bluuebunny/crossref_metadata_2025 huggingface dataset:
Telemedicine Room Design
Authors: Major Janet
Published: January 2017

Proper design of rooms for telemedicine store-and-forward and realtime interactive consultations is critical. The challenge is to incorporate communication technology into medical practice to facilitate efficient communication and effective patient care. If this is done properly, the technology becomes unnoticeable to those involved in the telemedicine interaction. This article describes some of the steps that can be taken in a telemedicine room design to achieve this goal. Room location, treatments, background, lighting, power and telecommunications aspects are reviewed. Although every room design will have its own unique challenges, adhering to these basic principles will provide an excellent foundation to begin with.
Quality and Efficacy of a Telecolposcopy Programme
Authors: Perisic Zivko , Rasic Rajko , Raznatovic Svetlana
Published: January 2017

We tested the performance of telecolposcopy in the diagnosis of various squamous intraepithelial lesions. There were three groups of physicians: Group 1 consisted of 15 gynaecologists who were not trained in colposcopy; Group 2 consisted of six experienced colposcopists (specialists); Group 3 was a supervising team consisting of three experts (colposcopists with more than 15 years of colposcopy experience). The first group took colpophotographs during gynaecological examinations and used a Web browser to compare them with examples from a database of colposcopy findings. Group 2 made their own diagnoses independently. Then the supervising team examined the findings from all 250 patients and made diagnoses that could be considered the ' ‘gold standard’. The findings were identical for Groups 1 and 2 in 219 cases, i.e. an inter-observer agreement of 88%; Cohen's kappa was 0.81. The findings were identical for Groups 1 and 3 in 208 cases, i.e. an inter-observer agreement of 83%; Cohen's kappa was 0.74. The findings were identical for Groups 2 and 3 in 239 cases, i.e. an inter-observer agreement of 96%; Cohen's kappa was 0.93. There was high inter-observer agreement between all participants. However, there were also significant differences in some cases. In the cases of suspected invasive carcinoma, the results showed a significant difference (χ2=4.8, P<0.005) because gynaecologists from Group 1 were not sure of their diagnosis and they wanted to obtain a second opinion by referring the decision to a higher level.
Evaluation of a Distance Consulting Service Based on Interactive Video and Integrated Computerized Technology
Authors: Jennett P A , Hall W G , Morin J E , Watanabe M
Published: January 2017

Telemedicine equipment was installed at a rural site in Drumheller and at Calgary, 85 miles (136 km) away. It allowed consultation between health-care providers at Drumheller and specialists and subspecialists at the Faculty of Medicine in Calgary. The efficacy of the system in providing more equitable access to health care for persons living in geographically remote sites was evaluated during a 12-month pilot project. Seventy-five encounters were attempted during the study. A total of 55 encounters (42 clinical and 13 non-clinical) were completed. The completed clinical encounters were distributed across a wide spectrum of medical specialties. Users of the system reported favourably on the impact of the telemedicine system on access to health services for rural patients, on diagnostic, investigative and management decisions, on patient and physician travel times, on feelings of professional isolation and educational opportunities and on overall patient health status. The study provides new knowledge and demonstrates the success of the technology in this project. As expected, other problems were raised and addressed in a preliminary manner including: the potential for health-provider education; acquisition and retention of rural physicians; ethical, legal and patient confidentiality issues; minimum acceptable technology; and network management issues.
US Policy Support for Telehealth: Organizational Response to a New Policy Environment
Authors: Milio Nancy
Published: January 2017

A sample of 40 from 176 public policy organizations in Washington, DC, was studied. The organizations were those whose leadership was deemed necessary to develop a new strategic vision of electronic technologies to support public health. The results showed that large, secure and well positioned organizations became active only to the extent of their mandates, while smaller and less influential groups, which were freer to think and act innovatively, had an incentive to work with other organizations to gain effective support for their policy positions. The conclusion is that the constituencies of leading policy organizations will have to ensure that well connected leaders and environmental scanning structures guide their organizations and that they have the institutional capacity to develop unconventional strategies to meet health challenges.
Remote Continuous Physiological Monitoring in the Home
Authors: Johnson P , Andrews D C
Published: January 2017

As part of a larger study we established a remote physiological monitoring network to investigate cardiorespiratory function during sleep in 400 infants in their homes. The objective of the study was to link measurements made at three weeks and three months of age with detailed measurements of maternal and fetal nutrition during pregnancy and subsequent outcome (growth, development and cardiorespiratory diseases). Five infants per night were monitored anywhere within a radius of 10 miles (16 km) of the remote hub. Of 800 overnight studies on 64 (of 400) infants, 99 were completed. Options allowed downloading data from monitor memory as well as review (on- and off-line) from the infants' or nurses' homes, the hub and the Oxford telemonitoring centre. The reasons for these measurements being made at home were to ensure physiological accuracy and to reduce cost. The network was effectively run by local community nurses; with the exception of the size and cost of the monitors, it had all the elements of a remote primary-care clinical service.
Establishing a Postgraduate Qualification in Remote Health Care
Authors: Haston W , Horsley H , Milne A
Published: January 2017

