SNI Blog

FROM BRAINWAVES: Since its introduction in 1982, transcranial doppler ultrasound (TCD) has evolved into a portable, multimodality, noninvasive method for real-time imaging of intracranial vasculature. The detection of cerebral microemboli is among the more remarkable capabilities of TCD. Emboli create countable signals in the ultrasound display due to the higher reflection of sound waves compared to the blood cells. Experimental models have shown a high sensitivity and specificity for detection of a variety of substrates, including thrombotic, platelet and atheromatous emboli.

Microembolic signals (MES) within the intracranial vasculature are most frequently identified in patients with large-vessel atherosclerotic disease, such as carotid stenosis. They have also been reported in intracranial arterial stenosis, arterial dissection, cardiac disease and atheroaortic plaque. Additionally, they have been seen in arteries distal to coiled aneurysms.

There is strong evidence that MES detection predicts future ipsilateral stroke risk in patients with symptomatic carotid stenosis (Markus HS, et al.; King A, et al.). A recent study of patients with asymptomatic carotid stenosis demonstrated that MES predicted subsequent ipsilateral stroke and TIA, and also ipsilateral stroke alone, and that it is helpful in selecting patients who will benefit from carotid endarterectomy.

There was cause for celebration in the Swedish Radiosurgery Center on Thursday, Dec. 16, as neurosurgeon Ronald Young, M.D. (left), medical director of the Gamma Knife^® program, and radiation oncologist Bob Meier, M.D. (below), medical director of the CyberKnife program, treated the center’s first two Gamma Knifepatients. The center, formerly known as the Seattle CyberKnife Center, supports both the Swedish Cancer Institute and the Swedish Neuroscience Institute.

The center has offered CyberKnife services since 2006. This year Swedish installed an Elekta Leksell Perfexion Gamma Knife^®, making it one of the most advanced stereotactic radiosurgery centers in the country. CyberKnife can be used to treat cancerous and noncancerous tumors in all areas of the body.

At Swedish, Gamma Knife will be used to treat cancer of the brain and some neurological conditions, such as essential tremor, trigeminal neuralgia and arteriovenous malformations. Providing Swedish neurosurgeons and radiation oncologists access to both of these advanced technologies gives them greater flexibility in selecting the best radiation therapy for their patients. For more information, go to www.swedish.org/radiosurgery or call 206-320-7130.

At the conclusion of this session, attendees will have an increased ability to:

• Discuss options for expanding the treatment window for acute ischemic stroke
• Review the role of neuroimaging for identification of salvable tissue in stroke patients
• Discuss the results of the DEFUSE trial and the study design of the ongoing DEFUSE 2

SNI Grand Round Series is every 1st and 3rd Thursday of each month.

The brain tumor board at Swedish/Cherry Hill successfully launched its first WebEx^® conference on Monday, November 29 from a Seattle Science Foundation conference room. Dr. Namou Kim presented a case remotely from his office at First Hill, and an Ivy Center staff member attended the conference from the East Coast. The software allows providers to attend the conference remotely via desktop computer and telephone when a patient they refer is being discussed, or they can present films and pathology to the subspecialists present onsite at the conference. The program will now be rolled out to physicians throughout the Pacific Northwest. For more information or to present a case, contact John W. Henson, MD, FAAN, at john.henson@swedish.org or 206-320-2300.

The Leapfrog Group Announces Annual Top Hospitals List

The Leapfrog Group’s annual class of top hospitals – 65 from a field of nearly 1,200 – was announced today in Washington, D.C. and, for the first time, included Swedish Medical Center’s First Hill and Cherry Hill campuses. The announcement came at Leapfrog’s 10th anniversary meeting. A complete list of 2010 Leapfrog Top Hospitals can be viewed at www.leapfroggroup.org.

The Leapfrog Group is a coalition of public and private purchasers of employee health coverage – including Boeing and the Washington State Healthcare Authority – which was founded a decade ago to work for improvements in health-care safety, quality and affordability. Initially organized by the Business Roundtable, it is now an independent advocacy group working with a broad range of partners, including hospitals and insurers.

The ‘Top Hospital’ selection is based on the results of the Leapfrog Group’s national survey, which launched in 2001. It measures hospitals’ performance in crucial areas of patient safety and quality, including:

• The use of computer physician order entry (CPOE) to prevent medication errors;
• Standards for doing high-risk procedures such as heart surgery;
• Protocols and policies to reduce medical errors and other safe practices recommended by the National Quality Forat um; and
• Adequate nurse and physician staffing

The results of the survey are posted www.leapfroggroup.org.

Presented By: Chun Yuan, Ph.D., Professor of Radiology, Adjunct Professor of Bioengineering, University of Washington Objectives: At the conclusion of this session, attendees will have an incresed ability to:

• Describe the need for plaque characterization in identifying high risk lesions
• Recall current MRI-based plaque imaging technique and it's ability for plaque characterization

SNI Grand Rounds Series is every 1st and 3rd Thursday of each month

Thursday, November 18, 2010

7:30 to 8:30 a.m.

Swedish Education and Conference Center, Room B

Brian Louie, MD, FRCSC, FACS, Esophageal Surgery, Thoracic Surgery

At the conclusion of this session, attendees will have an increased ability to:

• Review the role of thymectomy in the management of myasthenia gravis and describe the options for thymectomy
• Discuss the management of thoracic neurogenic tumors and options for surgical treatment
• Discuss the role and outcomes of thoracic sympathectomy for hyperhidrosis

SNI Grand Rounds Series is every 1st and 3rd Thursday of each month.