bluuebunny/crossref_metadata_2025 huggingface dataset:
Culturally Responsive Interventions to Enhance Immunosuppressive Medication Adherence in Older African American Kidney Transplant Recipients
Authors: Russell Cynthia L.
Published: January 2017

Context

Immunosuppressive medication nonadherence is variable among older kidney transplant recipients and is a problem in African American recipients despite the severe consequences of this behavior. Many factors place older African American recipients at risk for medication nonadherence.

Objective

To provide an overview of interventions to enhance immunosuppressive medication adherence in older African American kidney transplant recipients using a culturally responsive model. Culturally sensitive, innovative, and transformation interventions are discussed. Situations when each intervention would be most and least appropriate are described.

Conclusion

Moving culturally appropriate interventions forward into practice and testing their effectiveness in improving adherence outcomes in vulnerable, older African American kidney transplant recipients is a worthy practice and research goal for transplant nursing.
Analysis of Morbidity in Liver Transplant Recipients following Human Albumin Supplementation: A Retrospective Pilot Study
Authors: Johnson Peter N. , Romanelli Frank , Smith Kelly M. , Ranjan Dinesh , Butler J. S. , Clifford Timothy M.
Published: January 2017

Objectives

To assess incidence of morbidity (ie, documented infection, acute renal failure, acute graft rejection, acute cardiovascular events, and hospital read-mission rates) 6 months following liver transplantation using linear regression as a function of cumulative albumin dose.

Design

Retrospective chart review.

Setting

A 473-bed tertiary care teaching facility with a solid-organ transplantation center.

Patients

Forty liver transplant recipients examined from January 1 to December 31, 2003.

Measurements and Results

Data from 40 liver transplant recipients were collected. Mean albumin dose administered was 190.9 ± 162.3 g. No statistical differences were identified in patients receiving less than 140 g (n = 20) or more than 140 g (n = 20) with respect to demographic data other than gender and ethnicity. The mean APACHE III (Acute Physiology and Chronic Health) score was 69.7 ± 24.3. Approximately 70 episodes of morbidity and 23 readmissions were observed. Regardless of the APACHE III score, albumin was associated with increased overall morbidity and cardiovascular complications. Liver transplant recipients receiving more than 140 g had a longer hospital stay (14 vs 8 days, P = .025) and intensive care unit stay (6 vs 3 days, P = .051) than patients receiving 140 g or less. No correlation with risk of acute rejection was seen with albumin or tacrolimus.

Conclusion

Albumin supplementation among liver transplant recipients was associated with a significant risk for cardiovascular complications and overall number of complications regardless of APACHE III score. Future prospective studies are needed to further define the potential risk for complications in this patient population.
Nonadherence with Immunosuppressive Drugs: Us Compared with European Kidney Transplant Recipients
Authors: Denhaerynck Kris , Desmyttere Ariane , Dobbels Fabienne , Moons Philip , Young Jim , Siegal Bonita , Greenstein Stuart , Steiger Jürg , Vanrenterghem Yves , Squifflet Jean-Paul , van Hooff Johannes P. , De Geest Sabina
Published: January 2017

Background

System factors increasingly are suggested as important yet understudied correlates of nonadherence.

Objective

To explore the relationship between healthcare system and prevalence of nonadherence with immunosuppressive regimen by studying variation in nonadherence between European and US kidney transplant recipients and as well as nonadherence in European countries.

Methods

We performed a secondary data analysis on data collected in 3 independent cross-sectional studies using comparable methodology including patients from the United States, the Netherlands, Belgium, and Switzerland. Nonadherence was measured using 1 item of the Siegal questionnaire. Patients were categorized as nonadherent if they reported missing a dose of immunosuppression in the last 4 weeks. Analyses were performed by multiple mixed logistic regression, with center as a random effect and clinical and demographical differences between groups as fixed effects.

Results

1563 US and 614 European patients from 3 different countries (Belgium [n=187], the Netherlands [n=85], and Switzerland [n=342]) were included. Prevalence of nonadherence in the United States and Europe was 19.3% and 13.2.%, respectively. This higher nonadherence in US patients was confirmed in a multiple logistic regression analysis (OR=1.78; 95% CI, 1.10–2.89). Nonadherence differed between Belgium (16%) and the Netherlands (14.1%) (OR=0.27; 95% CI, 0.09–0.80) and between Belgium and Switzerland (11.4%; OR=0.17; 95% CI, 0.0–0.42).

Conclusion

This is the first study showing differences in prevalence of nonadherence between European and US patients and among European patients. Further research should aim at unraveling the dynamics explaining these differences.
Advance Care Planning after Lung Transplantation: A Case of Missed Opportunities
Authors: Song Mi-Kyung , Dabbs Annette J. De Vito
Published: January 2017

After lung transplantation, recipients are regularly evaluated by the transplant team and often require multiple hospitalizations. The primary focus of care during this time is on detecting and treating complications and may not necessarily include advance care planning discussions. This focus may leave clinicians unaware of the recipient's treatment preferences and place a burden on families trying to decide whether to undergo or forgo life-sustaining treatment when the recipient's medical condition deteriorates. We report the case of a woman with bronchiolitis obliterans who was admitted to the transplant center 37 times and died in the intensive care unit. Although progressive deterioration of her medical condition was well documented, her medical records revealed no evidence of advance care planning discussions with the patient and family. Incorporating timely advance care planning and integrating palliative care in the ongoing posttransplant clinical management may benefit patients, families, and clinicians as recipients approach the final stage of their illness.
Managing the Kidney Waiting List
Authors: Zarifian April , O'Rourke Marian
Published: January 2017

