Subject(s)
Intestinal Volvulus/diagnostic imaging , Jejunal Diseases/diagnostic imaging , Tissue Adhesions/diagnostic imaging , Tomography, X-Ray Computed , Early Diagnosis , Female , Humans , Intestinal Volvulus/surgery , Jejunal Diseases/surgery , Middle Aged , Pancreatitis, Acute Necrotizing/complications , Tissue Adhesions/surgerySubject(s)
Intestinal Volvulus/diagnostic imaging , Jejunal Diseases/diagnostic imaging , Tomography, X-Ray Computed , Contrast Media , Female , Humans , Image Enhancement , Intestinal Volvulus/surgery , Jejunal Diseases/surgery , Jejunum/diagnostic imaging , Jejunum/parasitology , Middle Aged , Peritonitis/diagnosis , Tissue Adhesions/diagnosisABSTRACT
AIMS: Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and ß-hydroxy-ß-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. METHODS: Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and ß-hydroxy-ß-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. RESULTS: Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and ß-hydroxy-ß-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. CONCLUSIONS: While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and ß-hydroxy-ß-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and ß-hydroxy-ß-methylbutyrate in these high-risk subgroups might prove clinically valuable.
Subject(s)
Arginine/administration & dosage , Diabetic Foot/physiopathology , Dietary Supplements , Glutamine/administration & dosage , Valerates/administration & dosage , Wound Healing , Adult , Aged , Aged, 80 and over , Ankle Brachial Index , Diabetic Foot/diet therapy , Double-Blind Method , Female , Humans , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Portal vein embolization (PVE) has become a standard procedure to increase the future liver remnant (FLR) and enable curative resection of initially unresectable liver tumours. This study investigated the safety and feasibility of a new two-stage liver resection technique that uses in situ liver transection (ISLT) and portal vein ligation before completion hepatectomy. METHODS: A consecutive series of patients undergoing ISLT and extended right hepatectomy between 2009 and 2011 were compared with consecutive patients undergoing extended right hepatectomy after PVE. All patients had initially unresectable primary or secondary liver tumours, owing to an insufficient FLR (liver segments II/III). RESULTS: Fifteen patients who had PVE and seven who underwent ISLT before extended right hepatectomy were evaluated. ISLT induced rapid growth of the FLR within 3 days, particularly after insufficient PVE, from a mean(s.d.) of 293(58) ml to 477(85) ml, corresponding to a volume increase of 63(29) per cent. All patients who had ISLT underwent completion extended right hepatectomy within 8 days (range 4-8 days). CONCLUSION: ISLT is an effective and reliable technique to induce rapid growth of the FLR, even in patients with insufficient volume increase after PVE.
Subject(s)
Embolization, Therapeutic/methods , Hepatectomy/methods , Liver Neoplasms/surgery , Liver/growth & development , Portal Vein , Aged , Aged, 80 and over , Feasibility Studies , Female , Humans , Ligation/methods , Liver Regeneration/physiology , Male , Middle Aged , Operative Time , Prospective Studies , Retrospective StudiesABSTRACT
Congenital venous malformations (VM) at the hand are rare. VM consist of dysplastic venous vessels without progressive cellular proliferation. The therapy for VM is considerably different from that for vascular tumours (e. g., haemangiomas). Treatment options for vascular malformations are antithrombotic medication, local compression, resection of the VM, and obliteration of the lumina by percutaneous sclerosation. Here, the percutaneous sclerosation for the treatment of VM with sodium tetradecyl sulfate has been illustrated and discussed on the basis of 2 case reports.
Subject(s)
Arteriovenous Malformations/therapy , Hand/blood supply , Sclerotherapy/methods , Wrist/blood supply , Adult , Angiography, Digital Subtraction , Arteriovenous Malformations/diagnosis , Female , Follow-Up Studies , Humans , Image Interpretation, Computer-Assisted , Injections, Intravenous , Magnetic Resonance Angiography , Male , Retreatment , Sclerosing Solutions , Sodium Tetradecyl Sulfate , Young AdultABSTRACT
Injuries of the internal mammary artery after blunt thoracic trauma are rare but potentially fatal. A specific characteristic of these injuries is that they can become symptomatic even after a delay of several weeks. This article reports on the diagnosis and treatment of a 41-year-old motorcycle rider who suffered bilateral injuries of the internal mammary artery after a motorcycle accident without any additional bony lesions.
