bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial Differences in the Living Kidney Donation Experience and Implications for Education
Authors: Lunsford Shayna L. , Shilling Lilless M. , Chavin Kenneth D. , Martin Margaret S. , Miles Lucia G. , Norman Michele L. , Baliga Prabhakar K. 
Published: January 2017

Context Much has been written about the barriers to deceased organ donation in the African American community. However, relatively little research has been conducted on barriers to living donation among African Americans. A shortage of suitable deceased donor kidneys among African Americans has encouraged donation from living donors. Objective As a follow-up to several focus groups with health professionals about barriers to living donation and suggestions for educational interventions, we sought to determine kidney donors' thoughts and feelings about their donation. Design Telephone interviews with past donors. Participants Nine African Americans and 9 whites were selected from a database of laparoscopic donor nephrectomies from 1993 to 2003. Outcome Measures Transcribed phone interviews were reviewed by 3 researchers to determine recurring themes and categorize responses. Results Responses were categorized into 8 areas of concern: health, financial, life with 1 kidney, procreation, psychosocial matters, surgery related, success of the transplant, and concerns about the future. Whites (n =9) tended to volunteer more for laparoscopic kidney donation than did African Americans (n = 2). African American concerns focused on future health and living with only 1 kidney, whereas whites had concerns about the surgery and the medical system. Conclusions Findings indicated that education is the best way to reach living donors and dispell fears. Promoting general health of African Americans may increase their willingness to be a living donor. Altruistic motives are the main motivation for donation, and intervention programs should target groups on a personal level to help individuals see that they can make a difference in improving or saving lives.
Targeting Stem Cells in Brain Tumors
Authors: Lasky Joseph L. , Liau Linda M. 
Published: January 2017

Stem cells are commonly defined as undifferentiated cells capable of self-renewing and giving rise to a large number of differentiated progeny. It is becoming increasingly apparent that there exist cancer stem cells (CSCs) from which the cells of any given malignancy arise, whereby only a few cells out of a population of cancer cells are able to initiate tumor formation. These CSCs, like their normal counterparts, are characterized by self-renewal and the ability to “differentiate” into all of the cell types in the original tumor. Current chemotherapeutic strategies involve using non-specific cytotoxic agents that target rapidly cycling cells. Although this may reduce disease burden in many cases, these therapies may miss the rare, self-renewing population that truly gives rise to the malignancy (the CSC). This review will focus on the recent discovery of stem cell-like cells in human brain tumors, putative “brain cancer stem cells,” which exhibit the properties of self-renewal and the ability to recapitulate the original tumor heterogeneity. Dissecting the molecular mechanisms that underlie the ability of these cells to self-renew and maintain quiescence may allow the development of novel therapeutic strategies that will allow for more efficacious and less toxic therapies for these devastating malignancies.
Concomitant Conus Medullaris Arteriovenous Malformation and Sacral Dural Arteriovenous Fistula of the Filum Terminale
Authors: Hsu SW , Rodesch G , Luo CB , Chen YL , Alvarez H , Lasjaunias PL 
Published: January 2017

A patient with a spinal intradural arteriovenous malformation (AVM) at the conus medullaris concomitant with a sacral dural arteriovenous fistula (AVF) of the filum terminale is reported. A 44-year-old-male presentied with bilateral leg weakness and urinary incontinence for several months. Spinal angiography demonstrated two lesions: one was spinal intradural AVM at the conus medullaris supplied by the anterior spinal artery; the other was sacral dural AVF of the filum terminale supplied by the middle sacral artery. Although multifocal spinal cord AVMs have been reported, this is the first case report of two different types of vascular malformations coexisting in one patient. The arterial supply of the dural AVF of the filum by the middle sacral artery is also first demonstrated in the literature. The patient was treated successfully by surgical approach for both lesions in the same operation.
Persistent Autoregulatory Disturbance after Angioplasty for Cerebral Vasospasm
Authors: Song D.K. , Harrigan M.R. , Deveikis J.P. , McGillicuddy J.E. 
Published: January 2017

