Evaluating the Barriers and Facilitators to Implementing a Novel Referral System for Outpatient Geriatric Services: The Geri-Hub Quality Improvement Initiative.

Background: In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services.

Objectives: This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized "Geri-Hub." The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner.

The Role of Novel Tiered Reporting System in Serous Fluid Cytology and Risk of Malignancy Assessment: A Retrospective Study in a Tertiary Care Center.

Background: Serous effusion cytology (SEC) reporting is important for the management of the cancer patient. The International System for Reporting Serous Fluid Cytology (ISRSFC) provides tiered reporting terminology to standardize practice, looking into the risk of malignancy (MAL) for each category. In this study, we have assessed the utility of the ISRSFC and reported our experience at a tertiary cancer center.

Cytomorphological and immunohistochemical features of renal and extrarenal rhabdoid tumors.

Background: Rhabdoid tumors are rare, highly lethal neoplasms characterized by alterations of SMARCB1 gene in chromosome 22, which occurs in infants and children. Fine needle aspiration (FNA) is an effective technique to diagnose this tumor when combined with Immunohistochemistry (IHC) and molecular genetics. In this study, we describe four cases of renal and extra-renal rhabdoid tumor of which three cases were diagnosed on FNA with IHC.

T-lymphocyte-epithelial-cell interactions: integrin alpha(E)(CD103)beta(7), LEEP-CAM and chemokines.

The epithelia are the avascular layers of cells that cover the environment-exposed surfaces of the body. It appears that T cells localize to selected sites in or adjacent to epithelia via the selective expression of adhesion molecules and chemokine receptors on T cells. These bind to counter-receptors and to chemokines expressed by epithelial cells.

Lymphocyte adhesion to epithelia and endothelia mediated by the lymphocyte endothelial-epithelial cell adhesion molecule glycoprotein.

Upon encountering the relevant vascular bed, lymphocytes attach to endothelial adhesion molecules, transmigrate out of circulation, and localize within tissues. Lymphocytes may then be retained at microanatomic sites, as in tissues, or they may continue to migrate to the lymphatics and recirculate in the blood. Lymphocytes also interact transiently, but with high avidity, with target cells or APC that are infected with microbes or have taken up exogenous foreign Ags.

Calnexin expression does not enhance the generation of MHC class I-peptide complexes.

We investigated the requirement for calnexin in the biogenesis of MHC class I molecules. Mutant human cells lacking calnexin were infected with recombinant vaccinia viruses encoding mouse MHC class I molecules, Kd, Kb, Kk, Dd, Db, and Ld. Flow cytometry indicated that each of the six MHC class I allomorphs was transported to the cell surface at similar rates in calnexin-deficient cells and transfectants expressing calnexin.

A critical role for tapasin in the assembly and function of multimeric MHC class I-TAP complexes.

Newly assembled major histocompatibility complex (MHC) class I molecules, together with the endoplasmic reticulum chaperone calreticulin, interact with the transporter associated with antigen processing (TAP) through a molecule called tapasin. The molecular cloning of tapasin revealed it to be a transmembrane glycoprotein encoded by an MHC-linked gene. It is a member of the immunoglobulin superfamily with a probable cytoplasmic endoplasmic reticulum retention signal.

Roles for calreticulin and a novel glycoprotein, tapasin, in the interaction of MHC class I molecules with TAP.

Assembly of MHC class I-beta 2 microglobulin (beta 2m) dimers in the endoplasmic reticulum involves two chaperones. Calnexin has previously been shown to interact with free class I heavy chains. Here, we show that the related chaperone, calreticulin, binds human class I-beta 2m dimers prior to peptide loading.

Large cerebral arteriovenous malformations: experience with 27 cases.

Background: The management of large cerebral arteriovenous malformations is difficult. Surgical excision is often attempted after embolization. Interventional neuro-radiology is available in only a few centers.

A teratocarcinoma developing after gross total excision of a pineal teratoma in a patient with systemic lupus erythematosus.

This is a rare case of a teratocarcinoma developing at the same site one year after the gross total excision of a mature pineal teratoma. The malignant tumour arose probably from microscopic remnants of the teratoma. This patient also suffered from systemic lupus erythematosus.

Alzheimer's disease cerebrospinal fluid antibodies display selectivity for microglia. Investigations with cell cultures and human cortical biopsies.

