Endovascular Neurosurgery in the Northern Macro-Region of Rio Grande do Sul: Part I

Introduction The city of Passo Fundo, in the north of the Rio Grande do Sul state, has been standing out in the health care field for many years. The state has become a reference in endovascular interventional neuroradiology. We will cover 10 years of experience in this area and divide our observations in 3 parts: cerebral angiograms (part I), carotid angioplasties (part II) and intracranial aneurysms (part III). The goal of part I is to statistically assess the cerebral angiograms, their indications, risks and complications, as well as to do a technical review. Materials and Methods A retrospective study from 2005 to 2015 with a total of 5,567 interventional neuroradiology procedures performed. A total of 4,114 angiograms, 639 embolizations of intracranial aneurysms, 414 carotid angioplasties, 143 embolizations of cerebral arteriovenous malformations, 32 embolizations of dural arteriovenous fistulas, 102 cerebral vasospasm treatments, 21 treatments of epistaxis, 36 embolizations of craniocervical tumor, 25 thrombolysis of ischemic stroke, 18 vertebroplasties and 13 embolizations of arteriovenous malformations of the face. Results A total of 4,084 procedures performed, 21,811 vessels studied, average vase 7.62/2.82 vessel and patient/procedure. Of these, 2,536 were diagnostic procedures and 1,548 angiographic controls. Of the total, 1,188 patients received only an angiogram, 27.14% of which were therapeutic procedures. We obtained a total of 3.89% complications: 2.33% reflection vasovagal, 0.56% allergic skin reaction, anaphylactic shock 0.07%, 0.27% femoral hematoma, 0.26% transient neurological deficit, 0.12% permanent neurological deficit and no case of death. Conclusion Cerebral angiography in adults, children and infants is a safe procedure with low risk of permanent neurological complications.

Centros de referencia: Hospital Infantil Miguel Servet / Reference centers: Hospital Infantil Universitario Miguel Servet

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The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes.

In 1988, the New York State Health Commissioner was confronted with hospital-level data demonstrating very large, multiple-year, interhospital variations in short-term mortality and complications for cardiac surgery. The concern with the extent to which these differences were due to variations in patients' pre-surgical severity of illness versus hospitals' quality of care led to the development of clinical registries for cardiac surgery in 1989 and for percutaneous coronary interventions in 1992 in New York. In 1990, the Department of Health released hospitals' risk-adjusted cardiac surgery mortality rates for the first time, and shortly thereafter, similar data were released for hospitals and physicians for percutaneous coronary interventions, cardiac valve surgery, and pediatric cardiac surgery (only hospital data). This practice is still ongoing. The purpose of this communication is to relate the history of this initiative, including changes or purported changes that have occurred since the public release of cardiac data. These changes include decreases in risk-adjusted mortality, cessation of cardiac surgery in New York by low-volume and high-mortality surgeons, out-of-state referral or avoidance of cardiac surgery/angioplasty for high-risk patients, alteration of contracting choices by insurance companies, and modifications in market share of cardiac hospitals. Evidence related to these impacts is reviewed and critiqued. This communication also includes a summary of numerous studies that used New York's cardiac registries to examine a variety of policy issues regarding the choice and use of cardiac procedures, the comparative effectiveness of competing treatment options, and the examination of the relationship among processes, structures, and outcomes of cardiac care.

Helen Brooke Taussig and Edwards Albert Park: the early years (1927-1930).

The conventional history of paediatric cardiology teaches that it was Helen Taussig who founded the cardiac clinic for children at the Harriet Lane Home of the Johns Hopkins School of Medicine in 1930, when Edwards Park appointed her director of the clinic.1,2 However, the story was more complex than that, and involved the collaboration of institutions and the frustrations, doubts, and passions of both Park and Taussig. In this article, I explore the history in more depth through published works, and material preserved at the McGill University Archives, the Rockefeller Foundation Archives, and the Alan Chesney Medical Archives at Johns Hopkins.

Reseña histórica de la cardiología en el Estado Falcón / Cardiology in Falcón State a historical review

A partir de un pequeño y precario hospital construido en Coro a fines del siglo XVI hasta el moderno Hospital Universitario Alfredo Van Grieken, la medicina y la cardiología falconianas han recorrido un largo periplo. Con menguado recursos en sus comienzos, los médicos del Estado Falcón han sabido sobreponerse a todas las vicisitudes y dificultades para llevar adelante la tarea de ayuda de sus pacientes. Su perseverante afan por el progreso queda demostrado al ocupar el 2° lugar (antes que Caracas) entre los primeros en emplear los Rayos X confines diágnósticos. Sus mejores esfuerzos fueron dedicados a la construcción de hospitales públicos y no privados, lo cual nos habla de un encomiable espíritu en procura del bien colectivo. Este trabajo va dirigido a los jóvenes profesionales médicos de hoy, para que, inspirados en el interés social de que hicieron gala sus predecedores, se encaminen por la honrosa senda de un ejercicio genuinamente humanitario.

