation.

Methods:

Between 1998 and 2004, eight patients who underwent LD-free flap for lower limb (7) or head and neck (1) soft tissue reconstruction were enrolled in this study. Scar, shoulder pain, function, mobility, stability and strength were evaluated and measured by using the Patient Scar Assessment Questionnaire (PSAQ), the Scar Evaluation Scale (SES) score, the American Shoulder and Elbow Surgeons (ASES) form, goniometer and isokinetic tests. Measurements of the operated sides were compared to the non-operated sides.

Results:

Mean age was 54 ± 21 years and mean follow-up was 92.5 ± 36 months after surgery. Mean PSAQ was 73 (65%), mean SES score was 2 ± 1. When comparing the operated sides to the unoperated sides, ASES score was significantly lower in the operated side (76 versus 93, p = 0.008); The range of motion in active and passive endorotation, active extrarotation and active forward elevation were significantly reduced after surgery. Operated side revealed a significant joint instability (3.6 versus 1.2, p = 0.007) using the ASES form. Isokinetic tests revealed that only intra-rotation strength was significantly reduced (35.74 Newton-metre versus 42.7 Newton-metre, p = 0.03) in the operated side.

Conclusion:

LD harvesting can affect the function of the shoulder joint in the long run. Reduced mobility, instability and weakness could be obtained with objective measurements. However, the results should be interpreted with caution because of the small sample size, internal controls and retrospective nature of this study.
A new sensation? An international exploration of sensationalism and social media recommendations in online news publications
Authors: Brown Danielle K , Harlow Summer , García-Perdomo Víctor , Salaverría Ramón
Published: January 2017

The well-known phrase ‘if it bleeds, it leads’ describes the sensational approach that has penetrated the history of news. Sensationalism is a term without complete consensus among scholars, and its meaning and implications have not been considered in a digital environment. This study analyzes 400 articles from online-native news organizations across the Americas, evaluating the sensational treatment of news categories and news values, and their associated social media interaction numbers on Facebook and Twitter. Findings suggest that ‘hard’ news topics like government affairs and science/technology were treated sensationally just as often as traditionally sensationalized categories like crime or lifestyle and society. In addition, audiences are not necessarily more likely to respond to sensational treatments. This study also finds that online-native news organizations use sensationalism differently, and there is significant variation in publications from the United States, Argentina, Brazil, and Mexico.
Social media and a case of mistaken identity: A newspaper’s response to journalistic error
Authors: Smith Philippa K , Sissons Helen
Published: January 2017

Journalists can obtain information faster than ever before and interact with a variety of sources across multiple platforms from Facebook to Twitter without leaving their desk. The pressure to get stories online as soon as possible is not without its drawbacks, however. Incorrect information and photographs can be published even when not properly verified and, although these mistakes can be rectified quickly once identified, the credibility of a news organisation is at risk. Our research was prompted by the chance capture of a photograph published in a daily newspaper that mistakenly identified a New Zealand-born Israeli soldier who was shot dead during a firefight in Gaza in 2014 as an American actor. This presented an opportunity to investigate and understand the challenges journalists face in sourcing information in the digital age. Our research takes a two-pronged approach. First, we establish what went wrong in the newsroom that led to this case of mistaken identity drawing public criticism and ridicule, and second, we analyse the editor’s apology to highlight the news organisation’s efforts to restore its image and regain the trust of its readers in the professionalism of its journalism.
Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study
Authors: Rodriguez Rose J. , Addonizio Linda J. , Lamour Jacqueline M. , Mital Seema , Mosca Ralph , West Lori J. , Nova Jenny C. , Hsu Daphne T.
Published: January 2017

Heart transplantation with ABO blood type–incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.
Incomplete Event Documentation in Medical Records of Lung Transplant Recipients
Authors: Troiani John S. , Finkelstein Stanley M. , Hertz Marshall I.
Published: January 2017

Context

The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete.

Objective

To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data.

Design, Setting, and Subjects

Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years.

Outcome Measure

Proportion of acute bronchopulmonary illness events documented in clinic medical record.

Results

By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions.