The British Antarctic Survey (BAS) provides medical care for the scientists and support staff working on British scientific bases and research vessels in the Antarctic. The BAS directs significant resources towards medical research, so a doctor who does not complete the research component of the programme of training and medical duties represents a partially wasted investment. Additionally, the professional experience gained by the doctor is appropriate for a postgraduate qualification. For these reasons, the training, clinical placement and research undertaken by doctors were formalized as a masters degree in 1992. The objectives of the MSc degree were to optimize the benefits of the training and research for Antarctic doctors and their patients, and to improve the quality of the research output. In the three years before the degree was introduced, only 25% of doctors produced a useful research output. Following the introduction of the MSc, this figure rose to 88%.
Acute Appendicitis: The Reliability of Diagnosis by Clinical Assessment Alone
Authors: Kalliakmanis V. , Pikoulis E. , Karavokyros I. G. , Felekouras E. , Morfaki P. , Haralambopoulou G. , Panogiorgou T. , Gougoudi E. , Diamantis T. , Leppäniemi A. , Tsigris C.
Published: January 2017

Background and Aims:

This prospective study aimed to review the trustworthiness of the initial clinical assessment in acute appendicitis without employment of imaging modalities, laparoscopy or any other adjunct diagnostic test.

Patients and Methods:

717 patients were operated on for appendicitis by six different surgeons. Initial clinical and laboratory examination were evaluated in relation to the intraoperative and the pathological appreciation of the appendiceal inflammation.

Results:

598 patients were found to have appendicitis, 34 a different condition, 41 had both appendicitis and an additional condition and 44 no pathology. 6% of the laparotomies and 11 % of the appendectomies were unnecessary. The severity of the inflammation correlated significantly with periumbilical pain, pain migrating to right lower quadrant, loss of appetite, fever, rebound tenderness, local rigidity, polymorphonuclear predominance on deferential, polymorhonucleosis and leukocytosis. Leukocytosis was less frequent in aged patients. All the six surgeons were found to be equally reliable, although they all underestimated the setting compared to the pathologists. Patients with a long duration of symptoms had milder forms of inflammation and increased percentage of unanticipated abdominal conditions.

Conclusions:

Appendicitis can be reliably diagnosed clinically without employment of adjunct tests. These can be reserved for equivocal cases.
Epidemiologic Aspects of Complete Rectal Prolapse
Authors: Kairaluoma M. V. , Kellokumpu I. H.
Published: January 2017

Background and Aims:

This study was undertaken to find out the incidence of rectal prolapse.

Material and Methods:

Ninety-nine patients operated on for rectal prolapse at Jyvaskyla Central Hospital were studied. Patients operated between 1988 and 1998 were studied retrospectively from hospital records using chart review and thirty-five patients operated on between 1999 and 2002 were studied prospectively using our proctologic database.

Results:

The annual incidence of diagnosed complete rectal prolapse in the district of Central Finland was mean 2.5 (range, 0.79–6.08) per 100 000 population. There were ten men (10 percent) and 89 women (90 percent). Median age of the patients was 69 (range, 21–91) years. Forty-eight percent of the patients had concomitant cardiovascular disease and 15 percent psychiatric illness. Anal incontinence affecting quality of life was seen in 64 percent and constipation in 72 percent of patients. Constipation tended to be more attributed to difficult evacuation (72 percent) than to impaired bowel action (18 percent).

Conclusion:

The annual incidence of rectal prolapse is 2.5 per 100 000 population. Rectal prolapse is associated with anal incontinence and constipation in majority of patients.
Screening for Abdominal Aortic Aneurysm — Areas Where Informations is Still Inadequate
Authors: Wanhainen A. , Svensjö S. , Mani K.
Published: January 2017

Abdominal aortic aneurysm (AAA) fulfils the criteria for a disease suitable for screening. However, important aspects need to be further analysed; the optimal age of the male population considered for screening has not yet been established, and whether women or specific high risk groups would benefit from screening has not been sufficiently evaluated. The impact of the current shift toward a high proportion of AAA repair done with endovascular technique and the Longterm effect on QoL are additional issues that have not been adequately studied. Furthermore, therapeutic options for small AAA as well as secondary prevention programmes have to be developed.
Screening for AAA in the USA
Authors: Lederle F. A.
Published: January 2017

The United States (U.S.) was home to both the first and the largest reported abdominal aortic aneurysm (AAA) screening programs to date. Influenced by the results of four randomized trials conducted outside the U.S., the U.S. Preventive Services Task Force (USPSTF) recommended one-time AAA screening with ultrasound for men 65–75 years old who have ever smoked. After the USPSTF report, the U.S. Congress added a Medicare benefit for free, one-time AAA screening with ultrasound for men who have smoked and for men and women with a family history of AAA. Screening may be underutilized in this target population, but recommendations by American vascular societies for much broader use of screening and repair than can be justified by the available evidence are influencing practice and threaten the effectiveness and cost-effectiveness of AAA screen ing in the U.S.
The Value of a Nationwide Vascular Registry in Understanding Contemporary Time Trends of Abdominal Aortic Aneurysm Repair
Authors: Wanhainen A. , Mani K. , Björck M.
Published: January 2017

