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INTRODUCTION: The radiation exposure to unprotected parts of the body requires special attention for the interventional radiologist. During angiographic procedures, hands are exposed to the direct X-ray beam and scattered radiation. AIM: The aim of the study was to evaluate the radiation exposure of examiners hand with the use of lead-free X-ray protective gloves in clinical practice in terms of shielding and sense of touch. The aim of the study was to evaluate the radiation exposure of examiners hand with the use of lead-free X-ray protective gloves in clinical practice in terms of shielding and sense of touch. MATERIALS AND METHODS: Phantom measurements were conducted in the direct X-ray beam and the area of scattered radiation with and without shielding. Examiner measurements were determined in interventional angiographies in clinical routine of the lower limb in antegrade puncture technique through the femoral artery. In 24 out of 50 interventions, an elastic natural rubber latex glove with lead-free metal shielding against radiation was used. All measurements were performed with a direct dosimeter. After the intervention, an opinion of the examiner was requested for evaluation of the sense of touch. RESULTS: Phantom measurements; when using the protective glove in the direct X-ray beam, a significant increase of the Dose Area Product (DAP) (1084.2-1603.8 mGy*cm2; 67.6%; p<0.001) as well of the examiner's hand dose (143-221.8 µSv; 64.5%; p<0.001) was observed. A significant reduction of the examiner's hand dose was verifiable for scattered radiation (1.76-0.75 µSv; 42.6%; p<0.001). Examiner measurements; if protective gloves were used, a significant increase of the DAP (6183.2-10462.9 mGy*cm2; 59.1%; p<0.05) and decrease of the average dose rate (0.76-0.43 mSv/h; 56.6%) for the entire procedure was determined. The tactile sensitivity was assessed as not restricted (18/24). CONCLUSION: The new generation of protective gloves is characterized by a shielding effect against X-ray scattered radiation, without restricting the sense of touch. A significant reduction in radiation doses to the examiner can be accomplished with these gloves in the area of scattered radiation only. If the gloves were used in the direct X-ray beam, especially while the artery puncture was performed, a significant increase of the dose values was observed.
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INTRODUCTION: Endovascular procedures have increased for different indications over the recent years. To achieve a safe haemostasis after arterial puncture and for more comfort for the patients different vascular closure devices have been developed. AIM: To evaluate the effectiveness and safety of a percutaneous closure system based on a matrix patch for achieving haemostasis. MATERIALS AND METHODS: In this study from 2014 to 2015 a percutaneous vascular closure system Femoral Introducer Sheath and Haemostasis (FISH) was used in 54 patients (mean age 69.0±10.7 years), in an antegrade and retrograde technique within the context of an angiographic intervention. The system was used in conjunction with transfemoral approaches with a sheath size of 6F. Postinterventionally (on the following day and after 6 weeks), follow-up was conducted clinically and using colour coded ultrasound. RESULTS: Immediate haemostasis was achieved in 50/54 patients (92.6 %). In 4 cases, an immediate haemostasis was not achieved. In these cases, manual compression was successful. There was one major complication, a retroperitoneal bleeding requiring transfusion. Minor complications were not observed. CONCLUSION: Safe and effective haemostasis is possible with the percutaneous FISH closure system at puncture sizes of 6 F. An immediate re-puncture after using FISH is possible.
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We present the case of a man of 47 years with vertical and horizontal paresis of view combined with periorbital pain that developed initially on the right side but extended after 3-4 days to the left. Gadolinum uptaking tissue in the cavernous sinus was shown by MRI of the orbital region in the T1 spin echo sequence with fat saturation (SEfs) with a slice thickness of 2 mm. As no other abnormalities were found and the pain resolved within 72 hours of treatment with cortison a bilateral Tolosa-Hunt Syndrome (THS) was assumed. THS is an uncommon cause for Painful Ophthalmoglegia (PO) and only few cases of bilateral appearance have been reported. Even though the diagnostic criteria for THS oblige unilateral symptoms we suggest that in patients with bilateral PO THS should not be excluded as a differential diagnosis. Further more when using MRI to detect granulomatous tissue in the orbital region the chosen sequence should be T1 SEfs and slice thickness should possibly be as low as 2 mm, as granulomas are often no larger than 1-2 mm.
