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1.
Surgery ; 135(4): 411-8, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15041965

ABSTRACT

BACKGROUND: Five percent to 10% of chronic pancreatitis (CP) cases are complicated by portal venous occlusion leading to extrahepatic generalized portal hypertension (GPH). Pancreatic head resections (PHR) are regarded risky or contraindicated in patients with extrahepatic GPH. The aim of our study was to analyze the outcome of patients with extrahepatic GPH undergoing PHR for CP and to propose recommendations for surgical strategy. METHODS: Sixteen of 185 patients with PHR suffered from extrahepatic GPH. Perioperative and follow-up data were documented prospectively and analyzed to assess the outcome. RESULTS: Preoperative interventional thrombolysis of the portal vein was successfully performed in 5 patients and alleviated further PHR. Median operative time and blood transfusions were higher in patients with extrahepatic GPH compared with patients without extrahepatic GPH (P<.01). Overall complication rate was not statistically different (44% vs 34%). One death occurred in each group. At the end of follow-up (median, 18 months) 13 of 15 patients with extrahepatic GPH were free of pain. No variceal bleeding or cholestasis was documented. All patients judged their status as subjectively improved. CONCLUSION: Although technically demanding in the presence of extrahepatic GPH, PHR can be performed with an acceptable morbidity and mortality in an experienced center. Preoperative interventional recanalization of portal vein thrombosis may render PHR possible by restoring normal splanchnic blood flow in selected cases indicated for surgery.


Subject(s)
Hypertension, Portal/therapy , Mesenteric Veins , Pancreatectomy/methods , Pancreatitis/surgery , Portal Vein , Venous Thrombosis/therapy , Adult , Aged , Angiography , Chronic Disease , Female , Fibrinolytic Agents/therapeutic use , Heparin/therapeutic use , Humans , Hypertension, Portal/etiology , Male , Middle Aged , Pancreatitis/complications , Preoperative Care/methods , Prospective Studies , Thrombectomy/methods , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome , Venous Thrombosis/complications
2.
Invest Radiol ; 38(5): 243-9, 2003 May.
Article in English | MEDLINE | ID: mdl-12750612

ABSTRACT

RATIONALE AND OBJECTIVES: To evaluate the quality of chest radiographs after 32:1 compression/decompression with different image compression algorithms. METHODS: Ten digital (Thoravison) radiographs of an anthropomorphic chest phantom with superimposed simulated nodular lesions (NL) and linear reticular lesions (LL) were obtained. Each radiograph was subdivided into 15 fields; they contained the lesions with a probability of 0.5. The radiographs were compressed and decompressed by using JPEG, fractal and wavelet algorithms at a compression rate of 32:1. Five radiologists evaluated the images. Data were analyzed with the receiver operating characteristic (ROC) method (comparison of area under curve). RESULTS: At 32:1 JPEG or wavelet compression, no statistically significant difference was observed for both NL and LL when compared with the original images. The fractal algorithm performed significantly lower for both NL and LL when compared with the original radiographs. CONCLUSION: The JPEG and wavelet image compression does not result in loss of relevant information for chest x-rays at a compression rate of 32:1.


Subject(s)
Image Processing, Computer-Assisted/methods , Lung Neoplasms/diagnostic imaging , Algorithms , Area Under Curve , Fractals , Humans , Phantoms, Imaging , ROC Curve , Radiography, Thoracic , Radiology Information Systems
4.
J Vasc Interv Radiol ; 13(10): 1047-50, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12397128

ABSTRACT

Skeletal metastases commonly occur in patients with cancer and treatment is necessary to alleviate pain and prevent complications, such as mobility deficiencies and pathologic fractures. The authors present a patient with a stage IV malignant melanoma and a pathologic fracture of the left tibial plateau treated with radiofrequency heat ablation and percutaneous cementoplasty for defect filling and stabilization. The authors believe that this approach may be an alternative to the standard treatments in palliative-care situations.