Nationwide vascular registries offer rapid feed-back in an environment of fast new technical development, as is the case with the treatment of abdominal aortic aneurysm (AAA). Furthermore, they offer an opportunity to study non-selected, population-based data. The aim of this review was to analyze time-trends in published papers from nationwide registries on AAA-repair. In contrast to several US reports, an increased rate of intact AAA repair, associated with the introduction of endovascular repair, was reported in a recent publication based on the Swedish Vascular Registry (Swedvasc). The rate of ruptured abdominal aortic aneurysm (rAAA) repair is stable in most reports, while some report a decreasing incidence. Most nationwide studies report a reducing mortality over time after intact AAA repair, while time trends on the mortality after ruptured AAA repair are more heterogenic.
What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae
Authors: Lindblad B. , Holst J. , Kölbel T. , Ivancev K. ,   The Malmö Vascular Centre Group
Published: January 2017

Present knowledge on natural history and how to treat penetrating aortic ulcers or different forms of pseudoaneurysms with or without infection is limited as there are only case reports and small series of unusual aortic pathology and its treatment available.

Material:

From our centre we collected 65 patients treated with open (n=15) or endovascular reconstruction (n=50) during a 20-year period in the abdominal aorta. These patients are presented including a review of contemporary treatment.

Results:

Endovascular reconstructions seem to reduce morbidity and mortality compared to otherwise extensive open surgery. Even for patients with infectious etiology (mycotic aneurysms, aorto-enteric fistula) endovascular treatment may be a first-hand option bridging to a more elective open repair. However, a large proportion of patients being unfit for further open surgery were solely treated endovascularly and had no major infectious complications in the follow-up. Registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.

Conclusion:

Endovascular technique is a promising technique for treatment of aortic pseudoaneurysms of different etiologies. We firmly recommend, despite the lack of evidence, that the work up of patients with penetrating aortic ulcers, mycotic or other types of pseudoanerysms as well as aorto-enteric fistulae should enclose both endovascular and open (or combined) treatment modalities. However, our knowledge of the natural history is limited. Therefore, registers of cases with unusual aortic pathology, not only of those treated but also of those managed conservatively, are needed to define who to treat and if endovascular or open repair should be recommended.
Endovascular Repair of the Ruptured Abdominal Aortic Aneurysm
Authors: Norgren L. , Larzon T.
Published: January 2017

The present knowledge on endovascular repair of ruptured abdominal aortic aneurysms (rAAA) prevents firm conclusions when to use this method in comparison to open repair. This review article briefly summarizes results from case series, and discusses how to achieve reliable information despite the absence of randomized controlled trials. At present a careful conclusion might be that dedicated centers with an adequate organization and reasonably high volume of abdominal aortic aneurysm (AAA) should use detailed registry protocols to achieve experience and data to create an as reliable basis as possible for future recommendations.
A Study of Surgically Resected Peripheral Non-Small Cell Lung Cancer with a Tumor Diameter of 1.0 CM or Less
Authors: Baba T. , Uramoto H. , Kuwata T. , Oka S. , Shigematsu Y. , Nagata Y. , Shimokawa H. , Takenoyama M. , Hanagiri T. , Tanaka F.
Published: January 2017

Background and Aims:

The widespread use of high resolution computed tomography has increased the number of small peripheral lung cancers. This study reviewed the clinicopathological features of the patients with non-small cell lung cancer (NSCLC) with a tumor diameter of 1 cm or less, in order to explore the adequate management of such small sized lung cancers.

Material and Methods:

This study was a retrospective analysis of consecutive 58 patients (5.3% out of 1095 patients) who underwent a complete resection for a peripheral NSCLC with a diameter of 1.0 cm or less. The clinical features and outcomes were compared with 203 patients with NSCLC with a diameter between 1.1 and 2.0 cm.

Results:

The mean age was 64.5 years and there were 26 males and 32 females. Clinical stage was IA in 57 (98%) and IIIA in 1. Lobectomy was performed in 39 patients, segmentectomy in nine, and nonanatomic wedge resection in ten. Two patients, who underwent systemic lymph node dissection, had mediastinal lymph node metastasis and were diagnosed as pathological stage IIIA; however they did not relapse after surgery. One patient with pathological stage IA papillary adenocarcinoma died due to brain metastases. The five-year overall survival rate and disease free survival rate was 95.0% and 95.3%, respectively. Patients with NSCLC of 1.0 cm or less showed significantly better survival than those with tumors measuring 1.1–2.0 cm in size (p = 0.048).

Discussion:

The indications for avoiding systemic lymph node dissection for operable NSCLC should not be based on the size of the tumor. A small-sized lung cancer might be surgically treated before the tumor enlarges to more than 1.0 cm in size.
Magnetic Resonance Imaging of Acute Scrotum
Authors: Mäkelä E. , Lahdes-Vasama T. , Ryymin P. , Kähärä V. , Suvanto J. , Kangasniemi M. , Kaipia A.
Published: January 2017

Background and Aims:

The aim of the pilot study was to evaluate the feasibility of dynamic contrast enhanced (CE)-magnetic resonance imaging (MRI) in the detection of testicular ischemia and its ability to differentiate testicle torsion from other causes of acute scrotum.

