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1.
Z Orthop Unfall ; 148(4): 429-35, 2010 Aug.
Article in German | MEDLINE | ID: mdl-20714983

ABSTRACT

INTRODUCTION: Despite controversial discussions, hip resurfacing at the moment seems to be the most bone-sparing surgical procedure of the femoral bone when implanting hip endoprostheses. Main risks are septic and aseptic loosening and necroses of the coxal end of the femoral bone mainly influenced by the periprosthetic allocation of bone cement. Because of a lack of radiation transparency of the hip resurfacing implant, this cement allocation cannot be sufficiently evaluated by common radiological procedures. A pilot study was conducted to describe and validate the macromechanical interdigitation of bone cement with spongy bone of anatomic specimens compared to artificial bone models and to evaluate whether artificial bones may be used for further interdigitation studies of different implantation techniques. METHODS: Plastic models of polyoxymethylene (POM) according to the inside geometry of the Metasul Durom hip prosthesis were implanted on ex vivo femora (n = 14) versus artificial bone models (n = 24) (Sawbones) of three different spongy densities (0.16; 0.20; 0.32 g/cm(3)) (each n = 8) in a clinically standardised surgical procedure and reproduced by highly resolving computed tomography. Afterwards a computer-based analysis of the cement allocation was accomplished. RESULTS: It could be shown that the Sawbones of the lower spongy densities (0.16 and 0.20 g/cm(3)) were similar to the ex vivo femora regarding the bone penetration of cement. No significant differences could be shown regarding interdigitation. According to our data, both groups of Sawbones may be used for further studies.


Subject(s)
Arthroplasty, Replacement, Hip/methods , Bone Cements/therapeutic use , Equipment Failure Analysis , Femur/pathology , Hip Prosthesis , Models, Anatomic , Postoperative Complications/pathology , Prosthesis Design , Resins, Synthetic , Aged , Aged, 80 and over , Bone Density/physiology , Computer Graphics , Female , Humans , Image Processing, Computer-Assisted , In Vitro Techniques , Male , Middle Aged , Pilot Projects , Software , Tomography, X-Ray Computed
2.
Rofo ; 182(6): 507-11, 2010 Jun.
Article in German | MEDLINE | ID: mdl-20143287

ABSTRACT

PURPOSE: In this study we assessed the effect of an interactive breath-hold control system on procedure time and technical success in transthoracic CT-guided lung biopsies. MATERIALS AND METHODS: In 36 patients (4 female, 32 male, mean age 65 years; range 33 - 88) with a pulmonary nodule, we performed CT-guided biopsy using a 18G Tru-cut needle (Cardinal Health, Dublin, UK) in a 64 row dual-source CT scanner (Somatom Definition, Siemens, Forchheim, Germany) using intermittent imaging of the needle. In half of the patients (2 female, 16 male, mean age 67 years), an interactive breath-hold control system (IBC) (Mayo Clinic Medical Devices, USA) was applied. No additional device was used in the control group. RESULTS: The biopsy was visually successful in all patients. The diameter of the target lesion was comparable in both groups (IBC: 30 +/- 19 mm; control: 28 +/- 15 mm). The number of imaging steps was significantly smaller (p < 0.05) and the intervention time was significantly shorter (p < 0.05) in the IBC group (IBC: 9 +/- 5 steps 17 +/- 10 min; control: 13 +/- 5 steps 26 +/- 12 min). CONCLUSION: Application of the IBC unit reduced the intervention time and radiation exposure in CT-guided Tru-cut biopsy of pulmonary nodules.


