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1.
Hu Li Za Zhi ; 70(4): 87-94, 2023 Aug.
Article in Chinese | MEDLINE | ID: mdl-37469323

ABSTRACT

Uncontrolled hemorrhagic shock is the main cause of death in patients with traumatic injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly performed and less-invasive treatment to stop bleeding. The REBOA balloon may be placed at the location of bleeding to achieve hemostasis. Prior to balloon placement, the indications for placement must be evaluated, including non-thoracic aortic trauma and non-traumatic patients with postpartum hemorrhage, and the appropriate sheath size (from 5 to 8 French) must be selected based on the bleeding site. As vascular injury of aortic dissection, rupture, or perforation may occur during the procedure, changes in hemodynamic parameters should be monitored. After balloon placement, ischemic complications due to blood flow occlusion such as lower extremity ischemia and acute renal failure should be tracked. After balloon removal, reperfusion injuries may occur, which can result in multiple organ failure, and should be observed closely. When caring for patients receiving REBOA, physicians should explain the procedure to their families to obtain informed consent. Also, nurses should prepare supplies and closely monitor changes in critical life signs to minimize the risks of hypotension, arrhythmia, and changes in consciousness during the procedure. After placement, the neurovascular and peripheral limbs "5P" (pain, pallor, paresthesia, pulselessness and paralysis) condition should be evaluated and recorded in detail. This treatment approach requires further study and research to assess the long-term impacts of placement and improve quality of care in these patients.


Subject(s)
Balloon Occlusion , Endovascular Procedures , Nursing Care , Shock, Hemorrhagic , Female , Humans , Aorta , Hemorrhage/etiology , Hemorrhage/therapy , Shock, Hemorrhagic/therapy , Shock, Hemorrhagic/complications , Balloon Occlusion/adverse effects , Balloon Occlusion/methods , Endovascular Procedures/adverse effects , Endovascular Procedures/methods
2.
Radiol Case Rep ; 18(4): 1620-1627, 2023 Apr.
Article in English | MEDLINE | ID: mdl-36865618

ABSTRACT

We herein report a case of acute, massive lower gastrointestinal bleeding caused by Yakes type IIb inferior mesenteric arteriovenous malformation, which was successfully treated with endovascular embolization. The Yakes arteriovenous malformation classification provides curative treatment strategies based on specific angioarchitecture, thus serving as a valuable guide during treatment planning. We reviewed reported cases from 1988 to 2022 and conducted an angioarchitecture analysis based on the Yakes classification. We analyzed these reported cases to estimate the treatment success rates of surgery and embolization.

3.
Radiol Case Rep ; 12(1): 108-112, 2017 Mar.
Article in English | MEDLINE | ID: mdl-28228891

ABSTRACT

This study aimed to report a modification to the single-needle pass technique by use of a portal vein localization sheath for creation of a portosystemic shunt. The modification makes the single-needle pass technique a more straightforward procedure.

4.
Medicine (Baltimore) ; 95(5): e2616, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26844473

ABSTRACT

The aim of the present study was to compare differential impacts of bariatric surgery and exercise-induced weight loss on excessive abdominal and cardiac fat deposition.Excessive fat accumulation around the heart may play an important role in the pathogenesis of cardiovascular disease. Recent evidences have suggested that bariatric surgery results in relatively less decrease in epicardial fat compared with abdominal visceral fat and paracardial fat.Sixty-four consecutive overweight or obese subjects were enrolled in the study. Clinical characteristics and metabolic profiles were recorded. The volumes of abdominal visceral adipose tissue (AVAT), abdominal subcutaneous adipose tissue (ASAT), epicardial (EAT), and paracardial adipose tissue (PAT) were measured by computed tomography in the bariatric surgery group (N = 25) and the exercise group (N = 39) at baseline and 3 months after intervention. Subjects in both the surgery and exercise groups showed significant reduction in body mass index (15.97%, 7.47%), AVAT (40.52%, 15.24%), ASAT (31.40, 17.34%), PAT (34.40%, 12.05%), and PAT + EAT (22.31%, 17.72%) (all P < 0.001) after intervention compared with baseline. In both the groups, the decrease in EAT was small compared with the other compartments (P < 0.01 in both groups). Compared with the exercise group, the surgery group had greater loss in abdominal and cardiac visceral adipose tissue (AVAT, ASAT, PAT, EAT+PAT) (P < 0.001), but lesser loss in EAT (P = 0.037).Compared with the exercise group, bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for EAT. EAT, but not PAT, was relatively preserved despite weight reduction in both the groups. The physiological impact of persistent EAT deserves further investigation.


