Non-contrast preoperative MRI for determining renal perfusion and visualizing renal arteries in potential living kidney donors at 1.5 Tesla.

Background: The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal function and visualize renal arteries and any abnormalities in potential living kidney donors. Methods: In total, 28 subjects were examined using scintigraphy to determine renal function. In addition, 3D-pseudocontinuous arterial spin labeling (pCASL), a 2D-non-CE electrocardiogram-triggered radial quiescent interval slice-selective (QISS-MRA), and 4D-CE time-resolved angiography with interleaved stochastic trajectories (CE-MRA) were performed to assess renal perfusion, visualize renal arteries and detect any abnormalities. Two glomerular filtration rates [described by Gates (GFRG) and according to the Chronic Kidney Disease Epidemiology Collaboration formula (GFRCKD-EPI)]. The renal volumes were determined using both MRA techniques. Results: The mean value of regional renal blood flow (rRBF) on the right side was significantly higher than that on the left. The agreements between QISS-MRA and CE-MRA concerning the assessment of absence or presence of an aberrant artery and renal arterial stenosis were perfect. The mean renal volumes measured in the right kidney with QISS-MRA were lower than the corresponding values of CE-MRA. In contrast, the mean renal volumes measured in the left kidney with both MRA techniques were similar. The correlation between the GFRG and rRBF was compared in the same manner as that between GFRCKD-EPI and rRBF. Conclusion: The combination of pCASL and QISS-MRA constitute a reliable preoperative protocol with a total measurement time of <10 min without the potential side effects of gadolinium-based contrast agents or radiation exposure.

Functional bony entrapment of the dorsalis pedis artery caused by cranial subluxation in the talonavicular joint.

A 66-year-old female presented in the emergency department with Blue-Toe-Syndrome (BTS) and signs of osteitis of her left big toe. Imaging workup of the peripheral vasculature showed no findings. Upon invasive angiography, severe focal stenosis of the dorsalis pedis artery (DPA) could be seen at the talonavicular joint. Complete regression of the stenosis was inducible by dorsal extension in the ankle joint. Further imaging revealed an underlying subluxation of the talonavicular joint as cause of the arterial compression. Entrapment of the DPA is a rare condition and most often described in relation to connective tissue bands or variant muscular tendons (McCabe et al. 70:213-8, 2021; Weichman et al. 24:113, 2010; Smith et al.58:212-4, 2013; Griffin et al. 20:325-8; 2012). In the presented case, bony compression of the PDA due to cranial subluxation of the talus was seen as the cause of BTS and osteitis of the phalanx of the first toe.

Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate.

Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment.

Percutaneous creation of direct intrahepatic portosystemic shunts - an alternative for failed TIPS creation.

INTRODUCTION: Direct intrahepatic portosystemic shunt creation is a feasible and safe alternative for transjugular intrahepatic portosystemic shunt creation. It needs equipment like endovascular ultrasound with restricted availability. We performed the procedure percutaneously with a common interventional armamentarium to make it more feasible. METHODS: Retrospective analysis of 8 percutaneous DIPS insertions between 2016 and 2020. RESULTS: The procedure was successful in 8/8 patients. There was no short-term death reported within 30 days. The longest reported patency is 5 years. CONCLUSION: Percutaneous DIPS creation is a feasible alternative for failed TIPS. Percutaneously the procedure can be completed faster than conventional DIPS using only minimal puncture equipment. LEVEL OF EVIDENCE: Level 4, Case Series.

Terapia Ocupacional en el tiempo histórico del Acuerdo de Paz: posibilidades y retos para ampliar nuestros campos de acción / Occupational Therapy during the historical Peace Process period: challenges and possibilities to broaden our action areas / Terapia Ocupacional no tempo histórico do Acordo de Paz: possibilidades e desafios para ampliar nossos campos de ação

Este artículo expone una reflexión desde Terapia Ocupacional, situada en el momento de inflexión histórica que atraviesa Colombia tras la firma del Acuerdo de Paz entre el Gobierno Nacional y las Fuerzas Armadas Revolucionarias de Colombia ­ Ejército del Pueblo (FARC-EP). A partir del documento Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera, se busca identificar espacios de incidencia y acción profesional que amplíen los roles tradicionales de la profesión, atendiendo a la nueva institucionalidad que de este se deriva. Se identifican y analizan seis subpuntos del Acuerdo, en los cuales la participación de terapeutas ocupacionales se considera pertinente. Este análisis se articula con reflexiones de otras colegas sobre Terapia Ocupacional en contextos de conflicto armado y posacuerdo de paz, considerando el escenario actual como una oportunidad para abrir nuevos campos de ejercicio y transferir el acumulado teórico y la experiencia de la profesión a una necesidad del país, en pro del interés colectivo.

This article presents a reflection from Occupational Therapy, in the setting of the historical inflection moment that Colombia is going through with the peace agreement between the National Government and the Revolutionary Armed Forces of Colombia ­ People's Army (FARC-EP). From the Final Agreement for the Termination of the Conflict and the Construction of a Stable and Lasting Peace document, the aim is to identify areas of impact and professional action that broaden our traditional roles, taking into account the context of new institutionality derived from the agreement. Six sub-points of the Agreement are identified and analyzed, in which the participation of occupational therapists is considered relevant. This analysis is articulated to the reflections of other colleagues about the professional participation in contexts of armed conflict and post-peace agreement, considering the current period as an opportunity to open up new areas of professional practice and to transfer the profession's experience and theoretical capital accumulated to the country's needs, in benefit of the collective interest.

Este artigo expõe uma reflexão da Terapia Ocupacional, localizada no momento de inflexão histórica, pela qual a Colômbia está passando, após a assinatura do Acordo de Paz entre o Governo Nacional e as Forças Armadas Revolucionárias da Colômbia ­ Exército Popular (FARC-EP). A partir do documento Acordo Final para o Término do Conflito e a Construção de uma Paz Estável e Duradoura, busca-se identificar espaços de incidência e ação profissional que ampliem os papéis tradicionais da profissão, levando em consideração a nova institucionalidade que daí deriva. Seis sub-pontos do Acordo são identificados e analisados, nos quais a participação de terapeutas ocupacionais é considerada pertinente. Esta análise articula-se com reflexões de outros colegas sobre Terapia Ocupacional em contextos de conflito armado e acordo pós-paz. Considera-se o cenário atual como uma oportunidade para abrir novos campos de prática e transferir a teoria e a experiência, acumuladas da profissão, para a necessidade do país, em prol do interesse coletivo.