Conclusions

Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.
Leading the Flock: Organ Donation Feelings, Beliefs, and Intentions among African American Clergy and Community Residents
Authors: Davis Kimberly , Holtzman Samuel , Durand Roger , Decker Phillip J. , Zucha Bryanne , Atkins Lamon
Published: January 2017

Context

Despite a considerable potential role in organ donation for African American clergy, there has been little investigation to date of the beliefs, attitudes, and personal intentions of such clergy regarding donation.

Objective

To compare the beliefs, attitudes, and behavioral intentions regarding organ donation among African American clergy to those of African American residents of the same large US city.

Design

Focus groups and 3 cross-sectional surveys.

Setting

Greater Houston, Tex, metropolitan area.

Participants

A total of 761 randomly selected African American community residents and 311 African American clergy.

Main Outcomes Measures

Beliefs about the importance of organ donation; how comfortable one is in thinking about donation; whether one believes that organ donation is against one's religion; trust in healthcare professionals regarding death declaration; concerns that donation leads to body mutilation; and the likelihood that one will donate one's own organs upon death.

Results

Compared to general African American residents, African American clergy in the Houston area were found more often to believe in the importance of donation; to be more comfortable with thinking about donation; to feel more certain that donation was not against their religion; to believe that they could trust healthcare professionals regarding death declaration; to feel less often that donation leads to mutilation of the body; and to indicate a greater likelihood of donating their own organs upon death. The same was found to be true among clergy and congregants of the largest religious denomination in Houston, the Baptists.
Minimally Invasive Surgery for Live Kidney Donors: Techniques and Challenges
Authors: Brook Nicholas R. , Nicholson Michael L.
Published: January 2017

Live kidney donation is assuming an increasingly prominent role in kidney transplantation programs. The traditional operative approach has been through an incision in the upper quadrant of the abdomen or in the loin, with the attendant potential postoperative complications associated with a large surgical wound. These problems may act as disincentives to prospective donors. The introduction of laparoscopic donor surgery in 1995 heralded a new era offering reduced postoperative pain and improved cosmetic result. It is hoped that these benefits may counter some disincentives and thereby increase donation rates. Three minimal-access approaches and their advantages and disadvantages are described: classical laparoscopic, hand-assisted laparoscopic, and retroperitoneoscopic surgery. Published reports indicate extensive experience with the first 2 of these approaches and less experience with the latter. All 3 approaches present technical, physiological, and anatomical challenges in the context of retrieving an organ that is fit for transplantation. For minimal-access surgery to be accepted as the procedure of choice for live kidney donors, it must be demonstrated that morbidity is not transferred from donor to recipient when these techniques are used. Some concerns about these procedures are addressed. High-level evidence in the form of randomized controlled trials is generally lacking, but experiences of surgeons and patients suggest that, with appropriate modifications, these techniques are safe for both donors and allografts and also benefit donors' recovery.
Hand-Assisted Laparoscopic Donor Nephrectomy: A Low Rate of Complications
Authors: Sharma Ajay K. , Meier Scott , Larmeu Louis , Florman Sander , Slakey Douglas P.
Published: January 2017

Background

Laparoscopic donor nephrectomy is associated with a higher incidence of ureteral complications. Hand-assisted dissection minimizes the use of instruments for intraoperative retraction and handling of periureteric tissue, and may reduce posttransplant complications.

Objective

To assess the outcome of hand-assisted laparoscopic donor nephrectomy, in particular ureteral complications.

Methods

Records of 143 kidney transplant recipients who received allografts removed using the hand-assisted laparoscopic technique were retrospectively studied.

Results

Total operating time was 2.0±0.55 (range 1.08–4) hours. Warm ischemia time was 1.45±0.60 (range 0.58–3.00) minutes. Length of artery, vein, and ureter was 2.4±0.5 cm, 3.0±0.5 cm, and 10.3±2.1 cm, respectively. Estimated blood loss averaged 86.3±55.6 mL. Intraoperative suction was not needed in 65% of patients. Two donors developed incisional hernias and 1 had a postoperative ileus. Four of 143 (2.8%) recipients developed ureteral complications: reoperations for ureteral necrosis (1), stenting for ureteral stenosis (2), and urethral catheterization for ureterovesical leak (1). Graft loss in the first year after transplantation occurred because of renal vein thrombosis, thrombosis of revised arterial anastomosis, arterial thrombosis due to myocardial infarction, vasculitis, focal segmental glomerulosclerosis, and chronic rejection. Delayed graft function developed in 3 recipients. The acute rejection rate was 14.6%. Mean serum creatinine levels at 1 and 3 years were 134±61 μmol/L (1.52±0.69 mg/dL) and 121±35 μmol/L (1.37±0.40 mg/dL), respectively.

