Duplex ultrasound findings and clinical classification of lower extremity chronic venous insufficiency in a Thai population.

BACKGROUND: The objective of this study was to evaluate the association between the clinical classification of chronic venous insufficiency and duplex ultrasound findings. METHODS: A total of 1010 limbs with clinically suspected chronic venous insufficiency were stratified according to the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification and underwent duplex ultrasound evaluation consecutively between January 2012 and June 2015. Venous thrombosis, venous reflux, and anatomic distribution of the deep and superficial venous systems were investigated across the CEAP clinical classes. RESULTS: There were 259 male limbs (25.6%) and 751 female limbs (74.4%) in clinical class C0 (24 limbs [2.4%]), C1 (130 limbs [13.1%]), C2 (452 limbs [44.8%]), C3 (183 limbs [18.1%]), C4 (163 limbs [16.1%]), C5 (31 limbs [3.1%]), and C6 (27 limbs [2.7%]). The mean age in clinical class C4-C6 (60.77 ± 14.67 years) was statistically significantly higher than in C0-C3 (55.73 ± 18.85 years; P < .001). Male limbs were shown to have a predilection for presenting with clinical class C4-C6 over female limbs (36.3% vs 16.9%; odds ratio, 2.8; 95% confidence interval, 2.0-3.8). Positive findings were predominantly displayed in clinical class C4-C6 compared with C0-C3 (deep venous thrombosis, 3.2% vs 1.3%; deep venous reflux, 30.8% vs 26.9%; superficial vein thrombosis, 2.7% vs 2.0%; superficial venous reflux, 56.6% vs 47.6%; perforator vein reflux, 12.7% vs 8.2% [P = .049]). A low prevalence of small saphenous vein and perforator vein reflux in C1 limbs (0.3% and 4.6%) and C3 limbs (3.8 and 6.6%) was discovered. CONCLUSIONS: The prevalence of CEAP class C0-C3 was found to be higher than C4-C6. However, men were shown to have a predilection for presenting in clinical class C4-C6 over women. The mean age of patients with clinical class C4-C6 limbs was statistically significantly higher than of those with clinical class C0-C3 limbs. The prevalence of deep venous reflux, superficial venous reflux, and coincident deep and superficial venous reflux in clinical class C4-C6 limbs was higher than in clinical class C0-C3 limbs. Detection of incompetent perforator veins was shown to have a statistically significant correlation with clinical class C4-C6 limbs.

Predicting Factors for Failure of Percutaneous Drainage of Postoperative Intra-Abdominal Collection.

Objective: To determine the predictive factors for failure of percutaneous drainage (PD) of postoperative intra-abdominal collection, to better select the patients who might benefit from PD. Material and Method: From September 2011 to February 2013, the authors reviewed 42 patients with symptomatic postoperative intra-abdominal collection who had received PD at Ramathibodi Hospital. The PD was considered as failure when clinical sepsis persisted or subsequent surgery was needed. Univariate analysis was used to examine the relationships between failure of PD and the collection and drainage-related variables. Results: The success rate of PD in the present study was 80%. No major complication was detected. The overall mortality was 12%. Univariate analysis showed that the presence of biliary fistula (p = 0.012), subhepatic location (p = 0.040) and the drainage catheter size of 12F (p = 0.002) were significant predictive variables for failure of PD. Conclusion: Image-guided PD of postoperative intra-abdominal collection was found to be a safe and effective procedure with few complications. Initial recognition of biliary fistula in the collection at subhepatic region or in patients underwent hepatobiliary surgery was the important prognostic factor for unsuccessful PD. These patients may be more beneficial for initial surgical drainage.

Ultrasound predictors of thyroid cancer.

