RESUMO
Acute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection.
Assuntos
Angioplastia , Dissecção Aórtica/cirurgia , Aneurisma Intracraniano/cirurgia , Stents , Dissecação da Artéria Vertebral/cirurgia , Doença Aguda , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Isquemia Encefálica/etiologia , Tronco Encefálico/irrigação sanguínea , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Hemorragia Subaracnóidea/etiologia , Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/complicações , Dissecação da Artéria Vertebral/diagnóstico por imagemRESUMO
Dietary supplements containing Ephedra used for weight loss and physical performance enhancement such as "herbal ecstasy" are widely available, and it is estimated that at least 1% of the adult population have taken these products. Ephedra products including Ephedra alkaloids such as phenylpropanolamine or other ephedrine compounds are sold under different names such as Metabolife 356, Ripped Fuel, Thermadrene, and Shape-Fast Plus. Over 2 years, five patients with ischemic infarctions associated with use of Ephedra products were evaluated at Indiana University Hospital. Ephedrine, like other sympathomimetic agents, predisposes patients to both ischemic and hemorrhagic strokes. People who take over the counter Ephedra products that claim to boost weight loss, increase energy, or bolster physical performance are at risk of adverse events including ischemic and hemorrhagic strokes.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Ephedra/efeitos adversos , Medicamentos sem Prescrição/efeitos adversos , Acidente Vascular Cerebral/induzido quimicamente , Adulto , Mapeamento Encefálico , Córtex Cerebral/efeitos dos fármacos , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Infarto Cerebral/induzido quimicamente , Infarto Cerebral/fisiopatologia , Suplementos Nutricionais/efeitos adversos , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Preparações Farmacêuticas , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do TratamentoAssuntos
Eficiência , Radiologia/economia , Salários e Benefícios/economia , Competência Clínica/economia , Planos para Motivação de Pessoal/economia , Avaliação de Desempenho Profissional/economia , Humanos , Relações Interpessoais , Prática Profissional/economia , Serviço Hospitalar de Radiologia/economiaRESUMO
The authors consider the empirical data examining relationships between democratic governance and organizational success. There is overwhelming evidence that democratically run organizations excel in key parameters of success, such as business valuation, productivity, responsiveness, innovation, decision making, and worker morale and satisfaction. A review of physician surveys shows that discontent with academic administration is a major contributor to faculty turnover. Other data indicate that the basic concepts justifying autocratic governance of a department are deeply flawed and that autocratic governance is counterproductive. The authors conclude that the democratic governance of academic departments is the only model that is scientifically valid and would greatly enhance all missions of academic medicine in the 21st century.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Democracia , Liderança , Radiologia/organização & administração , HumanosRESUMO
How should academic medical departments be governed? Models of governance span a wide spectrum between autocracies, in which important decisions are made by a single individual, to democracies, in which each member enjoys a voice in decision making. Despite the fact that more participatory governance models are the norm in practice settings outside of academia, many academic physicians seem to take an autocratic model more or less for granted. In fact, however, most medical schools and universities do not mandate a governance system that vests authority in a powerful chairperson, and departments frequently enjoy more latitude than they suppose in determining how to govern themselves. Because an organization's effectiveness is powerfully influenced by its governance structure, academic physicians should give serious consideration to this subject, to ensure that academic medicine is well prepared to meet the many challenges now before it.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Tomada de Decisões Gerenciais , Docentes de Medicina/organização & administração , Conselho Diretor/organização & administração , Liderança , Modelos Organizacionais , Cultura Organizacional , Estados UnidosRESUMO
How should academic radiology departments be governed? This question has rarely been directly addressed in the radiology literature. The dominant model of administration in present-day academic departments differs from that typically seen in private group practices. Whereas private group practices tend to follow a democratic model whereby key decisions must be supported by a majority of the partners, in academic institutions, medical school deans and department chairs generally possess great latitude in strategic and operational decision making. This article considers arguments for and against "top-down" governance in academia. The rationale supporting this form of governance is weak, and the best evidence from the fields of management and organizational behavior suggests it may in fact be detrimental.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Tomada de Decisões , Eficiência Organizacional , Governo , Liderança , Modelos Organizacionais , Estados UnidosRESUMO
In this article, a patient with extensive cerebrovascular disease who had previously undergone bilateral carotid endarterectomy and subsequent operative revision on the left side is described. The patient developed critical restenosis at the cephalic end of the previous left patch angioplasty as well as a severe stenosis of the left common carotid artery origin, which originated from a bovine aortic arch configuration. His right common and internal carotid arteries had become occluded. Endovascular treatment with two metallic stents was successfully performed through a surgical cutdown on the immediate supraclavicular portion of the left common carotid artery to establish antegrade and subsequently retrograde vascular access.