Conclusions

Hand-assisted laparoscopic donor nephrectomy is associated with a low incidence of ureteral complications; may reduce the technical difficulty of the operation and minimize retraction with instruments, resulting in fewer complications for donors and recipients; and minimizes donor blood loss.
Coordinating Organ Transplantation in Turkey: Effects of the National Coordination Center
Authors: Tokalak Ibrahim , Karakayali Hamdi , Moray Gökhan , Bilgin Nevzat , Haberal Mehmet
Published: January 2017

In January 2001, the National Coordination Center, which brought tissue and organ procurement and transplantation under the Turkish Health Ministry, was established in Turkey. The main aims of this organization are to expand cadaveric donation and increase the number of transplantable organs supplied by cadaveric donors. We compared the proportions of cadaveric organ transplantations that were performed in Turkey before and after the national coordination system was established. Of all the cadaveric transplantations completed to date, 91.6% of kidney and 71.5% of liver procedures were done before implementation of the new system, and 8.4% and 28.5%, respectively, were performed after the system was established. The data show that the frequency of cadaveric donation has increased, as well as the number of cadaveric organ transplantations performed annually. The new national transplantation coordination system is making a good start at increasing cadaveric transplantation in Turkey. This system will hopefully lead to a larger organ pool and shorter waiting lists in future.
Trends in Adult-to-Adult Living Donor Liver Transplant Organ Donation: The Johns Hopkins Experience
Authors: Abougergi Marwan S. , Rai Rudra , Cohen Cynthia K. , Montgomery Robert , Solga Steven F.
Published: January 2017

Adult-to-adult living donor liver transplantation is an increasingly important option for 17000 patients awaiting liver transplantation in the United States. However, adult-to-adult living donor liver transplantation volumes peaked in 2001 (N=518), and have gradually fallen in 2002 (N=362), 2003 (N=321), and 2004 (N=323). Recent concerns about donor safety and ethical considerations have made careful analysis of donor availability and selection criteria critically important. We conducted a retrospective review of our active liver transplant recipient registry (N=251) and compared it to our living donor registry (N=231), which included all potential living donors before the selection process. Fifteen percent of recipients accounted for the majority (53%) of donor evaluations, whereas 42% of recipients did not have even a single donor evaluation. Recipient diagnosis appears to have a significant impact on donor availability, with donors rarely evaluated for patients with alcoholic cirrhosis. Careful and stringent selection criteria rule out 67% of potential donors.
An Exploratory Study of the Cognitive, Academic, and Behavioral Functioning of Pediatric Cardiothoracic Transplant Recipients
Authors: Brosig Cheryl , Hintermeyer Mary , Zlotocha Jane , Behrens Darcia , Mao Jingnan
Published: January 2017

Context

Limited information is available regarding the cognitive, academic, and behavioral outcomes of pediatric cardiothoracic transplant recipients.

Objective

To examine the cognitive, behavioral, and academic functioning of a group of children who have received heart, heart/lung, or lung transplants.

Design, Participants, and Setting

An exploratory cross-sectional outcomes study of surviving pediatric cardiothoracic transplant recipients at a Midwestern pediatric hospital.

Main Outcome Measures

Transplant recipients completed measures of cognitive and academic functioning. Parents and teachers completed measures of behavioral functioning. Parents and transplant recipients also provided qualitative data regarding their main concerns after transplantation.

Results

On measures of cognitive functioning, 46% showed significant delays (>2 SD below the normative population). Of those eligible for academic testing, 78% fell within the average range (within 1 SD of the normative population) for reading and spelling, and 57% fell within the average range for math. Twenty-seven percent of mothers, 11% of fathers, and 17% of teachers rated subjects as having significant behavioral concerns. Results highlight the need for close contact between transplant teams and school personnel to optimize outcomes. In addition, patients and families may benefit from psychological intervention after transplantation as there are ongoing concerns regarding life expectancy and quality of life.
Implementation of an Intervention Plan Designed to Optimize Donor Referral in a Donor Hospital Network
Authors: Van Gelder Frank , Van Hees Dirk , de Roey Joachim , Monbaliu Diethard , Aerts Raymond , Coosemans Willy , Daenen Willem , Pirenne Jacques
Published: January 2017

Context

The shortage of donor organs remains the most important factor of waiting list mortality in organ transplantation worldwide. Donor detection is influenced by the legal system, family refusal, and underreporting caused by erroneous knowledge of donation criteria and lack of familiarity with the procedure.