Candidates on the kidney transplant list wait for longer periods and have increasing numbers of comorbid conditions. To ensure that these candidates are acceptable for transplantation when an organ becomes available, physical, psychosocial, and financial strategies are essential. The authors surveyed 68 transplant centers to determine current practices. Eighteen percent of centers did not reevaluate candidates. Other programs used time on the list, disease, age, or a combination of these factors as evaluation criteria. Initial cardiac evaluation was relied upon by 51.4% of centers, with varying criteria used to determine status. Social work evaluation was done by 42.6% of centers, usually annually. Annual financial reevaluation was performed in 57.4%. Data support reviewing candidates, especially those with diabetes, those who have been receiving dialysis for a long time, and those older than 60 years. The dedication of one coordinator to manage waitlisted candidates using age, diagnosis, and time receiving dialysis was effective in this study.
Design and Evaluation of a Workplace Intervention to Promote Organ Donation
Authors: Quinn Michael T. , Alexander G. Caleb , Hollingsworth Diane , O'Connor Kate Grubbs , Meltzer David ,   For the Corporate Contributions for Life Consortium
Published: January 2017

Background

A number of efforts have been made to improve rates of deceased organ donation. However, few have been specifically designed for implementation in the workplace.

Objectives

To design and evaluate a workplace intervention to increase documentation of intention to be posthumous organ donors, communication of donation intention to families, and family members' documentation of their donation intentions.

Methods

The study was a randomized controlled trial of corporate employees. Within each corporation, worksites were randomized to a control condition or 1 of 2 educational interventions. Measures included baseline and 1-month postintervention measures of stage of organ donation intention, stage of family notification, and family members' organ donation intention.

Results

Across 12 corporations, 40 worksites with a total of 754 participants were randomized. At 1-month follow-up, 495 participants (66%) completed a posttreatment questionnaire. The percentage of participants who signed organ donor cards increased in the 2 intervention groups (29%, P < .001, and 31%, P < .002) but not in the control group (17%, P = .454). The percentage who discussed their donation intentions with family members increased significantly across all 3 arms (39%-47%, P < .001). The mean percentage of participants' family members who signed organ donor cards increased by 14% in the control group ( P = .016) and by 17% in the 2 intervention groups ( P < .001).

Conclusions

Educational interventions in the corporate workplace setting can be effective in increasing organ donation intention, family notification, and recruitment of family members as potential organ donors.
Intention to Register as Organ Donors: A Survey of Adolescents
Authors: Baughn Daniel , Rodrigue James R. , Cornell Danielle L.
Published: January 2017

Background

Little is known about factors that influence the intention of adolescents to register as organ donors. The identification of such factors has important implications for the development and implementation of educational programs and subsequent donor registration rates.

Objective

To determine whether adolescents with an expressed commitment to becoming organ donor registrants differ significantly from nondonors on sociodemographic characteristics and factors influencing their decision.

Participants

Four hundred forty-five adolescents visiting a Department of Motor Vehicles office for a permit or license (n = 153) or attending a driver's education course (n = 292) completed a semistructured interview and questionnaire.

Results

Female (52.6%) and white (55.8%) adolescents were more likely to have favorable donation intentions relative to male (45.6%) and nonwhite (39.0%) adolescents (χ2 = 7.5, P = .02, and χ2 = 19.7, P = .003, respectively). Those with favorable donation intentions also endorsed significantly more positive factors (benevolence, need awareness, existentialism) as being more important in their decision. Adolescents who did not want to donate (58.7%) and those who were undecided (23.1%) were less likely to have discussed their decision with parents than were those who wanted to donate (67.7%, χ2 = 63.6, P = .0001). Finally, providing adolescents with a free driver's license in exchange for organ donor registration would have the greatest impact on registering undecided adolescents (29.8%, χ2 = 33.2, P = .0001).

Conclusions

There is a pressing need for more systematic and culturally sensitive organ donation education directed toward adolescents, and the Department of Motor Vehicles and driver's education courses may be appropriate venues. An educational program from the US Department of Health and Human Services, Decision: Donation, could be used in this context.
In My Shoes: Children's Quality of Life after Heart Transplantation
Authors: Green Angela , McSweeney Jean , Ainley Kathy , Bryant Janet
Published: January 2017

Background

Although heart transplantation has been offered for 2 decades to prolong the lives of children with end-stage heart disease, we know little about how these children view their lives, how they deal with their complicated medical regimen, and how the transplantation affects their quality of life.

Objectives

To examine the quality of life of school-aged heart transplant recipients and to identify the key factors they believe affect their quality of life.

Design

Focused ethnography.

Participants and Setting

Eleven children (7 girls, 4 boys) between the ages of 6 and 12 years (mean 9.1 years) who had received a transplant at least 6 months earlier were recruited from a large children's hospital.