Subject(s)
Mammary Arteries/injuries , Mammary Arteries/surgery , Multiple Trauma/surgery , Thoracic Injuries/surgery , Wounds, Nonpenetrating/surgery , Adult , Humans , Male , Multiple Trauma/diagnosis , Thoracic Injuries/diagnosis , Wounds, Nonpenetrating/diagnosisSubject(s)
Appendicitis/diagnosis , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Pregnancy Complications/diagnosis , Abdomen, Acute/etiology , Adult , Calculi/diagnosis , Diagnosis, Differential , Early Diagnosis , Female , Humans , Placenta Previa/diagnosis , Pregnancy , Pregnancy Trimester, SecondSubject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Coated Materials, Biocompatible , Diagnostic Imaging , Iliac Artery , Polytetrafluoroethylene , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Prosthesis Failure , Stents , Ureteral Diseases/diagnosis , Ureteral Diseases/therapy , Urinary Fistula/diagnosis , Urinary Fistula/therapy , Vascular Fistula/diagnosis , Vascular Fistula/therapy , Aged, 80 and over , Angiography, Digital Subtraction , Diagnosis, Differential , Extravasation of Diagnostic and Therapeutic Materials/diagnosis , Extravasation of Diagnostic and Therapeutic Materials/therapy , Female , Hematuria/etiology , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Tomography, X-Ray Computed , UrographyABSTRACT
We report a case of acute esophageal necrosis after endovascular stenting for acute rupture of a thoracic aortic aneurysm into the mediastinum caused by mediastinal compartment syndrome and overstenting of intercostal arteries.
Subject(s)
Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/diagnostic imaging , Aortic Rupture/surgery , Blood Vessel Prosthesis/adverse effects , Compartment Syndromes/diagnostic imaging , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/surgery , Esophagus/pathology , Ischemia/diagnostic imaging , Ischemia/surgery , Mediastinum/diagnostic imaging , Mediastinum/surgery , Postoperative Complications/diagnostic imaging , Postoperative Complications/surgery , Postoperative Hemorrhage/diagnostic imaging , Postoperative Hemorrhage/surgery , Stents/adverse effects , Aged , Angiography, Digital Subtraction , Aortography , Compartment Syndromes/pathology , Compartment Syndromes/surgery , Esophageal Fistula/pathology , Esophagoscopy , Esophagus/blood supply , Esophagus/surgery , Fatal Outcome , Female , Humans , Ischemia/pathology , Mediastinum/pathology , Necrosis , Postoperative Complications/pathology , Postoperative Hemorrhage/pathology , Reoperation , Tomography, X-Ray Computed , Trachea/pathology , Trachea/surgeryABSTRACT
Haemorrhage is a recognized complication of catheter-directed thrombolysis. We report one case of an afore unknown colo-rectal carcinoma, which was detected due to rectal bleeding following intraarterial thrombolysis. As reported with warfarin induced gastrointestinal bleeding complications, patients with unknown tumor developing rectal bleeding after thrombolysis procedure, should receive full diagnostic work-up of the gastrointestinal tract in order to exclude serious but potentially curable disease.
