Interventional Neuroradiology: Henry Ford Hospital Experience with Nonembolization Procedures

Innovative technical developments over the past two decades have resulted in the development of a variety of useful interventional procedures for minimally invasive treatment of a variety of head and neck lesions. We have had experience with four different types of nonembolization interventional neuroradiologic procedures at Henry Ford Hospital from 1981 through 1985. Percutaneous transluminal angioplasty of six external carotid artery stenoses has been performed in five patients. Five were successful, and the artery became occluded in one patient. Intracarotid BCNU infusion was performed successfully in five patients with recurrent astrocytoma. Intraarterial streptokinase infusion was performed in one patient with acute thrombosis of an ectatic basilar artery. A traumatic carotid cavernous fistula was successfully closed by detachable silicone balloon technique

Interventional Neuroradiology: Henry Ford Hospital Experience with Transcatheter Embolization of Vascular Lesions in the Head, Neck, and Spine

Innovative developments over the past 15 years have resulted in increased sophistication and effectiveness of therapeutic neuroembolization procedures. As a result, percutaneous transcatheter embolization has assumed an increasingly important role in the management of patients with vascular lesions of the head, neck, and spine. By reducing bleeding during surgery, this technique can markedly facilitate the surgical approach to difficult vascular lesions. The technique may also be applied in cases where surgery is contraindicated. Therapeutic neuroembolization has been performed in 23 patients with vascular lesions of the head, neck, or spine at Henry Ford Hospital. Devascularization of the extraaxial blood supply was achieved in all cases, and no neurologic complications were encountered. Eighteen patients with vascular tumors of the head, neck, or spine and three patients with arteriovenous malformations (AVM) were embolized preoperatively, resulting in marked facilitation of the surgical procedures. One patient with a dural AVM and one with a spinal metastasis were embolized without surger

Comparison of CT and integrated PET-CT based radiation therapy planning in patients with malignant pleural mesothelioma

<p>Abstract</p> <p>Background</p> <p>When combined with adequate tumoricidal doses, accurate target volume delineation remains to be the one of the most important predictive factors for radiotherapy (RT) success in locally advanced or medically inoperable malignant pleural mesothelioma (MPM) patients. Recently, 18-fluorodeoxyglucose positron emission tomography (PET) has demonstrated significant improvements in diagnosis and accurate staging of MPM. However, role of additional PET data has not been studied in RT planning (RTP) of patients with inoperable MPM or in those who refuse surgery. Therefore, we planned to compare CT with co-registered PET-CT as the basis for delineating target volumes in these patients group.</p> <p>Methods</p> <p>Retrospectively, the CT and co-registered PET-CT data of 13 patients with histologically proven MPM were utilized to delineate target volumes separately. For each patient, target volumes (gross tumor volume [GTV], clinical target volume [CTV], and planning target volume [PTV]) were defined using the CT and PET-CT fusion data sets. The PTV was measured in two ways: PTV1 was CTV plus a 1-cm margin, and PTV2 was GTV plus a 1-cm margin. We analyzed differences in target volumes.</p> <p>Results</p> <p>In 12 of 13 patients, compared to CT-based delineation, PET-CT-based delineation resulted in a statistically significant decrease in the mean GTV, CTV, PTV1, and PTV2. In these 12 patients, mean GTV decreased by 47.1% ± 28.4%, mean CTV decreased by 38.7% ± 24.7%, mean PTV1 decreased by 31.1% ± 23.1%, and mean PTV2 decreased by 40.0% ± 24.0%. In 4 of 13 patients, hilar lymph nodes were identified by PET-CT that was not identified by CT alone, changing the nodal status of tumor staging in those patients.</p> <p>Conclusion</p> <p>This study demonstrated the usefulness of PET-CT-based target volume delineation in patients with MPM. Co-registration of PET and CT information reduces the likelihood of geographic misses, and additionally, significant reductions observed in target volumes may potentially allow escalation of RT dose beyond conventional limits potential clinical benefits in tumor control rates, which needs to be tested in future studies.</p

A Novel Classification of Lung Cancer into Molecular Subtypes

The remarkably heterogeneous nature of lung cancer has become more apparent over the last decade. In general, advanced lung cancer is an aggressive malignancy with a poor prognosis. The discovery of multiple molecular mechanisms underlying the development, progression, and prognosis of lung cancer, however, has created new opportunities for targeted therapy and improved outcome. In this paper, we define “molecular subtypes” of lung cancer based on specific actionable genetic aberrations. Each subtype is associated with molecular tests that define the subtype and drugs that may potentially treat it. We hope this paper will be a useful guide to clinicians and researchers alike by assisting in therapy decision making and acting as a platform for further study. In this new era of cancer treatment, the ‘one-size-fits-all’ paradigm is being forcibly pushed aside—allowing for more effective, personalized oncologic care to emerge

Global impact of COVID-19 on stroke care and IV thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.Paroxysmal Cerebral Disorder

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Effect of Dangling Bonds on De-Poling Time for Polymeric Electric Field Optical Sensors

This paper investigates the possible chemical changes in polydimethylsiloxane (PDMS) caused by two different techniques of fabrication for ultra-sensitive electric field optical sensors. The sensing element is a micro-sphere made from 60:1 PDMS (60 parts base silicon elastomer to one part polymer curing agent by volume). The measurement principle is based on the morphology dependent resonances (MDR) shifts of the micro-sphere. We present the effects of curing and poling of polymer micro-spheres used as optical sensors. The degree of curing leads to changes in the de-poling time which results from dangling bonds in the polymeric chains. Consequently, the longevity of the sensitivity of the sensor can extended by two orders of magnitude. An analysis is carried out along with preliminary experiments to investigate that behavior