Long-Term Follow-Up Results following Elective Treatment of Unruptured Intracranial Aneurysms with the Pipeline Embolization Device.

BACKGROUND AND PURPOSE: Numerous reports of treatment of wide-neck aneurysms by flow diverters have been published; however, long-term outcomes remain uncertain. This article reports the imaging results of unruptured aneurysms treated electively with the Pipeline Embolization Device for up to 56 months and clinical results for up to 61 months. MATERIALS AND METHODS: One hundred nineteen aneurysms in 98 patients from 3 centers admitted between August 2009 and June 2011 were followed at 6-month, 1-year, and 2+-year postprocedural timeframes. Analyses on the effects of incorporated vessels, previous stent placement, aneurysm size, and morphology on aneurysm occlusion were performed. RESULTS: The 1- and 2+-year imaging follow-ups were performed, on average, 13 and 28 months postprocedure. At 2+-year follow-up, clinical data were 100% complete and imaging data were complete for 103/116 aneurysms (88.8%) with a 93.2% occlusion rate. From 0 to 6 months, TIA, minor stroke, and major stroke rates were 4.2%, 3.4%, and 0.8% respectively. After 6 months, 1 patient had a TIA of uncertain cause, with an overall Pipeline Embolization Device-related mortality rate of 0.8%. An incorporated vessel was significant for a delay in occlusion (P = .009) and nonocclusion at 6 months and 1 year, with a delayed mean time of occlusion from 9.1 months (95% CI, 7.1-11.1 months) to 16.7 months (95% CI, 11.4-22.0 months). Other factors were nonsignificant. CONCLUSIONS: The Pipeline Embolization Device demonstrates continued very high closure rates at 2+ years, with few delayed clinical adverse sequelae. The presence of an incorporated vessel in the wall of the aneurysm causes a delay in occlusion that approaches sidewall closure rates by 2 years.

An Australian experience of retrievable inferior vena cava filters in patients with increased risk of thromboembolic disease.

AIM: Pulmonary embolism (PE) is a common cause of death and morbidity. Anticoagulant therapy reduces the risk of PE but is associated with bleeding. Inferior vena caval (IVC) filters protect against PE but have an increased long term risk of deep vein thrombosis (DVT). Temporary IVC filters allow protection against PE during high risk situations and may be later removed avoiding the need for long term anticoagulation. METHODS: We present our experience with the Recovery (Bard, Tempe, AZ) and Tulip (Cook, Bloomington, IN) optionally retrievable filters. RESULTS: Retrievable filters were planned for 121 patients. Mean age: 58.8 years; 72 male. The indications included: Established venous thromboembolism (VTE) and contraindication to anticoagulation; high risk of VTE and need for surgery with high risk of bleeding; VTE extension despite anti-coagulation. A retrievable filter was placed without significant incident in 113 patients. There were two proven cases of PE. In total there were 27 deaths of patients during the period of their follow up. There was 1 death related to confirmed filter migration. There was 1 sudden unexplained death in a patient with suspected malignancy. Filter removal was attempted in 58 cases at a mean of 44 days and was performed successfully in 52. Thromboembolus was found in the retrieved filter in 30 cases but did not prevent removal in 29. CONCLUSION: Retrievable IVC Filters are safe and effective in preventing PE in high risk patients. We have demonstrated success in retrieving filters up to 182 days following insertion, avoiding the need for long term anticoagulation.

Initial Australian experience with the recovery inferior vena cava filter in patients with increased risk of thromboembolic disease.

Inferior vena cava (IVC) filters are an alternative treatment in venous thromboembolism where there are contraindications to anticoagulation. There are, however, concerns about the long-term safety of permanent IVC filters. Often, the period of risk from anticoagulation therapy is short, which supports the use of non-permanent IVC filters. In this series, 54 Recovery Filters (Bard, Tempe, AZ, USA) were placed since its approval for use in Australia in March 2004 (approved for removal up to 160 days after insertion). The most common indication for filter placement in this series was established thromboembolic disease with a temporary contraindication to anticoagulation. Twenty-two filters were successfully retrieved without complication. In one case, it was not possible to retrieve the filter because of extensive contained thrombus. No complication was experienced at filter placement or retrieval; however, a fatal complication occurred as a result of filter migration. Mean time from placement to retrieval was 48 days (range 7-90 days). We describe methods we found useful at filter retrieval to overcome filter tilting.

Generalised lymphadenomegaly associated with methimazole treatment in a hyperthyroid cat.