Subject(s)
Adenocarcinoma/diagnosis , Fibrinolytic Agents/adverse effects , Gastrointestinal Hemorrhage/chemically induced , Paraneoplastic Syndromes/drug therapy , Popliteal Artery , Rectal Neoplasms/diagnosis , Thrombolytic Therapy/adverse effects , Thrombosis/drug therapy , Tissue Plasminogen Activator/adverse effects , Adenocarcinoma/complications , Adenocarcinoma/pathology , Female , Fibrinolytic Agents/therapeutic use , Humans , Middle Aged , Neoplasm Staging , Postoperative Complications/drug therapy , Rectal Neoplasms/complications , Rectal Neoplasms/pathology , Thrombectomy , Tissue Plasminogen Activator/therapeutic use , Tomography, Spiral ComputedSubject(s)
Breast Neoplasms/diagnostic imaging , Image Processing, Computer-Assisted , Liver Neoplasms/secondary , Liver/blood supply , Lung Neoplasms/secondary , Phlebography , Superior Vena Cava Syndrome/diagnostic imaging , Tomography, Spiral Computed , Adult , Azygos Vein/diagnostic imaging , Collateral Circulation , Contrast Media , Device Removal , Diagnosis, Differential , Equipment Failure , Female , Humans , Infusion Pumps, Implantable , Liver Neoplasms/blood supply , Liver Neoplasms/diagnostic imaging , Lung Neoplasms/blood supply , Lung Neoplasms/diagnostic imaging , Superior Vena Cava Syndrome/surgerySubject(s)
Acromioclavicular Joint/injuries , Acromion/injuries , Fractures, Bone , Scapula/injuries , Thoracic Wall/injuries , Accidents, Traffic , Adult , Fractures, Bone/diagnostic imaging , Fractures, Bone/mortality , Humans , Image Processing, Computer-Assisted , Male , Motorcycles , Thoracic Wall/diagnostic imaging , Tomography, Spiral ComputedABSTRACT
BACKGROUND: Nonocclusive disease (NOD) is known to be a common cause of ischemic colitis, which is frequently underestimated. MATERIAL AND METHODS: A computer-assisted search of radiological reports at our institute over a period of 18 months, describing ischemic colitis of the ascending colon with an unimpaired perfusion of the superior mesenteric artery, was performed. RESULTS: A retrospective analysis of the clinical and radiological data of 14 patients was performed. In ten cases colonic ischemia was confirmed clinically or intraoperatively. Most of our patients needed intravenous catecholamines due to severe hypotension. However, no significant radiographic predictors could be identified. CONCLUSION: Awareness of NOD seems to be crucial. Especially in cases of acute abdominal pain associated with severe hypotension, renal insufficiency, or pancreatitis, one should include NOD as a differential diagnosis at an early stage.
Subject(s)
Abdominal Pain/diagnosis , Colitis, Ischemic/diagnostic imaging , Colon, Ascending/diagnostic imaging , Tomography, X-Ray Computed/methods , Abdominal Pain/etiology , Adult , Aged , Aged, 80 and over , Colitis, Ischemic/complications , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Persistent left-sided inferior vena cava (VCI) is a rare venous anomaly, its prevalence being estimated at 0.2-0.5%. Thrombotic occlusion of a VCI has been reported in only a few of these cases. We report the case of a 24-year old woman who suffered an acute thrombosis in a left-sided VCI and recurrent pulmonary embolism. After thrombectomy the course was uneventful. The diagnostic approach and the treatment strategy are discussed with reference to the literature.
Subject(s)
Femoral Vein/diagnostic imaging , Iliac Vein/diagnostic imaging , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Pulmonary Embolism/diagnostic imaging , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed , Vena Cava, Inferior/abnormalities , Adult , Angiography, Digital Subtraction , Arteriovenous Shunt, Surgical , Female , Femoral Vein/surgery , Humans , Iliac Vein/surgery , Phlebography , Pulmonary Embolism/surgery , Thrombectomy , Thrombosis/surgery , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgeryABSTRACT
Bile leak is a well-known complication of cholecystectomy. Endoscopic drainage and decompression of the biliary system including temporary insertion of a biliary stent is generally considered the treatment of choice. We report the successful obliteration of a bile leak using fibered platinum coils placed under fluoroscopic guidance after stent treatment had failed.