OBJECTIVE: To identify ultrasound (US) features associated with cancer in thyroid nodules. MATERIAL AND METHOD: During a two and a half-year period, medical charts, US images, and pathological findings in 629 consecutive patients with thyroid nodules who underwent US examination as well as fine needle aspiration biopsy (FNAB) or surgical excision or both were retrospectively reviewed. Clinical and US findings associated with thyroid cancer were identified using statistical models. RESULTS: Unequivocal cytological or pathological findings were available for 578 patients. Forty-eight patients (8%) had thyroid cancer. Independent clinical and US features associated with thyroid cancer included younger age, symptoms other than palpable mass, solid nodules, fewer number of nodules, presence of calcifications, and enlarged cervical lymph nodes. The combination of all these features was most specific for the diagnosis of thyroid cancer. The absence of all these features could rule out all thyroid cancers. CONCLUSION: The risk of the thyroid cancer in patients with thyroid nodules could be estimated by using relevant clinical and US features.

Efficacy of percutaneous radiofrequency ablation of hepatic malignant tumors using a perfused-cooled electrode.

OBJECTIVE: Evaluate the efficacy of percutaneous radiofrequency ablation ofhepatic malignant tumors. MATERIAL AND METHOD: An ultrasound-guided percutaneous radiofrequency ablation using a 17-gauge single needle perfusedcooled electrode (Cool-tip) RF ablation system was performed on 30 hepatic tumors in 26 patients between January 2009 and September 2010. The medical records, CT scan, and MRI results were assessed at one and three months after the procedure was completed. Primary technical success, local tumor progression, and complication were also evaluated. RESULTS: Twenty-six hepatic lesions in 23 patients were primarily hepatocellular carcinoma. Only four lesions in three patients were metastasized. Three of them were from colorectal cancer whilst another one was from malignant melanoma. At 1-month follow-up imaging post percutaneous radiofrequency ablation, complete ablation rate was 86.7%. Local tumor progression at 3-month follow-up imaging was 4.2%. The rate for minor complication was 3.8%. No major complication was found Complete ablation rate was found to increase signiJicantly in tumors size of less than 2 cm compared to those diameter larger than 2 cm (p < 0.05). CONCLUSION: Percutaneous radiofrequency ablation is one of the most effective and invulnerable therapeutic modality in treatment of hepatic malignant tumor. Size is the key factor of technical success as the smaller the size of tumor the better the outcome achieved.

Vascular access stenosis and central vein obstruction interventions: five years of experience in Ramathibodi Hospital.

OBJECTIVE: To evaluate initial post-treatment and six months outcome of patients sent to the intervention radiology unit with vascular access malfunctions. MATERIAL AND METHOD: A retrospective study of venoplasty, venoplasty with stenting, and venoplasty with thrombolysis for vascular access failure patients, included 53 patients with 67 interventional radiology procedures at the intervention radiology unit of Ramathibodi Hospital between January 2004 and June 2009. RESULTS: Sixty-seven intervention procedures were performed in 53 patients. Two patients had severe stenosis of AVF anastomosis with a resulting in failure to perform venoplasty. There were 34 lesions of central venous obstruction. The lesions were usually short and 79% shorter than 4.0 cm. In the group of central venous obstruction that performed venoplasty alone, the degree of stenosis was 58.7 +/- 18.6% (mean +/- SD) with 69.2% technical success and 84.6% clinical successes. However the technical success was increased to 71.4% and clinical success was increased to 100% in the stent placement group. At the six-month follow-up, there was no significant clinical re-obstruction. Fair to good outcomes of interventional procedures of vascular access and peripheral venous stenosis were achieved. Within the group of 14 lesions of patients who underwent AVBG, the degree of stenosis was 64.4 +/- 14.4% with 57.1% technical success and 100% clinical successes. In the other group of 19 lesions that underwent native AVF the degree of stenosis was 61 +/- 9.4% with 52.6% technical success and 89% clinical successes. Two patients had re-stenosis and thrombosis in AVBG six months after treatment procedure. CONCLUSION: Percutaneous interventional radiology procedure continues to play a beneficial role in treatment, and remains the first treatment of choice in vascular access malfunction and corollary complications of central venous obstruction. The technical success rate of treatments is determined by morphologic features of each lesion, with the identification of these features helping in proper planning and the use of appropriate instruments.