Material and Methods:

Seventeen boys or young men with an acute scrotum were included in the prospective study during the time period from October 2001 to December 2005. The median age of the patients was 16,4 (7–44) years. The duration of the symptoms preceding the MRI study varied from six hours to 30 days. The study protocol included physical examination by a surgeon, laboratory tests and Doppler ultrasound (DUS) and finally testicles were imaged by using a 1,5 T MRI scanner; T1-weighted and diffusion weighted images were produced. The gadolinium uptake, reported as the region of interest (ROI) perfusion values and presented as curves, was compared between the affected and contralateral testicle. In testicles with normal blood circulation the ROI values increased during the imaging time. Nine patients were operated on, because the spermatic cord torsion could not be excluded by clinical or DUS findings.

Results and Conclusions:

All the normal testicles gave increasing ROI values meanwhile all three testicles with torsion gave constantly low values referring to no perfusion. Other causes of acute scrotum, such as epididymitis and torsion of testicular appendage seemed to be related with normal perfusion. Dynamic CE-MRI seems to show reliably ischemia of testicle and thus it may be helpful in selecting patients with acute scrotum for urgent operation.
Why be a journalist? US students’ motivations and role conceptions in the new age of journalism
Authors: Coleman Renita , Lee Joon Yea , Yaschur Carolyn , Meader Aimee Pavia , McElroy Kathleen
Published: January 2017

This mixed-methods study using a national, random sample of journalism students explores their motivations for majoring in journalism and conceptions of the roles of journalists. It showed many similarities among students today and yesterday and some differences between students and professionals. Students’ ranking of the importance of roles compared to professionals showed no significant correlation. They still recognize the same four main roles of journalists, but rank them in a different order and define them differently. These future journalists see ‘soft news’ as being on equal footing, if not more important, than traditional ‘hard news’. They consider it fair game for journalists to join the conversation about important issues of the day. They see citizen journalists as not only taking over more of the adversarial duties of journalists but also increasing the amount of information and opinion that people have access to, making the interpretive role of journalists more necessary as someone needs to sift through all this information and let people know what is valid. Suggestions for educators are discussed.
Journalists, sources, and policy outcomes: Insights from three-plus decades of investigative reporting contest entries
Authors: Lanosga Gerry , Martin Jason
Published: January 2017

This study of American investigative reporting from 1976 to 2012 examines a random sample (N = 757) of prize contest entry materials created by journalists. This novel data source and methodology allow for analysis of the dynamics of journalistic process rather than relying on assumptions drawn from published news content. The results provide a fuller and more sophisticated explanation of how investigative journalism is related to democratic governance, including fresh insight into journalist/source relationships, story triggers, policy outcomes, and agenda-building relationships among journalists, sources, and policymakers. A model for predicting policy agenda-building in investigative journalism is proposed and tested based on attributes of the reporting process, policy results, and other actions by public officials produced by journalists’ investigations. While the analysis indicates a key role for sources in the origination of investigative news stories, it also reveals a more prominent place for journalistic enterprise than previously acknowledged. At the same time, investigative stories that are initiated by tips from sources and that have a more diverse array of sources are more likely to achieve substantive policy results. Overall, the findings point to a greater degree of interdependence among investigative reporters and policymakers that challenges conceptions of journalists as passive recipients of information but also reveals the limitations of news organizations’ ability to independently spark policy change.
Predictors of Organ Donation Behavior among Hispanic Americans
Authors: Alvaro Eusebio M. , Jones Sara Pace , Robles Antonio Santa Maria , Siegel Jason T.
Published: January 2017

Context

Hispanic Americans have a substantial need for organ transplants and are underrepresented among organ donors, yet little is known about predictors of organ donation outcomes in this population.

Objective

To assess factors that may function as significant predictors of organ donation behavior among Hispanic Americans.

Design

A random-digit-dial computer-assisted telephone-interview survey.

Setting

Pima and Maricopa counties in Arizona.

Participants

1200 Hispanic Americans.

Main Outcome Measures

Family discussion of organ donation and willingness to be an organ donor.

Results

Significant predictors of family discussion of organ donation include knowing someone willing to be an organ donor and disagreeing that carrying a donor card results in inadequate medical care. Willingness to be a donor is also predictive of family discussion. Significant predictors of willingness to be an organ donor are knowing someone willing to be an organ donor, being female, and disagreeing that thoughts about donation leads to thoughts about one's own mortality. Having a family discussion about organ donation is also predictive of willingness to be an organ donor.

Conclusion

The data provide a springboard for larger studies encompassing the diversity and geographical dispersion of Hispanic Americans. The data also highlight the importance of educational efforts to make Hispanic Americans aware of people in their community who have donated in the past or who are now potential donors.
Longitudinal Impact of Mindfulness Meditation on Illness Burden in Solid-Organ Transplant Recipients
Authors: Kreitzer Mary Jo , Gross Cynthia R. , Ye Xin , Russas Valerie , Treesak Charoen
Published: January 2017

Background

In 2001, more than 24000 solid-organ transplant surgeries were performed in the United States. Although survival rates have steadily risen over the past 2 decades, transplant recipients commonly experience a myriad of symptoms after transplantation that compromise quality of life. Anxiety, depression, and insomnia frequently occur despite excellent function of the transplanted organ. Use of complementary and alternative medicine has risen sharply over the past 10 years, particularly among people with chronic illnesses.