Subject(s)
Adiposity , Bariatric Surgery/statistics & numerical data , Exercise Therapy/statistics & numerical data , Intra-Abdominal Fat/pathology , Obesity, Morbid/therapy , Pericardium , Adult , Body Mass Index , Cardiovascular Diseases/etiology , Female , Humans , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/pathology , Pericardium/pathology , Subcutaneous Fat, Abdominal/pathology , Weight Loss
5.
Cardiovasc Intervent Radiol ; 38(4): 894-902, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25476873

ABSTRACT

PURPOSE: This study aimed to retrospectively assess the efficacy of a bare intervascular tunnel for salvage of a thrombosed hemodialysis fistula. We examined the clinical outcomes and provided follow-up images of the bare intervascular tunnel. MATERIALS AND METHODS: Eight thrombosed fistulas lacked available recanalizable outflow veins were included in this study. These fistulas were salvaged by re-directing access site flow to a new outflow vein through a percutaneously created intervascular tunnel without stent graft placement. The post-intervention primary and secondary access patency rates were calculated using the Kaplan-Meier method. RESULTS: The procedural and clinical success rates were 100%. Post-intervention primary and secondary access patency at 300 days were 18.7 ± 15.8 and 87.5 ± 11.7%, respectively. The mean follow-up period was 218.7 days (range 10-368 days). One patient died of acute myocardial infarction 10 days after the procedure. No other major complications were observed. Minor complications, such as swelling, ecchymosis, and pain around the tunnel, occurred in all of the patients. CONCLUSIONS: Percutaneous creation of a bare intervascular tunnel is a treatment option for thrombosed hemodialysis fistulas without recanalizable outflow in selected patients.


Subject(s)
Arteriovenous Fistula/surgery , Graft Occlusion, Vascular/surgery , Kidney Failure, Chronic/complications , Renal Dialysis , Salvage Therapy/methods , Thrombosis/surgery , Aged , Arteriovenous Fistula/complications , Female , Graft Occlusion, Vascular/complications , Humans , Male , Middle Aged , Retrospective Studies , Thrombosis/complications , Treatment Outcome , Vascular Patency
6.
Am J Cardiol ; 112(7): 943-9, 2013 Oct 01.
Article in English | MEDLINE | ID: mdl-23809622

ABSTRACT

Epicardial adipose tissue (EAT) is considered to play a role in the pathogenesis of coronary atherosclerosis. However, whether total EAT volume or location-specific EAT thickness may be a better predictor of obstructive coronary artery disease (CAD) is inconclusive. We investigated whether the total volume or location-specific thickness of EAT measured on computed tomography (CT) could be a useful marker of CAD on top of clinical risk factors and Agatston score. Two hundred eight consecutive subjects with clinical suspicion of CAD receiving coronary arterial calcium (CAC)-scoring CT and CT coronary angiography were retrospectively divided into 2 groups: an obstructive CAD group (n = 97) and a nonobstructive CAD group (n = 111). Total EAT volume and EAT thicknesses at different locations were measured on CAC-scoring CT. Left atrioventricular groove (AVG) EAT thickness was the sole EAT measurement that showed association with increasing number of vessels exhibiting ≥50% stenosis (p for trend <0.001). Logistic regression showed that left AVG EAT thickness was the most important EAT predictor of obstructive CAD (odds ratio 1.16, 95% confidence interval 1.04 to 1.29, p = 0.006; optimal threshold ≥15 mm, odds ratio 4.62, 95% confidence interval 2.24 to 9.56, p <0.001). Adding left AVG EAT thickness on top of clinical risk factors plus Agatston score improved prediction of obstructive CAD (area under the curve from 0.848 to 0.912, p = 0.002). In conclusion, excessive left AVG EAT adiposity is an important risk factor for obstructive CAD, independent of clinical risk factors and Agatston score. However, further trials are needed in investigation of combined assessment of location-specific EAT thickness and Agatston score on CAC scan as to whether this biomarker could improve CAD risk stratification in the general population.