Subject(s)
Bone Neoplasms/secondary , Bone Neoplasms/therapy , Catheter Ablation , Fractures, Spontaneous/therapy , Melanoma/secondary , Melanoma/therapy , Palliative Care , Polymethyl Methacrylate/administration & dosage , Tibial Fractures/therapy , Adult , Combined Modality Therapy , Female , Fractures, Spontaneous/etiology , Humans , Injections , Skin Neoplasms/pathology , Tibial Fractures/etiology
5.
Invest Radiol ; 37(11): 594-9, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12393971

ABSTRACT

RATIONALE AND OBJECTIVE: The aim of this study was to demonstrate and measure perfusion deficits caused by central bronchogenic carcinoma and to compare magnetic resonance angiography (MRA) perfusion data with data of perfusion scintigraphy. The diagnostic value of 2D MRA in detection of malignant pulmonary artery stenosis in comparison with conventional DSA was investigated. MATERIALS AND METHODS: Eighteen patients were included in the study. MRA, conventional pulmonary angiograms, and pulmonary perfusion scintigrams were performed. MRA and DSA were compared and MR pulmonary perfusion data were assessed and compared with scintigraphical data. RESULTS: Perfusion defect could be demonstrated and localized in all patients. A quantitative perfusion deficit and a side dependent perfusion ratio could be evaluated. There was statistically significant correlation between MR perfusion and scintigraphically acquired data. 2D MRA showed a high correlation for detection and grading of stenosis compared with angiograms. CONCLUSIONS: Pulmonary perfusion could be demonstrated by using an ultrafast 2D projection MR DSA sequence. This technique allows measurement and quantification of pulmonary perfusion abnormalities in patients with malignant stenosis with statistically significant correlation to perfusion scintigraphy. The diagnostic potency in the evaluation of malignant pulmonary artery stenosis compared with conventional DSA could be shown.


Subject(s)
Arterial Occlusive Diseases/diagnosis , Carcinoma, Bronchogenic/diagnosis , Lung Neoplasms/diagnosis , Lung/blood supply , Magnetic Resonance Angiography/methods , Pulmonary Artery , Angiography, Digital Subtraction , Arterial Occlusive Diseases/diagnostic imaging , Carcinoma, Bronchogenic/diagnostic imaging , Carcinoma, Bronchogenic/pathology , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Neoplasm Staging , Radionuclide Imaging
6.
Eur J Radiol ; 44(1): 28-32, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12350407

ABSTRACT

Pulmonary sequestration is a relatively rare but clinically significant congenital anomaly. This disease is a spectrum of disorders involving the pulmonary airways, the arterial supply to the lungs, the lung parenchyma and its venous drainage. Traditionally, the diagnosis of pulmonary sequestration has been made definitively with arterial angiography. It is imperative for the preoperative evaluation that the arterial supply and venous drainage of the sequestered segment is identified. Several cases of MR diagnosis and preoperative evaluation of pulmonary sequestration and blood supply have been reported. In this case, MR imaging was able to provide important information about systemic blood supply via intercostal arteries and regular venous drainage. Furthermore this imaging technique revealed a second pulmonary sequestration in the dorsal phrenicocostal sinus that was not diagnosed before.


Subject(s)
Bronchopulmonary Sequestration/diagnosis , Lung/blood supply , Magnetic Resonance Angiography/methods , Adolescent , Bronchopulmonary Sequestration/surgery , Humans , Lung/diagnostic imaging , Lung/surgery , Male , Radiography
7.
J Thorac Cardiovasc Surg ; 123(4): 768-76, 2002 Apr.
Article in English | MEDLINE | ID: mdl-11986605