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CONTEXT: Carpal bossing is an osseous formation at the dorsal portion of the quadrangular joint, which rarely becomes symptomatic. However, in some patients it causes pain, restricted mobility and can lead to complications like tendon rupture, inflammatory and degenerative joint disease. AIM: In this article, we present our experiences with this rare disorder in order to improve diagnostic and therapeutic proceedings. SETTINGS DESIGN: This is a multicenter and interdisciplinary observation made by orthopaedic surgeons and radiologists in the years 2010 to 2015. Retrospective observational study. The follow up period was 2 years. MATERIALS AND METHODS: In the observed time period, eight patients were diagnosed with symptomatic carpal bossing. Symptoms were pain at palmar flexion and limited mobility of the wrist in combination with a palpable protuberance over the quadrangular joint. All patients underwent X-ray, CT and MRI examinations. A conservative treatment strategy was initiated for 6 weeks in all patients, followed by a wedge resection when symptoms were persisting and disabling. RESULTS: After the conservative treatment schedule, five patients were asymptomatic. Three patients had persisting pain and were thus recommended for surgery. In the postoperative course, two patients were asymptomatic. One patient developed a type 1 complex regional pain syndrome (CRPS) in the first postoperative year, which was successfully treated with pain-adapted physiotherapy, pharmacotherapy with analgesics and calcitonin, and a triple CT-guided thoracic sympathetic nerve blockade. CONCLUSION: Carpal bossing is a mostly asymptomatic entity, which in our experience gets symptomatic due to direct trauma or repetitive stress, especially in competitive racket sports players. It can be diagnosed by thorough clinical examination and multimodal diagnostic imaging. Conservative treatment comprises an excellent prognosis, however surgery, either wedge resection or arthrodesis, must be considered if the response is not positive after 6 weeks.
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INTRODUCTION AND OBJECTIVE: In elderly patients with reduced bone quality, insufficiency fractures of the sacrum are relatively common and are typically accompanied by severe, disabling pain. The objective of this study was to evaluate the feasibility of cement augmentation by RFS, as well as to determine postinterventional leakages and present the patients' outcomes. MATERIAL AND METHOD: In 20 patients (18 women, 2 men) with an average age of 80.4 (65-92) years, a fracture of the sacrum was detected by CT and MRI. Clinically manifest osteoporosis with QCT values of below 50 mg/ml was found in all patients. An initially performed conservative treatment over a period of 3 weeks did not achieve a satisfactory reduction in the severe, disabling pain. The cement augmentation was performed under CT guidance by means of RFS under intubation anaesthesia. A Jamshidi needle was advanced into the respective fracture zone in the sacrum from dorsal to ventral (short axis) or from lateral to medial transiliac (transiliac axis). After removing the inner needle, a flexible osteotome was inserted through the positioned hollow needle and used to extend the spongious space in the fracture zone and thus prepare a cavity for the cement filling. The highly viscous polymethyl methacrylate (PMMA) cement, activated by radiofrequency, was then inserted into the prepared fracture zone through a substituted screw cannula. Cement filling was performed discontinuously under instrumental guidance at 1.3 ml/min under CT guidance. Cement leakages were determined in CT images and conventional X-rays on the day after the intervention. Pain was documented on a visual analogue scale (VAS) on the day before the intervention, on the second day, and after 6 and 12 months after the intervention. Additionally occurring complications were recorded, and the patients were asked to state how satisfied they were after 12 months. RESULTS: RFS was technically feasible in all patients. In the control CT scans and X-rays, sufficient cement distribution and interlocking with vital bone was found along the course of the fracture in the sacrum. 7.2 (4-9) ml of cement were inserted per fracture. Leakage could be ruled out. The mean pain score on the VAS was 8.8 ± 1.2 before the intervention, and a significant reduction in pain (p < 0.001) was seen on the second postoperative day, with an average value of 2.3 ± 0.7, which was stable at 2.2 ± 1.3 after 6 months and 2.1 ± 1.1 after 12 months. All of the patients could be fully re-mobilised and discharged back home. A high level of patient satisfaction was found after 12 months, with 18 of the 20 patients stating that they would undergo the intervention again. One patient died of a stroke, another of cancer over the course. CONCLUSION: As a minimally invasive procedure, RFS is an effective and safe method of treatment for rapid, significant and sustained pain reduction.
