RESUMEN
AIM: To analyze the clinical value and radiation dose of plain x-rays and CT in examining patients suspected of ingesting drug-filled packets. MATERIALS AND METHODS: Thirty-eight patients with suspected internal concealment of drug-filled packets who were examined with plain x-rays or CT or both were included in the study. CT studies were performed using low-dose and standard-dose techniques. All radiographic images were analysed by two radiologists regarding identification of the packets and estimating the effective radiation dose from standard- and low-dose CT versus conventional x-ray examinations. Descriptive calculations were made regarding the number and density of packs and radiation dosage. The diagnostic performance of both radiologists with standard- and low-dose CT was calculated by analysing differences in the mean number of packs found. RESULTS: Thirty-one patients were positively identified as body packers with an average of 13 packs (min: n = 1, max: n = 58, total: n = 390); seven patients were not concealing drug packets. X-ray images were taken of 24 patients prior to CT, thus allowing a direct comparison between the two methods. The correct diagnosis was made in 42%, in 33% the radiologists were uncertain, and in 25% of drug packets were either not or wrongly identified. X-ray imaging had a positive predictive value of 20% with a negative predictive value of 81%. A total of 55 CT examinations were performed on all patients with a mean effective dose of 2 mSv (low dose) versus 9.3 mSv (standard dose). The visibility of packets on low-dose CT images compared to high-dose CT was not reduced: the radiologists identified 385 and 381 of the packets, respectively, with no difference regarding the examination technique (p = 0.24 and p = 0.253, respectively). The radiodensity of all drug-filled packets at CT ranged from 26-292 HU (mean 181.2 HU). CONCLUSION: X-ray imaging of supposed body packers leads to a significant risk of diagnostic errors and additional need for CT. Instead, a single abdominal low-dose CT examination will deliver the correct diagnoses in most cases, leading to safe clinical management of the suspects.
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Tráfico de Drogas , Cuerpos Extraños/diagnóstico por imagen , Drogas Ilícitas , Dosis de Radiación , Estómago/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Servicios Médicos de Urgencia/métodos , Servicio de Urgencia en Hospital , Mesas de Exámenes , Femenino , Medicina Legal/métodos , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Radiografía Abdominal/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Adulto JovenRESUMEN
AIM: The present study investigates the geometry of failing left ventricles with a special focus on apical deformation. A new surgical remodelling technique is evaluated. METHODS: In 124 patients with impaired left ventricular function (EF<40%) undergoing coronary artery bypass grafting (CABG) left ventricular (LV) geometry was evaluated by MRI scanning before and after surgery. Besides the sphericity index (SI) two further indices were calculated, longitudinal EF (LEF) and an apical conicity index (ACI). The results were compared to 15 patients with coronary heart disease and normal LV function and 10 test persons. In 35 patients with impaired LV function perpendicular apical compression (AC) stitches were placed. RESULTS: In failing left ventricles indexed LV length increased (5.3 ± 0.6 cm/m2 vs. 4.7 ± 0.8 cm/m2 in control patients and 4.6 ± 0.3 cm/m2 in test persons, P=0.03). LEF was reduced (6% ± 4 versus 22% ± 6 and 19% ± 7 P=0.04). The classical SI was 0.56 ± 0.06 in heart failure patients, 0.50 ± 0.05 in control patients and 0.48 ± 0.04 in test persons. The ACI were 0.75 ± 0.06, 0.58 ± 0.06 and 0.57 ± 0.04 respectively (P<0.05), indicating a pronounced dilatation at the apex. After apical compression LEF improved to 15 ± 1%, the ACI to 0.64 ± 0.04 (P=0.04). LVEDV (166 ± 11 mL [AC] vs. 196 ± 14 mL [without AC]) as well as LV-EF (48 ± 3% [AC] vs. 36 ± 2% [without AC]) significantly improved only after remodelling (P<0.05). CONCLUSION: Apical compression improved ventricular geometry and ventricular function in patients with dialatation of the left ventricular apex.
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Procedimientos Quirúrgicos Cardíacos , Insuficiencia Cardíaca/cirugía , Hipertrofia Ventricular Izquierda/cirugía , Técnicas de Sutura , Disfunción Ventricular Izquierda/cirugía , Función Ventricular Izquierda , Remodelación Ventricular , Anciano , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/patología , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/cirugía , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Alemania , Insuficiencia Cardíaca/patología , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipertrofia Ventricular Izquierda/patología , Hipertrofia Ventricular Izquierda/fisiopatología , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Volumen Sistólico , Resultado del Tratamiento , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
MR-guided laser-induced interstitial thermotherapy (LITT) is a percutaneous, minimally invasive treatment modality for treating liver lesions/metastases, soft tissue tumours and musculoskeletal lesions. In this group, MR-guided LITT is currently performed under local anaesthesia on an out-patient basis with a specially designed saline-cooled laser application system. Nd:YAG laser (1064 nm wave length) was used for tumour ablation. Magnetic resonance imaging (MRI) using both open and closed MR units has proven clinically effective in validating the exact positioning of optical fibres. It also allows for real time-monitoring of thermal effects and the evaluation of treatment-induced coagulation necrosis. In liver tumours, percutaneous MR-guided LITT achieves a local tumour control rate of 98.7% at 3 months post-therapy and 97.3% at 6 months with metastases smaller than 5 cm in diameter. The mean survival rate for 1259 patients with 3440 metastases treated with 14 694 laser applications at the institute (calculated with the Kaplan-Meier method) was 4.4 years (95% confidence interval: 4.1-4.8 years) and median survival was 3.00 years. No statistically significant difference in survival rates was observed in patients with liver metastases from colorectal cancer vs metastases from other primary tumours. The rate of clinically relevant side effects and complications requiring secondary treatment was 2.2%. The clinical use of MR guided LITT (size < 5 cm, number < 5) is justified in patients with liver metastases of colorectal and/or breast cancers if the inclusion criteria are carefully observed. Further indications for MR guided LITT include recurrent cancer lesions in the head and neck, lung metastases and bone and soft tissue lesions.
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Hipertermia Inducida/métodos , Terapia por Láser , Neoplasias Hepáticas/terapia , Imagen por Resonancia Magnética , Humanos , Hipertermia Inducida/efectos adversos , Rayos Láser/efectos adversos , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
We have analyzed the effectiveness of repetitive transarterial chemoembolization (TACE) of liver metastases as a neoadjuvant or palliative treatment modality in comparison with published data. Chemoembolization of liver metastases is performed with different cytotoxic drugs. In a 4-week interval, 357 patients were treated with repetitive 1,158 TACE courses performed with lipiodol, mitomycin C and spherex. 254 patients were treated palliatively, 18 patients symptomatically and 79 patients via the neoadjuvant protocol, 71 patients of whom received additional MR-guided laser-induced thermoablation (LITT) of the metastases after TACE. Our results were compared with the literature. Most of the patients with a low rate of local complications like vascular occlusion or liver abscess could be treated successfully using TACE. In 81 % of the treated lesions a primary high lipiodol retention was observed. In the palliative group a reduction of the tumor size was noted in 36 % of the lesions, a growth stop in 24 % and a reduction of the tumor growth rate in 40 %. In 70 % of the patients treated neodadjuvantly a reduction of the tumor size was found. The median survival rate of our collective of patients with liver metastases averages 8.6 months. In the literature median survival rates in patients with liver metastases were between 8.5 and 23 months after TACE. TACE is judged as a minimal invasive and outpatient treatment protocol for liver metastases. A combination of TACE and different local treatment modalities presents a neoadjuvant treatment strategy to control the diseased liver.