Subject(s)
Adipose Tissue/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Pericardium/diagnostic imaging , Vascular Calcification/diagnostic imaging , Aged , Coronary Angiography , Female , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
7.
Eur Radiol ; 23(5): 1226-33, 2013 May.
Article in English | MEDLINE | ID: mdl-23239060

ABSTRACT

OBJECTIVES: To validate the reliability of the visual coronary artery calcification score (VCACS) on low-dose CT (LDCT) for concurrent screening of CAC and lung cancer. METHODS: We enrolled 401 subjects receiving LDCT for lung cancer screening and ECG-gated CT for the Agatston score (AS). LDCT was reconstructed with 3- and 5-mm slice thickness (LDCT-3mm and LDCT-5mm respectively) for VCACS to obtain VCACS-3mm and VCACS-5mm respectively. After a training session comprising 32 cases, two observers performed four-scale VCACS (absent, mild, moderate, severe) of 369 data sets independently, the results were compared with four-scale AS (0, 1-100, 101-400, >400). RESULTS: CACs were present in 39.6 % (146/369) of subjects. The sensitivity of VCACS-3mm was higher than for VCACS-5mm (83.6 % versus 74.0 %). The median of AS of the 24 false-negative cases in VCACS-3mm was 2.3 (range 1.1-21.1). The false-negative rate for detecting AS ≥ 10 on LDCT-3mm was 1.9 %. VCACS-3mm had higher concordance with AS than VCACS-5mm (k = 0.813 versus k = 0.685). An extended test of VCACS-3mm for four junior observers showed high inter-observer reliability (intra-class correlation = 0.90) and good concordance with AS (k = 0.662-0.747). CONCLUSIONS: This study validated the reliability of VCACS on LDCT for lung cancer screening and showed that LDCT-3mm was more feasible than LDCT-5mm for CAD risk stratification. KEY POINTS: • Low-dose computed tomography (LDCT) rarely misses significant coronary artery calcification (CAC). • Visual scoring of CAC on LDCT is highly concordant with Agatston scoring. • LDCT-3mm is more feasible than LDCT-5mm for CAD risk stratification. • CAC assessment enriched the screening information for LDCT lung cancer screening.


Subject(s)
Calcinosis/diagnostic imaging , Calcinosis/epidemiology , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/epidemiology , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/epidemiology , Tomography, X-Ray Computed/statistics & numerical data , Comorbidity , Female , Humans , Incidence , Male , Mass Screening/statistics & numerical data , Middle Aged , Reproducibility of Results , Risk Assessment , Sensitivity and Specificity , Taiwan/epidemiology
8.
J Chin Med Assoc ; 75(9): 464-7, 2012 Sep.
Article in English | MEDLINE | ID: mdl-22989543

ABSTRACT

BACKGROUND: This study was conducted to investigate whether detectable missed breast cancers could be distinguished from truly false negative images in a mammographic screening by a regular peer auditing. METHODS: Between 2004 and 2007, a total of 311,193 free nationwide biennial mammographic screenings were performed for 50- to 69-year-old women in Taiwan. Retrospectively comparing the records in Taiwan's Cancer registry, 1283 cancers were detected (4.1 per 1000). Of the total, 176 (0.6 per 1000) initial mammographic negative assessments were reported to have cancers (128 traditional films and 48 laser-printed digital images). We selected 186 true negative films (138 traditional films and 48 laser-printed ones) as control group. These were seeded into 4815 films of 2008 images to be audited in 2009. Thirty-four auditors interpreted all the films in a single-blind, randomized, pair-control study. The performance of 34 auditors was analyzed by chi-square test. A p value of < 0.05 was considered significant. RESULTS: Eight (6 traditional and 2 digital films) of the 176 false negative films were not reported by the auditors (missing rate of 4.5%). Of this total, 87 false negatives were reassessed as positive, while 29 of the 186 true negatives were reassessed as positive, making the overall performance of the 34 auditors in interpreting the false negatives and true negatives a specificity of 84.4% and sensitivity of 51.8%. The specificity and sensitivity in traditional films and laser-printed films were 98.6% versus 43.8% and 41.8% versus 78.3%, respectively. Almost 42% of the traditional false negative films had positive reassessment by the auditors, showing a significant difference from the initial screeners (p < 0.001). The specificity of their reinterpretation of laser-printed films was obviously low. CONCLUSION: Almost 42% of the false negative traditional films were judged as missed cancers in this study. A peer auditing should reduce the probability of missed cancers.


Subject(s)
Breast Neoplasms/diagnostic imaging , Early Detection of Cancer , Mammography , Medical Audit , Aged , False Negative Reactions , Female , Humans , Middle Aged
10.
Breast Care (Basel) ; 7(3): 220-224, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22872796

ABSTRACT

BACKGROUND: Female breast tissue has a rich vascular supply and carries a high risk of excessive bleeding during large-core needle biopsy. It is crucial to shorten bleeding time and reduce hematoma size after the procedure. Currently, more efficient hemostatic dressings are becoming available. MATERIAL AND METHODS: The bleeding time and hematoma size after breast biopsy with use of either Instant Clot Pad (ICP) dressings or cotton gauze were compared. RESULTS: ICP could attract a vast number of red blood cells and formed blood clots in about 30 s (in vitro blood clotting test). In clinical breast biopsy examinations, the average bleeding time with ICP was significantly reduced to about 2.9 min as compared to 6.4 min with cotton gauze (p < 0.005). The average hematoma size was also reduced with the use of ICP (0.89 cm(3)) as compared to cotton gauze (1.28 cm(3)). In patients with benign breast disease, ICP significantly reduced hematoma size. CONCLUSION: ICP used after breast biopsy could shorten the bleeding time in all patients, and significantly reduce the hematoma size in patients with benign compared to those with malignant breast disease.