Methods

Twenty solid-organ transplant recipients were enrolled in a clinical trial of mindfulness-based stress reduction. During the 8-week course, subjects learned various forms of meditation and gentle hatha yoga. Participants were given audiotapes for home practice and maintained practice diaries. Longitudinal analysis focused on the impact of mindfulness-based stress reduction on symptom management, illness intrusion, and transplant-related stressors.

Results

Significant improvements in the quality and duration of sleep continued for 6 months after completion of the mindfulness-based stress reduction course. Improvements after the completion of the course were also noted in self-report measures of anxiety and depression.

Conclusions

Mindfulness-based stress reduction is an effective treatment in improving the quality and duration of sleep. Because sleep is highly correlated with positive mental health and overall well-being, these findings suggest that mindfulness-based stress reduction has the potential of being an effective, accessible and low-cost intervention that could significantly change transplant recipients' overall health and well-being.
Introduction to the Interpretation of Chest Radiographs during Donor Care
Authors: Powner David J. , Biebuyck Jean-Christophe
Published: January 2017

Organ procurement coordinators often provide independent interpretations of chest radiographs during donor care. Catheter or tube position, lobar atelectasis, extra-alveolar air, air bronchograms, pleural fluid, and other findings are important throughout donor care and when deciding if a lung is acceptable for transplantation. Technical factors, features of a normal chest radiograph, and abnormal radiographic findings are reviewed and examples are presented.
The Dilemma of Alcohol Use by Potential Living Liver Donors
Authors: Bramstedt Katrina A. , Stowe Judy , Lemberg Brent
Published: January 2017

Previous and current alcohol use by potential living liver donors presents ethical challenges for donor selection committees. Discussing these challenges, we offer guidelines for selection and management of these individuals. Donor safety and welfare should be the primary concern, thus relapse potential during the postdonation period for those with a history of alcohol dependence or abuse is of importance, especially because of the potentially severe consequences of mixing pain relievers (eg, acetaminophen) and alcohol during liver regeneration. Psychosocial and chemical dependency evaluations are critical for potential living donors as well as recipients.
Histological Investigation of Endothelial Cell Proliferation on the Coil Surface after Endovascular Treatment Using FactorXIII
Authors: Hino K. , Konishi Y. , Shimada A. , Sato E. , Hara M. , Saito I.
Published: January 2017

Recently, endovascular treatment of coil embolisation has been widely used for obliterating cerebral aneurysms. However, the process of endothelial cell growth within aneurysms to prevent aneurysmal rupture associated with endovascular coil embolisation remains unclear. Fourteen aneurysms were produced in seven matured swine and embolised with Guglielmi Detachable coils (GDCs). The aneurysms were resected either immediately or three weeks after coil embolisation, and subjected to histological and scanning electron microscopic examinations. Blood coagulation factor XIII was administered in four animals on the day of embolisation and on the following four days. These aneurysms were also resected three weeks after the embolisation and investigated histologically. Marked fibroblast proliferation and growth of endothelial cells on the intraluminal surface of the coil were observed more often in the group administered factor XIII than in those not given factor XIII. These results suggest that administration of factor XIII may contribute to more effective aneurysm obliteration during coil embolisation.
Remote Manipulation of Guidewire Using a Virtual Reality Device
Authors: Fukasaku K. , Negoro M. , Himeno R.
Published: January 2017

A trial of remote manipulation for micro guidewire is reported. The system had master-slave style. When an operator manipulated the virtual torque device at the master side, a machine at the distant slave side reproduced the manipulation. At the same time, the operator could feel the force feedback from the manipulation at the slave. We could experimentally realize this remote manipulating system using a virtual reality device.
Treatment of Asymptomatic Unruptured Intracranial Aneurysms
Authors: Hirai S. , Ono J. , Odaki M. , Serizawa T. , Sato M. , Isobe K. , Sunami K. , Kubota M. , Saeki N. , Yamaura A.
Published: January 2017

The indication of preventive surgery for patients who harbor asymptomatic unruptured intracranial aneurysms remains controversial. To evaluate the benefit of this treatment, we investigated the management outcome in 128 patients with 157 unruptured aneurysms. Surgery was planned in patients 70 years old or younger without serious systemic complications. A total of 77 patients underwent surgery including four endovascular interventions, and conservative management was chosen in 51 patients. There was no mortality and 6.5% morbidity as postoperative results, and no complication was found after endovascular treatment. Among the patients in conservative management, four patients suffered from subsequent rupture during the total follow-up period of 148 person-years. The annual rupture rate was estimated at 2.7%. According to the clinical decision analysis based on our data, preventive surgery is beneficial for a Japanese 70 years old or younger. However, the expected utility decreases if the rupture rate is set at 0.5% or 0.05%, posing a doubt about the benefit of the surgery. Decision analysis provides an aid for logical and objective choice in the management of unruptured aneurysms. The actual risk of rupture has a major impact on decision making in therapeutic strategy.
Rupture of Aneurysms during and after Embolization with Guglielmi Detachable Coils
Authors: Matsumaru Y. , Sonobe M. , Nakai Y. , Takahashi S. , Nose T.
Published: January 2017

