Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty.
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The major technical drawback of percutaneous vertebroplasty is the potential for neural compromise from leakage of polymethylmethaorylate into epidural or perivertebral veins. We have combined the procedure of intrathecal injection of contrast medium with vertebroplasty to better delineate spinal canal encroachment during injection when the posterior vertebral wall is compromised by myeloma. (+info)
Sacroplasty: a treatment for sacral insufficiency fractures.
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Sacral insufficiency fracture is a debilitating injury for which no active treatment is currently available. We present three consecutive cases of elderly patients with sacral insufficiency fractures whose symptoms were relieved immediately by treatment of the fractures by polymethylmethacrylate injections, a so-called sacroplasty. (+info)
Revision parathyroidectomy guided by intraoperative radionuclide imaging.
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BACKGROUND: Technetium-99m sestamibi scintigraphy has become one of the most popular techniques for localization of the parathyroid gland after failure of primary neck exploration. OBJECTIVE: To examine the efficacy of sestamibi with the hand-held gamma ray detecting probe for the identification of parathyroid adenomas during revision parathyroidectomy. METHODS: We reviewed six cases of probe-assisted neck exploration for parathyroid lesions following unsuccessful primary exploration. RESULTS: In all cases the pathologic glands were successfully detected and removed. CONCLUSIONS: With careful planning, a gamma ray detecting probe can be used optimally 2-3 hours after technetium-99m sestamibi injection. The probe is efficient, easy and convenient to use. (+info)
Computed tomography-guided biopsy of mediastinal lesions: fine versus cutting needles.
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PURPOSE: To report the experience of a radiology department in the use of computed tomography guided biopsies of mediastinal lesions with fine and cutting needles, describing the differences between them. The results of adequacy of the sample and histologic diagnoses are presented according to the type of needle used. METHODS: We present a retrospective study of mediastinal biopsies guided by computed tomography performed from January 1993 to December 1999. Eighty-six patients underwent mediastinal biopsy in this period, 37 with cutting needles, 38 with fine needles, and 11 with both types (total of 97 biopsies). RESULTS: In most cases, it was possible to obtain an adequate sample (82.5%) and specific diagnosis (67.0%). Cutting-needle biopsy produced a higher percentage of adequate samples (89.6% versus 75.5%, P = 0.068) and of specific diagnosis (81.3% versus 53.1%, P = 0.003) than fine-needle biopsy. There were no complications that required intervention in either group. CONCLUSION: Because they are practical, safe, and can provide accurate diagnoses, image-guided biopsies should be considered the procedure of choice in the initial exploration of patients with mediastinal masses. In our experience, cutting needles gave higher quality samples and diagnostic rates. We recommend the use of cutting needles as the preferred procedure. (+info)
Malignant biliary obstruction: treatment with interventional radiology.
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OBJECTIVE: To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction. METHODS: From January 1995 to February 2001, 243 consecutive patients (161 men and 82 women; aged 26 - 91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis. RESULTS: One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8, P < 0.001) with an average patency of 9.7 months (log rank 4.7, P < 0.05). CONCLUSION: Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients. (+info)
Radiation exposure benefit of a lead cap in invasive cardiology.
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BACKGROUND: Occupational head exposure to radiation in cardiologists may cause radiation induced cataracts and an increased risk of brain cancer. OBJECTIVE: To determine the effectiveness of 0.5 mm lead equivalent caps, not previously used in invasive cardiology, in comparison with a 1.0 mm lead equivalent ceiling mounted lead glass screen. DESIGN: An anthropomorphic Alderson-Rando phantom was used to represent the patient. Scatter entrance skin air kerma to the operator position (S-ESAK-O) was measured during fluoroscopy for all standard angulations and the S-ESAK-O per dose-area product (DAP) calculated, as applied to the phantom. RESULTS: Measured mean (SD) left/right anterior oblique angulation ratios of S-ESAK-O without lead devices were 23.1 (10.1), and varied as a function of tube angulation, body height, and angle of incidence. S-ESAK-O/DAP decreased with incremental operator body height by 10 (3)% per 10 cm. A 1.0 mm lead glass shield reduced mean S-ESAK-O/DAP originating from coronary angiography from 1089 (764) to 54 (29) nSv/Gy x cm2. A 0.5 mm lead cap was effective in lowering measured levels to 1.8 (1.1) nSv/Gy x cm2. Both devices together enabled attenuation to 0.5 (0.1) nSv/Gy x cm2. The most advantageous line of vision for protection of the operator's eyes was > or = 60 degrees rightward. CONCLUSIONS: Use of 0.5 mm lead caps proved highly effective, attenuating S-ESAK-O to 2.7 (2.0) x 10(-3) of baseline, and to 1.2 (1.4) x 10(-3) of baseline where there was an additional 1.0 mm lead glass shield. These results could vary according to the x ray systems used, catheterisation protocols, and correct use of radiation protection devices. (+info)
Synchronous carotid endarterectomy and retrograde endovascular treatment of brachiocephalic or common carotid artery stenosis.
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OBJECTIVES: To retrospectively evaluate the safety and the long-term results of retrograde brachiocephalic and common carotid angioplasty and stenting (AS) performed for >70% stenosis synchronously with the carotid endarterectomy (CEA). PATIENTS: Sixteen patients operated between April 1999 and March 2002. RESULTS: 14/16 procedures were successful. There was no neurological morbidity or mortality. Per-operative angiography showed the optimal stent positioning and patency of both proximal and distal arteries in all patients. In the follow-up, all patients showed patency of the treated vessels without restenosis and the absence of any cerebrovascular symptoms. CONCLUSION: Intra-operative retrograde AS combined with CEA is an effective, safe and durable alternative to conventional surgery when a tandem significant proximal lesion is identified in a patient with an high grade carotid stenosis. (+info)
Endovascular treatment of popliteal artery aneurysms.
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OBJECTIVE: To present the results of the endovascular treatment of popliteal artery aneurysms. METHODS: From April 1999 to January 2002, 11 patients, aged 40-94 years, with 12 popliteal aneurysms were treated. Nine (75%) underwent an endoluminal repair, of whom three were done emergently due to an aneurysm rupture. Aneurysm diameter was 28-105 (mean 69) mm. A Hemobahn stent graft was inserted in six, Wallgraft in two and Passager in one case. RESULTS: During a mean follow-up of 14 (3-31) months, four (44%) thromboses occurred: two in the early postoperative period (30 days) and two during the late postoperative period. Two of the four occluded grafts were successfully reopened, and in the one a stenosis of the distal end of the stent graft was treated with balloon dilatation. Patency rates at 1 and 12 months were 64/47% (primary patency) and 88/75% (secondary patency), respectively. CONCLUSION: Initial experience with endovascular treatment of the popliteal aneurysm in high-risk patients yielded modest results. Larger number of patients and further follow-up time is necessary to evaluate the long-term results. (+info)