Hyperdynamic therapy, consisting of hypervolemia, haemodilution, and hypertension, is an established treatment for cerebral vasospasm following subarachnoid haemorrhage. Angioplasty has emerged as an additional, effective treatment for symptomatic vasospasm. Loss of autoregulation, however, can occur despite effective angioplasty, underscoring the need for treatment with hyperdynamic therapy in combination with angioplasty. A 43-year-old woman underwent endovascular coiling of a ruptured left posterior communicating artery aneurysm. The patient went on to develop symptomatic vasospasm and was treated with hyperdynamic therapy and angioplasty. Autoregulation was assessed with xenon CT cerebral blood flow (CBF) measurement. An initial CBF study was obtained when the patient received dopamine and dobutamine infusions to maintain systolic blood pressure at 160 mmHg. The vasopressor drips were then temporarily held for twenty minutes, allowing the patient's systolic blood pressure to drop to 140 mmHg, and a repeat CBF study was obtained. Several days after angioplasty, CBF decreased significantly when the patient was taken off vasopressors, indicating impaired autoregulation. Hyperdynamic therapy was continued, and another CBF study one week later showed a return of autoregulation and normalization of CBF without induced hypertension. Autoregulation is disturbed during vasospasm. Although angioplasty can improve large artery blood flow during vasospasm, hyperdynamic therapy is also needed to maintain cerebral perfusion, particularly in the face of impaired autoregulation. Quantitative CBF measurement permits the maintenance of optimal CBF and monitoring of response to therapy.
Clinical Results and Pathological Findings of Stent-Assisted Coil Embolization for Basilar Artery Trunk Dissecting Aneurysms
Authors: Nagashima H. , Hongo K. , Matsumoto Y. , Oya F. , Kobayashi S. , Higuchi K. 
Published: January 2017

Stent-assisted coil embolization is a new method for treating dissecting or fusiform aneurysm, especially the aneurysms arising from the basilar artery trunk or dominant vertebral artery. At present, this technique is considered as an effective treatment option to obliterate such aneurysm keeping the parent artery patent. Several authors reported the effectiveness and excellent radiological result of this treatment, but fewer reports focus on the limitations of this technique. We treated two patients with a basilar artery trunk dissecting aneurysm with this technique. Transient ischemic symptoms were observed in one patient and haemorrhagic and thromboembolic complications were observed the other. We lost the latter patient due to postoperative complications, and the pathological finding was achieved by autopsy. We report the clinical and pathological findings in the two cases and investigate the efficacy and limitations of this technique.
Intra-arterial Chemotherapy for Malignant Tumors of Head and Neck Region Using Three Types of Modified Injection Method
Authors: Kumagai T. , Takeda N. , Fukase S. , Koshu H. , Inoue A. , Ibuchi Y. , Yoneoka Y. 
Published: January 2017

Relatively higher infusion rate in the intra-arterial chemotherapy (IA chemotherapy) could induce the higher concentration and the more sufficient distribution of chemotherapeutic agents on tumors. To get the relatively higher infusion rate in IA chemotherapy, we used three types of injection method: high-flow injection, high-dose injection with detoxification and flow-controlled injection method for the treatment of malignant brain tumors, skull base tumors and head and neck tumors. Between January 1997 and October 2001, twenty-seven patients (mean age 61 y.o.) with supratentorial glioblastoma (4 cases), supratentorial anaplastic astrocytoma (1), CNS lymphoma (2), matastatic skull base tumors (3), and neck tumors (15 squamous cell carcinoma, 1 malignant melanoma and 1 neuroblastoma) received our three types of IA chemotherapy. Sixty-five consecutive procedures were performed. Conventional radiation therapy and/or surgical removal were performed in some of these patients. The median follow-up period was 10 months ranging 2 to 56 months. Fifteen (55.6%) and 6 (22.2%) of 27 patients achieved complete response (CR) and partial response (PR) respectively after initial treatment [CR+PR: 21 (77.8%)]. All responded patients showed clinical improvement. The response rate declined to 55.6% at the end of follow-up period. Eighteen patients are still alive and 15 of them show no evidence of local recurrence. The median post treatment survival was 12 months. There was no serious complication except transient nausea in 4 of 27 (14%) patients, vertigo and granulocytopenia in 1 each (3%) of 27 patients. Our modified IA chemotherapy has provided favorable clinical and radiological results without technical difficulties and serious complications.
Training in Neurovascular Intervention Usefulness of in-Vitro Model and Clinical Practice
Authors: Sugiu K. , Tokunaga K. , Sasahara W. , Watanabe K. , Nishida A. , Katsumata A. , Kusaka N. , Date I. , Ohmoto T. , Rufenacht D.A. 
Published: January 2017

