Study rationale The incidence, location, morphology and size characteristics of cerebral aneurysms in patients presenting to Groote Schuur hospital with either subarachnoid haemorrhage or 3 rd nerve palsy have not been established by a formal audit. Objectives To determine the patient demographics, frequency of CT angiographic detection of cerebral aneurysms and aneurysmal characteristics in patients presenting to Groote Schuur Hospital with sub-arachnoid haemorrhage and /or 3 rd nerve palsy Materials and methods Computed tomographic angiographic reports of cerebral vessels of patients who presented either with subarachnoid haemorrhage or 3 rd nerve palsy to Groote Schuur hospital were reviewed over a 19-month period from January 2018 – July 2019. The data obtained were coded, entered and analysed using IBM SPSS version 25 software. Descriptive statistics was used to report the means, modes and frequencies. Demographic and aneurysmal data were compared with a similar period 5 years previously. Results One hundred and twenty-one aneurysms (121) were analysed in 2018 -2019 and 124 in 2013-2014. The large majority were solitary (92% in both groups), small (94% and 90%) and saccular (96% and 87%) respectively. Significantly more fusiform aneurysms (13% vs 6%) were seen in the earlier group. 8 % of patients had multiple aneurysms. Less than 1% were ‘giant' ( >20mm). The mean age of the patients was the same for both periods (47 years). The mean aneurysm body size was 5.7mm and 7.1mm and the mean body: neck ratio was 6 2.1 vs 1.8b). Themost frequent locations were the posterior communicating artery (31.4% [2018/2019], 35% [2013- 2014]), anterior communicating artery (29% [2018/2019], 18.5% [2013/2014]) and the middle Cerebral Arteries (13.2% [2018/2019], 13.7% [2013/2014]). The least common sites were the Superior Cerebellar artery (SCA) [2018/2019] and the Vertebral artery (0.8%) [2013/2014]. Conclusion This study has compared the demographics of patients presenting to Groote Schuur Hospital with CT angiographically confirmed symptomatic intracranial aneurysms over two periods (January to July) 5 years apart. Both the patient demographics and the aneurysmal architecture were consistent over these time periods. Further our findings conform to that described previously both in Southern Africa and abroad i.e aneurysms which have bled are most commonly related to the posterior communicating, anterior communicating and the middle cerebral arteries and most aneurysms are small and saccular in shape. Over the periods studied, there was no change in the number of patients presenting to Groote Schuur Hospital for CT cerebral angiography and Interventional treatment post aneurysm rupture. These data represent a baseline for future statistical comparison and the information extrapolated from this study will be useful for interventive planning and resource mobilization at our institution and within the Western Cape Department of Health.

No description available.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Title: Individual movement compensation program influencing the correct postures at professional riders of BMX flatland Objectives: The aim of this work was to diagnosed the current state of the musculoskeletal system of selected probands. The next aim of this work was to created the individual movement compensation program based on the initial diagnosis and verify its effect. Partial goals were the introduction of the compensation program to probands, the confirmation of hypotheses and the interpretation of results. Methods of work: The thesis was based on the principle of case studies. Its idea was a creation and more importantly the appliciation of the individual three-months movement compensation program of five professional czech riders of BMX flatland. Part of this work was the kinesiology analysis which included the static and the dynamic testing, and the segment analysis on the Tanita MC-980 device. The Static test was consisted of the aspection and of the evaluation of the postures from three sides - from the back, from the front and from the side. Dynamic tests included the examination of muscle shortening, the examination of movement stereotypes and the testing of hypermobility. From other possible methods I used the interview, the observation and the peer to peer review. Results: At the...