Data Collection and Analysis

Semistructured interviews were conducted in private locations. Data were analyzed using content analysis and constant comparison.

Results

The children described their quality of life as “mostly good,” yet reported that life was “easy and not easy.” Ten factors that affected the children's quality of life were Doing Things/Going Places, Favorite School Activities, Hard Things About School, Being With Friends and Family, Doing Things/Going Places With Friends and Family, Interactions With Friends and Family, Taking Care of My Heart, My Body, The Transplant Team, and Other Health Problems. Based on similarities in meaning, these factors were combined into 3 themes: Doing What Kids Do, Being With Friends and Family, and Being a Heart Transplant Kid. The themes and factors can provide useful direction for interventions aimed at improving the quality of life for children after heart transplantation.
The Role of Women in the Donation Consent Decision: Building on Previous Research
Authors: Dodd-McCue Diane , Tartaglia Alexander , Cowherd Robin
Published: January 2017

Background

Recently published findings emphasize the dominant role of women in the donation discussion. With some noteworthy exceptions, the empirical literature on gender and donation, and the role of gender in healthcare decisions as well as donation, is limited.

Objectives

To provide preliminary information needed to begin theoretical or framework development and to initiate more rigorous research on the role of gender in donation discussions.

Design

This exploratory study is a descriptive qualitative retrospective study using focus group methodology.

Setting and Participants

Two focus groups were conducted in 2 major cities in the organ procurement organization's service area. Participants were women who were involved in the donation discussion within the past 5 years; 6 participated in 1 session, 8 in the other.

Results

The focus group discussions highlight the role of women in the donation process relative to information needs, information usage, and the ensuring dynamics of the donation discussion. Compared to men, women tend to seek more information and reframe this information for others. Because women are frequently central in family communication networks, they serve as a communication conduit for other family members and may influence others.

Conclusions

Involving key women decision makers in the early stages of the donation discussion and providing information elaboration build on women's central placement and role in family communication network processes. The significance of women's central placement may carry cultural implications, particularly for racial or ethnic groups with strong matriarchal or extended kinship structures.
Young Australian Adults' Knowledge and Beliefs about Organ Donation
Authors: Hyde Melissa K. , White Katherine M.
Published: January 2017

Context

Limited studies, particularly in Australia, are aimed at understanding young people's beliefs about organ donation. Identification of such beliefs may serve to increase donation decision registration and decision discussion rates among this age cohort.

Objectives

To examine young adults' knowledge about organ donation and to use a theory of planned behavior framework to determine the differences in behavioral, normative, and control beliefs between young adults who had and those who had not registered and discussed their organ donation decision with family or significant others.

Participants

Australian university students (N = 233) completed a questionnaire assessing knowledge about the organ donation process and beliefs related to organ donation decision registration and decision discussion.

Results

Young adults demonstrated knowledge deficits about the support of Western religious denominations for organ donation and the circumstances surrounding donation. Unregistered donors were more likely to focus on the costs of registering; however, no belief-based differences for decision discussion emerged. Young adults who had registered and discussed their decision were more likely to believe that family members and friends thought they should do so. Lack of motivation was reported as preventing registering and discussing, and uncertainty about how and when to raise the topic prevented young adults discussing their donation decision.

Conclusions

Understanding of young adults' knowledge and beliefs enables the development of strategies encouraging donation decision registration and donation decision discussion with family or significant others, thereby increasing the likelihood that the donor's wishes will be carried out.
Imaging Bone–Cartilage Interactions in Osteoarthritis Using [18F]-NaF PET-MRI
Authors: Savic Dragana , Pedoia Valentina , Seo Youngho , Yang Jaewon , Bucknor Matt , Franc Benjamin L. , Majumdar Sharmila
Published: January 2017

Purpose:

Simultaneous positron emission tomography–magnetic resonance imaging (PET-MRI) is an emerging technology providing both anatomical and functional images without increasing the scan time. Compared to the traditional PET/computed tomography imaging, it also exposes the patient to significantly less radiation and provides better anatomical images as MRI provides superior soft tissue characterization. Using PET-MRI, we aim to study interactions between cartilage composition and bone function simultaneously, in knee osteoarthritis (OA).

Procedures:

In this article, bone turnover and remodeling was studied using [18F]-sodium fluoride (NaF) PET data. Quantitative MR-derived T1ρ relaxation times characterized the biochemical cartilage degeneration. Sixteen participants with early signs of OA of the knee received intravenous injections of [18F]-NaF at the onset of PET-MR image acquisition. Regions of interest were identified, and kinetic analysis of dynamic PET data provided the rate of uptake ( Ki) and the normalized uptake (standardized uptake value) of [18F]-NaF in the bone. Morphological MR images and quantitative voxel-based T1ρ maps of cartilage were obtained using an atlas-based registration technique to segment cartilage automatically. Voxel-by-voxel statistical parameter mapping was used to investigate the relationship between bone and cartilage.

Results:

Increases in cartilage T1ρ, indicating degenerative changes, were associated with increased turnover in the adjoining bone but reduced turnover in the nonadjoining compartments. Associations between pain and increased bone uptake were seen in the absence of morphological lesions in cartilage, but the relationship was reversed in the presence of incident cartilage lesions.