Between March, 1997 and June, 2000, 104 aneurysms, including 75 ruptured and 29 unruptured aneurysms, were treated with Guglielmi detachable coils by 120 embolizations in our institution. Intraprocedual perforation occurred in four cases, representing 3.3% of the embolizations. Subsequently, two cases deteriorated, and the other two cases recovered completely without any deficit. Aneurysmal perforations mostly occurred in acutely ruptured aneurysms, small aneurysms less than 4 mm, anterior communicating artery aneurysms, or first coil delivery. Rebleedings in the acute period of subarachnoid hemorrhage occurred in four cases of partial occlusion due to aneurysmal morphology, such as a wide neck or an irregular shape. Rebleedings in the chronic period occurred in two cases, one of which rebled two months after partial occlusion, and the other of which rebled 27 months after nearly total occlusion. No subarachnoid hemorrhages documented from previously unruptured aneurysms occurred after embolizations. Insufficient embolization for ruptured aneurysms cannot prevent rebleeding, and partially occluded aneurysms and recurring aneurysms in the follow-up period require immediate re-treatment.
An Intelligent Catheter System Robotic Controlled Catheter System
Authors: Negoro M. , Tanimoto M. , Arai F. , Fukuda T. , Fukasaku K. , Takahashi I. , Miyachi S.
Published: January 2017

We have developed a novel catheter system, an intelligent catheter system, which is able to control a catheter by an externally-placed controller This system has made from master-slave mechanism and has following three components; 1) a joy stick as a master (for operators) 2) a catheter controller as a slave (for a patient), 3) a micro force sensor as a sensing device.

This catheter tele-guiding system has abilities to perform intravascular procedures from the distant places. It may help to reduce the radiation exposures to the operators and also to help train young doctors.
Gene Transfer for Experimental Saccular Aneurysms
Authors: Okamoto T. , Miyachi S. , Negoro M. , Suzuki O. , Otsuka G. , Sahara Y. , Hattori K. , Ryuke Y. , Mizuno M. , Yoshida J.
Published: January 2017

Reinforcing an aneurysmal wall is one possible way to prevent from aneurysm rupture. We preliminarily tried focal gene transfer against the wall of experimental aneurysms to aim the transgene remodeling of aneurysmal wall. Two experimental saccular aneurysms were created on canine common carotid artery with an artificial dissecting method, which resemble clinical aneurysms. Adenovirus vector (AxCALacZ, 108 pfu) was slowly injected into the aneurysm cavity for over 30 minutes under the condition of in-traaneurysmal flow arrest using balloon-assisted neck-plasty technique. The arteries and aneurysms were evaluated 48 hours after the transduction with X-gal staining, and β-galac-tosidase expression was detected mainly in the intima in both cases. No adverse effects on the normal carotid wall and no systemic complications were observed after the procedure. This experimental study suggests the possibility of gene therapy for cerebral aneurysms.
Long Term Angiographical Follow-up of Cerebral Aneurysms after Coil Embolization
Authors: Kaku Y. , Hayashi K. , Sawada M. , Sakai N.
Published: January 2017

We evaluated long-term angiographical follow-up of cerebral aneurysms treated with detachable platinum coils with special reference to the long-term morphological outcomes of incompletely obliterated aneurysms.

Serial long-term follow-up cerebral angiograms (>1 year) were obtained in 47 cases out of 134 cases treated with GDCs or IDCs from 1994 to 1999. In 47 patients, intial angiographical results demonstrated ten complete aneurysmal occlusion, seven aneurysms with a small neck remnant, twenty aneurysms with body filling and ten aneurysms with both of neck remnant and body filling.

In the ten completely obliterated aneurysms, follow-up angiograms revealed no aneurysmal recanalization. In seven aneurysms with neck remnant, three remained unchanged, four showed enlargement of contrast filling in the part of the neck of the aneurysm. In twenty aneurysms with body filling, five had developed into complete obliteration, three remained unchanged, 11 had recanalization, and one aneurysm displayed regrowth. In ten aneurysms with both of neck remnant and body filling, two remained unchanged, five had recanalization, and three aneurysms displayed regrowth.

Long-term angiographical follow-up results are less satisfactory in cases involving incompletely obliterated lesions. A higher incidence of recanalizations were promoted in cases with neck remnant and/or body filling. Strict follow-up angiography is mandatory when a complete obliteration is not achieved.
Stent Assisted Coil Embolization: The Treatment of Wide-Necked, Dissecting, and Fusiform Aneurysms
Authors: Irie K. , Negoro M. , Hayakawa M. , Eayashi J. , Kanno T.
Published: January 2017

Stent assisted coil embolization is a useful therapeutic modality for wide-necked and geometrically difficult aneurysms, as the stent provide a buttress that allows for coil deposition while preventing coil haerniation into the parent vessel lumen, and placement of an endovascular stent within the parent artery across the aneurysm neck may divert the blood from the aneurysm inflow tract and promote intra-aneurysm stasis and thrombosis. We report herein a 3 patients treated with endovascular stent-assisted coil embolization for symptomatic or enlarging wide-necked, dissecting, and fusiform aneurysms of the carotid and vertebrobasilar arteries.