We introduce our training tools and system of neurovascular intervention. An in vitro cerebral vascular model was used for the young residents to understand the basic interventional techniques and devices. The model included several vascular lesions such as cerebral aneurysm, dural arterio-venous fistula, or carotid artery stenosis. Endovascular procedures in the model were performed under fluoroscopic or direct visual control, and consecutive haemodynamic changes were visualized by using digital subtraction angiography and direct observation. Thus, traineess could have an easy understanding of clinical conditions. New medical devices, such as platinum coils, were successfully implanted in the model under stable conditions. After the initial training using vascular model, the residents had started clinical experiences under the control of senior surgeons. Although it is difficult to describe usefulness of our clinical training, we believe that we provide enough good quality and quantity of clinical cases to the residents. Because our endovascular team has recently had 150–200 interventional procedures every year, one resident can have experienced more than 100 cases per year. The qualification of a Board Certified Specialist of the Japanese Society of Intravascular Neurosurgery (JSIN) requires that the applicant must have experienced more than 100 cases for four years. So our residents can have enough case materials to qualify the board examination.
The Choice of Treatment Method for Unruptured Cerebral Aneurysm
Authors: Manabe H. , Takemura A. , Hasegawa S. , Nagahata M. , Islam S. 
Published: January 2017

To compare complications, anigographical results, duration of postoperative hospital stay and cost for treatment of surgical clipping and coil embolization in the treatment of unruptured cerebral aneurysm. One hundred and nine non-giant saccular aneurysms in 90 patients were treated by either endovascular treatment (E group) or direct surgery (S group) in our Neurosurgical Department between April 1996 and April 2002. The complications and angiographical results were reviewed. The duration of postoperative hospital stay and cost for the treatment were calculated from bills for health insurance for 38 operations and 12 embolizations in 47 patients whose aim of hospitalization was only treatment for their unruptured aneurysm. Neck clipping was performed for 89 aneurysms (S group), wrapping for four (S group), embolization using Guglielmi's detachable coils (GDCs) for 15 (E group), and failed embolization followed by clipping for one (E group). The postoperative temporary deficit (disappeared within one month) and permanent deficit was seen in five cases (6.7%) and in three cases (morbidity: 4.0%) of S group, and in one case (6.7%) and none (morbidity; 0%) of E group, respectively. No death was seen in both group (mortality; 0% in both group). The rate of angiographical complete occlusion of the aneurysm was significantly higher in S group (P = 0.015, 88% in S group vs 50% in E group). The postoperative hospital stay was significantly shorter in E group (P= 0.000013, mean days: 17.1 in S group vs 6.3 in E group), but cost for treatment was rather cheep in S group (N.S., mean cost: 1684329 yen in S group vs. 2259011 in E group). This retrospective study suggested that surgical treatment may be less expensive treatment with higher rate of postoperative angiographical complete occlusion than coil embolization, and treatment-related complication rate was similar in both treatment.
Morphologic and Haemodynamic Changes after Stent Placement for Experimental Carotid Aneurysm
Authors: Tenjin H. 
Published: January 2017

We investigated and compared the morphologic and haemodynamic changes between 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 stent placement, the arteries were perfused with 70% ethanol, the specimens were embedded in polyester plastic resin and thin slices were stained with hemtoxilin-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.
Percutaneous Transluminal Angioplasty for Atherosclerotic Stenoses of Intracranial Vessels
Authors: Matsumaru Y. , Tsuruta W. , Takigawa T. , Hyodo A. , Sato H. , Matsumura A. 
Published: January 2017