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Cementos para Huesos/uso terapéutico , Fracturas Osteoporóticas/cirugía , Dolor/cirugía , Polimetil Metacrilato/uso terapéutico , Sacro/cirugía , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia/métodos , Anciano , Anciano de 80 o más Años , Cementos para Huesos/efectos adversos , Tornillos Óseos/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Dimensión del Dolor , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vertebroplastia/efectos adversosRESUMEN
We present the case of a 73 year-old Caucasian male with acute abdominal pain, peritonism and vomiting. Due to the severity of symptoms a CT examination of the abdomen was performed. The scans revealed multiple jejunal diverticula, wall thickening of the duodenum and jejunum, and free peritoneal fluid. No clear signs of mesenteric infarction, free abdominal air or abscess formation were seen. An additional exploratory laparotomy was conducted to confirm the CT findings and rule out the need for resection of small bowel. Since the results were matching, conservative therapy was scheduled and the patient recovered well. Jejunal diverticulitis is a rare cause of acute abdomen, however has to be considered as a differential diagnosis to more common entities. It usually stays localized, while in our case the inflammation ascended to the duodenum. CT is the modality of choice to diagnose and rule out potentially life threatening complications.
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PURPOSE: The purpose of this retrospective study was to evaluate the benefit of lumbar computed tomography-assisted sympathicolysis (CTSy) in patients with primary focal hyperhidrosis of the feet. METHODS: A lumbar CTSy was conducted on 35 patients (mean age 36.6 ± 11.9 years) with primary focal hyperhidrosis of the feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients evaluated the severity of their symptoms before the intervention, 2 days after the intervention, and 6 and 12 months after the intervention on the basis of a Dermatology Quality of Life Index(©) (DLQI) and side effects experienced. RESULTS: The interventions performed led to a statistically significant decrease in the preinterventional severity of symptoms 2 days after the intervention, and 6 and 12 months after CTSy (p < 0.05). No major complications occurred. As the most common side effect, 12 of the patients reported compensatory sweating. CONCLUSIONS: After conservative measures have been exhausted or as a complement to the existing therapy regimen, CT-assisted sympathicolysis represents a therapeutic option low in side effects that provides a marked benefit to patients with primary, focal hyperhidrosis.
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Pie/inervación , Hiperhidrosis/cirugía , Radiografía Intervencional , Simpatectomía/métodos , Tomografía Computarizada por Rayos X , Adulto , Medios de Contraste , Femenino , Humanos , Yopamidol/análogos & derivados , Masculino , Calidad de Vida , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: Recanalization of chronic total occlusions (CTOs) of the femoropopliteal arteries depends on a successful lesion crossing with the guide wire. The aim of this retrospective study was to evaluate the safety, feasibility, and the primary results of retrograde recanalization of CTOs with balloon-assisted excimer-laser atherectomy (ELA) via a transpopliteal approach after failed antegrade attempts. METHODS: A total number of 15 patients (10 male, 5 female) with a mean age of 68.5 years (range: 43-91 years) treated with retrograde transpopliteal ELA in the years 2009-2012 were included retrospectively. After unsuccessful antegrade recanalization attempts with conventional guide wires and catheters, patients were treated with a retrograde recanalization attempt via a transpopliteal access using an excimer laser, followed by pressure-only balloon angioplasty (POBA). The mean length of the CTOs in the femoropopliteal arteries was 17.8 ± 5.4 cm (range: 9-29 cm). RESULTS: Technically successful recanalization was achieved in 14 of 15 patients. Provisional stenting was done in two cases. There were no major adverse events regarding the laser atherectomy or popliteal access site. One acute reocclusion was observed in the first 48 hours after intervention. The ankle-brachial Index increased from preinterventional 0.45 ± 0.07 to 0.77 ± 0.29 (P < 0.05) in the follow-up period (1.5 months), resulting in a primary patency of 80%. CONCLUSION: The retrograde ELA for recanalization of chronic femoropopliteal occlusions via a popliteal access turned out to be a safe and effective procedure with promising primary results. Thus it may be an endovascular treatment option for long chronic occlusions after failed antegrade recanalization or in patients who are not suitable for surgery.
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Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study. High-level underwater rugby players with hook fractures diagnosed during a five-year interval (2005-2010) were studied retrospectively. Medical data on these patients were reviewed for information on the mechanism of injury, type of fracture, radiological imaging, treatment, and outcome. In ten patients, hook fractures of the leading hand were confirmed by computed tomography, all of which were associated with specific injuries during underwater rugby games. Conservative treatment resulted in delayed healing or non-union, wherefore fragment excision and open reduction and internal fixation was performed in ten and five patients, respectively, while two patients declined surgery. After surgery, all patients were able to play underwater rugby again. In underwater rugby, hook fractures occur frequently due to high and repeated forces applied to the leading hand during games.