Subject(s)
Biliary Fistula/therapy , Cholecystectomy , Cholecystitis/surgery , Embolization, Therapeutic , Postoperative Complications/therapy , Acute Disease , Aged , Biliary Fistula/diagnostic imaging , Cholangiopancreatography, Endoscopic Retrograde , Cholecystitis/diagnostic imaging , Cystic Duct/diagnostic imaging , Cystic Duct/surgery , Duodenoscopy , Fluoroscopy , Humans , Male , Postoperative Complications/diagnostic imaging , Surgical Wound Dehiscence/diagnostic imaging , Surgical Wound Dehiscence/therapyABSTRACT
Opinions differ regarding the indications for antithyroid drugs, radioiodine and surgery in patients with Graves' disease because the likelihood of long-term remission after medical treatment cannot be predicted. The aim of this study was to assess the value of quantifying thyroid blood flow in an attempt to predict outcome following withdrawal of antithyroid drug therapy. Spectral Doppler recordings were obtained from the thyroid arteries in 24 patients with Graves' disease at the time of diagnosis. Thyroid blood flow levels measured at the time of diagnosis of Graves' disease were correlated with outcome following withdrawal of medical treatment (mean duration of treatment: 14 months). Clinical follow-up for at least 18 months (range: 18 - 39 months) after antithyroid drug withdrawal was possible in 13 patients (12 women). Mean peak systolic velocity and volume flow rate values as well as thyroid volume measured at the time of diagnosis were significantly higher (139 cm/s, SD 46; 195 ml/min, SD 170; 52 ml, SD 18) in patients who relapsed after drug treatment compared with patients in remission (71 cm/s, SD 27; 67 ml/min, SD 61; 25 ml, SD 13). The correlation between thyroid blood flow measurements and thyroid volume was high (r = 0.79 - 0.96). Recurrence of disease could be predicted with a sensitivity of 71 % and a specificity of 100 % based on thyroid blood flow measurements. This preliminary data suggest that quantification of thyroid blood flow by means of Doppler sonography might be a useful tool to predict the outcome of Graves' disease following withdrawal of medical treatment and could be helpful in finding the adequate kind of therapy.
Subject(s)
Antithyroid Agents/therapeutic use , Graves Disease/diagnostic imaging , Graves Disease/drug therapy , Adult , Blood Flow Velocity , Blood Volume , Humans , Middle Aged , Predictive Value of Tests , Recurrence , Regional Blood Flow , Thyroid Gland/blood supply , Thyroid Gland/diagnostic imaging , Ultrasonography, Doppler, ColorABSTRACT
We hypothesized that in patients with negative fluid-attenuated inversion recovery (FLAIR) images T(2) weighted fast spin-echo (FSE) images and T(1) weighted spin-echo (SE) images before and after intravenous administration of gadolinium-based contrast medium display no pathology either. Thus, we assessed the negative predictive value of FLAIR images to rule out MR-detectable brain lesions. 1026 consecutive cranial MR examinations were reviewed. Routine MRI of the brain included T(1) weighted coronal imaging before and after administration of gadopentetate dimeglumine, axial T(2) weighted FSE and fast-FLAIR imaging. The FLAIR images were rated by two radiologists into categories of 0 (without pathologic changes) and 1 (with pathologic changes). Two other radiologists analysed the complete examination. In 284 MR examinations of the brain no abnormalities were found (28%). FLAIR-ratings were false-negative in four cases and false-positive in 30 cases. Sensitivity and specificity of the FLAIR sequence for MR-detectable brain lesions were 99.5% and 89.4%. The unselective application of gadolinium avoided one false-negative MR-reading and improved the sensitivity of the MR-examination from 99.5% to 99.6%. Positive and negative predictive values were 96.1% and 98.4%, respectively. The interobserver reliability was kappa=0.93 for the FLAIR-readers and 0.89 for the readers who rated the complete examination. In conclusion, negative FLAIR images provide a high negative predictive value for MR-detectable brain lesions. Thus, in patients with negative FLAIR images the unselective application of gadolinium seems to be unnecessary.