Mercy San Juan Medical Center

BackgroundVenous sinus stenting (VSS) is increasingly performed for managing venous sinus stenosis associated with refractory idiopathic intracranial hypertension and/or pulsatile tinnitus. The Monopoint System (MS; Route 92 Medical, San Mateo, CA) is a telescoping catheter system with a single point of control outside the body, consisting of an 8F Guide Catheter (Base Camp), a 0.088‐in. inner diameter catheter‐extender (HiPoint 88), and a ledge‐reducing delivery catheter (Tenzing 8). In this study, we describe the MS technique for VSS and our multicenter clinical experience.MethodsWe retrospectively reviewed consecutive patients who underwent VSS with the MS from 2022 to 2023 for intracranial hypertension and/or pulsatile tinnitus at 13 sites. Base Camp is placed in the internal jugular bulb. HiPoint 88 is advanced over the Tenzing 8 through the stenosis. The stent‐delivery system is placed across the stenosis (inside the HiPoint 88), then unsheathed by HiPoint pull‐back, followed by successful stent deployment. Operators were also surveyed on MS performance.ResultsSeventy‐one patients were included, 97% female, mean age 40 ± 11 years, body mass index 35 ± 11. The primary indication for venous stenting was intracranial hypertension (79%, 56/71) and/or debilitating pulsatile tinnitus (87%, 62/71). Visual changes were present in 74%, with papilledema in 63%. Hipoint 88 advanced beyond the stenosis over Tenzing 8 in all cases, and all stents (diameters 6–10 mm and lengths 30–80 mm) successfully deployed. Median stenosis decreased from 80% (interquartile range 75–87) to 0% (interquartile range 0–0) post stenting (P<0.001). There were no Monopoint‐related complications. compared with the operators’ typical VSS catheter setup/technique, MS was rated “better” in 93% and “slightly better” in 6%; operators cited ease of crossing the stenosis, improved trackability and support, as well as lack of stent‐catheter length incompatibilities. Headache, pulsatile tinnitus, and papilledema improved in 81%, 95%, and 91%, respectively.ConclusionThe MS is a safe and effective catheter platform for VSS.

IntroductionMechanical thrombectomy using stent retrievers and aspiration techniques has emerged as the standard of care for patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (LVO). This study intended to collect real‐world clinical evidence on the safety and effectiveness of endovascular treatment of AIS using the SOFIA Flow Plus 6F aspiration catheter. The primary endpoint was the proportion of subjects achieving mTICI ≥2b. Secondary endpoints included good functional outcomes (mRS 0‐2) at Day 90, revascularization time, first line and first pass mTICI ≥2b, occurrence of procedure‐related SAEs, vasospasm involving the accessed vascular tree, embolization to new territories (ENTs), symptomatic intracerebral hemorrhage (sICH) within 24 hours and mortality at Day 90.MethodsSOFAST was a prospective, multicenter, single‐arm, observational post‐market study. The enrolled subjects were ≥21 and ≤85 years with large vessel (ICA or MCA) proximal occlusion, pre‐morbid mRS ≤1, baseline NIHSS ≥5, and for whom groin puncture was within 8 hours of symptom onset. A total of 108 patients were enrolled and treated using aspiration thrombectomy with SOFIA 6F as the first line treatment device. Patients were followed at 24 hours, 7 days/discharge, and 90 days post‐procedure. Cerebral angiography was performed pre‐ and post‐procedure. Clinical assessments included the NIHSS and mRS scales. All neurological, device‐related, and procedure‐related AEs and deaths were adjudicated by independent medical reviewers. Angiographic and other imaging data was adjudicated by an independent core laboratory.ResultsA total of 108 subjects were enrolled (mean age 62.7 years, 50% men) with a median NIHSS of 15.5. Of 108 subjects, 97.2% (105/108), 85.2% (92/108) and 55.6% (60/108) achieved mTICI ≥2b, ≥2c and =3 revascularization, respectively. With first line aspiration using SOFIA 6F, 87.0%, 79.6% and 52.8% achieved mTICI ≥2b, ≥2c and =3 revascularization, respectively. Median number of passes was one (range 1‐3). First pass rate of mTICI 2c or 3 using SOFIA 6F was 70.4%, of which 50.9% patients achieved mTICI score of 3. Mean duration from groin puncture to initial clot contact was 13.0 min and to successful revascularization was 17.9 min.Good functional outcome was achieved in 66.7% (72/108) of subjects at Day 90 (mRS 0‐2), procedure‐related SAEs occurred in 2.8% (3/108) of subjects and sICH in 0.9% (1/108) of subjects within 24 hours. Procedural vasospasm was recorded in in 9.3% (10/108) of subjects, and mortality in 7.4% (8/108) subjects at Day 90 (none related to the study device). No ENTs occurred.ConclusionIn SOFAST study, mTICI ≥2b revascularization was achieved in the majority of patients at the end of all procedures (97.2%) and with first line treatment (87.0%) with a large fraction of these subjects achieving mTICI ≥2c following the first SOFIA 6F pass (70.4%). Durations from groin puncture to clot contact and successful revascularization were relatively short. The study presented high rates of good functional outcome at Day 90 and low rates of safety events. In summary, the study provides encouraging evidence of the safety and effectiveness of the SOFIA 6F device for aspiration thrombectomy in acute ischemic stroke subjects.