ABSTRACT

OBJECTIVE: The purpose of this preliminary study was to devise a new surgical procedure for minimally invasive aortic valve implantation with a transluminal technique. METHODS: The new collapsible heart valve was prepared by mounting a porcine aortic valve, taken from a freshly slaughtered pig, into a self-expandable nitinol stent by means of a suture technique. The outer diameter of the valved stent ranged from 15 to 23 mm, and the length ranged from 21 to 28 mm. Before implantation in vivo, these valved stents were tested in an in vitro circulatory system. Only in vitro-tested valved stents with a pressure gradient of less than 7 mm Hg and regurgitation of I degrees or less were used for transluminal aortic valve implantation in vivo. Six of these valved stents were implanted in the descending aorta and 8 in the ascending aorta of anesthetized pigs. The catheter delivery system (22F) was extraperitoneally inserted through the left iliac artery or the infrarenal aorta. Measurements for transvalvular gradient, valvular opening and closure, blood-flow characteristics, regurgitation, and macroscopic analysis were performed at baseline and after the observation period (164 +/- 48 minutes). RESULTS: This preliminary study contained 14 animals. One animal died of ventricular fibrillation. Technical failure occurred in 2 pigs as a result of stent twisting. At the end of the observation period, the 11 successfully implanted valved stents demonstrated low transvalvular gradients (mean end-systolic Deltarho(max) of 5.4 +/- 3.3 mm Hg for the descending aorta group, 5.4 +/- 1.2 mm Hg for the supracoronary group, and 5.4 +/- 1.1 mm Hg for the subcoronary group), which did not differ from their in vitro gradients. Two-dimensional echocardiography demonstrated complete valvular closure and opening in 5 of 5 cases. Angiography indicated only a physiologic jet of regurgitation (0 degrees ) in 8 animals and mild (I degrees ) regurgitation in 3 animals. Color Doppler ultrasonography indicated no regurgitation in 5 of 5 cases and minor paravalvular leakage in 1 case. CONCLUSION: Aortic valved stents can be successfully implanted without thoracotomy by using a transluminal catheter technique. Long-term function of the valves remains to be established.


Subject(s)
Aortic Valve/surgery , Bioprosthesis , Heart Valve Prosthesis Implantation/methods , Animals , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/physiopathology , Blood Flow Velocity/physiology , Device Removal , Echocardiography , Models, Animal , Postoperative Complications/etiology , Postoperative Complications/mortality , Stents , Swine , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/mortality , Ultrasonography, Doppler, Color
8.
Eur J Radiol ; 41(2): 153-60, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11809545

ABSTRACT

INTRODUCTION/OBJECTIVES: Contrast-enhanced MRA (ce-MRA) has been claimed by many authors as a replacement of conventional angiography evaluating peripheral arterial occlusive disease. However, reliable detection of relevant stenoses (>70%) has to be provided for planning vascular interventions. Only few data in the literature focuses on this crucial problem. The purpose of this study was to evaluate this topic using a two-step body-coil-based MRA protocol. METHODS AND PATIENTS: Forty three patients presenting with 82 stenoses >/=50% and 61 stenoses >70% on conventional catheter angiogram received fast Gadolinium-DTPA-enhanced high resolution 3D MR angiography at 1.5 T covering the pelvic and peripheral vascular tree in two examination steps using the body-coil. The data were evaluated double-blinded by three readers distinguishing moderate (50-70%) from severe stenoses (>70%). RESULTS: Overall sensitivity/specificity/accuracy was 84/60/70% evaluating 143 segments. Specificity was rather poor in the iliac (58%) and crural (50%) region and moderate in the femoral and popliteal level (73%). The negative predictive value ranged between 78 and 91%. The grade of stenosis tend to be overestimated rather than underestimated in all levels with positive predictive values between 55 and 78%. DISCUSSIONS AND CONCLUSIONS: Body-coil-based contrast-enhanced MRA has limited potential in distinguishing moderate from severe stenoses in peripheral occlusive disease. Overestimations are more common than underestimations. Both occur mainly in small-sized crural arteries but also in larger iliac arteries where vessel course in partition direction may cause inadequacy between voxel size and lumen diameter in severe stenosis.


Subject(s)
Arterial Occlusive Diseases/diagnosis , Femoral Artery/pathology , Iliac Artery/pathology , Magnetic Resonance Angiography , Popliteal Artery/pathology , Adult , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Contrast Media , Female , Humans , Male , Middle Aged , Prospective Studies , Sensitivity and Specificity
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