Medicine and cardiology in Falcon have made a long journey, from their beginning at a small, modest hospital built in Coro at the end of the 16 th century to themodern Alfredo Van Grieken University Hospital. With only limited resource in their early days, the doctors of the State of Falcón have managed to overcome all kinds of vicissitudes and dificulties in order to perform the tesk of helpíng their patients. Proof of their persistent desire for progress is the fact that Falcón was among the first states to employ x-reys for diagnostic purposes, coming second (ahead of Caracas). Their most admirable efforts were in the construction of public and non-private hospitals, which speaks of praiseworthy public spiritedness. This paper is aimed at today´s young medical professionals so that, inspired by the lack of interest in monetary gain displayed by their predecessors, they travel the honorable path of practicing their profession in a genuinely humanitarian manner.

Succinct history of Greek cardiac surgery.

The development and evolution of Greek Cardiac Surgery (GCS) has followed the international cardiothoracic surgery after the invention of cardiopulmonary bypass machine by John Gibbon in 1953. Chronologically, the development of GCS could be divided in four periods: (a) the first or essay period (1950-1960) characterized by the lack of organization, the experimentation and hesitation from the surgeons' side, and the reluctance from the patients' side to have an operation in Greece. (b) The second or stabilization period (1960-1970) is the period during which several separate cardiovascular departments were organized and performed the first valve replacement in 1964. (c) The third or "strengthening" period (1970-1985), during which Greek surgeons were trained abroad and adopted new methods and techniques of surgical therapy. The first operations of coronary artery bypass grafting and aortic aneurysm were performed (1973-1975). Various purely Cardiothoracic Centers were founded in Athens and Thessalonica and cardiac surgery became a routine operation. However, these centers were numerically not enough to cover the demand of patients in need of cardiac surgery. (d) The fourth or maturity period (1985 till today). It is characterized by the creation of private cardiac surgery departments and the gradual establishment of new university centers at the periphery, which along with the Onassis Cardiac Center, eliminated any need for patients to leave the country.

Cardiology at Westmead Hospital from 1990 to 2007.

Professor John Uther was the Director of Cardiology at Westmead Hospital from 1979 to 1990. Professor David Ross and Dr Pramesh Kovoor followed in this capacity subsequently. Networking between Westmead and metropolitan hospitals was established by conjoint appointment of cardiologists across the facilities. Westmead has maintained its excellence in electrophysiology with leadership in operative/catheter ablation of atrial fibrillation, development of catheter for mapping tricuspid annulus, multi-electrode mapping and intramural ablation of ventricular tachycardia and paediatric electrophysiology. Dr. Hugh Paterson became the Director of Cardiothoracic Surgery in 2006. The previous Directors were Dr. David Johnson, Dr. Graham Nunn and Associate Professor Richard Chard. Westmead established an area-wide acute infarct angioplasty service for all patients presenting to any facility in Western Sydney along with triage of chest pain in the ambulance in 2004. Collaborative sessions with vascular surgeons for non-coronary interventions commenced in 2005. In the future, Westmead will continue its excellence in vascular and electrophysiological interventions. Imaging (echocardiography, computerised tomography and magnetic resonance imaging) will be a major part of the service. Innovation in basic science is likely. Overall, it will be an exciting time to be a cardiologist, vascular surgeon or cardiothoracic surgeon at Westmead.

Cardiology at Westmead Hospital 1978-1990.

The development of the cardiology unit at Westmead Hospital occurred simultaneously with major advances in cardiology. Being the only teaching hospital built in New South Wales in the twentieth century, the hospital opened on 10 November 1978 on the site of the old Parramatta speedway. John Uther commenced in April 1979 and the electrophysiology laboratory opened in June, beginning an era of research and arrhythmia management that lead to the unit being a centre of excellence for arrhythmias. Cardiac surgery commenced in November 1981 with David Johnson as the initial surgeon, developing electrophysiological surgery. At the same time, Andreas Gruntzig was pioneering coronary angioplasty and this service commenced at Westmead in 1983. The early electrophysiology research culminated in the Ralph Reader prize being awarded to three Westmead fellows, David Richards, Robert Denniss and Lorraine Holley over the first three years with Mark Cooper awarded in 1986. Also in 1986, the era of thrombolytic therapy commenced for acute myocardial infarction. Dr Michel Mirowski implanted the first defibrillator in 1980 with approval by the FDA in 1985. Telectronics developed the first Australian defibrillator with considerable input from the unit, resulting in the first Australian made defibrillator inserted by the unit in 1987. The staffing at the unit has been a combination of staff specialists and visiting medical officers who have worked in all invasive and non invasive laboratories. This resulted in a unique and successful concept with the VMOs also attending the peripheral hospitals of the area resulting in the first successful example of clinical networking throughout the area. This has resulted in a full range of cardiac services available to all patients in all hospitals of the area.

Surgery and ablative therapy for ventricular tachycardia.

In the absence of acute ischaemia, ventricular tachycardia (VT) is the most common arrhythmia leading to cardiac arrest and death. This paper will describe the history of research into VT and the therapies that evolved. The contributions of John Uther and other members of the Department of Cardiology at Westmead Hospital will be outlined and placed into perspective.