Embolization of Dural Carotid-Cavernous Fistulas via the Thrombosed Superior Ophthalmic Vein

WOS: 000321698400015PubMed ID: 23715515Purpose: To present the authors' experience treating dural carotid-cavernous sinus fistulas (CCF) with retrograde embolization via the thrombosed superior ophthalmic vein (SOV). Methods: The medical records of 4 patients with dural CCFs treated via the thrombosed SOV were reviewed. All procedures were performed unilaterally in the interventional radiology unit with the administration of general anesthesia. The SOV was exposed via an eyelid crease incision, and then an angiocatheter was inserted in the vein and advanced through the segment with thrombosis to the cavernous sinus, where embolizing agents were deposited. After the procedure, the patients were followed up and evaluated clinically. Results: Three patients had unilateral CCFs, and 1 had a bilateral CCF (3 women and 1 man; age range, 58-68 years). The CCFs were Barrow type B (n = 2) and Barrow type D (n = 2). All patients had severe venous congestive orbital symptoms, chorioretinopathy, increased intraocular pressure, and visual loss. In all cases, the SOV appeared as a pale, thin, tortuous vessel adherent to the surrounding tissues during the surgical procedure. In 3 patients, the cavernous sinus was successfully embolized, and all symptoms were completely resolved without recurrence during follow up (3, 15, and 24 months). In the patient in whom the SOV could not be catheterized, the symptoms regressed slowly, but visual acuity remained unchanged during follow up (64 months). Conclusions: Dural CCFs can be successfully treated through the SOV, even when the vein is thrombosed. Identification and catheterization of the thrombosed SOV may be difficult because of the tiny and fibrotic structure of the vein

Use of cross-border healthcare services among ethnic Danes, Turkish immigrants and Turkish descendants in Denmark: a combined survey and registry study

Abstract Background Healthcare obtained abroad may conflict with care received in the country of residence. A special concern for immigrants has been raised as they may have stronger links to healthcare services abroad. Our objective was to investigate use of healthcare in a foreign country in Turkish immigrants, their descendants, and ethnic Danes. Methods The study was based on a nationwide survey in 2007 with 372 Turkish immigrants, 496 descendants, and 1,131 ethnic Danes aged 18–66. Data were linked to registry data on socioeconomic factors. Using logistic regression models, use of doctor, specialist doctor, hospital, dentist in a foreign country as well as medicine from abroad were estimated. Analyses were adjusted for socioeconomic factors and health symptoms. Results Overall, 26.6% among Turkish immigrants made use of cross-border healthcare, followed by 19.4% among their descendants to 6.7% among ethnic Danes. Using logistic regression models with ethnic Danes as the reference group, Turkish immigrants were seen to have made increased use of general practitioners, specialist doctors, hospitals, and dentists in a foreign country (odds ratio (OR), 5.20-6.74), while Turkish descendants had made increased use of specialist doctors (OR, 4.97) and borderline statistically significant increased use of hospital (OR, 2.48) and dentist (OR, 2.17) but not general practitioners. For medicine, we found no differences among the men, but women with an immigrant background made considerably greater use, compared with ethnic Danish women. Socioeconomic position and health symptoms had a fairly explanatory effect on the use in the different groups. Conclusions Use of cross-border healthcare may have consequences for the continuity of care, including conflicts in the medical treatment, for the patient. Nonetheless, it may be aligned with the patient’s preferences and thereby beneficial for the patient. We need more information about reasons for obtaining cross-border healthcare among immigrants residing in European countries, and the consequences for the patient and the healthcare systems, including the quality of care. The Danish healthcare system needs to be aware of the significant healthcare consumption by immigrants, especially medicine among women, outside Denmark’s borders.</p

Use of cross-border healthcare services among ethnic Danes, Turkish immigrants and Turkish descendants in Denmark: a combined survey and registry study

BACKGROUND: Healthcare obtained abroad may conflict with care received in the country of residence. A special concern for immigrants has been raised as they may have stronger links to healthcare services abroad. Our objective was to investigate use of healthcare in a foreign country in Turkish immigrants, their descendants, and ethnic Danes. METHODS: The study was based on a nationwide survey in 2007 with 372 Turkish immigrants, 496 descendants, and 1,131 ethnic Danes aged 18–66. Data were linked to registry data on socioeconomic factors. Using logistic regression models, use of doctor, specialist doctor, hospital, dentist in a foreign country as well as medicine from abroad were estimated. Analyses were adjusted for socioeconomic factors and health symptoms. RESULTS: Overall, 26.6% among Turkish immigrants made use of cross-border healthcare, followed by 19.4% among their descendants to 6.7% among ethnic Danes. Using logistic regression models with ethnic Danes as the reference group, Turkish immigrants were seen to have made increased use of general practitioners, specialist doctors, hospitals, and dentists in a foreign country (odds ratio (OR), 5.20-6.74), while Turkish descendants had made increased use of specialist doctors (OR, 4.97) and borderline statistically significant increased use of hospital (OR, 2.48) and dentist (OR, 2.17) but not general practitioners. For medicine, we found no differences among the men, but women with an immigrant background made considerably greater use, compared with ethnic Danish women. Socioeconomic position and health symptoms had a fairly explanatory effect on the use in the different groups. CONCLUSIONS: Use of cross-border healthcare may have consequences for the continuity of care, including conflicts in the medical treatment, for the patient. Nonetheless, it may be aligned with the patient’s preferences and thereby beneficial for the patient. We need more information about reasons for obtaining cross-border healthcare among immigrants residing in European countries, and the consequences for the patient and the healthcare systems, including the quality of care. The Danish healthcare system needs to be aware of the significant healthcare consumption by immigrants, especially medicine among women, outside Denmark’s borders