Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences.

OBJECTIVES: The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved ("time-resolved imaging of contrast kinetics", TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF. METHODS: We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern. RESULTS: Intermodality agreement for the Cognard classification was excellent (ĸ = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern. CONCLUSIONS: The combination of MRI and DSA is the new gold standard in LDAVF treatment planning. KEY POINTS: • DSA is superior to the MRI in detecting LDAVF arterial feeders. • MRI excellently evaluates the venous side of an LDAVF. • MRI can replace DSA in initial diagnosis and monitoring of LDAVF. • MRI and DSA combined are the new gold standard in LDAVF treatment planning.

[Multidimensional pain assessment in patients with dementia]. / Mehrdimensionale Schmerzmessung bei Demenzpatienten.

BACKGROUND: It is well known that patients with dementia complain less about pain and receive fewer analgesics than other patients. The question arises of whether disorders associated with dementia change the processing of pain. METHODS: A total of 20 patients with dementia and 40 patients with mild cognitive impairment (MCI) as well as 40 healthy control subjects were investigated for their subjective (category scale), facial (FACS) and motor (R-III reflex) pain responses to mechanical and electrical stimuli. RESULTS: Patients with dementia did not rate the intensity of the stimuli differently; however, they were less frequently capable of providing ratings. At equal levels of stimulus intensity, demented patients showed stronger facial responses. The R-III reflex thresholds were lowered in demented patients. MCI patients appeared only slightly changed. CONCLUSIONS: Our findings suggest that the processing of acute noxious stimuli is intensified in patients with dementia. Against the background of a reduced prescription of analgesics, an under-treatment of pain in patients with dementia might be the consequence.

Health services at large public institutions: funding, utilization, and staffing.

When a mandatory health fee policy for students on campuses of the State University of New York (SUNY) was instituted in fall 1991, the projection was that the policy, which was at the option of individual institutions, would result in significant changes for SUNY health service operations. The changes would affect funding sources, staffing requirements, utilization rates, and services offered. In the past, the SUNY system had been inconsistent in health fee policies. This study was conducted to assist in implementing the mandatory health service fees. The authors surveyed 53 public higher education institutions viewed as comparable to the University at Buffalo in terms of location in an equivalent state, enrollment of 10,000 or more students, similar academic disciplines, average SAT scores, faculty salaries, and graduate enrollment. Two institutions that no longer met the original criteria were not included. The final tabulation was based on data from 42 institutions, for a return rate of 82%. Survey results showed that public higher education institutions are significantly altering traditional practices associated with student healthcare. Health services are providing more specialty services, increasing the focus on wellness and health education, seeking accreditation, and increasing student representation in decision making. In addition, funding sources have shifted dramatically, with a larger percentage of the student health budget derived directly from fees assessed to students and a much smaller percentage derived from institutional or state appropriations.