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Traumatismos en Atletas/epidemiología , Fútbol Americano/lesiones , Fijación Interna de Fracturas/métodos , Fracturas Óseas/epidemiología , Hueso Ganchoso/lesiones , Tomografía Computarizada por Rayos X , Traumatismos de la Muñeca/epidemiología , Adulto , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Alemania/epidemiología , Hueso Ganchoso/diagnóstico por imagen , Hueso Ganchoso/cirugía , Humanos , Incidencia , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/cirugía , Adulto JovenRESUMEN
PURPOSE: Percutaneous mechanical thrombectomy (PMT) is now established as an alternative treatment of acute arterial occlusions in addition to fibrinolysis and surgical thrombectomy. The objective of this retrospective study was the investigation of a rotational atherothrombectomy catheter in terms of safety and efficacy in the treatment of acute and subacute femoropopliteal bypass occlusions. MATERIALS AND METHODS: Forty-two patients (average age 65.8 ± 9.1 years) with acute (<14 days [n = 31]) and subacute (14-42 days [n = 11]) femoropopliteal bypass occlusions were treated consecutively with a rotational debulking and removal catheter (Straub Rotarex). The average occlusion length was 28.4 ± 2.9 (24-34) cm. Thirty-four (81%) patients underwent venous bypass, and 8 (19%) patients underwent polytetrafluoroethylene bypass. RESULTS: The technical success rate was 97.6% (41 of 42). In 1 patient, blood flow could not be restored despite the use of the atherothrombectomy system. The average catheter intervention time was 6.9 ± 2.1 (4-9) min. Ankle-brachial index increased from 0.39 ± 0.13 to 0.83 ± 0.11 at discharge and to 0.82 ± 0.17 after 1 month (p < 0.05). There were a total of 2 (4.8%) peri-interventional complications: One patient developed a distal embolism, which was successfully treated with local lysis, and another patient had a small perforation at the distal anastomosis, which was successfully treated with a stent. CONCLUSION: PMT with the Rotarex atherothrombectomy catheter represents a safe and effective option in the treatment of acute and subacute femoropopliteal bypass occlusions because it can quickly restore blood flow.
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Cateterismo Periférico/instrumentación , Procedimientos Endovasculares/instrumentación , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/terapia , Enfermedad Arterial Periférica/cirugía , Trombectomía/instrumentación , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Índice Tobillo Braquial , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/cirugía , Cateterismo Periférico/métodos , Catéteres , Estudios de Cohortes , Procedimientos Endovasculares/métodos , Femenino , Arteria Femoral/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Enfermedad Arterial Periférica/diagnóstico por imagen , Arteria Poplítea/cirugía , Radiografía Intervencional/métodos , Flujo Sanguíneo Regional/fisiología , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Trombectomía/métodos , Resultado del Tratamiento , Grado de Desobstrucción Vascular/fisiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
BACKGROUND: Mass-forming focal pancreatitis (FP) may mimic pancreatic cancer (PC) on magnetic resonance (MR) imaging, and the preoperative differential diagnosis is often difficult. Recently, the usefulness of diffusion-weighted imaging (DWI) in the diagnosis of pancreatic cancer has been reported in several studies. PURPOSE: To investigate if apparent diffusion coefficient (ADC) measurements based on diffusion-weighted echo-planar imaging (DW-EPI) may distinguish between normal pancreas parenchyma, mass-forming focal pancreatitis, and pancreas carcinoma. MATERIAL AND METHODS: MRI was performed on 64 patients: 24 with pancreas carcinoma (PC), 20 with mass-forming focal pancreatitis (FP), three patients with other focal pancreatic disease as well as 17 controls without any known pancreatic disease. Diffusion-weighted sequence with ADC maps and T2-weighted sequence for anatomical information was performed. Apparent diffusion coefficient (ADC) maps were automatically created and analyzed using a dedicated user interface. In the group with pancreas disease the abnormal parenchyma was detected by using T1- and T2-weighted images and the region of interest (ROI) was transferred exactly to the ADC map and the coefficients were registered. In the control group the ROI was set to the head of the pancreas followed by a similar registration of the ADCs. RESULTS: ADC values for mass-forming FP and PC differed significantly from ADC values for normal pancreas parenchyma (P = 0.001/P = 0.002). Mean ADC values for mass-forming FP were 0.69 ± 0.18 × 10(-3) mm(2)/s. ADC values for PC were 0.78 ± 0.11 × 10(-3) mm(2)/s, compared to ADC values of 0.17 ± 0.06 × 10(-3) mm(2)/s in the control group. However there was no significant difference in ADCs between PC and mass-forming FP (P = 0.15). CONCLUSION: ADC measurements clearly differentiated between normal pancreatic tissue and abnormal pancreas parenchyma (PC and mass-forming FP). However there is an overlap in values of PC and mass-forming FP, with the consequent problem of their correct identification.