Previous investigations demonstrated that the cerebrospinal fluid (CSF) from Alzheimer's disease (AD) patients contains antibodies that recognize specific neuronal populations in the adult rat central nervous system (CNS). These findings suggest a pathogenic role for immunological aberrations in this disorder. To determine if antibodies may provide a means to differentially diagnose the dementias, CSF from a diversified dementia population was screened against the developing rat CNS and a cell culture system.

Surgery for brain metastases in Singapore.

The best possible treatment for a single metastasis to the brain is complete surgical excision followed by whole brain irradiation. A survey was done to determine the proportion of patients with brain metastases who had surgical excision of the lesion. The number of patients with a preoperative diagnosis of cerebral metastases who underwent surgical excision in Tan Tock Seng Hospital from 1985 to 1989 was obtained from the operation records.

The management of arteriovenous malformations in children.

Between January 1941 and June 1989, 46 children below the age of 18 with an arteriovenous malformation (AVM) were managed. There were 7 patients with AVM diagnosed before the age of 2; 10 patients were diagnosed between the ages of 3 and 10; and 29 patients were diagnosed between 11 and 18. There were equal numbers of male and female patients.

The anterior cavernous sinus space.

The anterior cavernous sinus space is the venous space anterior to the cavernous carotid artery. It is tetrahedral in shape with the anterior apex at the superior orbital fissure. The superomedial wall is formed by the base of the anterior clinoid process.

Direct surgery for carotid bifurcation artery aneurysms.

Eighteen patients with bifurcation of internal carotid artery aneurysms were treated with direct surgery. In all cases the pterional approach was used. The strategy used in dissecting the aneurysm depends on the size of the aneurysm and the length of the intracranial internal carotid artery.

Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm. Case report.

A case is presented in which a giant intracranial vertebral artery aneurysm gave rise to an associated ipsilateral posterior inferior cerebellar artery (PICA) from its waist. Proximal vertebral artery ligation at C-1 was achieved. The aneurysm filled from the opposite vertebrobasilar junction.

Giant intracranial aneurysm surgery: the role of microvascular reconstruction.

The surgical management of 62 anterior circulation giant intracranial aneurysms is presented. Women were affected three times as frequently as men. Thirty-two patients presented with local mass effect, which was the most common mode of presentation, while 26 patients had subarachnoid hemorrhage.

Use of experimental aneurysms to evaluate wrapping materials.

Experimental venous pouch aneurysms in rats were wrapped with muscle, bovine collagen, muslin, cotton, or polyvinyl alcohol. The rats were killed 6 or 12 weeks later, and the aneurysms were compared with control aneurysms. Bovine collagen and muscle were reabsorbed and the aneurysms were similar to the control group.

Vascular malformations and pregnancy.

Between January 1975 and June 1989, 240 patients with cerebral vascular malformations were treated at Henry Ford Hospital. In 16 of the patients, the treatment was influenced by pregnancy. Eleven of the patients presented with hemorrhage, four with seizures, and one with hydrocephalus.

Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency.

Eighty-three patients underwent 85 intracranial to extracranial pedicle bypass anastomosis procedures to the posterior circulation. There were 15 patients with occipital artery (OA) to posterior inferior cerebellar artery (PICA) anastomosis, 20 patients with OA to anterior inferior cerebellar artery (AICA) anastomosis, and 50 patients with superficial temporal artery (STA) to superior cerebellar artery (SCA) anastomosis. All patients had transient ischemic attacks (TIA's) suggestive of vertebrobasilar ischemia.

Intracranial vertebral endarterectomy.

Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA).

Thrombolytic therapy and posterior circulation extracranial-intracranial bypass for acute basilar artery thrombosis. Case report.

Basilar artery thrombosis has a very poor prognosis. A 56-year-old comatose man with acute basilar artery occlusion was successfully treated with local urokinase infusion which reopened the basilar artery and revealed a midbasilar stenotic plaque. This procedure was followed by a superficial temporal artery to superior cerebellar artery anastomosis for protection of the posterior circulation.

Balloon embolization of nontraumatic vertebral arteriovenous fistulae in children.

Two children, aged 4 and 8 years, with nontraumatic extracranial vertebral arteriovenous fistula are described. Under general anesthesia and with fluoroscopic guidance, using a percutaneous endovascular technique, latex detachable balloons were used to successfully occlude the fistulae. The patients were monitored with somatosensory and auditory evoked potentials and kept hypotensive for 24 hours.