Background: The specific clinical impact of delays to hemostatic intervention in trauma is under-explored. Objectives: Investigate the current understanding of the impact of increasing time to hemostasis and assess its relationship with clinical outcomes. Methods: We conducted a systematic review to characterize existing definitions of delayed hemostasis and its clinical sequelae. We conducted a cohort study of 147 trauma patients to investigate the impact of increased time to hemostasis. Results: Most studies demonstrated significant relationships between time to hemostasis and mortality, despite heterogeneity. The cohort study failed to demonstrate a significant association between time to hemostasis and mortality. Discussion: The thesis has taken steps to investigate time to hemostasis with appropriate methodology. The findings are limited by sample size and confounding by indication. Conclusions: There remains a substantial gap in the literature with respect to understanding the impact of increasing time to hemostasis in trauma and larger studies are needed.

Reversible hyperosmotic blood-brain barrier disruption (BBBD) has been used in pharmaceutical research as well as human medicine to enhance drug delivery across the blood-brain barrier. However a technique for repeatable BBBD in the canine has not been described. This study describes a repeatable technique for BBBD in the dog and evaluates the clinical and morphological effects of BBBD. Using fluoroscopic guidance, an arterial catheter was directed into the internal carotid artery via the femoral artery in ten dogs. BBBD was achieved in 5 dogs using 25% mannitol while 5 control dogs received only saline. Following recovery, dogs were monitored for clinical signs before a second, non-survival procedure was performed 2-3 weeks later. BBBD was estimated using CT densitometry as well as Evan's blue staining on post-mortem exam. Histopathological evaluation of the brain was performed on all dogs. Seven dogs completed the study. Two treatment dogs were lost after the first infusion with deteriorating neurologic function attributed to CNS edema and increased intracranial pressure. One control dog was lost due to vessel wall damage during catheterization. The remaining dogs exhibited only transient neurologic, ocular, and vasculature injury. Successful BBBD was demonstrated in all treatment dogs as evidenced by CT and Evan's blue staining. Histopathological evaluation revealed multifocal areas of infarction in all dogs indicating refinement of the technique is needed. This study shows that repeatable disruption the BBB in the dog is possible and opens the way for further investigations of BBBD using the dog as a model. / Master of Science

The percutaneous revascularization of chronic total occlusions represents a major challenge to interventional cardiologists. Procedural success is currently limited by the inadequate soft-tissue contrast of x-ray fluoroscopy and the inability to visualize the position and orientation of a revascularization device with respect to the lesion and the vessel wall. In this thesis methods are developed that enable the percutaneous revascularization of occlusive lesions to be guided using magnetic resonance (MR) imaging. Unlike x-rays, MR has excellent soft-tissue contrast and this can be exploited to provide valuable information regarding the composition and geometry of the lesion. The first method is a robust and redundant technique for determining the position and orientation of a catheter inside an MR scanner. The technique uses phase information introduced into the MR signal by a small receive coil located at the distal tip of the catheter. The technique is developed theoretically and is demonstrated with a feasibility experiment. A forward-looking intravascular imaging catheter is then presented that is capable of acquiring of high-resolution MR images of occlusive lesions and the vessel wall in front of the catheter. The imaging catheter consists of two orthogonal receive coils located at the distal tip of the catheter. The use of the imaging catheter is demonstrated in phantoms and in vivo. A third method enables active visualization of MR compatible guidewires. The method utilizes a catheter-based pick-up coil that is magnetically coupled to the guidewire. The proposed technique enables one to concentrate all active components on a catheter thereby facilitating the use of safety features. Complete characterization is presented theoretically and validated experimentally. In addition, the use of a practical catheter device is demonstrated in an in situ environment. Finally, future work required for the development of an integrated catheter-based device for the MR-guided revascularization of chronic total occlusions is discussed.