Objective

To identify possible key factors of donor referral patterns within an existing cooperation with donor hospitals and donor units across the Dutch-speaking part of Belgium, an area of approximately 3 million inhabitants. An intervention plan to optimize the cooperation and procedure quality and efficiency was designed.

Design

The intervention plan was based on 3 essential principles in donor referral by donor reporters, information on donor criteria, facilitation of the donor procedure, and communication between donor reporters and the transplant center. The interventions were structured to optimize all 3 of these principles. Two successive periods of 4 years were retrospectively compared.

Participants

Data were collected retrospectively on donor referral behavior from a total of 37 donor hospitals and donor units over an 8-year period.

Main Outcome Measures

The referrals were reviewed for potential donors, effective donors, percentage of effective donors, refusal rate of relatives, number of tissue donors, impact on local and national transplant programs, and national donor numbers.

Results

Data showed a significant positive impact on donor referrals and donor referral behavior (+27% potential donors, +30% effective donors, +172.7% tissue donors, −7% family refusals rates, +9.63% national donors). The results stress the importance of reduced workload and optimization of communication and information availability in an existing donor hospital network.
Liver Transplantation in Italy: Analysis of Risk Factors Associated with Graft Outcome
Authors: Quintieri Francesca , Pugliese Orsola , Mattucci Dino Alberto , Taioli Emanuela , Venettoni Sante , Costa Alessandro Nanni
Published: January 2017

Objective

To analyze the graft outcome after liver transplantation in Italy in the years 1995 to 2000.

Methods

We performed a longitudinal study with follow-up at 3 months, 1 year, 3 years, and 5 years on 1987 liver grafts. The effect of several variables on graft survival was also analyzed.

Results

Several variables affect graft survival: Donor and recipient older age, gender mismatching, prolonged cold ischemia time, acute hepatic necrosis, and retransplantation are reported to significantly affect liver graft survival. Donors older than 60 years show a relative risk of 1.59 (95% CI, 1.23–2.05) compared with donors with an age between 19 and 60 years; recipients older than 50 years show a relative risk of 1.29 (95% CI, 1.04–1.60) compared with recipients aged 19 to 50 years. A cold ischemia time of 12 hours or longer doubled the risk of failure (relative risk = 2.01, 95% CI, 1.36–2.96) compared with a cold ischemia time of less than 6 hours.

Conclusions

The results show that the overall quality of liver transplantation in Italy is satisfying and comparable to the outcome reported by international registries. Follow-up studies on large numbers of liver transplants are useful to define predictors of outcome, and subsequently modify the criteria for organ allocation.
Endovascular Management of Intradural Berry Aneurysms
Authors: Fuse A. , Rodesch G. , Alvarez H. , Lasjaunias P.
Published: January 2017

Endovascular management of intracranial arterial aneurysms (AA) is well described and performed by many teams. The aim of this work is to review a series of consecutive cases treated in our institution and to compare to the data available in the literature.

225 AA were seen in Bicêtre between 1993 and 1998 in 203 patients. 201 of them (in 180 patients) were treated by our group. The endovascular treatment, its indications, results and complications have been reviewed and studied. The clinical follow-up of the patients has been evaluated.

