ABSTRACT
The study was aimed at assessing possibilities and determining diagnostic significance of the method of contrast-free magnetic resonance phlebography (MR phlebography) in diagnosis of diseases of the inferior vena cava (IVC) and its basin. Presented herein is experience with examining a total of 74 patients at two therapeutic-diagnostic facilities: the National Medical Surgical Centre named after N.I. Pirogov and the Medical Diagnostic Centre "Ramsey Diagnostics". The studies were carried out on magnetic resonance tomographs "Philips Intera Nova" and "GE Optima MR360", using a special protocol of contrast-free MR-phlebography in consequences at free breathing, followed by 3D reconstruction and processing of the obtained images as MIP and 3D. According to the obtained results our method makes it possible to visualize the anatomical passage of the vessels of the IVC basin, interrelationship with adjoining structures and osseous elements, to determine localization of the thrombus, its length, diameter of the vessel and degree of its narrowing at the level of the lesion, as well as to assess the collateral outflow without contrast enhancement. The sensitivity of the method in thromboses of the IVC basin veins amounted to 92%, with the specificity amounting to 90%. Hence, contrast-free MR phlebography is the most optimal screening method requiring no contrast medium, short in time and absolutely safe procedure in diagnosing the causes of extra- and intravasal pathology of the IVC and its basin as compared with ultrasonographic examination, contrast-enhanced phlebography, computed tomography (CT) and contrast-enhanced magnetic resonance tomography.
Subject(s)
Magnetic Resonance Angiography/methods , Phlebography/methods , Vena Cava, Inferior/diagnostic imaging , Venous Thrombosis/diagnosis , Adult , Aged , Comparative Effectiveness Research , Female , Humans , Image Processing, Computer-Assisted/methods , Male , Mass Screening/methods , Middle Aged , Sensitivity and Specificity , Vena Cava, Inferior/pathology , Venous Thrombosis/physiopathologyABSTRACT
Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality.
Subject(s)
Aortic Aneurysm, Thoracic , Aortic Dissection , Blood Vessel Prosthesis Implantation , Coronary Artery Bypass , Coronary Artery Disease , Postoperative Complications/therapy , Respiratory Insufficiency , Aged , Aortic Dissection/diagnosis , Aortic Dissection/etiology , Aortic Dissection/physiopathology , Aortic Dissection/surgery , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/physiopathology , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/methods , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/physiopathology , Coronary Artery Disease/surgery , Humans , Intraoperative Care/methods , Male , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Stents , Tomography, Spiral Computed/methods , Treatment OutcomeABSTRACT
There are difficulties in procedure of regional block of 2 and 3 brunches of the trigeminal nerve despite availability of many different methods of nerves imaging. The difficulties are connected with complex anatomy structure. Neurostimulation not always effective and as a rule, is accompanied with wrong interpretation of movement response on stimulation. The changing of the tactics on paraesthesia search improves the situation. The use of new methods of nerves imaging (3D-CT) also allows decreasing the frequency of fails during procedure of regional block of the brunches of the trigeminal nerve.