Conclusion:

This study shows significant cartilage and bone interactions in OA of the knee joint using simultaneous [18F]-NaF PET-MR, the first in human study. These observations highlight the complex biomechanical and biochemical interactions in the whole knee joint in OA, which potentially could help assess therapeutic targets in treating OA.
Exploring the Properties of Habits and Routines in Daily Life
Authors: Reich John W. , Williams Jason
Published: January 2017

This study investigated the properties of habit and routine in daily living, extending prior studies exploring people's judgments about the stability of patterns in their lives. Scales assessing sensory, behavioral, and motivational aspects of habit were included, and confirmatory factor analysis techniques were employed to determine the presence of underlying constructs relating the various measures of habit and routine. A sample of 126 college students responded to a set of 11 scales and subscales of previous measures of habit. The resulting measurement structure incorporated 10 of those scales into a two-factor model: one factor represented cognitions and beliefs about one's routine and habits, and the other represented sensory stimulation and sensory reactions, habitual behaviors, and motivations of approach and avoidance. The results were discussed in the framework of a more comprehensive picture of the nature of habit. It was also suggested that this model potentially will have value for further exploration of measurement issues and for developing more effective interventions for improving people's daily well-being.
A Methodology for Developing Evidence about Meaning in Occupation: Exploring the Meaning of Working
Authors: Baker Nancy A. , Jacobs Karen , Tickle-Degnen Linda
Published: January 2017

Using research-based evidence to support practice is becoming a standard of care. Although occupational therapists believe that occupation can be used as a therapeutic agent to promote health and well-being in their clients, there is only limited research to support this. One reason for this is the difficulty in quantitatively constructing “occupation” for research. This article describes one method that can be used to quantitatively measure meaning, an important indicator of occupation. This study explicates the “meaning” of working as examined through three interconnected constructs of work meaning (work centrality, societal norms about working, and valued work outcomes) and provides an exemplar study in which these three constructs were used to examine the meaning of working in a group of telecommunication workers. The Meaning of Working Survey was used to gather information from 170 telecommunication workers. Data from the survey were analyzed using both descriptive methods and cluster analysis. By evaluating these three constructs, it was possible to identify trends and patterns of the meaning of working for this group of workers. They did not view work as a central life role and viewed working as a constraint or a reciprocal arrangement. They valued benefits and wages over intrinsic outcomes. The cluster analysis revealed that meaning was generally related to external outcomes. The discussion focuses on how this methodology for measuring meaning could be used to develop research on the meaning of occupation and its effect on health outcomes. This study provides occupational therapy researchers with one quantitative methodology for examining the meaning of working and an exemplar on how that methodology has been used in research on meaning and occupation.
Incorporating or Resisting Assistive Devices: Different Approaches to Achieving a Desired Occupational Self-Image
Authors: Lund Maria Larsson , Nygård Louise
Published: January 2017

The purpose of this study was to enhance the understanding of how people with disabilities experience the meaning of their assistive devices in their occupations and how they act on their experiences. Seventeen participants were interviewed and data were analyzed using a qualitative approach. The participants' experiences showed that they reacted differently to the manifold and often contradictory meaning of assistive devices. The analysts organized the participants' reactions into three categories: pragmatic users, ambivalent users, and reluctant users. The differences between the participants were understood as representing different adaptive approaches to achieve desired occupational self-images. Thus, the assistive devices were not in themselves important, but were merely a means to achieve a desired self-image. The findings reflect that the participants' experiences of using assistive devices reveal meanings about their use that go beyond the traditional medical perspective that focuses on the role of assistive devices as compensation for physical impairment.
The Use of Smart Glasses for Surgical Video Streaming
Authors: Hiranaka Takafumi , Nakanishi Yuta , Fujishiro Takaaki , Hida Yuichi , Tsubosaka Masanori , Shibata Yosaku , Okimura Kenjiro , Uemoto Harunobu
Published: January 2017

Observation of surgical procedures performed by experts is extremely important for acquisition and improvement of surgical skills. Smart glasses are small computers, which comprise a head-mounted monitor and video camera, and can be connected to the internet. They can be used for remote observation of surgeries by video streaming. Although Google Glass is the most commonly used smart glasses for medical purposes, it is still unavailable commercially and has some limitations. This article reports the use of a different type of smart glasses, InfoLinker, for surgical video streaming. InfoLinker has been commercially available in Japan for industrial purposes for more than 2 years. It is connected to a video server via wireless internet directly, and streaming video can be seen anywhere an internet connection is available. We have attempted live video streaming of knee arthroplasty operations that were viewed at several different locations, including foreign countries, on a common web browser. Although the quality of video images depended on the resolution and dynamic range of the video camera, speed of internet connection, and the wearer’s attention to minimize image shaking, video streaming could be easily performed throughout the procedure. The wearer could confirm the quality of the video as the video was being shot by the head-mounted display. The time and cost for observation of surgical procedures can be reduced by InfoLinker, and further improvement of hardware as well as the wearer’s video shooting technique is expected. We believe that this can be used in other medical settings.
GERD Management
Authors: Ayoub Joelle , White Nicole D.
Published: January 2017