A female dominance was noted (64.5%) with a mean age of patients of 44.3 years. 65.6% of patients were treated in the acute phase after intracranial haemorrhage, 72% of them being Hunt and Hess grade 1 or 2. Most of these AA (73.6%) were located in the anterior circulation. In 86.1% of cases the AA was smaller than 10 mm. 85.6% of the AA needed only one session of endovascular therapy. No mortality occurred in the group of unruptured AA. Overall management mortality was 11% in ruptured AA (3.5% in HH1–2, 30.3% in HH3–5). Technical or transient complications occured in 11.6% of cases, but permanent morbidity was seen in 3.1% of cases. Control angiograms were performed 3 months and one year after therapy. In doubtful cases a control at 6 months was also performed. 100% occlusion rate was noted in 60.8% of cases; 22.8% of AA were occluded between 90–99%, and 13.3% between 80–90%. Only 3.1% of AA had an occlusion rate of less than 80%. One patient with a ruptured basilar tip AA which was partially coiled regrew and rebled three months after. The patient declined the recommended complementary surgery. Clinical follow up of patients with ruptured AA treated by embolisation shows satisfactory results with 8., 5% of GOS 1–2, 3.4% of GOS 3–4, and 11% of GOS 5 (mortality).

Overpacking of the AA may not be necessary to protect patients from (re)bleeds over time. The related technical risks and increased costs of dense overpacking do not seem justified. Secondary thrombosis of the ruptured AA after coiling is more often seen than coil compaction. Analysis of the AA architecture and recognition of false aneurysms are mandatory in order to obtain good clinico-morphological logical results.
The Feasibility of Three-Dimensional Guglielmi Detachable Coil for Embolisation of Wide Neck Cerebral Aneurysms
Authors: Tan C.B. , Kwok J.C.K. , Iu P.P. , Chan K.Y. , Lam H.S.
Published: January 2017

The three-dimensional Guglielmi detachable coil is a modification of the conventional Guglielmi coil. It has a unique complex structure, with alternating small and large loops at 90 degrees angle to each other during deployment. The enhanced coil complexity optimizes coil purchase on the aneurysm wall, promoting coil stability within the aneurysm sac. It may be the solution of the single catheter technique in the embolisation of wide neck aneurysms. We report our early experience in the embolisation of wide neck aneurysms using these complex coils.
Wyburn-Mason or Bonnet-Dechaume-Blanc as Cerebrofacial Arteriovenous Metameric Syndromes (CAMS)
Authors: Bhattacharya J.J. , Luo C.B. , Suh D.C. , Alvarez H. , Rodesch G. , Lasjaunias P.
Published: January 2017

The diagnosis of Bonnet-Dechaume-Blanc or Wyburn-Mason syndrome encompasses a spectrum of phenotypic expression. Features of the syndrome as originally described, and common to all, include arteriovenous malformations of the brain and orbit (with retinal and/or retrobulbar lesions). A portion of these patients manifest the complete expression of the disease with additional high-flow arteriovenous malformations of the maxillofacial or mandibular regions. These present the distinct and additional risks of life-threatening epistaxis or gingival haemorrhage. We suggest new diagnostic criteria for the syndrome. Applying insights from modern developmental biology to our series of 15 patients (the largest to date), together with a review of the literature, we have recognised metameric patterns of involvement in what we believe to be a disease of the neural crest or adjacent cephalic mesoderm. This allows us to propose a new rational classification reflecting the putative, underlying disorder and to suggest a new name: Cerebrofacial Arteriovenous Metameric Syndrome (CAMS).
Clinical Results and Problems of Percutaneous Transluminal Angioplasty and Stenting for Extracranial Internal Carotid Stenoses
Authors: Tsuura M. , Terada T. , Masuo O. , Matsumoto H. , Itakura T. , Hyoutani G. , Nakamura Y. , Moriwaki H. , Hayashi S.
Published: January 2017

110 patients with extracranial ICA stenosis were treated by PTA or stenting. In 21 of 55 cases of only PTA and in 40 of 55 cases of stenting, we used our blocking balloon systems to prevent distal embolism. The morbidity and the mortality rates were 5.4% and 0%, respectively. There was only one embolic complication in cases of PTA or stenting where blocking balloon systems were used. In contrast, distal embolism occurred in 3 of 34 cases of PTA without blocking balloon systems (one symptomatic case) and in 4 of 15 cases of stenting without blocking balloon systems (3 symptomatic cases). Our blocking balloon catheter system is a useful device to reduce the risk of symptomatic distal embolism.
Endovascular Treatment for Intracranial Atherosclerotic Stenosis
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Kubo K. , Nakai E. , Itakura T.
Published: January 2017

