Neuroradiologic aspects of pediatric orthotopic liver transplantation

To investigate the occurrence of neurologic symptomatology in pediatric orthotopic liver transplantation patients and to evaluate the utility of CT in uncovering the origin of their symptoms, we reviewed the medical records and head scans (when performed) of 71 patients. Neurologic problems occurred in 48%; the majority involved seizures, mental status changes, or coma. Patients who only had seizures generally had negative CT scans, except for two patients with minimal subarachnoid hemorrhages. Three-quarters of the comatose patients, however, had significant intracerebral hemorrhages defined by CT. Prominent sulci and ventricles were found in approximately one-third of the patients scanned, but did not correlate with symptomatology or steroid dose

Wide variation and rising utilization of stroke magnetic resonance imaging: Data from 11 States

Objective: Neuroimaging is an essential component of the acute stroke evaluation. Magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) for the diagnosis of stroke, but is more costly and time‐consuming. We sought to describe changes in MRI utilization from 1999 to 2008. Methods: We performed a serial cross‐sectional study with time trends of neuroimaging in patients with a primary International Classification of Diseases, 9th Edition, Clinical Modification discharge diagnosis of stroke admitted through the emergency department in the State Inpatient Databases from 10 states. MRI utilization was measured by Healthcare Cost and Utilization Project criteria. Data were included for states from 1999 to 2008 where MRI utilization could be identified. Results: A total of 624,842 patients were hospitalized for stroke in the period of interest. MRI utilization increased in all states. Overall, MRI absolute utilization increased 38%, and relative utilization increased 235% (28% of strokes in 1999 to 66% in 2008). Over the same interval, CT utilization changed little (92% in 1999 to 95% in 2008). MRI use varied widely by state. In 2008, MRI utilization ranged from a low of 55% of strokes in Oregon to a high of 79% in Arizona. Diagnostic imaging was the fastest growing component of total hospital costs (213% increase from 1999 to 2007). Interpretation: MRI utilization during stroke hospitalization increased substantially, with wide geographic variation. Rather than replacing CT, MRI is supplementing it. Consequently, neuroimaging has been the fastest growing component of hospitalization cost in stroke. Recent neuroimaging practices in stroke are not standardized and may represent an opportunity to improve the efficiency of stroke care. Ann Neurol 2012;71:179–185Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90061/1/22698_ftp.pd

Unmasking Male Voices in \u3cem\u3eWoman Hollering Creek\u3c/em\u3e: Contributions to Pedagogy and Masculinity Studies

In teaching Sandra Cisneros’ Woman Hollering Creek to undergraduates, we have developed a sociocultural and historical framework, beginning with the theoretical work of Gloria Anzaldúa’s Borderlands and the concept of transfrontera feminism. With incidents of seduction and sexual abuse of women, spousal abuse, and patriarchal family structures, the collection of stories strongly indicates the oppressive representation of machismo. Scholars and teachers have drawn important critiques of Cisneros’s work based on destructive sociocultural forces on women. However, in rereading the text with an intended focus on the representations of male characters, we have surmised that Cisneros structured the stories in the text to reveal that men are simultaneously affected by sociocultural pressures. The male characters in this story collection play an important role beyond the characterization as oppressors. Cisneros’s stories have helped us unmask important social forces that affect not only Chicana characters, but husbands, lovers, and even neglected fathers. Male characters in Woman Hollering Creek also have basic needs for food, shelter, love, and dignity, and they too suffer the consequences of politically charged borders. Furthermore, these masculinity effects may not often be acknowledged in teaching literature courses. The pain and struggle of male and female genders are aligned within this collection; there are several male characters who signify masculinity, and compassion, and beauty. Therefore, in revising our curricula, we intend to place some stories from Woman Hollering Creek and Rigoberto González’s Men without Bliss (2008) in conversation with each other. We do not intend to privilege one writer against another, but encourage students to consider the contributions and limitations of each in terms of theme, characterization, plot, and literary technique. It is our intention to teach students that Cisneros’s Woman Hollering Creek humanizes both men and women in their strength, frailty, and quest for love

129 Xe chemical shift in human blood and pulmonary blood oxygenation measurement in humans using hyperpolarized 129 Xe NMR

