bluuebunny/crossref_metadata_2025_split huggingface dataset:
Caregivers' Perspectives on Decision Making about Lung Transplantation in Cystic Fibrosis
Authors: Dellon Elisabeth P. , Shores Mitchell D. , Nelson Katherine I. , Wolfe Joanne , Noah Terry L. , Hanson Laura C. 
Published: January 2017

Context Lung transplantation extends survival for some patients with advanced cystic fibrosis, but it is complicated, has many potential risks, and its outcomes are difficult to predict. No standards exist for informed decision making about transplantation. Objective To assess decision making from the perspective of caregivers of patients who faced the transplant decision before dying of cystic fibrosis or transplant complications. Design Semistructured interviews with descriptive and qualitative content analysis. Participants Twenty-eight caregivers of patients with cystic fibrosis who received care at our center and died between 1996 and 2006. Results Of 28 patients who considered lung transplantation, 19 (68%) received transplants, 6 (21%) died while waiting for transplant, and 3 (11%) declined transplant. Three caregivers (11%) thought that the patient did not fully understand the reason for transplant referral. Five (18%) thought that the patient did not fully understand potential risks. Ten (36%) thought that alternatives were not fully understood. The only alternatives to transplant identified, progressive illness and the possibility of earlier death without transplant, were unacceptable to most. Thirteen caregivers (46%) reported that the patient thought that declining transplant was not an option. Caregivers described the decision as “easy” for 19 (68%), often expressing a sentiment of “do or die.” Those who described the decision as “easy” recalled fewer elements of informed decision making. Conclusions From caregivers' reports, patients with cystic fibrosis may not fully understand risks of and alternatives to lung transplantation. Because a strong desire to prolong life necessitates honest communication about potential outcomes, interventions are needed to facilitate high-quality decision making.
Aneurysm Clipping after Partial Endovascular Embolization for Ruptured Cerebral Aneurysms
Authors: Nomura M. , Kida S. , Uchiyama N. , Yamashima T. , Yamashita J. , Yoshikawa J. , Matsui O. 
Published: January 2017

The aim of this study was to investigate the advantages and disadvantages of a two-stage treatment for ruptured cerebral aneurysms; partial embolization in acute stage followed by clipping in chronic stage of subarachnoid hemorrhage. Between April 1997 and August 1999, twenty ruptured cerebral aneurysms were initially treated endovasculary using Guglielmi detachable coils in our institution. Among them, complete embolization could not be achieved in 6 lesions. For these lesions, subsequent clipping was added. The radiological and operative findings, and outcomes of these cases were retrospectively reviewed. In 1 case, rerupture occurred during the endovascular procedure. Rerupture was not observed in any cases in the postembolization period. In 2 cases, complications related to the clipping but not the endovascular procedure occurred. These complications included impaired visual acuity for unverified reasons, and memory disturbance due to sacrifice of a perforator arising from the anterior communicating artery. In 3 cases, coil extraction was needed during the clipping, because the loops of the coil extended into the residual neck. Complications related to coil extraction were not observed in these 3 cases. Acute partial embolization of ruptured aneurysm appears to be effective for the prevention of subsequent rerupture during the subacute period, in which treatment for vasospasm should be performed, and the clipping procedure. However, in the case of relatively large aneurysms, small arteries or other normal structures behind the aneurysm cannot be observed directly during surgery, because of the immovability of the embolized aneurysm. Further, complete clip closure is impossible when loops of coil herniate into the neck. In such situations, coil extraction with or without resection of the aneurysm might be necessary, and care must be taken not to damage parent artery and surrounding vessels.
Influence of the Perianeurysmal Environment on Rupture of Cerebral Aneurysms Preliminary Observation
Authors: Sugiu K. , Jean B. , Ruiz D. San Millan , Martin J-B. , Delavelle J. , Rüfenacht D. A. 
Published: January 2017

