Radiography of thoracic intravascular stents in children with congenital heart disease

Seventeen balloon expandable stents were placed in thoracic vessels in eleven children with vascular stenoses related to congenital heart lesions. We describe the normal radiographic appearance of three types of balloon expandable stents implanted in pulmonary arteries, pulmonary veins, and the superior vena cava of these children as well as the appearance of the complications we encountered. Knowledge of the radiographic appearance of these devices is important as chest radiography is a primary method of follow-up in children with balloon expandable stents placed to treat stenoses of intrathoracic vessels related to congenital heart disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46700/1/247_2005_Article_BF02012400.pd

Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

AbstractOBJECTIVES: The full potential of stereotactic body radiation therapy (SBRT), in the treatment of unresectable intrahepatic malignancies, has yet to be realized as our experience is still limited. Thus, we evaluated SBRT outcomes for primary and metastatic liver tumors, with the goal of identifying factors that may aid in optimization of therapy. METHODS: From2005 to 2010, 62 patients with 106 primary and metastatic liver tumors were treated with SBRT to a median biologic effective dose (BED) of 100 Gy (42.6-180). The majority of patients received either three (47%) or five fractions (48%). Median gross tumor volume (GTV) was 8.8 cm3 (0.2-222.4). RESULTS: With a median followup of 18 months (0.46-46.8), freedom from local progression (FFLP) was observed in 97 of 106 treated tumors, with 1- and 2-year FFLP rates of 93% and 82%. Median overall survival (OS) for all patients was 25.2 months, with 1- and 2-year OS of 81%and 52%. Neither BED nor GTV significantly predicted for FFLP. Local failure was associated with a higher risk of death [hazard ratio (HR) = 5.1, P = .0007]. One Child-Pugh Class B patient developed radiationinduced liver disease. There were no other significant toxicities. CONCLUSIONS: SBRT provides excellent local control for both primary and metastatic liver lesions with minimal toxicity. Future studies should focus on appropriate selection of patients and on careful assessment of liver function to maximize both the safety and efficacy of treatment

Long-term morphological and hormonal follow-up in a single unit on 115 patients with adrenal incidentalomas

We investigated the natural course of adrenal incidentalomas in 115 patients by means of a long-term endocrine and morphological (CT) follow-up protocol (median 4 year, range 1–7 year). At entry, we observed 61 subclinical hormonal alterations in 43 patients (mainly concerning the ACTH–cortisol axis), but confirmatory tests always excluded specific endocrine diseases. In all cases radiologic signs of benignity were present. Mean values of the hormones examined at last follow-up did not differ from those recorded at entry. However in individual patients several variations were observed. In particular, 57 endocrine alterations found in 43 patients (37.2%) were no longer confirmed at follow-up, while 35 new alterations in 31 patients (26.9%) appeared de novo. Only four alterations in three patients (2.6%) persisted. Confirmatory tests were always negative for specific endocrine diseases. No variation in mean mass size was found between values at entry (25.4±0.9 mm) and at follow-up (25.7±0.9 mm), although in 32 patients (27.8%) mass size actually increased, while in 24 patients (20.8%) it decreased. In no case were the variations in mass dimension associated with the appearance of radiological criteria of malignancy. Kaplan–Meier curves indicated that the cumulative risk for mass enlargement (65%) and for developing endocrine abnormalities (57%) over time was progressive up to 80 months and independent of haemodynamic and humoral basal characteristics. In conclusion, mass enlargement and the presence or occurrence over time of subclinical endocrine alterations are frequent and not correlated, can appear at any time, are not associated with any basal predictor and, finally, are not necessarily indicative of malignant transformation or of progression toward overt disease

Screening for Dementia among Adults with Intellectual Disability: Outcomes from a Pilot Study

Introduction Screening for dementia among individuals with ID is important to identify individuals in need of care and support. The objective of this pilot study was to identify obstacles associated with screening and assessment of dementia among older adults with ID in a crisis-prone population. Method The Early Detection Screen for Dementia (EDSD) was administered to eligible enrollees ages 50 years and older within the START (Systemic, Therapeutic, Assessment, Resources, and Treatment) program. Focus groups were carried out to understand the barriers to screening and diagnosis of dementia. Results Of the 95 eligible enrollees, 63 participants had dementia screening tools completed. Obstacles identified through focus groups included difficulty differentiating changes from baseline function, competing priorities in this crisis-prone population, lack of access to providers, and an unclear understanding of the benefit or purpose of screening among some caregivers. START coordinators noted that the EDSD provided a helpful way to collect information and document changes in the enrollee’s functioning. Conclusions The EDSD may be helpful for capturing potential dementia-associated changes overtime in crisis-prone adults with ID, though obstacles remain to the access of further evaluation for dementia

Clinical applications of the VIA Inventory of Strengths with Individuals with Intellectual/Developmental Disabilities

Strengths-based clinical practices are critical for supporting the wellbeing of individuals with intellectual and/or developmental disabilities. The VIA Inventory of Strengths (‘VIA Survey’) is an assessment grounded in positive psychology that may contribute to strengths-based practices. To identify how this assessment is used in clinical practice with individuals with intellectual and/or developmental disabilities, we conducted focus groups (n = 15) with clinicians who have used this survey with this population. We also asked individuals with intellectual and/or developmental disabilities (n = 36) to comment on the process of completing the VIA Survey. We found that clinicians utilize the VIA Survey with individuals with intellectual and/or developmental disability to foster self-esteem and self-understanding, provide a framework for understanding strengths, communicate across service systems and shape strengths-based interventions. Individuals with intellectual and/or developmental disabilities also endorsed use of the survey to increase their self-knowledge and self-esteem. Future research should address accessibility of the survey to foster greater uptake and propose standard protocols for independent survey completion