Gastroesophageal reflux disease (GERD) is a common condition in the United States, routinely treated with proton pump inhibitors (PPIs). While effective and generally well tolerated, PPIs have been associated with undesirable long-term side effects and are often used inappropriately. Lifestyle medicine can be effective in reducing GERD symptoms in many patients without the untoward side effects of pharmacotherapy. This article will describe relevant emerging and established side effects of long-term PPI use, the efficacy of lifestyle modifications in the management of GERD, and discuss the importance of advocating for lifestyle when PPIs are not otherwise indicated.
Vascular Anomalies and the Risk of Multiple Aneurysms Development and Bleeding
Authors: Mazighi M. , Porter P. J. , Rodesch G. , Alvarez H. , Aghakhani N. , Lasjaunias P.
Published: January 2017

The pathogenesis of aneurysmal subarachnoid hemorrhage is still debated and the prognosis remains severe, especially in multiple aneurysms, where the therapeutic management is complex. The aim of this study was to look for vascular anomalies and assess their relationship with aneurysm formation and bleeding in patients with multiple intracranial aneurysms. A prospective angiographical review was performed on 141 patients with multiple intracranial aneurysms seen from 1992 to 2000. Three hundred and fifty three aneurysms were studied. In 88% of the patients vascular anomalies were found.

The most common were: asymmetric caudal basilar fusion (43.2%), variations of the anterior communicating artery (AcoA) complex (31.2%), symmetric caudal basilar fusion (26.2%), antero-inferior cerebellar artery-postero-inferior cerebellar artery (AICA-PICA) (15.6%), extradural origin of the PICA (10.6%), cavernous origin of the ophthalmic artery or dorsal ophthalmic artery (dOPH) (3.5%). Some aneurysm locations were associated with a high rate of vascular anomalies, e.g.: posterior cerebral aneurysm with asymmetric caudal fusion, AcoA aneurysm with AcoA complex variation, basilar tip aneurysm with extradural PICA or symmetric caudal fusion, PI CA aneurysm with AICA-PICA, para-ophthalmic aneurysm with dOPH. These aneurysm locations bled proportionally more frequently when associated with the related vascular anomaly. In conclusion, these results suggest that vascular anomalies are associated with aneurysm development and bleeding.
Coil Breakage during Aneurysm Embolization
Authors: Kwon O-K. , Lee K. Jae , Han M. Hee , Ko Y.-C.
Published: January 2017

Stretched Guglielmi detachable coils (GDCs; Boston Scientific, USA) can be easily broken if forceful manipulation is applied. However, coil fracture without stretching has not been known. We report an extremely unusual occurrence of fracture without coil stretching during aneurysm embolization.
Spontaneous Recanalization of Occluded Dural Venous Sinuses after Successful Trans Arterial Embolisation of a Dural Arteriovenous Shunt
Authors: Brew S. , Taylor W. , Lasjaunias P.
Published: January 2017

Dural arteriovenous shunts (DAVS) occur within the walls of dural venous sinuses or their tributaries. They may be related to previous episodes of sinus thrombosis. The presence of impediments to venous outflow results in venous congestion, predisposing to haemorrhage and cerebral parenchymal damage. Cerebral venous congestion is an indication for treatment.

This case is unusual in some respects; firstly, the patient was relatively well despite worrisome features on imaging and secondly the occluded dural venous sinuses appeared to spontaneously recanalize after treatment of the DAVS. Anticoagulation may have had a role in avoiding thrombosis of the patient's precarious venous drainage after embolisation and in encouraging recanalization of the thrombosed dural venous sinuses.
Single Hole High Flow Arteriovenous Fistula
Authors: Campos C. , Piske R. , Nunes J. , Soares S.B. , Castro J.A. , Mourao G. , Lima S.S.
Published: January 2017

A high flow pial arteriovenous fistula in a twenty-years-old girl is described. The arteriovenous communication corresponds to a single hole fistula on the right rolandic area, with a giant venous ectasia. The patient presented seizures and left hemiparesis as symptoms. The fistula was embolized with glue obtaining total occlusion of the shunt. Hypotension was induced and valsalva manoeuver was done during the glue injection to reduce the flow into the fistula, however 26 hours after the procedure the patient bled resulting in a fatal outcome. The purpose of this paper is discuss the presentation of Rendu-Osler-Weber (ROW) in children and the therapeutic guidelines.
Anatomical and Clinical Outcomes after Endovascular Treatment for Unruptured Cerebral Aneurysms
Authors: Kwon B. J. , Han M. H. , Oh C.W. , Kim K. H. , Chang K-H
Published: January 2017

To describe the immediate and follow-up anatomical outcomes as well as procedure-related morbidity after endovascular procedures for unruptured cerebral aneurysms, we reviewed 68 patients with 78 unruptured aneurysms treated with detachable coils from may 1996 to february 2002. Angiograms were retrospectively reviewed for the nature of the aneurysms and the degree of therapeutic obliteration. Periprocedural complications, immediate clinical outcome and long-term neurological status were analyzed.