We evaluate the perianeurysmal environment and study parameters potentially influencing rupture of cerebral aneurysms. 101 consecutive aneurysm cases were retrospectively evaluated using radiological observation including imaging documents such as MR, CT and DSA studies. Aneurysm contact with perianeurysmal environment was classified and correlated with aneurysm shape, size, location and likely rupture point. Topographic relation of the aneurysm to the cisternal compartment was studied. Presence of contact with the surrounding structures was evaluated for bone, dura, brain, cranial nerves, arteries, and veins. The aneurysm shape and likely rupture point was found to be significantly influenced by the aneurysm environment. Depending on aneurysm type, location and size, the growth pattern also exhibited signs of interaction with the environment. Overall, there was no significant difference in the largest average diameter of the dome of ruptured (7.8 mm) and unruptured (6.7 mm) aneurysms. When compared to unruptured aneurysms (6/42), the presence of a bleb was more frequent in ruptured aneurysm (41/59). The perianeurysmal environment was found to have a significant influence on aneurysmal rupture pattern, whenever direct contact between the aneurysm and the anatomical structures in the perianeurysmal environment was visualized. This influence was independent of aneurysm size. Aneurysm size seems to be a poor indicator for the risk of rupture when compared to shape of the aneurysm and the degree of direct contact with the perianeurysmal environment.
Electromicroscopic Investigation of the Efficacy of FactorXIII for Coil Embolization in Experimental Aneurysms Preliminary Report
Authors: Konishi Y. , Hino K. , Shimada A. , Sato E. , Hara M. , Saito I. 
Published: January 2017

In recent years, endovascular treatment has often been used to treat cerebral aneurysms. Basic investigation to elucidate the process of endothelial cell growth within aneurysms is a crucial problem. We performed elecrtro-detachable coil embolization in aneurysms under administration of blood coagulation factor XIII, a wound-healing accelerator, and examined changes in endothelial cells on the surface of the inserted coil with a scanning electron microscope. Experimental aneurysms produced in animals were treated by coil embolization and histological changes in embolized coil after the treatment of factor XIII were investigated. Aneurysms were produced in four matured swines under general anesthesia and coil embolization was performed with a elecrtro-detachable coil. The aneurysms were resected immediately and 3 weeks after coil embolization, and investigated histologically with a scanning electron microscope. Seven animals were administrated with blood coagulation factor XIII on the day of embolized and the following 4 consecutive days. These aneurysms were also resected 3 weeks after embolization and investigated histologically. More marked fibroblast proliferation and growth of endothelial cells on the surface of luminal side of embolized coil were seen in the aneurysms in the group administrated with factor XIII than in aneurysms treated without factor XIII. More effective and sufficient coil embolization can be obtained by administration of factor XIII.
Postmortem Pathological Examination of a Case One Month after Carotid Artery Stenting
Authors: Otsuka Y. , Waki R. , Yutani C. , Ishibashi-Ueda H. , Onodera T. , Kimura K. 
Published: January 2017

There have been few pathological reports on human carotid stenting. A 73-year-old diabetic male with 80% stenosis in the left carotid bifurcation. Despite no neurological events, he died of pneumonia one month after. Findings pathological examination revealed: successful dilatation without deformity of the stent, eccentric compression and partial disruption of the plaque by struts, thrombi around disrupted plaque, and neointimal growth. Findings were generally compatible with those reported on coronary stenting. Case accumulation is required to clarify an exact pathological process and establish a procedure to reduce complications.
Follow-up Study after Intracranial Percutaneous Transluminal Cerebral Balloon Angioplasty
Authors: Mori T. , Fukuoka M. , Kazita K. 
Published: January 2017

To find the angiographic lesions specific characteristics appropriate for intracranial percutaneous transluminal cerebral angioplasty (PTCBA). Forty-two clinically symptomatic patients with 42 haemodynamically significant intracranial lesions (% diameter stenosis >70) were treated by PTCBA between January 1992 and May 1996. Before the angioplasty treatment, the patients were classified into three groups according to the angiographic lesions' characteristics summarised as follows: type A, a short and concentric stenosis; type B, a tubular lesion, or an extreme eccentric lesion; and type C, a diffuse lesion. They were followed after PTCBA from one month to six years to compare between the three groups. Primary end points were death, stroke, or bypass surgery. The clinical success rates in type A, B and C groups were 92%, 86% and 33% (p=0.0032), respectively. Cumulative risks of fatal or nonfatal ischaemic stroke / ipsilateral bypass surgery in type A, B and C groups were 8%, 26% and 87% (p<0.0001), respectively. The cumulative risk of 8% in type A group patients appeared to be smaller than in historical studies. PTCBA for intracranial simple (type A) lesions produces a favourable clinical outcome for symptomatic patients.
Morphologic and Hemodynamic Changes after Stent Placement for Experimental Carotid Aneurysm
Authors: Tenjin H. , Ohshita Y. , Daimon R. 
Published: January 2017