Subject(s)
Biofeedback, Psychology/instrumentation , Biopsy, Needle/instrumentation , Lung Neoplasms/pathology , Lung Neoplasms/secondary , Lung/pathology , Respiration , Solitary Pulmonary Nodule/pathology , Surgery, Computer-Assisted/instrumentation , Tomography, X-Ray Computed/instrumentation , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Equipment Design , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity , Solitary Pulmonary Nodule/diagnostic imaging
3.
Rofo ; 181(2): 155-60, 2009 Feb.
Article in German | MEDLINE | ID: mdl-19186316

ABSTRACT

PURPOSE: To evaluate a new Seldinger puncture device for computed tomography-guided interventions under difficult conditions, to analyze applicability, and to investigate assets and drawbacks. MATERIALS AND METHODS: From November 2007 to March 2008, we performed CT-guided interventions in 16 patients (7 women, 9 men; mean age 62 years old) using a new 20G-Seldinger needle (Sika-Med, Wiehl, Germany). This novel needle serves as a guide for many different interventional devices due to a guide wire welded on the proximal needle end. It allows continuous application of anesthesia via four tiny holes at the distal needle end until the region of interest is reached. Each intervention was subject to difficult interventional conditions. The indications for intervention were drainage (n = 7), Trucut biopsy of tumor (n = 8) and radiofrequency ablation (n = 1). Handling, success, advantages, drawbacks, complications and patient tolerance were noted after each procedure. A pain scale from 1 - 10 was used to grade the pain level during the intervention. RESULTS: All interventions were performed successfully and no severe complications were observed. Patient tolerance was very good resulting in a mean pain score of 2 +/- 1. Regions with dangerous and difficult access were successfully reached with the new Seldinger needle in 15 of 16 cases by dilatation of the puncture tract and continuous administration of local anesthesia via the system. Furthermore, different devices such as Trucut systems and a drainage catheter were able to be inserted without complication via the needle. With a proximal removable luer-lock connection, liquid material was able to be aspirated in six cases. CONCLUSION: Under difficult interventional conditions, the use of a Seldinger needle as a reliable technique for CT-guided interventions can provide a safe and successful procedure.


Subject(s)
Anesthetics/administration & dosage , Injections/instrumentation , Needles , Radiographic Image Enhancement/instrumentation , Radiography, Interventional/instrumentation , Tomography, X-Ray Computed/instrumentation , Adolescent , Adult , Equipment Design , Equipment Failure Analysis , Female , Humans , Male , Young Adult
4.
Eur Radiol ; 18(8): 1690-5, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18392831

ABSTRACT

To compare the impact of iodine concentration using two different contrast materials (CM) at standardized iodine delivery rate (IDR) and overall iodine load in 16-multidetector-row-CT-angiography (MDCTA) of the pulmonary arteries of 192 patients with known or suspected pulmonary embolism. One hundred three patients (group A) received 148 ml of a CM containing 300 mg iodine/ml (Ultravist 300, BayerScheringPharma) at a flow rate of 4.9 ml/s. Eighty-nine patients (group B) received 120 ml of a CM with a concentration of 370 mg iodine/ml (Ultravist 370) at a flow rate of 4.0 ml/s, resulting in a standardized IDR (approximately 1.5 gI/s) and the same overall amount of iodine (44.4 g). Both CM injections were followed by a saline chaser. Mean density values were determined in the pulmonary trunk, the ascending and the descending aorta, respectively. Applying repeated-measures ANOVA, no statistically significant differences between both MDCTA protocols were found (p = 0.5790): the mean density in the pulmonary trunk was 355 +/- 116 Hounsfield Units (group A) and 358 +/- 115 (group B). The corresponding values for the ascending and descending aorta were 295 +/- 79 (group A) and 284 +/- 65 (group B) as well as 272 +/- 71 and 262 +/- 70. In conclusion, the use of standardized IDR and overall iodine load provides comparable intravascular CM density in pulmonary 16-MDCTA for delivering contrast materials with different iodine concentrations.


Subject(s)
Angiography/methods , Iohexol/analogs & derivatives , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/methods , Contrast Media/administration & dosage , Dose-Response Relationship, Drug , Female , Humans , Injections, Intra-Arterial , Iohexol/administration & dosage , Male , Middle Aged , Pulmonary Artery/drug effects , Reproducibility of Results , Sensitivity and Specificity
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