To study the efficacy and long-term outcome of percutaneous transluminal angioplasty (PTA) with/without stent placement for intracranial atherosclerotic stenoses, we reviewed our treated cases retrospectively. Between May 1992 and October 2003, PTA with/without stents was performed in 64 intracranial and skull base vessels in 62 patients, including 24 middle cerebral arteries, 16 internal carotid arteries, 13 vertebral arteries, and 11 basilar arteries. PTA was technically successful in 55 vessels (86%). However, four vessels (6%) failed to achieve satisfactory dilatation. We encountered five periprocedural strokes as symptomatic complications, for a mortality rate of 4.7% and a morbidity rate of 3.1%. All the patients with stent placements survived angioplasty without any complication. In the clinical follow-up available for one week to 11.5 years (mean, 4.7 years), there were three strokes related to the treated vessels. The annual stroke rate in the affected territory was estimated at 1.2% per year. According to these results, PTA for intracranial atherosclerotic stenoses seems to be a beneficial therapy for immediate anatomical results and long-term stroke prevention. Stent-assisted PTA could help patients achieve successful dilatation and avoid complications.
Early Treatment for Ruptured Cerebral Aneurysms
Authors: Kobayashi S. , Koguchi Y. , Fujikawa A. , Wada M. , Oish H. , Miysta A. , Nakamura H. , Yagishita T. 
Published: January 2017

The purpose of this study was to evaluate the effect of endovascular treatment with Guglielmi detachable coils (GDC) on the outcomes of subarachnoid haemorrhage (SAH) patients of poor grades and high ages for each location of aneurysms. Between 1990 and 2003, 529 SAH cases underwent angiograghy as candidates of early aggressive treatment in our hospital. For the 299 cases in 1990–96 (Group 1), treatment options were early and intensively delayed craniotomy surgery and conservative management, while for the 230 cases in 1997–2003 (Group 2), GDG embolization at acute stage was added to these three treatment options. We compared clinical courses and outcomes of the poor grade (Hunt & Kosnik Grade 4–5) patients and high age (> =70 years old) patients between two groups for each location of aneurysms. Introduction of GDC embolization expanded the indication for early treatment in the poor grade patients with anterior communicating artery aneurysm (A-Comm An), the high age patients with internal carotid artery aneurysm (IC An) and all patients with Basilar bifurcation aneurysm (BA-Top An), and has contributed to improvement of their outcomes. To the poor grade patients with middle cerebral artery aneurysm (MCA An), GDC embolization was hardly indicated, because haematoma evacuation concomitantly performed with aneurysm occlusion would be necessary for those patients. In conclusion, results of treatment with GDC embolization at an acute stage are desirable for poor grade patients with A-Comm An, aged patients with IC An and all patients with BA-Top An. The indication of GDC embolization for the patients with MCA An is limited.
Clinical Outcomes of Coil Embolization for Acutely Ruptured Aneurysm
Authors: Hirohata M. , Abe T. , Fujimura N. , Takeuchi Y. , Morimitsu H. , Shigemori M. 
Published: January 2017

The purpose of this prospective study was to evaluate clinical results in patients with acutely ruptured cerebral aneurysm treated by neck clipping (NC) or coil embolization (CE) when CE was considered the first option. Between 1998 and 2003, 280 patients with acutely ruptured cerebral aneurysms excluding intracerebral hematoma were evaluated. Patients were managed prospectively according to the following protocol: primary treatment modality was CE (n =179). NC (n=101) was selected for the patients with aneurysms that were small (less than 2 mm) or an unsuitable shape for CE. Surgical complication rates were 4.5% for CE and 16.8% for NC. Symptomatic vasospasm occurred in 8.4% of CE patients and 29% of NC patients. Good recovery on the Glasgow Outcome Scale was achieved by 71% of CE patients and 50% of NC patients at discharge. Surgical complications and symptomatic vasospasm were significantly reduced in CE compared to NC. Clinical outcome at discharge was also better with CE. Although 18.3% of CE patients showed various degrees of aneurysmal recanalization and 7% of CE patients required additional treatment (re-CE or NC), aneurysmal rebleeding occurred in only one patient during follow-up (mean, 3.95 years).
Facial Vein Catheterization for Transvenous Embolization of the Cavernous Sinus
Authors: Karygiannis M.N. , Szatmary Z. , Claudino P.A. , Houdart E. 
Published: January 2017

