Shamar Young

Examination of the Lille Apathy Rating Scale in Parkinson Disease

Apathy is a unique, multidimensional syndrome commonly encountered in patients with Parkinson disease (PD). Recently, the Lille Apathy Rating Scale (LARS), a semistructured interview yielding a global score, and composite subscores for different domains of apathy (i.e., cognitive, behavioral, affective, self awareness), was developed and given to a sample of patients with PD in France. This study is the first outside of its original developers to examine the English language version of the LARS in PD. We found the LARS to be a coherent instrument demonstrating both convergent and divergent validity, as compared to the Apathy Scale (AS) and Beck Depression Inventory (BDI‐II). Using a receiver operating characteristic (ROC) analysis comparing the LARS to the AS, a validated and widely‐used measure, we identified a cut‐off score (sensitivity = 64%, specificity = 92%, PPV = 88%, NPV = 75%) that was higher than that proposed by the original authors, who derived their cut‐off by comparing LARS global scores to clinical judgments of apathy. Although the present study does not compare the LARS to a diagnostic gold standard or promote its utility for diagnosing apathy, it provides further support for the LARS as a promising instrument to examine apathy in PD.

Port-Site Recurrence of Pancreatic Adenocarcinoma Following Laparoscopic Pancreaticoduodenectomy

IntroductionMinimally invasive surgical approaches have only recently been applied to pancreatic adenocarcinoma.DiscussionSignificant apprehension exists that minimally invasive pancreatic surgery will not lead to equivalent or superior oncologic outcomes compared to traditional surgical approaches. This is the first case report of a port-site recurrence following laparoscopic pancreaticoduodenectomy.

Review of the Clinical Evidence for the Use of DEBIRI in the Treatment of Colorectal Metastatic Disease

Colorectal cancer is a common malignancy that most commonly metastasizes to the liver. There has been considerable effort in developing new treatment options for these patients. One method that has been developed for the treatment of colorectal metastases to the liver is irinotecan-loaded drug-eluting bead (DEBIRI) embolization. This article reviews the current literature on DEBIRI and discusses the state of current knowledge and possible areas of future investigation.

Vacuum-Assisted Thrombectomy of Massive Pulmonary Embolism

Figure 4. Axial gadolinium-enhanced T1-weighted magnetic resonance imaging of a 63-year-old man with hepatocellular carcinoma 1month after treatment with IRE. Note the zone of ablation (arrows) extending beyond the unenhanced tumor (#). Asterisk indicates contracted gallbladder. Arrowheads (˄) indicate perfusional changes adjacent to the zone of ablation and not tumor recurrence. Young et al ’ JVIR 1094 ’ Letters to the Editor

Comparison of Traditional and Emerging Surgical Therapies for Lower Urinary Tract Symptoms in Men: A Review

Lower urinary tract symptoms (LUTS) are one of the most common health issues in men and pose a significant economic challenge in healthcare. Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment for medically refractive LUTS secondary to benign prostatic hyperplasia. The institution of medical therapy and the development of several minimally invasive surgical therapies (MISTs) began in the 1980’s and 1990’s. Together, these therapies brought about a change in the natural course of the disease, stimulating investigation into the economic consequences of various management approaches. TURP has been observed to have higher complication rates, but better efficacy and lower retreatment rates compared to MISTs. Staying abreast of the evolving understanding of LUTS and the alternative treatment options is imperative for radiologists.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of PAE for the treatment of LUTS in men with BPH.

Significant arterial complications after pancreas transplantation – A single center experience and review of literature

Arterial fistulas and pseudoaneurysms are rarely described significant arterial complications associated with pancreas transplantation that sometimes present with herald or catastrophic bleeding. We herein describe our institutional case series with a focus on management and outcomes. Of 2256 pancreas transplants, 24 arterial complications were identified in 23 recipients. Chart review was performed to describe the clinical characteristics, treatments, and outcomes of the complications (pseudoaneurysm, arterial enteric/cystic/ureteric fistula, or arteriovenous fistula). Of these 23 patients, 57% had a failed allograft at the time of the complication. Nine patients underwent primary surgical repair of 10 complications, 13 were treated by endovascular methods, and one patient by medical management. In total, 3 embolized patients rebled, 2 of which had failed allografts prior to treatment. Of those with graft function that were treated by embolization alone, all retained graft function. Diagnosis of arterial complications requires a high degree of suspicion and should involve early systemic angiography to evaluate the pancreatic vasculature. Management can be endovascular or surgical and should be individualized. We report our centers evolution from a predominantly surgical to endovascular approach as a definitive vs stabilizing therapy, with selective coiling mostly reserved for well‐defined peripheral lesions in patients with a functioning allograft.