11.
Radiology ; 258(3): 705-13, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21212368

ABSTRACT

PURPOSE: To evaluate multidetector computed tomographic (CT) images to investigate the prevalence, morphology, natural course, and prognostic effect of intramural blood pools (IBPs) in patients with acute intramural hematoma (IMH). MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Sixty-five patients (41 men; mean age, 65.9 years ± 11.3 [standard deviation]) with acute IMH undergoing three or more multidetector CT examinations during follow-up for 12 months or longer (median = 18 months), except for those undergoing surgery (n = 16), were enrolled. Associated factors of developing and resorption of IBP in IMH were analyzed by using logistic regression. RESULTS: There were 40 IBPs in 10 patients at initial multidetector CT, and 15 new IBPs developed in 11 patients during follow-up. IBPs occurred most in the descending thoracic (55% [31 of 56]) and abdominal (41% [23 of 56]) aorta in 28% (18 of 65) of patients. During 33.8 months (range, 2.8-50 months) of follow-up in these 18 patients, 57% (32 of 56) of IBPs showed complete resorption in 15 patients, 29% (16 of 56) of IBPs showed incomplete resorption in eight patients, and 14% (eight of 56) of IBPs had interrupted follow-up because of surgery or death in three patients. Logistic regression showed that age younger than 70 years (odds ratio [OR], 8.74; 95% confidence interval [CI]: 1.03, 76.9) and IMH wall thickness greater than 10 mm (OR, 4.93; 95% CI: 1.04, 23.0) were associated with developing IBP at initial multidetector CT, while IBP with larger transmural diameter (OR, 1.16; 95% CI: 1.02, 1.31) and multidetector CT-demonstrated connection with intercostal or lumbar artery (63% [35 of 56]) (OR, 5.44; 95% CI: 1.43, 20.9) were associated with incomplete resorption. CONCLUSION: IBPs are frequently observed at multidetector CT in patients with IMH. They may resolve over time or appear during follow-up. These findings are not associated with a poor prognosis, and IBPs should be distinguished from ulcerlike projections.


Subject(s)
Aortic Diseases/diagnostic imaging , Hematoma/diagnostic imaging , Tomography, X-Ray Computed/methods , Aged , Aortic Diseases/epidemiology , Aortic Diseases/pathology , Female , Hematoma/epidemiology , Hematoma/pathology , Humans , Logistic Models , Male , Prevalence , Prognosis , Risk Factors
13.
Anal Chim Acta ; 653(1): 71-6, 2009 Oct 19.
Article in English | MEDLINE | ID: mdl-19800476

ABSTRACT

Nonionic surfactants, such as Triton X-100 and Tween-20, were shown in this study to improve the electrocatalytic activity of screen-printed carbon paste electrodes (SPCE). The electrochemical response of SPCE to hydrogen peroxide increased 8-10-fold with the modification of nonionic surfactants. In addition, the glucose biosensors fabricated from nonionic surfactant-modified SPCE exhibited 6.4-8.6-fold higher response to glucose than that fabricated from unmodified SPCE. A concentration effect is proposed for nonionic surfactant to bring neutral reactants to the surface of electrode. Moreover, nonionic surfactant-modified SPCE exhibits a capability of repetitive usage and good reproducibility (R.S.D.<5%) in the measurement of H(2)O(2). Interestingly, the nonionic surfactant-modified SPCE exhibited an opposite effect to ascorbic acid, a common electroactive agent, which causes interference during clinical diagnosis. The differential responses of nonionic surfactant-modified SPCE to H(2)O(2) and ascorbic acid suggest its potential in the development of biosensors for clinical diagnosis.


Subject(s)
Biosensing Techniques/methods , Carbon/chemistry , Electrochemical Techniques/methods , Hydrogen Peroxide/analysis , Surface-Active Agents/chemistry , Electrodes , Enzymes, Immobilized/metabolism , Glucose/analysis , Glucose Oxidase/metabolism
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