Immediate anatomical outcomes were complete in 35 aneurysms (45%); residual neck in 24 (31%), partial contrast filling in 17 (22%), and failed embolization in two (2%). Of 27 aneurysms with follow-up angiography, 12 of the 13 aneurysms that were completely occluded in the initial treatment were still completely occluded at the end of a mean follow-up period of 17 months. Periprocedural complications were thromboembolic (n = 6), haemorrhagic (n = 3), coil protrusion (n = 7) and other unrelated complications (n = 3). Only two patients, with thromboembolic complications were moderately disabled with permanent neurological deficits in immediate clinical outcome, and their condition improved to independent in 1.5 and three months each. Small aneurysms and posterior circulation location showed more protective immediate results than aneurysms of large and anterior circulation after endovascular treatment (p values: 0.01 and 0.02).

Our experiences of endovascular treatment for unruptured cerebral aneurysms were comparable to the results of recent series. Endovascular treatment for small posteriorly located aneurysms produced significantly better results than for large anteriorly located lesions.
Early Experience Studying Cerebral Aneurysms with Rotational and Three-Dimensional Angiography and Review of CT and MR Angiography Literature
Authors: Castaño-Duque C.H. , Ruscalleda-Nadal J. , de Juan-Delago M. , Guardia-Mas E. , Roman-Manzanera L. San , Bartomeus-Jene F. , Molet-Teixido J. , Tresserras-Ribo P. , Pares-Muñoz P. , Laria P. Clavel
Published: January 2017

From september 2000 to september 2001, 32 consecutive patients with ruptured intracranial aneurysms were examined with rotational and 3D reconstruction angiography using an Integris V5000 Philips Medical System: 39 aneurysms were detected.

After a selective cerebral artery was catheterized with a 5F or 4F-catheter, 35 ml of contrast medium was intra-arterially administered at a rate of 4 ml/s and a 180° rotational angiography was performed in eight seconds. This information was transferred to a computer (Silicon Graphics Octane) with software (Integris 3DRA, Philips Integris Systems) and a three-dimensional reconstruction was made.

The information provided by Angio-3D was useful for evaluating the parent artery, aneurysmal sac, aneurysmal neck and arterial branches. It was also very useful in selecting the therapeutic method.

For open surgery, this technique provides preoperative images that are useful for planning microsurgical approaches, especially in cases of large aneurysm showing complex surrounding arteries.

For endovascular embolization, various anatomic characteristics of the aneurysm such as neck and sac size, shape, lobularity, parent artery and arterial branches adjacent to the aneurysmal neck must be demonstrated. This is very important to determine the best projection for embolization and to avoid multiple series. This is also essential in the choice of the first coil to create a good basket producing total occlusion.

Microaneurysms are demonstrated well with this technique whereas this is difficult to do with conventional arteriography.

The Angio-RM and Angio-CT literature show a lower sensitivity and specificity in comparasion with our experience with 3D IA-ROT-DSA. For this reason, we believe that 3D IA-ROTDSA is now the gold standard for patients presenting intracranial aneurysms.
Distal Middle Cerebral Artery Aneurysms
Authors: Baltacioğlu F. , Cekirge S. , Saatci I. , Öztürk H. , Arat A. , Pamir N. , Ozgen T.
Published: January 2017

Intracranial aneurysms of the distal intracranial arteries are uncommon lesions which are difficult to treat with surgical techniques. Distal middle cerebral artery (MCA) aneurysms constitute approximately 5% of all MCA aneurysms. We report the results of our coil embolization for the treatment of distal MCA aneurysms.

Eleven patients (four men and seven women, average age 37 years) with distally located MCA aneurysms were treated. Four of the aneurysms were fusiform in shape and the remainder were saccular.

Seven of the aneurysms were in the dominant hemisphere.

Four of the seven patients who had saccular aneurysms were treated with selective aneurysm embolization. The remaining seven patients were treated with aneurysmal sac and parent artery coiling. All patients had good retrograde flow into the peripheral branches of the occluded artery. All the procedures were completed successfully without any additional neurological deficits.

Coil embolization is a safe and effective technique for the treatment of distal MCA aneurysms.

If the parent artery cannot be preserved, pial collaterals can supply adequate blood to prevent neurological deficits.
A Case of Superficial Recurrent Ophthalmic Artery Supplying an Infratentorial Vascular Tumour
Authors: Herwadkar A , Laitt R D
Published: January 2017

We present a case of ophthalmic artery contribution to a posterior fossa vascular tumour by the superficial recurrent ophthalmic artery. This branch arises from the second portion of the ophthalmic artery and is rarely seen on angiography. We review the anatomy and embryology of this arterial variant. Furthermore, this case illustrates the capacity of the ophthalmic artery to supply posterior fossa neoplasms.
The Role of GDC Embolization as a Second Choice in the Treatment of Ruptured Cerebral Aneurysm
Authors: Manabe H. , Hasegawa S. , Takemura A.
Published: January 2017

We investigated the role of GDC embolization as a second choice for the treatment of ruptured cerebral aneurysm.

From september 1997 to may 2001, 139 ruptured aneurysms out of 151 consecutive ruptured aneurysms transferred to our hospital were treated by clipping (first choice) or GDC embolization (second choice). Patient selection was decided by more than two neurosurgeons under the policy that GDC embolization is the second choice of treatment. The mid-term (longer than three months) outcome of both group was examined.