In older adults, acute and chronic illness, including late-onset psychiatric disorders, occur within the context of age-related alterations in physiology at the organ-system, cellular, and genomic levels. Some of these changes reflect the ineluctable response to normal aging, but their onset and severity often are influenced by patient behaviors (e.g., smoking, lifestyle) and the environment (e.g., culturally influenced diets, environmental toxins). These age-related changes affect virtually all organ systems and increase the vulnerability of older adults to functional decline, disability, and organ-system dysfunction, thereby contributing to the burden of multiple comorbidities. This chapter discusses general principles of aging and age-related changes in the function of individual organ systems that should be considered by the psychiatrist in the diagnosis and management of the older psychiatric patient.

This is a report of the use, efficacy, and theoretic safety of negative-pressure wound therapy over ocular structures as a part of surgical treatment for necrotizing fasciitis. We treated a 65-year-old man with facial necrotizing fasciitis requiring serial debridement and closure of extensive periorbital and nasal wounds with skin grafts. Negative-pressure wound therapy was first used as a bridge to allow temporary closure and to encourage granulation tissue development. It was then used as a bolster dressing to stabilize skin grafts in the complex wound, not amenable to tie-over dressings. Excellent functional and cosmetic reconstruction of the periorbital and nasal regions was achieved. After treatment, the patient's corrected vision was 20/20. To our knowledge, the use of negative-pressure wound therapy directly over ocular structures has not been previously documented. In this case, it was safely used over the eyes with no sequelae to the patient's vision.

Nurse turnover costs thousands of dollars and negatively affects patient outcomes. Study results indicate experienced nurses perceive decreased autonomy and task orientation, and increased work pressure in their work environments. Strategies are presented to help retain RNs, save money, and improve patient outcomes.

Mantle-zone lymphoma (MZL) is a histologically distinctive variant of follicular lymphocytic lymphoma which is characterized by a proliferation of atypical small lymphoid cells as wide mantles around benign-appearing germinal centers. Immunoperoxidase stains were performed on fixed and processed lymph nodes from four patients with MZL. Three cases were of the intermediate lymphocytic type, and one was of the small cleaved lymphocytic type. In all cases, the small lymphoid cells of the mantle zones did not stain. A monoclonal population (IgM, lambda) of plasma cells and large lymphoid cells was demonstrated predominantly in the paracortical areas in one case. In all cases, small numbers of plasma cells and large lymphoid cells in the follicle centers stained in a polyclonal pattern, confirming the benign nature of the centers. These findings suggest that follicular lymphomas of the mantle-zone type are exceptions to the theory that follicular B-cell lymphomas are derived from follicular center cells. Apparently, the lymphoid cells of MZL home to the mantle zones of secondary follicles, where they surround, proliferate, and eventually obliterate residual benign germinal centers.

Brief Reports1 October 1979Bone-Marrow Suppression Associated with CimetidineHENRY K. CHANG, M.D., STEPHEN L. MORRISON, M.D.HENRY K. CHANG, M.D.Search for more papers by this author, STEPHEN L. MORRISON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-91-4-580 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMetiamide, an H2-receptor antagonist, was withdrawn from human use because of its side effect of granulocytopenia, including one case of fatal agranulocytosis (1). This side effect was thought to be due to its thiourea moiety causing bone-marrow suppression. Cimetidine, a newer H2-receptor antagonist, differs from metiamide in that the thiourea moiety is replaced by a cyanoguanidine side chain. Since cimetidine's introduction in July 1974, five cases of agranulocytosis and two cases of pancytopenia, all reversible, have been implicated with its use (2). We present here a case of fatal bone-marrow suppression associated with cimetidine use.A 66-year-old white man was...