The percutaneous revascularization of chronic total occlusions represents a major challenge to interventional cardiologists. Procedural success is currently limited by the inadequate soft-tissue contrast of x-ray fluoroscopy and the inability to visualize the position and orientation of a revascularization device with respect to the lesion and the vessel wall. In this thesis methods are developed that enable the percutaneous revascularization of occlusive lesions to be guided using magnetic resonance (MR) imaging. Unlike x-rays, MR has excellent soft-tissue contrast and this can be exploited to provide valuable information regarding the composition and geometry of the lesion. The first method is a robust and redundant technique for determining the position and orientation of a catheter inside an MR scanner. The technique uses phase information introduced into the MR signal by a small receive coil located at the distal tip of the catheter. The technique is developed theoretically and is demonstrated with a feasibility experiment. A forward-looking intravascular imaging catheter is then presented that is capable of acquiring of high-resolution MR images of occlusive lesions and the vessel wall in front of the catheter. The imaging catheter consists of two orthogonal receive coils located at the distal tip of the catheter. The use of the imaging catheter is demonstrated in phantoms and in vivo. A third method enables active visualization of MR compatible guidewires. The method utilizes a catheter-based pick-up coil that is magnetically coupled to the guidewire. The proposed technique enables one to concentrate all active components on a catheter thereby facilitating the use of safety features. Complete characterization is presented theoretically and validated experimentally. In addition, the use of a practical catheter device is demonstrated in an in situ environment. Finally, future work required for the development of an integrated catheter-based device for the MR-guided revascularization of chronic total occlusions is discussed.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成21年3月25日 靍見有史氏の博士論文として提出された

Bakgrund: Trots en snabb utveckling av undersökningsmetoderna inom IR har inte strålskydden utvecklats i samma takt. Den joniserande strålning som förekommer på modaliteten kan medföra en hälsorisk för personalen därav finns det stråldosgränser att hålla sig inom för att minimera risken för yrkesrelaterade strålskador. För att förebygga risken för strålningsrelaterade skador är det viktigt att undersöka olika metoder av skydd för att optimera personalens strålsäkerhet.Syfte: Syftet med studien var att belysa metoder för att reducera stråldosen för personal verksam vid interventionell radiologi.Metod: Sökningarna av artiklarna genomfördes i databaserna CINAHL, PubMed och Scopus varav 13 studier valdes ut, kvalitetsgranskades samt analyserades kritiskt med utgångspunkt från en innehållsanalys.Resultat: Resultatet visade på 11 strålskyddsmetoder för personalen: blyförkläde med thyroideablyskydd, Suspended Personal Radiation Protection System, blyglasögon, blyhandskar, takfäst blyglas, golvbaserade blyglas, patientblyskydd, direktdigital dosimeter, avstånd till patienten genom automatisk kontrastspruta, vismut-bariumöverdrag samt erfarenhet och information.Konklusion: Trots att metoderna enskild reducerade stråldosen till personalen skulle det kunna vara mer effektivt att kombinera olika strålskydd för bättre reduceringseffekt. Genom resultatet anser författarna att fortsatt forskning krävs inom utvecklandet av nya strålskydd som är mer ergonomiska mot personalen samt hur strålskydden påverkar patienterna både fysiskt och psykiskt. / Background: Despite the fast development of examination methods in IR, the development of the radiation protections has not been as rapid. Ionizing radiation that occurs in the modality can be a threat to the personnel of which there are radiation dose limits to keep within in order to minimize the risk of occupational radiation damage. In order to minimize the risk of occupational radiation damage, it is of importance to explore different methods to optimize the radiation protection for the personnel.Purpose: The aim of this study was to illuminate methods to reduce the radiation dose to personnel working in interventional radiology.Method: Searches were conducted in the databases CINAHL, PubMed and Scopus from which 13 studies were selected, viewed and analyzed with basis from a content analysis.Results: The results showed 11 different radiation protection methods for the staff were identified and those were: lead apron with a thyroid lead shield, Suspended Personal Radiation Protection System, leaded eyeglasses, leaded gloves, ceiling suspended leaded shield, rolling leaded shield, patient lead shield, real-time dosimeter, distance to the patient through an automatic power injector, bismuth - barium shielding and experience and information.Conclusion: Although the methods individual reduced radiation dose to the personnel, it might be more efficient to combine the various radiation protections for better reduction effect. The authors recommend that further research is required in the development of new radiation protection that is more ergonomic to the personnel and how the radiation shields affects patients both physically and psychologically.