Excimer laser assisted complex inferior vena cava filter retrieval: a single institution's experience over 6 years.

AIM: To investigate inferior vena cava (IVC) filter retrievals and the use of the excimer laser sheath to assist in complex cases. MATERIALS AND METHODS: Retrospective analysis was undertaken of 181 attempted filter retrievals over a 6 year period. Pre- and perioperative imaging was analysed from both standard retrieval and complex retrieval techniques. RESULTS: One hundred and eighty-one IVC filter retrievals were attempted: 130 (72%) standard retrievals were successful and 51 (28%) failed due to device endothelialisation. Forty (23%) cases then had subsequent successful complex retrieval under general anaesthetic. Eighteen (45%) cases were removed with the sling technique and 22 (55%) cases using the excimer laser dissection technique. Where preoperative venography/computed tomography (CT) demonstrated embedding of the filter feet versus filter apex, this was predictive of requiring dissection techniques versus sling technique (13/18 patients; p<0.05 chi-squared test). The difference in device indwelling time was statistically significant between the successful standard retrieval group (134 days) versus patients who failed standard retrieval and required complex techniques (243 days; p=0.00018). CONCLUSION: Standard retrieval techniques failed in 28% of cases. This correlated with devices that were indwelling for longer. When imaging demonstrated filter-feet endothelisation/perforation, this was predictive of requiring dissection techniques with the excimer laser.

Mean velocity and peak systolic velocity can help determine ischaemic and non-ischaemic priapism.

AIM: To determine the threshold waveform characteristics at Doppler ultrasound (DUS) to differentiate between ischaemic and non-ischaemic priapism. MATERIALS AND METHODS: Fifty-two patients were categorised into "ischaemic" and "non-ischaemic" types based on clinical and blood-gas findings: 10 patients with non-ischaemic priapism; 20 with ischaemic priapism before surgical shunt placement and 22 with ischaemic priapism after surgical shunt placement. DUS traces were analysed: peak systolic velocity (PSV) and mean velocity (MV) were calculated. Histological samples were obtained at the time of surgery. Three clinical outcome groups were defined: (1) normal, (2) regular use of pharmacostimulation, and (3) refractory dysfunction/penile implant. RESULTS: All non-ischaemic priapism cases had a PSV >50 cm/s and all but one had an MV of >6.5 cm/s. In pre-surgery ischaemic cases, all men had a PSV <50 cm/s and MV <6.5 cm/s. Two flow patterns were observed in this group: PSV <25 cm/s in all men scanned before needle aspiration; and in 6/14 after needle aspiration, a high velocity/high resistance (low net inflow) pattern, with peak systolic flows >22 cm/s but diastolic reversal. In post-surgery ischaemic priapism, flow parameters overlapped with the non-ischaemic group. PSV/MV did not predict clinical outcome or histology. CONCLUSION: In the present cohort, PSV <50 cm/s and MV <6.5 cm/s were predictive of ischaemic priapism (pre-shunt; p<0.01). Patients with ischaemic priapism may show PSV >22 cm/s, but have diastolic reversal and therefore low net perfusion. Post-shunt, DUS findings were extremely variable and did not predict histology or clinical outcome.

Imaging of palatal lumps.

Palatal tumours are relatively rare and of variable aetiology, rendering radiological evaluation a daunting process for many. A systematic approach to the imaging of a palatal lump is therefore essential. The hard and soft palates are oral cavity and oropharyngeal structures, respectively. They have different tissue compositions, and therefore, lesions occur with different frequencies at each site. The hard palate has the highest concentration of minor salivary glands in the upper aerodigestive tract and most tumours here are salivary in origin, whereas most tumours at the soft palate are epithelial in origin, i.e., squamous cell carcinomas, in line with other oropharyngeal subsites. The most common malignant tumours of the palate, after squamous cell carcinoma, are minor salivary gland tumours, predominantly adenoid cystic and mucoepidermoid carcinomas. These tumours have a propensity to spread perineurally; understanding the anatomy and imaging features of perineural spread is vital, as it can have significant implications for patient management and tumour resectability. When confronted with a palatal lump, it is important to consider the following: its location on the hard or soft palate; whether it is mucosal or submucosal; the frequently occurring lesions at that site; the most suitable imaging techniques (ultrasound, computed tomography, magnetic resonance imaging); whether there are typical imaging features for any of the common lesions; and whether there are aggressive features, such as bone erosion or perineural spread. This approach allows the radiologist to narrow the differential diagnosis and assist the clinicians with planning treatment.