An Objective Study of Anatomic Shifts in Intracranial Hypotension Using Four Anatomic Planes

Purpose Intracranial hypotension (IH) often remains undetected using current MR diagnostic criteria. This project aims to demonstrate that central incisural herniation is highly effective in helping to make this diagnosis. Materials and Methods Magnetic resonance imaging (MRI) was analyzed in 200 normal and 81 clinically known IH patients. MRI reference lines approximating the plane of the incisura, the plane of the diaphragma sella, the plane of the foramen magnum, and the plane of the visual pathway were utilized to measure the position of selected brain structures relative to these reference lines. Results All IH patients had highly statistically significant (p < 0.0001) measurable evidence of downward central incisural herniation when compared to normal controls. The first of the important observations was a downward shift of the mammillary bodies, which shortened the midsagittal width of the interpeduncular fossa cistern. A concurrent downward shift and deformity of the tuber cinereum accompanied the mammillary body shift. The second essential observation was an abnormal clockwise rotation of the long axis of the visual pathway. A severity grading system is proposed based on the extent of these shifts as well as secondary shifts of the brain stem, splenium, and cerebellar tonsils. Conclusion This study objectively delineates the anatomic shifts of brain structures adjacent to the incisura and foramen magnum. This methodology is sufficient to recognize the features of IH and to stratify the spectrum of IH findings into a functional grading system for quantifying the results of interventional therapy.

Current trends in the treatment of hepatocellular carcinoma with transarterial embolization: a cross-sectional survey of techniques

PurposeDespite being accepted as a mainstay of treatment for hepatocellular carcinoma (HCC), technical aspects of transarterial chemoembolization (TACE) continue to vary by reporting author, leading to heterogeneity in the literature and making meaningful comparisons between treatments difficult. The goal of this survey was to report international chemoembolization practices for the treatment of HCC in an effort to understand current treatment strategies as a first step towards technique standardization.Materials and methodsAn anonymous 18-question online survey, evaluating technical aspects of their TACE practice, was distributed via email to practicing members of the five largest interventional radiology societies in Chinese and English. A total of 1160 responses were obtained from 62 countries. Responses were categorized according to region of practice and analyzed using Fisher’s exact test and chi-square test with Bonferroni correction as needed.ResultsThere were significant statistical differences between regions for nearly all questions. Doxorubicin was more commonly used among respondents from North America, Europe, and South Korea than Japan and China (p = 0.0001). For single and multiple HCCs, drug-eluting bead TACE was most popular in North America and Europe (p = 0.0001), while conventional TACE was most popular in Japan, Korea, and China (p = 0.0001). CT was the most commonly used modality for follow-up among all respondents, although MR was used more commonly in North America and in academic centers (p = 0.0001).ConclusionThis survey provides comprehensive information on and confirms the heterogeneous nature of current practice patterns in regard to TA(C)E for HCC.Key Points• There is a lack of information regarding current practice patterns in the area of technical considerations when performing transarterial chemoembolization.• Type of transarterial chemoembolization utilized to treat hepatocellular carcinoma varies widely across geographical area.• Chemotherapeutic agents and embolic agents used to perform transarterial chemoembolization for the treatment of hepatocellular carcinoma vary widely across geographical areas.

Treatment of peristomal hemorrhage: A review of outcomes and comparison of two minimally invasive techniques

PURPOSE The purpose of this study was to review and compare outcomes between percutaneous sclerotherapy and transjugular intrahepatic portosystemic shunt (TIPS) treatments in patients with peristomal variceal bleeding. MATERIALS AND METHODS Ten patients who underwent sclerotherapy (n = 3 patients), TIPS placement (n = 5 patients) or both (n= 2 patients) for peristomal variceal bleeding were retrospectively reviewed. There were 6 women and 4 men, with a mean age of 62.6 years (range: 44-84 years). Data pertaining to the technical aspects of the procedure, demographics, and information regarding the underlying cause of ostomy and portal hypertension were collected. Treatment was considered a primary success if no further hemorrhage occurred. RESULTS No differences in primary success were found between TIPS cohort (100%) and sclerotherapy cohort (40%) (P=0.4). Sclerotherapy patients had a poorer nutritional status (mean albumin serum level of 2.04g/dL in the sclerotherapy group and 2.95g/dL in theTIPS group; P=0.04) and worse liver function (mean total bilirubin serum level of 4.9mg/dL in the sclerotherapy group and 1.6mg/dL in the TIPS group; P=0.07). CONCLUSION While further investigation is needed, TIPS may be more effective than sclerotherapy in treating peristomal variceal bleeding. However, sclerotherapy may serve as an effective bridging mechanism in critically ill patients.