Fourty-five cases of intracranial atherosclerotic stenoses greater than 70% for intradural lesions or 60% for extradural lesions were treated by PTA or stenting. The stenotic lesions were successfully dilated in 44/45 patients and future stroke was prevented during a mean 29 month follow-up period. Stenotic ratio significantly reduced in stent-treated group compared with PTA-treated group and stenting was effective for cases refractory to PTA, such as elastic recoil or restenosis. However, stenting had its own drawbacks, such as difficulty in delivery, migration, and acute thrombosis.
The Embolization of Ruptured Aneurysms in Acute Stage
Authors: Sonobe M. , Nakai Y. , Matsumaru Y. , Sugita K.
Published: January 2017

We have treated 93 ruptured aneurysms with Guglielmi Detachable Coils (GDC) in acute period. Seventy-three patients (78%) were independent on discharge. Among the patient of Hunt and Hess Grade I, II and III, 59 patients (88%) were independent. Acute re-rupture occurred in two elderly patients with insufficient embolization and two patients experienced re-rupture in the follow up period. Symptomatic vasospasm was reported in 17.6% of patients. The permanent morbidity rate is 4.4% and one patient died (1.5%). Although the long-term results remain to be determined, embolization with GDC is a safe and promising treatment for acutely ruptured aneurysms.
Evaluation of the Stability of Intracranial Aneurysms Occluded with Guglielmi Detachable Coils
Authors: Tamatani S. , Ito Y. , Koike T. , Abe H. , Kumagai T. , Takeuchi S. , Tanaka R.
Published: January 2017

The purpose of this study is to evaluate the long-term stability of embolized aneurysms using the volume embolization rate (VER).

One hundred and six aneurysms in 96 patients who were treated with Guglielmi detachable coils were selected for this study. Follow-up angiography was performed at six or more months after initial treatment.

Every aneurysm was packed as densely as possible, however, the percentage of stability varied according to the size of the aneurysm or the size of the aneurysm neck. The percentage of stable aneurysm was 82% (56/68) in small aneurysms with small necks, 68% (13/19) in small aneurysms with wide necks and 42% (8/19) in large aneurysms. The mean VER of embolized aneurysms in each size was 30%, 22% and 17%, respectively. There was a correlation between the percentage of stable aneurysms and the mean VER. On the other hand, there seemed to be a difference of VER for the stability of embolized aneurysms between ruptured aneurysms and unruptured ones. In small aneurysms with small necks, the stability of embolized aneurysms in ruptured ones was obtained only when the VER was greater than 30%, whereas it was found in unruptured ones even though the VER was less than 20%.

In conclusion, the long-term stability of embolized aneurysms was obtained in small-sized aneurysms, especially small neck aneurysms, and unruptured ones. The VER is a good, objective index to predict the long-term stability of embolized aneurysms.
Treatment of Dissecting Vertebral Aneurysm
Authors: Kai Y. , Hamada J. , Morioka M. , Todaka T. , Mizuno T. , Ushio Y.
Published: January 2017

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site.

We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.
Newly Developed Stent Graft with Micropored and Heparin Impregnated SPU Film
Authors: Nishi S. , Nakayama Y. , Ueda H. , Ishikawa M. , Matsuda T.
Published: January 2017

The use of stents has improved results after balloon carotid angioplasty. Some materials have been reported for covering the metal surface of the stent to reduce the rate of subacute thrombosis and restenosis. We have already developed a new stent graft with thin-walled controlled micropored polymer covering, and in a previous study we confirmed tissue ingrowth via the micropores at one month in a beagle model. The progress of cell migration was controlled by micropore density using a constant micropore diameter (30μm diameter, 125μm inter-pore distance). In the present study, we applied our newly developed stent graft impregnated with heparin for implantation in the rabbit carotid artery, and carried out an angiographic and histological investigation. Our stent graft was made from a Palmaz-Schatz stent and a micropored segmental polyurethane (SPU) thin film with a heparin coating. Micropores 30μm in diameter and 125μm apart were created on the thin SPU film using an excimer laser ablation technique. The surface of the micropored film was then impregnated with photosensitive gelatin that incorporated the heparin. The metal stent was rolled up and fixed to this modified SPU film under microscopic observations. These stent grafts were deployed in the common carotid arteries (CCAs) of rabbits (37 carotid arteries, 20 rabbits). The animals were sacrificed one, two and three months later, and a histological study and scanning electron microscopy study were performed for evaluation of endoluminal endothe-lialization and intimal thickening at the late stage. CCAs treated with stent grafts of micropored film showed poor-patency and intimal hyperplasia compared with those treated with a simple bare stent or a heparin-impregnated stent. In terms of intimal hyperplasia and patency, the heparin-impregnated stent was superior to the bare stent. Intimal hyperplasia was prevented by control of tissue ingrowth through the micropores. The antithrombogenicity of the impregnated heparin improved patency in the early stage. Our new stent graft with a heparin-impregnated SPU film thus appears promising for prevention of restenosis due to neointimal hyperplasia.
Restenosis after Stent Placement for Ostial Stenosis of Vertebral Artery
Authors: Kogure S. , Sakai N. , Iihara K. , Sakai H. , Higashi H. Sakaida T. , Takahashi J.C. , Ohta H. , Nagamine T. , Anei R. , Soeda A. , Taniguchi A. , Nagata I.
Published: January 2017