One patient had intracranial mass effect, the second had subarachnoid haemorrhage, and the third had angiographic evidence of enlarging aneurysm. The aneurysm was located in the petrous segment of internal carotid artery in one patient and in the intracranial vertebral artery in the other two patients. For all patients, we used balloon expandable stent (such as GFX, S-670) in this technique. Complete obliteration of the aneurysms could be achieved in all cases, with preservation of distal circulation.
Transarterial Wedged-catheter, Flow-arrest, N-butyl Cyanoacrylate Embolization of Three Dural Arteriovenous Fistulae in a Single Patient
Authors: Russell S.M. , Woo H.H. , Nelson P. K.
Published: January 2017

The pathogenesis of dural arteriovenous fistulas (DAVFs) is currently unknown, with multiple DAVFs being rare. For patients with limited venous access secondary to sinus thrombosis, or for patients where parent sinus occlusion would not be tolerated, transvenous embolization may not be possible and other treatment methods must be considered. A 69-year-old female patient with a two-year history of progressive headaches, memory loss, and unsteady gait underwent cerebral angiography that revealed three separate DAVFs with congested cortical venous drainage overlying both frontal lobes. Using an application of a transarterial wedged-catheter, flow-arrest technique, N-butyl cyanoacrylate was deposited across all three pathologic arteriovenous connections providing a definitive cure. Transarterial NBCA embolization may provide curative treatment of DAVFs, and is of particular utility in situations where access to the draining venous structures is limited.
Treatment of Carotid Cavernous Fistula Secondary to Rupture of a Giant Intracavernous Carotid Aneurysm
Authors: Kam C.K. , Alvarez H. , Lasjaunias P.
Published: January 2017

Carotid cavernous fistula secondary to ruptured giant intracavernous aneurysm of the internal carotid artery is rare. We report a case of direct carotid cavernous fistula secondary to rupture of a giant intracavernous ICA aneurysm. The presence of mirror or twin aneurysms of bilateral ophthalmic arteries raises therapeutic challenge.

Coiling of the intracavernous aneurysm could partially occlude the fistula. Complete closure of the fistula was facilitated by secondary carotid compression.
Early Disappearance of Cord Signal Changes following Endovascular Treatment of a Spinal Dural AV Fistula
Authors: Srikanth S. G. , Sivakumar D. , Jayakumar P. N. , Veerendrakumar M. , Thomas M.
Published: January 2017

Spinal dural arterio venous fistulas (SDAVFs) are the commonest type of spinal vascular malformations and are encountered mostly among adult patients. Magnetic Resonance Imaging (MRI) in patients with SDAVFs demonstrates features like spinal cord swelling and signal changes. Cord signal changes are believed to be due to venous stasis. Treatment of a spinal vascular malformation may result in complete or partial resolution of MR findings with associated clinical improvement. The earliest documentation of reduction or disappearance of cord signal changes on post treatment MR images, was one month later in one series in the literature. We present and discuss disappearance of cord signal changes on MRI within 72 hours following endovascular treatment by liquid glue injection in a patient with SDAVF.
High-Flow Traumatic arotico-Jugular Fistula Manifesting as Venous Hypertensive Encephalopathy
Authors: Gupta A. K. , Purkayastha S. , Varma D. R. , Kapilamoorthy T. R. , Thomas B.
Published: January 2017

We report the clinical and angiographic findings in a patient who presented with venous hypertensive encephalopathy secondary to a traumatic carotico-jugular fistula. Endovascular entrapment of the fistula by occluding the common carotid artery and internal jugular vein at the base of the skull resulted in near total improvement of the patient's neurological status.
Endovascular Treatment of Brain Arteriovenous Malformations Using Onyx: Preliminary Results of a Prospective Multicenter Study
Authors: Pierot L. , Januel A. C. , Herbreteau D. , Barreau X. , Drouineau J. , Berge J. , Sourour N. , Cognard C.
Published: January 2017

The main final goal of the treatment of brain AVMs is to prevent bleeding and to obtain a complete occlusion of the nidus. The strategy of treatment of brain arteriovenous malformations (AVM) has to be defined by a multidisciplinary team and will usually combine several modalities (surgery, radiosurgery, embolization). Embolization is generally the first step of treatment. Occasionally embolization is able to completely occlude a small AVM.

Otherwise embolization is the first step before surgery or radiosurgery. Several embolic agents have been proposed for embolization of brain AVMs like particles or cyanoacrylates. The main disadvantage of particles is the high frequency of recanalization.

The cyanoacrylates are probably more appropriate, providing a permanent occlusion. However, due to the polymerizing characteristics of the glue, the time of injection is relatively short (few seconds or minutes) and a complete or substantial occlusion of the nidus is difficult to obtain, especially in the case of medium or largesized AVMs.

Onyx is a nonadhesive liquid polymer made of a mixture of ethylene-vinyl-alcohol copolymer and dimethylsulfoxide. The theoretical advantage of a nonadhesive liquid is to eliminate the risk of gluing the microcatheter and subsequently to perform a more durable injection with a larger amounts of agent delivered in a single injection.

