血栓化脳動脈瘤

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Endovascular repair with extracorporeal membrane oxygenation as a rescue strategy for aortobronchial fistula: a case report

Abstract Aortobronchial fistula (ABF) is a rare and potentially lethal complication of thoracic aortic replacement surgery. Currently, thoracic endovascular aortic repair (TEVAR) has emerged as a less invasive alternative to open surgery for ABF to facilitate prompt hemostasis. However, there are no published reports of TEVAR for ABF, particularly for presentation with life-threatening respiratory failure from massive hemoptysis. A 48-year-old male patient, who had recently undergone aortic root and arch replacement due to aortic dissection, was transferred to the emergency department with massive hemoptysis and severe dyspnea. A single-lumen endotracheal tube was immediately placed in the right main bronchus to protect the nonbleeding lung from spillage of blood. Chest computed tomography (CT) showed leakage of contrast material from the distal anastomosis of the aortic graft and consolidated lung tissue adjacent to the leakage. He was diagnosed with an ABF following aortic arch replacement, and an emergency TEVAR was performed. After adequate hemostasis, severe hypercapnia remained uncorrected despite the maximum ventilatory support. Thus, venovenous extracorporeal membrane oxygenation (VV ECMO) was immediately initiated, and severe respiratory acidosis improved dramatically. Furthermore, VV ECMO facilitated prompt bronchoscopic washout of the remaining blood clot without any danger of respiratory collapse and was weaned off successfully after 5 days as ventilation improved. This case demonstrates that emergency TEVAR in combination with VV ECMO can be a rescue strategy for massive hemoptysis from an ABF

Flow assessment application "Flow-Insight"の脳血管撮影への臨床応用

出版社版得られた画像データに時間軸を加えて解析するソフトウエアFlow assessment application "Flow-Insight"を開発し、脳血管撮影に応用した。Flow-Insightは時間解析、造影剤の輝度積算量の解析、可視化が可能であり、前交通動脈瘤に対するコイル塞栓術中の状態をFlow-Insightにて後方視的に検討した結果、定性化に加えカラーバーによって頭蓋内全体の血流変化が容易に可視化された。Flow-Insightは現在の感覚的な動脈瘤塞栓術後のneck remnantやdome fillingを客観的に評価できる可能性があり、コイル塞栓術中の血栓性合併症の追加治療介入の指標として有用性が示唆された。また、治療中にオンタイムで稼働させ、動脈瘤治療、CAS、AVMの塞栓術中、術後の合併症の指標などいくつかの臨床応用に期待される

Ruptured Aneurysm With Delayed Distal Coil Migration Requiring Surgical Treatment: Case Report

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Usefulness of Implementation Outcome Scales for Digital Mental Health (iOSDMH): Experiences from Six Randomized Controlled Trials

Objectives: Measuring implementation outcomes for digital mental health interventions is essential for examining the effective delivery of these interventions. The “Implementation Outcome Scale of Digital Mental Health” (iOSDMH) has been validated and used in several trials. This study aimed to compare the iOSDMH for participants in six randomized controlled trials (RCTs) involving web-based interventions and to discuss the implications of the iOSDMH for improving the interventions. Additionally, this study examined the associations between iOSDMH scores and program completion rate (adherence). Methods: Variations in total scores and subscales of the iOSDMH were compared in six RCTs of digital mental health interventions conducted in Japan. The web-based intervention programs were based on cognitive behavioral therapy (2 programs), behavioral activation (1 program), acceptance and commitment (1 program), a combination of mindfulness, behavioral activation, and physical activity (1 program), and government guidelines for suicide prevention (1 program). Participants were full-time employees (2 programs), perinatal women (2 programs), working mothers with children (1 program), and students (1 program). The total score and subscale scores were tested using analysis of variance for between-group differences. Results: Total score and subscale scores of the iOSDMH among six trials showed a significant group difference, reflecting users’ perceptions of how each program was implemented, including aspects such as acceptability, appropriateness, feasibility, overall satisfaction, and harm. Subscale scores showed positive associations with completion rate, especially in terms of acceptability and satisfaction (R-squared = 0.93 and 0.89, respectively). Conclusions: The iOSDMH may be a useful tool for evaluating participants’ perceptions of features implemented in web-based interventions, which could contribute to improvements and further development of the intervention