Stent assisted coil embolization is useful in treating broad neck aneurysms, and there are many kinds of stents that can be applied in the cerebral artery, however their characteristics are not well known. We investigated and compared morphologic and hemodynamic changes before and after stent placement when several different kinds of stents were applied to experimental aneurysms. Experimental aneurysms in eight pig carotid arteries were used. Stents were placed covering the aneurysm orifice. Five Cordis stents (coil stent), two GFXs (multilink stent), and one Multilink (tube stent) were used in this study. After coil placement, the arteries were perfused with 70% ethanol, the specimens were embedded in polyester plastic resin and thin slices were stained with hematoxylin-eosin. Blood flow in the aneurysm was measured using digital subtraction angiography. The parent artery was stretched in multilink stent (GFX) cases, and was most markedly stretched by use of the tube stent (Multilink). Stent placement with any type of stent decreased intra-aneurysmal blood flow.
Transvenous Occlusion of a Dural Cavernous Sinus Fistula Using a New Expandable Hydrogel-Platinum Coil (Hydrocoil®)
Authors: Morsi H. , Benndorf G. , Klucznik R. , Mawad M. 
Published: January 2017

Hydrogel-coated platinum coils (Hydrocoils®) are currently under clinical investigation for their efficacy to improve anatomic results of endovascular occlusion of cerebral aneurysms. A case is presented in which this new expandable coil type was added to bare platinum coils in order to accelerate the transvenous occlusion of a dural cavernous sinus fistula (DCSF). A 53-year -old woman presenting with mild left-sided eye redness and diplopia due to a DCSF (type D) underwent transvenous occlusion using bare platinum coils (Trufill®) and hydrogel coated coils (Hydrocoil®). After successful catherization of the cavernous sinus, bare platinum coils were densely packed and eventually combined with Hydrocoils® which resulted in immediate and complete occlusion of the fistula. No technical or clinical complication occurred. The new expansile hydrogel-coated platinum coil (Hydrocoil®) can be successfully combined with bare platinum coils to accelerate transvenous occlusion of an AV-shunting lesion. Controlled volume expansion after deployment of this device offers potential benefits for occlusion of dural arteriovenous fistulas in other locations or for parent vessel occlusions in the treatment of giant or large complex aneurysms.
Retrieval of a Migrated Coil Using an X6 MERCI Device
Authors: O'Hare A. , Brennan P. , Thornton J. 
Published: January 2017

Coil migration is a recognised but rare complication of endovascular coiling. Many techniques are available commercially for coil retrieval. We report the case of an acute subarachnoid hemorrhage in a 54-year-old woman in which a migrated coil was successfully retrieved using an X6 MERCI device.
Endovascular Treatment of Very Small Intracranial Aneurysms
Authors: Iskandar A. , Nepper-Rasmussen J. 
Published: January 2017

The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm). Between November 1999 and November 2009 endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms and subsequently comparing it to the results of larger aneurysms. Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54 aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated with a higher rate of procedural ruptures (7.2% versus 4.4%) and procedural mortality (4.7% versus 2.7%) but a lower procedural morbidity (1.9% versus 4.0%). However none of these differences reached statistical significance (p = 0.186, p= 0.388, respectively). The retreatment rate was higher for the larger aneurysms (8.2% and 6.3%), but this was not significant either (p= 0. 496). At nine-month follow-up significantly more small aneurysms were found to have a stable occlusion grade compared to large aneurysms. Endovascular treatment of very small aneurysms is feasible with a lower retreatment rate compared to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms.
Combination of Rare Right Arterial Variation with Anomalous Origins of the Vertebral Artery, Aberrant Subclavian Artery and Persistent Trigeminal Artery
Authors: Ishihara H. , Ruíz D. San Millán , Abdo G. , Asakura F. , Yilmaz H. , Lovblad K.O. , Rüfenacht D.A. 
Published: January 2017

A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed.
Intracranial Aneurysms Associated with a Double Origin of the Posterior Inferior Cerebellar Artery
Authors: Trivelato F. Padovani , Rezende M.T. Salles , Santos R. Brito , Madeira T. Hilton Vieira , Campos R. Cardoso , Ulhôa A. Cordeiro 
Published: January 2017

The posterior inferior cerebellar artery (PICA) frequently has a variable course and target territory. However, double origin PICA is a rare finding. Its significance is uncertain, but it has been associated with intracranial aneurysms localized at the PICA proper or at a distant site. The presence of this variation imposes specific challenges. We describe two cases of double origin PICA, one of them associated with an ipsilateral PICA aneurysm. The role of this finding was critically reviewed. A literature search identified 23 cases of double origin PICA, including both cases reported in this paper. Intracranial aneurysms were strongly associated with double origin PICA (71% in 21 detailed cases of double origin PICA). The current patient harboring a PICA aneurysm was successfully treated by endovascular trapping. In the setting of double origin PICA aneurysms, this variation beneficially affects the treatment choice once the two limbs enable the safe sacrifice of the channel involved, with preservation of blood flow through the other channel.
Optimization of the Reconstruction Interval in Neurovascular 4D-CTA Imaging
Authors: Hoogenboom T.C.H. , Van Beurden R.M.J. , Van Teylingen B. , Schenk B. , Willems P.W.A. 
Published: January 2017