We describe three cases of transvenous embolization of arteriovenous fistulas of the cavernous sinus, achieved through the facial vein approach. The facial vein was catheterized from a jugular vein access. This cervical approach offered good stability to the guiding catheter that permitted us to negotiate difficult curves of the facial vein and to recanalize venous thrombosis in one case.
Results of Endovascular Management for Mid-Basilar Artery Aneurysms
Authors: Zhang J. , Zhang R. , Wu Z. , Lv X. , Liu B. 
Published: January 2017

We evaluated the results of endovascular management of patients with mid-basilar artery aneurysm (mBAA). During a seven year period, 14 patients (mean age 39.6 years, male/female ratio 1:1) with mBAA were treated with endovascular techniques at our institute. Pretreatment clinical grades were determined using the Hunt-Hess scale. Outcome was evaluated using the Glasgow Outcome Scale scores (GOS) during a mean follow-up period of 15.6 months (range, three to 70 months). Fourteen patients with 15 mBAAs were treated endovascularly. Four (28.6%) patients died of rebleeding within one day after embolization. In ten mBAAs, immediate postprocedural angiograms showed that complete occlusion was achieved, subtotal occlusion in one, and incomplete occlusion in four. Follow-up angiographic results in ten patients confirmed complete occlusion of 11 aneurysms. Long-term outcome was good (GOS Score 4 or 5) in ten patients (71.4%) and fatal (GOS Score 1) in four (28.6%). Favorable overall long-term outcome can be achieved in 78.6% patients with mBAAs. Endovascular management of mBAAs is an effective treatment in the long-term. In our experience, the natural history of mBAAs is dismal.
Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning
Authors: Kochar P.S. , Morrish W.F. , Hudon M.E. , Wong J.H. , Goyal M. 
Published: January 2017

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.
Radiosurgery following Embolisation and/or Surgery of Brain AVM's
Authors: Killer M. , Kitz K. , Griffitt W. , Bavinzski G. , Gruber A. , Richling B. 
Published: January 2017

A series of 45 patients who have undergone combined treatment for cerebral arteriovenous malformations (AVM's) is presented. All patients underwent additional radiosurgery after endovascular and/or surgical treatment. Stereotactic radiosurgical treatment using the Gamma knife has been available in our institution since 1992. The treatment strategy for brain AVM's has changed since that time. The possibility for total cure of partially embolised AVM's, where other treatment options had been exhausted, increased with adjunctive radiosurgery. Complex or giant AVM's in eloquent areas can now be treated using radiosurgery after embolisation and/or microsurgery, with minor risk of neurological deficit. In all 45 patients treated since September 1992 at the University of Vienna, embolisation was performed to reduce the size of the nidus in order to facilitate surgical resection or radiosurgical treatment. In 37 patients radiosurgery was performed after endovascular treatment only, and in 8 patients radiosurgery was performed after embolisation and surgery. All AVM's were classified according to Spetzler's Grading System. 31 patients (68.9%) were classified as Grade 3 or 4. Two patients (4.5%) were classified as Grade 5. In a mean follow up time of 16 months (range 2–40), there were 15 complete obliterations and 2 patients with unexpected residual AVM after two years. Of patients who required staged radiosurgical therapy, 12 have been followed for less than two years after their final procedure. In an additional 12 patients the follow-up period is less than 12 months. 4 patients were lost to follow up. There is a morbidity of 8.8% and no mortality in this patient group.