One hundred and nineteen Ans (BA two, IC-paraclinoid one, IC-PC or IC-Ach 36, IC-ant. Wall two, ACoA34, ACA six, MCA38) were treated by clipping (clipping group), 20 Ans (surgical difficulty; BA three, IC-paraclinoid three, VA dissection six, general complications; IC-PC two, IC-dissection one, ACoA four, VAPICA one) by GDC embolization (GDC group) within 24 hours after admission. SAH grade and GOS of each group were Gr1: 35&4, Gr2: 41&5, Gr3: 23&5, Gr4: 11&4, Gr5: 9&2, respectively, and GR: 79&14, MD: 8&3, SD: 11&0, VS: 8&0, D: 13&3 respectively. Good prognosis (better than MD) was gained in 73% of clipping group and 85% of GDC group. No rebleeding was seen in GDC group.

GDC embolization for the cases with surgical difficulty or general complication raised the overall outcome. GDC embolization would be suitable for IC-paraclinoid Ans, BA-VA Ans, and ruptured VA dissections. Because of the good clinical outcome gained in the GDC group, GDC treatment would be the first choice of treatment for such aneurysms as geometrically suitable for coiling.
Angiographic Follow-up of Embolization Using Guglielmi Detachable Coils for Cerebral Aneurysms
Authors: Nakai Y. , Sonobe M. , Sugita K. , Matsumaru Y.
Published: January 2017

The purpose of this study is to evaluate the mid or long-term angiographical stability of Guglielmi Detachable Coils (GDC) after embolization for cerebral aneurysms.

Between march 1997 and november 2001, 164 aneurysms, including 116 ruptured and 48 unruptured aneurysms, were treated using GDC at Mito National Hospital. Cerebral angiograms over one month after embolization were obtained in 111 aneurysms, including 71 ruptured and 40 unruptured aneurysms. At the time of initial GDC embolization of the 71 ruptured aneurysms, complete occlusion was achieved in 31 aneurysms, neck remnant in 18 aneurysms, and body filling in 22 aneurysms. Morphological changes were observed in 26 aneurysms (37%) in follow-up. Progressive thrombosis was obtained in 12 out of 71 aneurysms, no changes were shown in 45, and recanalizations occurred in 14. In the initial embolization of the 40 unruptured aneurysms, complete occlusion was achieved in 15 aneurysms, neck remnant in five and body filling in 20 aneurysms respectively. Morphological changes were observed in 12 aneurysms (30%), in which 12 aneurysms showed progressive thrombosis and 28 aneurysms were unchanged.

There were significant differences of the long-term angiographical stability between ruptured and unruptured aneurysms. Rigorous follow-up angiography is mandatory when complete aneurysm occlusion is not achieved in ruptured aneurysms.
Treatment Strategy for Aneurysms of the Posterior Cerebral Artery
Authors: Suzuki O. , Miyachi S. , Negoro M. , Okamoto T. , Sahara Y. , Hattori K. , Kobayashi N. , Kojima T. , Yoshida J.
Published: January 2017

The authors carried out a retrospective review of the records of 12 patients with aneurysms of the posterior cerebral artery (PCA). Four were asymptomatic, 1 presented with a mass effect, and 7 with a subarachnoid haemorrhage (SAH). Of the 7 ruptured aneurysms, 3 were embolized and 2 were clipped. However, 2 patients died from rebleeding before any treatment. Of the 5 unruptured aneurysms, 1 was embolized with coils but the remaining 4 have been conservatively observed. No aneurysms have ruptured during the follow-up period, and 3 have thrombosed spontaneously. According to our results, the PCA aneurysms should be treated aggressively in the early phase. Although the preservation of the anatomical integrity of the PCA should naturally be one of the prime objectives, PCA occlusion may sometimes be inevitable when treating large or fusiform aneurysms. On the other hand, conservative therapy is one of the options for the treatment of incidentally encountered unruptured ones, because these have the possibility of spontaneous thrombosis.
Symptomatic Cavernous Internal Carotid Artery Aneurysms Treated with Detachable Coils
Authors: Akai F. , Nakagawa S. , Fukawa T. , Yugami H. , Taneda M.
Published: January 2017

We reviewed the cranial nerve dysfunctions of eight patients with symptomatic cavernous internal carotid (CSIC) aneurysms treated by endovascular intraaneurysmal occlusion.

Aneurysms were classified into three types according to their location and direction of growth. Anterior type aneurysms, which involved anterior bend of CSIC represented third nerve dysfunction. Posterior type aneurysms, which located posterior bend of CSIC preferred to affect sixth nerve function. CSIC aneurysms that extended over the both bends had total ophthalmoplegia. All patients responded to endovascular treatment, though partial resolution was recorded in the case of upward gaze or lateral gaze impairment. Endovascular treatment with detachable coils offers an excellent alternative with acceptable risks of morbidity.
Experimental Polyvinyl Alcohol Core Coil for a Drug Delivery System
Authors: Matsumoto H. , Terada T. , Tsuura M. , Itakura T. , Ogawa A.
Published: January 2017