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Imagen de Difusión por Resonancia Magnética/métodos , Imagen Eco-Planar/métodos , Neoplasias Pancreáticas/patología , Pancreatitis/patología , Adulto , Anciano , Anciano de 80 o más Años , Pancreatocolangiografía por Resonancia Magnética/métodos , Medios de Contraste , Diagnóstico Diferencial , Femenino , Gadolinio , Humanos , Aumento de la Imagen/métodos , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Páncreas/patologíaRESUMEN
INTRODUCTION: Models of isolated and perfused lungs study pathophysiological phenomena of the airways, but are limited by restricted resemblance to the human situation, non-physiological perfusates or the need for the use of high numbers of laboratory animals. The present model was established to address these difficulties. OBJECTIVES: Aim of the current study was the establishment of an animal model that uses slaughterhouse animals and closely resembles physiological conditions found in humans. METHODS: We used a model of hemoperfused isolated porcine slaughterhouse lungs using autologous blood, metabolically controlled via a dialysis system. Over a period of 135 minutes positive inspiratory pressure, pulmonary arterial pressure, pulmonary vein oxygen partial pressure and lung weight were assessed. RESULTS: Stable organ function was maintained over 135 minutes with an amount of 2,500-3,000 ml perfusate without fall in pulmonary arterial pressure. During the time the positive inspiratory pressure and lung weight increased, while pulmonary vein oxygen partial pressure decreased. CONCLUSIONS: The present model of isolated hemoperfused slaughterhouse lungs displays a useful new and economic approach to evaluate pulmonary function and toxicity of different substances on an organ level. As a major economic advantage in comparison to models using laboratory animals, the current model might be run using blood and organs obtained from slaughterhouse animals.
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Pulmón/irrigación sanguínea , Pulmón/fisiología , Pruebas de Función Respiratoria/métodos , Porcinos , Mataderos , Animales , Pulmón/anatomía & histología , Técnicas de Cultivo de Órganos , Tamaño de los Órganos , Farmacología/métodosRESUMEN
PURPOSE: To evaluate the safety and performance of ultrasound-enhanced thrombolysis in the treatment of acute thrombotic or embolic occlusion of the lower limb arteries. METHODS: From April 2005 to July 2006, 25 patients (15 men; mean age 64.1 years, range 37-82) presenting with acute (<14 days old) occlusions of the lower limb arteries were treated with local thrombolysis [recombinant tissue plasminogen activator (rtPA)] in a dosage of 1.0 mg/h using the EKOS Lysus Peripheral Catheter System with an ultrasound core. No bolus injection of rtPA was given. The mean occlusion length was 25.1 cm (range 2-70). RESULTS: The technical success rate was 100%. Total clot removal was achieved in 22 (88%) patients after 16.9 hours (range 5-24) using a mean 17 mg (range 5-25) of rtPA. In 8 cases, total clot removal of the main lesion was achieved after 6 hours (6 mg of rtPA). In 1 patient, lysis was stopped after 2.5 hours because of bleeding due a dislocation of the introducer sheath. In 2 cases, total clot removal could not be achieved; these patients were successfully treated with thromboaspiration. At the 1-month follow-up, the treated vessel was still patent in 20 patients. Two reocclusions occurred; 1 was treated with a bypass graft and the other with conservative therapy. There were no cases of amputation or death during follow-up. There were no side effects related to rtPA or the catheter system. CONCLUSION: This study demonstrates that local lysis of acute arterial occlusions using the Lysus Peripheral Catheter System is safe and effective. Blood flow is restored quickly.