Time resolved whole brain CT angiography (4D-CTA) is a novel imaging technology providing information regarding blood flow. One of the factors that influence the diagnostic value of this examination is the temporal resolution, which is affected by the gantry rotation speed during acquisition and the reconstruction interval during post-processing. Post-processing determines the time spacing between two reconstructed volumes and, unlike rotation speed, does not affect radiation burden. The data sets of six patients who underwent a cranial 4D-CTA were used for this study. Raw data was acquired using a 320-slice scanner with a rotation speed of 2 Hz. The arterial to venous passage of an intravenous contrast bolus was captured during a 15 s continuous scan. The raw data was reconstructed using four different reconstruction-intervals: 0.2, 0.3, 0.5 and 1.0 s. The results were rated by two observers using a standardized score sheet. The appearance of each lesion was rated correctly in all readings. Scoring for quality of temporal resolution revealed a stepwise improvement from the 1.0 s interval to the 0.3 s interval, while no discernable improvement was noted between the 0.3 s and 0.2 s interval. An increase in temporal resolution may improve the diagnostic quality of cranial 4D-CTA. Using a rotation speed of 0.5 s, the optimal reconstruction interval appears to be 0.3 s, beyond which, changes can no longer be discerned.
Time of Flight 3D Magnetic Resonance Angiography in the Follow-up of Coiled Cerebral Aneurysms
Authors: Adams W.M. , Laitt R.D. , Jackson A. 
Published: January 2017

The use of Guglielmi Detachable Coil (CDC) for the endovascular treatment of intracerebral aneurysms is increasing, particularly in those aneurysms for which there is a high surgical morbidity and mortality. However, the long-term efficacy of GDC is not known. Until the natural history of GDC treatment is established long-term follow-up in this cohort of patients is required, of necessity involving repeated intraarterial angiography (IA DSA) with its known attendant risks and exposure to ionising radiation. Three dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) is now readily accepted as a non-invasive screening tool for familial aneurysmal disease and has been used as an alternative to IA DSA in the surgical management of aneurysmal subarachnoid haemorrhage. MRA in patients treated with GDC is safe, imparts no radiation dose and provides acceptable image quality. The aim of this study was to assess 3D TOP MRA source data, maximum intensity projection (MIP) and 3D isosurface reconstruction in comparison to IA DSA in the follow-up of 25 patients treated with GDC. Images were assessed for parent and branch artery flow, the presence of neck recurrence and aneurysm regrowth. There was good correlation for all these features when 3D isosurface MRA and source data were compared with IA DSA. The correlation between MIP MRA and IA DSA was less robust. Additional confidence can be obtained by performing plain films of the skull to demonstrate change in coil ball configuration. MRA has the potential to replace IA DSA in the follow-up of GDC treated cerebral aneurysms.
Association Between Medicare Star Ratings for Patient Experience and Medicare Spending per Beneficiary for US Hospitals
Authors: Trzeciak Stephen , Gaughan John P , Bosire Joshua , Angelo Mark , Holzberg Adam S , Mazzarelli Anthony J 
Published: January 2017

Objective: To test the association between patient experience and Centers for Medicare and Medicaid Services (CMS) spending at the hospital level. Methods: Using CMS Hospital Compare data set, we analyzed 2014 data for CMS patient experience star ratings and the hospital Medicare Spending per Beneficiary (MSPB) Measure, which assesses price-standardized, risk-adjusted payments for services provided to Medicare beneficiaries for an episode of care from 3 days before hospital admission to 30 days following discharge. We tested the association using linear regression, adjusting for complexity of care using hospital Case Mix Index (CMI) and for socioeconomic status of the hospital patient population using Disproportionate Share Hospital (DSH) status. Results: The MSPB decreased with increasing hospital patient experience ratings. After adjustment for CMI and DSH, better hospital patient experience was associated with lower spending per episode (5.6% decrease from the lowest to highest patient experience star rating). Conclusion: We found that better hospital patient experience was associated with lower health-care spending. Further research is needed to define what specific elements and phases of the episode of care are driving the association.