We developed a new type of coil with a polyvinyl alcohol core (PVA-core coil) to absorb and release various types of biologically active materials, for the endovascular treatment of intracranial aneurysms. A 10 mm segment of the PVA-core coil was used in this study. PVA-core coils were immersed in basic fibroblast growth factor (b-FGF) solution. The PVA-core coil, which absorbed b-FGF in the PVA core, was named FGF-core coil. This coil gradually released b-FGF in the solution without b-FGF. In vitro study, FGF-core coils, PVA-core coils and unmodified coils were cultured with fibroblasts (NIH3T3) respectively and their surface was observed with scanning electron microscopy (SEM). In vivo study, each coils were inserted into the rat common carotid artery. Rats were sacrificed and the arterial lumen were histologically examined 14 days and 28 days after coil implantation. Electron microscopy findings demonstrated remarkable cellular adhesion to the surface of the FGF-core coils, while no adhesion to the surface of the PVA-core coils and unmodified coils was found. Histologically, remarkable cellular proliferation and wall thickness like neointimal hyperplasia was demonstrated in the implanted common carotid artery of the FGF-core coil group at 14 days and 28 days. On the other hand, these changes did not occur in PVA-core coil group and unmodified coil group. We suggest that FGF-core coils may be effective to induce fibrotic changes inside cerebral aneurysms.
Transcranial Doppler Enhanced Thrombolysis for Embolic Occlusion of Major Cerebral Arteries
Authors: Yamanome T. , Sasoh M. , Kubo Y. , Nishikawa Y. , Endoh H. , Satoh N. , Ogawa A.
Published: January 2017

For the treatment of 11 patients with hyperacute embolic occlusion of major cerebral arteries (ten with occlusion of middle cerebral artery and one with occlusion of basilar artery), TCD-enhanced thrombolysis (TCDET) was performed in combination with ultrasound irradiation, using diagnostic transcranial Doppler (TCD) (TC2-64B: 2MHz, 100mW/cm2, pulsed wave) (TCDET group), and the effectiveness of this procedure was compared with that of local intra-arterial fibrinolysis (LIF) in 45 patients with embolic occlusion of the middle cerebral artery (LIF group). Regarding dose of TPA, the LIF group used 1046.7 ± 607.8 units and the TCDET group 700.0 ± 431.3 units (p < 0.05). Regarding time technically required to attain recanalization, the LIF group required 68.2 minutes, and the TCDET group 28.6 minutes. A good outcome was noted in 60.8% of the LIF group and 64% of the TCDET group. Haemorrhagic transformation was observed in 7.8% of the LIF group and in 0% of the TCDET group. No complications due to TCD irradiation were observed in the TCDET group. These findings suggest that TCDET can be an effective method of achieving recanalization.
Stenting of Extracranial Carotid Artery Stenosis
Authors: Koshimae N. , Morimoto T. , Nagata K.
Published: January 2017

The purpose of this study is to evaluate our cases of cervical internal carotid artery stenosis for safty stenting. We investigate the preoperative internal carotid artery stenosis using by integrated backscatter (IBS) method of ultra sonography, comparing with the thirty five surgical specimens as to their nature, histological structure, thickness of fibrous cap. We choose the protection method according to plaque structure, and placed Easy-Wall stent or Smart stent after prePTA. We added post PTA according to the extent of expansion and IVUS findings. Calibrated IBS = IBS value (ROI)/intinal IBS value of ‘bleeding’, ‘lipid’, ‘thrombus’, ‘fiber’, ‘hyalinization’ were −27.5, −22.5, −15.2, −11.1, +2.1. That of the thin fibrous cap were −10.9*, that of thic fibrous cap were −2.4 (*p < 0.001). There was a good coleration between the extent of expansion and expected histological findings. All conplications were two cases of small cerebral infarction and a case of bleeding from the complicated lung cancer. The protection at prePTA lead to no comploications in case of acute cerebral infarctions. It is very important to check the histological specimen carefully for safty stenting.
Coil Retrieval following Embolization of Cerebral Aneurysms
Authors: Kojima T. , Miyachi S. , Negoro M. , Nakabayashi K. , Fukui K. , Takahashi I. , Sahara Y. , Suzuki O. , Hattori K. , Kobayashi N. , Hattori K. , Nakai K. , Yoshida J.
Published: January 2017

Failed coil embolization of cerebral aneurysms may be occasionally followed by direct surgical treatment. We had 5 patients who underwent coil retrieval and surgical clipping after coil embolization because of periprocedural complications. The patients, ranging in age from 40 to 71, had wide-neck aneurysms located at the anterior communicating artery (AcomA) in 3 patients, the middle cerebral artery (MCA) in 1, and the internal carotid-ophthalmic artery (IC-Ophthalmic) in 1. They were embolized with Guglielmi detachable coils (GDCs), which had to be retrieved within 8 days because of coil protrusion and migration in 3 patients, aneurysm rupture in 1, and increased mass effect due to coil compaction in 1. Coils were successfully removed with aneurysmotomy or arteriotomy under temporary trapping, aneurysms were then clipped or trapped. Three patients had a good outcome, but one suffered permanent visual disturbance and the other had a motor deficit. Our study revealed that a small AcomA aneurysm had a high risk of complication in a case of complex anatomy of the AcomA-A1-A2 complex with its difficult access. In addition, insufficient packing of the inflow zone in a large and symptomatic aneurysm may cause coil compaction and regrow with increasing mass effect.

The indication and treatment strategy for these aneurysms should be carefully determined.