Several French centers have undertaken a prospective, multicentric study to evaluate the clinical value of Onyx in embolization of brain AVMs. As required, 50 patients were included. Preliminary results are presented regarding the first 48 patients, the last 2 patients being included after writing of this paper.

The treatment is now completed in 15 patients. As expected, it was possible with Onyx to perform long duration injections (5 to 70 minutes with a mean of 34 minutes).

Volumes injected per session were also important (0.25 to 6 ml with a mean of 1.6 ml). According to the clinical experience of the centers, duration and volume injected were most important with Onyx than with cyanoacrylates. Out of the 15 patients for whom embolization is now completed, 14 had a percentage of occlusion of the nidus greater than 60% (with 2 complete occlusion).
Clinical Analysis of 50 Cases of BAVM Embolization with Onyx, a Novel Liquid Embolic Agent
Authors: Song Donglei , Leng Bing , Gu Yuxiang , Zhu Wei , Xu Bin , Chen Xiecheng , Zhou Liangfu
Published: January 2017

To report the embolization technique of using Onyx, a new liquid embolic agent, to treat cerebral arteriovenous malformations (AVMs) as well as its efficacy.

38 cases of cerebral AVMs located in eloquent area (motor, speech, visual nerve center), 9 in deep cerebral area, and another 3 cases in cerebellar hemisphere. The diameter of AVMs was smaller than 3cm in 10 cases, 3–6cm in 30 cases, and larger than 6cm in 10 cases. A 6F sheath was placed into the femoral artery after Selding's puncture. After a 6F guiding catheter was introduced into the internal carotid artery or vertebral artery, Ultraflow or Marathon microcatheter could be navigated into the nidus of AVMs. A long-slow injection of Onyx under fluoroscopic control was performed to embolize cerebral AVMs by adopting the “plug and push” technique.

10 AVM cases (20.0%) were considered to be totally occluded with Onyx in this group, 3 cases of which were found no regrowth by a 6-month follow-up. 25 cases (50%) were subtotally occluded while another 15 cases (30%) were partially embolized. Complications include: (1) severe cerebral hemorrhage occurred in three cases, two of them left hemiplegia after hematoma resection. (2) mild hemiplegia occurred in one lager frontal AVM patient. (3) mild visual deficit was left in one larger occipital AVM case. There was no severe complication in other 45 patients.

Onyx has unique and distinctive superiority in treating cerebral AVMs. Nonetheless, the correct embolization technique should be learned to achieve good clinical results and to avoid complications. The long-term efficacy of Onyx embolization needs to be followed up.
Neurovascular Radiosurgery
Authors: Söderman M. , Guo W.Y. , Karlsson B. , Pelz D.M. , Ulfarsson E. , Andersson T.
Published: January 2017

This article focuses on the treatment of neurovascular diseases, in particular brain arteriovenous malformations (BAVMs), with radiosurgery. The target group for this review is physicians who manage patients with neurovascular diseases, but are not actively engaged in radiosurgery.

Radiosurgery for BAVMs is an established treatment with clearly defined risks and benefits. The efficacy of radiosurgery for dural arteriovenous shunts (DAVSs) is probably similar but the treatment has not yet gained the same acceptance. Radiosurgical treatment of cavernomas (cavernous hemangiomas) remains controversial.

Well founded predictive models for BAVM radiosurgery show:

The probability of obliteration depends on the dose of radiation given to the periphery of the BAVM. The risk of adverse radiation effects depends on the total dose of radiation, i.e. the amount of energy imparted into the tissue. The risk is greater in centrally located lesions. The risk of damage to brainstem nucleii and cranial nerves must be added to the risk predicted from current outcome models. The risk of hemorrhage during the time span before obliteration depends on the BAVM volume, the dose of radiation to the periphery of the lesion and the age of the patient. Central location is a probably also a risk factor.
Time Resolved 3D MRA. Applications for Interventional Neuroradiology
Authors: Stracke CP , Spuentrup E. , Reinacher P. , Thron A. , Krings T.
Published: January 2017

The decision for endovascular treatment of cranial dural AV fistulae and angiomas and their follow-up after treatment is usually based on conventional DSA. New techniques of magnetic resonance angiography (MRA) facilitate high temporal and spatial resolution images. The purpose of this study was to evaluate the applicability and clinical use of a newly developed 3D dynamic MRA protocol on a 3T scanner for neurointerventional planning and decision-making.

Using a 3T whole body scanner, a three-dimensional dynamic contrast enhanced MRA sequence with parallel imaging, and intelligent k-space readout (Keyhole and “CENTRA” k-space filling) was added to structural MRI and time-of-flight MRA in seven patients. DSA was performed in each patient following MR examination.

In all patients MRA allowed the identification and correct classification of the vascular lesion. Hemodynamic characteristics and venous architecture were clearly demonstrated. Larger feeding arteries could be identified in all cases. Smaller feeding vessels were overlooked in dynamic MRA and only depicted in conventional DSA

High temporal and spatial resolution 3D MRA may correctly identify and classify fistulae and angiomas and help to reduce the number of pre- or post-interventional invasive diagnostic angiograms.