Purpose: To evaluate the dependency of the 129 Xe-red blood cell (RBC) chemical shift on blood oxygenation, and to use this relation for noninvasive measurement of pulmonary blood oxygenation in vivo with hyperpolarized 129 Xe NMR. Methods: Hyperpolarized 129 Xe was equilibrated with blood samples of varying oxygenation in vitro, and NMR was performed at 1.5 T and 3 T. Dynamic in vivo NMR during breath hold apnea was performed at 3 T on two healthy volunteers following inhala- tion of hyperpolarized 129 Xe. Results: The 129 Xe chemical shift in RBCs was found to increase nonlinearly with blood oxygenation at 1.5 T and 3 T. During breath hold apnea, the 129 Xe chemical shift in RBCs exhibited a periodic time modulation and showed a net decrease in chemical shift of ~ 1 ppm over a 35 s breath hold, corresponding to a decrease of 7–10 % in RBC oxygenation. The 129 Xe-RBC signal amplitude showed a modulation with the same frequency as the 129 Xe-RBC chemical shift. Conclusion: The feasibility of using the 129 Xe-RBC chemical shift to measure pulmonary blood oxygenation in vivo has been dem- onstrated. Correlation between 129 Xe-RBC signal and 129 Xe-RBC chemical shift modulations in the lung warrants further investiga- tion, with the aim to better quantify temporal blood oxygenation changes in the cardiopulmonary vascular circuit

Initial clinical use of a novel mechanical thrombectomy device, XCOILTM, in hemodialysis graft and fistula declot procedures

PURPOSEWe aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae.METHODSIn 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32–69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOILTM was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOILTM performance were documented.RESULTSThrombosis occurred 1–30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10–50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOILTM removed 80%–100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOILTM required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOILTM, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOILTM use occurred.CONCLUSIONXCOILTM is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics

Cerebral angiography in meningeal sarcomatosis and carcinomatosis

The angiographic findings in a case of metastatic meningeal carcinomatosis and a case of primary meningeal sarcomatosis are presented. The presence of focal arterial narrowing at the base of the brain and/or over the cerebral convexities, with or without a communicating hydrocephalus, may be the important clues to a diagnosis of diffuse meningeal involvement by tumor. In a patient who presents with bizarre and poorly localizing signs and symptoms, when the cerebrospinal fluid analysis does not fully support a diagnosis of meningitis or subarachnoid hemorrhage, and when there is nothing in the history to suggest drug abuse or a systemic collagen disease, the angiographic findings may point to an unexpected diffuse meningeal tumor. Les auteurs rapportent les données angiographiques dans lun cas de carcinomatose méningée métastatique et dans un cas de sarcomatose méningée primitive. La présence de sténoses artérielles localisées à la base du cerveau et/ou au niveau des convexités cérébrales avec ou sans hydrocéphalie communicante peuvent représenter des signes importants en faveur d'un envahissement tumoral méningé diffus. Chez un malade présentant une symptomatologie atypique et mal localisée, lorsque l'examen du liquide céphalo-rachidien ne parle pas franchement en faveur d'une méningite ou d'une hémorragie méningée et lorsque l'anamnèse n'évoque aucune intoxication exogène ni collagénose, les données angiographiques peuvent faire découvrir une tumeur méningée diffuse. In der vorliegenden Arbeit werden die angiographischen Befunde eines Falles einer metastatischen meningealen Karzinomatose und eines Falles einer primären meningealen Sarkomatose geschildert. Dabei läßt sich besonders die umschriebene arterielle Gefäßeinengung an der Basis des Gehirns und/oder über den Konvexitäten beobachten. Dieser Befund kann mit einem Hydrocephalus communicans kombiniert sein. Wenn bei einem Patienten merkwürdige und schlecht lokalisierbare neurologische Symptome vorliegen, wenn durch die Liquoruntersuchung die Diagnose einer Meningitis oder einer Subarachnoidalblutung nicht gesichert werden kann und wenn bei dem Patienten auch kein Drogen-Abusus besteht, ist bei den beschriebenen angiographischen Veränderungen an eine diffuse meningeale Tumorabsiedlung zu denken.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46669/1/234_2004_Article_BF00341592.pd

Modern meningioma imaging techniques

Steady improvements in imaging modalities have enabled a new realm of capabilities in the identification and assessment of meningiomas. The cross-sectional imaging modalities, MRI and CT, have improved in resolution and fidelity. These modalites now provide not only improved structural information but also insights into functional behavior. MRI has, in particular, proven to have powerful capabilities in evaluating meningiomas because of the ability to assess soft tissue characteristics such as diffusion and vascular supply information, such as perfusion. Recent investigational advances have also been made using a combination of X-ray fluoroscopy for selective catheterization followed by MR perfusion measurement performed with intra-arterial injection of contrast. Together all these modalities provide the radiographer with powerful capbilities for evaluating meningiomas