The purpose of this study was to evaluate our initial procedural success rate and angiographical outcome of stent placement for vertebral artery (VA) stenosis at the intermediate follow-up period (11.3±7.3 months). Stent placement was successfully performed in 20 procedures (19 patients), resulting in a marked reduction of stenosis from 78.7 ± 12.6 % before to 8.7% ± 10.6 after stenting. Follow-up angiography, performed after an interval of 11.3 ± 7.3 months, revealed restenosis greater than 50% in a total of 6 procedures (40%) out of 15. Although PTA with stent placement for stenosis affecting VA origin provided excellent initial success, restenosis occurred at a significant rate even during the intermediate follow-up period.
Selection of Endovascular Approach of Vein of Galen Aneurysmal Malformation
Authors: Ito O. , Goto K. , Ogata N. , Utsunomiya H. , Sato S. , Fukumura A.
Published: January 2017

Vein of Galen aneurysmal malformation (VGAM) is one of the most difficult intracranial vascular lesions because this disease consists of extremely high flow shunts and affects infants and small children. Thanks to the development of various diagnostic modalities, early diagnosis became possible allowing us to prepare appropriately according to the patients' general and neurological conditions. Recent improvements of endovascular techniques and materials enabled both transarterial and transvenous approaches even to the newborn infants, widening therapeutic windows. In this article, we discuss the selection of endovascular approaches based upon angioarchitecture of VGAM presenting four representative cases from our file.
Vasculogenesis and Angiogenesis: Molecular and Cellular Controls
Authors: Kubis N. , Levy B.I.
Published: January 2017

Angiogenesis characterizes embryonic development, but also occurs in adulthood in physiological situations such as adaptation to muscle exercise, and in pathological conditions like cancer. Major advances have been made in understanding the molecular mechanisms responsible for vasculogenesis and angiogenesis, largely due to the use of “knock-out mice”, i.e. mice in which the gene coding for the protein under investigation has been inactivated. Interestingly, the same growth factors and their receptors are equally involved in the different aspects of vasculogenesis and angiogenesis during development and in adulthood. This review aims to describe in detail their respective roles and how interactions between them lead to a newly formed vessel.
Management of a Direct Carotid Cavernous Fistula Caused by Rupture of a Cavernous Aneurysm Previously Embolized with Coils
Authors: Poon W.L. , Alvarez H. , Lasjaunias P.
Published: January 2017

The development of a high-flow carotid-cavernous fistula from the rupture of a large cavernous aneurysm successfully embolized by coils is rare. A 50-year-old male patient developed a high-flow carotid-cavernous fistula 48 hours after successful coiling of a large left cavernous aneurysm, presumably due to rupture of a focal dissection at or close to the neck of the aneurysm. He initially responded to daily self-compression of the left common carotid artery, but the fistula recurred. After failing to approach the fistula site via transvenous route, balloon trapping of the internal carotid artery was planned. Prior to its placement for functional occlusion test, the detachable balloon slipped into the fistula site and occluded it. It was thereafter detached in this position. The sequence of events, a large cavernous aneurysm spontaneous ruptured after coiling, suggested dissecting process or disease. We address in the report the complexity of the endovascular management of this rare association.