A nine-year-old, domestic shorthair cat was diagnosed with hyperthyroidism and treated with methimazole, which resulted in lethargy, inappetence and marked generalised lymphadenomegaly within two weeks of initiation of therapy. Cytology, histopathology and immunohistochemistry were suggestive of atypical lymphoid hyperplasia. Cessation of treatment resulted in resolution of all clinical signs and physical abnormalities within two days. Subsequent treatment with radioactive iodine cured this cat of its hyperthyroidism. The lymphadenomegaly did not return at any stage and the cat is currently asymptomatic. Although methimazole administration for feline hyperthyroidism has been associated with many side effects, lymphadenomegaly has, to the authors' knowledge, not been previously reported.

[Study of the learning climate in a nursing college]. / 'N ondersoek na die leerklimaat by 'n verpleginskollege.

A descriptive survey was undertaken to determine the learning climate with the focus on the psychological climate. Questionnaires were distributed amongst second, third and fourth year students that follow the Diploma in Nursing Leading to Registration as a Nurse (General, Psychiatric, Community) and Midwife. The results indicated that a positive learning climate is maintained to a great extent in the college and during structured clinical accompaniment. However there are some problems which impede maintenance of an optimal learning climate. The learning climate in health care units is inadequate. Accompaniment of students by tutors realize to a greater extent in the third and fourth years, but second year students identified problems in this regard. Second year students are of the opinion that their clinical tutors are not adequately available for accompaniment while they work in the health care services. Accompaniment by registered nurses is inadequate.

[A study of the attainment of program objectives of the 4-year diploma course]. / 'N ondersoek na die bereiking van die programdoelstellings van die vierjaar diplomakursus.

A descriptive survey was undertaken to determine the the extent to which the programme objectives for the Diploma in Nursing Leading to Registration as a Nurse (General, Psychiatric, Community) and Midwifery are being met. Questionnaires were completed by diplomates and nursing service managers. Various problem areas regarding realization of the programme objectives were identified.

[Curriculum evaluation as implemented by the Ann Latsky Nursing College]. / Kurrikulumevaluering soos geïmplementeer by die Ann Latsky verplegingskollege.

Comprehensive curriculum evaluation, based on Roos's curriculum evaluation model, was completed at the Ann Latsky Nursing College. This project was planned and implemented by means of a curriculum evaluation plan. In this article, the authors discuss the methodology that was followed during curriculum evaluation and that can serve as a guideline for tutors from other colleges.

Putting Leininger's nursing theory "culture care diversity and universality" into operation in the curriculum--Part 1.

The culturally diverse South African society necessitates inclusion of transcultural nursing in the curriculum. This article focuses on research regarding the putting of Leininger's nursing theory into operation in the curriculum to provide a scientific base for the inclusion of such nursing. The research process and results are discussed.

Including transcultural nursing content in the curriculum--Part 2.

Transcultural nursing should be included in the curricula of the basic nursing courses. In this article, the transcultural nursing curriculum content that could be included, is discussed. To ensure a comprehensive approach to this field, a basic course in socio-cultural anthropology should be followed by transcultural nursing study units at strategic points in the curriculum.

[A study of the use of simulation in clinical instruction at the Ann Latsky Nursing College]. / 'N studie gerig op die benuting van simulasie as onderrigstrategie in die kliniese onderrig afdeling by Ann Latsky Verplegingskollege.

Simulation gives the student the opportunity for creativity while experimenting under simulated circumstances. Simulation provides an area where complex objectives can be achieved and potentially dangerous procedures can be practised in a risk-free area. Students can also repeat aspects of a complicated procedure until they reach the required competency level and gain the necessary self confidence of function in the work situation. Where learning experiences are lacking in the practical area, simulation could be used. An effective simulation facility should present the practical situation of the ward.

A situation analysis of nursing education. Part one: Conceptual framework.

A Strategic Planning Committee was established by the Transvaal Provincial Administration to plan for and reposition nursing education in the Transvaal. Various focus areas were identified, including the Focus Area Curricula. The aim of the Focus Area Curricula Committee is the establishment of curricula for the education and training of all categories of nurses to provide for the needs of nursing services in the Transvaal. The committee is still working towards the aim but a situation analysis has been completed. The purpose of this Article is to discuss a conceptual framework by which a logical approach to the situation analysis can be maintained.

Natural micronutrients as controlling factors in Western diseases--a lesson in nature-programming.

Micronutrients, essential for approximately 65% of all known enzymes, have during this century been considerably reduced in modern Western diets, due to food refinement, canning, refrigeration and additives. This reduction coincided with a phenomenal increase of Western and industrial diseases, many of them with genetic associations. Different basic diets in genetic races over thousands of years have led to a high percentage of enzyme polymorphisms, suggesting different basic diets necessary for different genetic races. These basic diets, with or without micronutrient supplementation, should be a necessary component of Western diseases prevention and therapy.