Construct validity and reliability of structured assessment of endoVascular expertise in a simulated setting.

OBJECTIVES: To study the construct validity and reliability of a novel endovascular global rating scale, Structured Assessment of endoVascular Expertise (SAVE). DESIGN: A Clinical, experimental study. MATERIALS: Twenty physicians with endovascular experiences ranging from complete novices to highly experienced operators performed a video-recorded simulated contra-lateral iliac-artery-stenting procedure. The virtual-patient case was a novel technically challenging procedure presenting the distal arteries below the knee. METHODS: Three experts assessed the performances blinded to operator identity. Validity was analysed by correlating experience with performance results. Reliability was analysed according to generalisability theory. RESULTS: The mean score on the 29 items of the SAVE scale correlated well with clinical experience (R = 0.84, P < 0.01) and was found discriminative even among the more experienced participants having performed up to 500 endovascular procedures in total. Only the most experienced participants (>5000 procedures) obtained maximum scores. The inter-rater reliability was high (G = 0.94 and G = 0.95). The procedure time (median 69 min, range 32-86) correlated moderately with clinical experience (R = -0.53, P < 0.05), whereas the fluoroscopy time and amount of contrast fluid did not correlate. CONCLUSIONS: The construct validity and reliability of assessment with the SAVE scale was high when applied to performances in a simulation setting with advanced realism. No ceiling effect was present in the assessment situation.

Systemic thrombolytic therapy alone and in combination with mechanical revascularization in acute ischemic stroke in two children.

Thrombolytic therapy is not recommended for acute ischemic stroke (AIS) in patients under the age of 18 and published experience is limited. In this case report, we describe two children treated with systemic thrombolytic therapy. One child received additional mechanical revascularization and achieved a good clinical outcome. The differences in the fibrinolytic system and the different etiology of AIS in childhood may limit a simple extrapolation of the adult guidelines for systemic thrombolytic therapy. Acute multimodal imaging to clarify the etiology of AIS might help to select the most appropriate treatment modality.

Mechanical detachable platinum coil: report of the European phase II clinical trial in 60 patients.

PURPOSE: To determine the safety and reliability of the mechanical detachment system of a platinum coil (Detach-18) when used for neurovascular embolization. MATERIALS AND METHODS: Sixty patients (21 men, 39 women; age range, 26-75 years; mean age, 56.2 years) were treated in seven centers. Ease of introduction of the coil to the microcatheter, effect of coil passage on the microcatheter shape and stability during its delivery, retrievability of the coil before and after the transition zone passed beyond the microcatheter, detachment of the coil, and effect of coil rotation on the microcatheter stability were evaluated. The detachment system itself was evaluated for premature detachment, failure of the coil to detach, detachment time, number of turns, visibility of radiopaque markers, number of coils deployed per patient, and percentage of vessel occlusion obtained. A 0.015-inch-diameter regular coil and a 0.014-inch-diameter soft coil were used. RESULTS: A total of 1,061 coils were used; 1,009 were detached. The number of coils deployed ranged from four to 104 (mean, 17 coils). The coils passed easily through the microcatheter. The detachment maneuver occurred within 5-25 seconds, with five to 60 turns of the introducing wire. One premature coil detachment occurred without clinical sequela; 100% occlusion of the vessel lumen was achieved in 53 patients; 80%-90%, in four; and 70%-80%, in two. There were no device-related complications. CONCLUSION: The detachment system was safe and reliable. This is a useful system for coil embolization in neurovascular diseases.

A report of the clinical use of the detach-18 mechanical detachable platinum coil in 41 patients.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the safety and reliability of the mechanical detachment system of a new platinum coil, Detach-18, when used as a vascular occlusive device for neurovascular disease. METHODS: Forty-one patients (nine male and 32 female patients; age range, 26-75 years; mean age, 54.4 years) underwent treatment at seven centers. Twenty-two patients had dural arteriovenous fistulae of the transverse sinus treated by a transvenous route. Fourteen patients underwent internal carotid artery occlusion in the treatment of aneurysms, meningioma, facial tumor, or carotid injury. One patient underwent occlusion of the basilar artery and one patient underwent occlusion of the vertebral artery for treatment of aneurysms. In two patients, coils were used as part of the treatment of their arteriovenous malformations. In all cases, the Detach-18 coils were delivered through a microcatheter with two distal markers. Two types of coils, a 0.015-inch-diameter "regular" coil and a 0.014-inch-diameter "soft" coil, were used. RESULTS: A total of 569 coils were used, 541 of which were detached. The number of coils in ranged from four to 53 (average number of coils, 14). The coils passed easily through the microcatheter. The detachment maneuver occurred within 10 to 25 s with 20 turns of the introducing wire. No premature coil detachment occurred. Complete occlusion of the vessel lumen was achieved in 35 cases. In three cases, 80% to 90% occlusion was achieved. In two cases, 70% to 80% occlusion was achieved. There were no device-related complications. CONCLUSION: The detachment system was safe, reliable, consistent, and fast. This is a useful system for coil embolization in neurovascular applications.

Recurrence of uterine intravenous leiomyomatosis with intracardiac extension. Diagnostic considerations and surgical removal.

A 28-year-old woman (gravida 2, para 2) was admitted 20 months after a hysterectomy because of fibromyoma. The hysterectomy specimen had shown intravenous leiomyomatosis. The patient presented with unspecific abdominal symptoms, serologic signs of hepatic and renal failure and clinical right-sided heart failure. Progression despite treatment with a gonadotropin-releasing hormone analogue promoted transferral to the present centre. Abdominal ultrasonography, phlebography and transoesophageal echocardiography showed a left pelvic mass and a seemingly free-floating tumour extending from the left main iliac vein via the inferior caval vein to the right ventricle. During a combined cardiac and distal caval approach using extracorporeal circulation, a 45 cm massive leiomyoma was removed successfully. Seven weeks later the left pelvic tumour was removed radically together with left oophorectomy. At control 12 months later the patient was well and without any remaining symptoms.

Indomethacin in controlling "normal perfusion pressure breakthrough" in a case of large cerebral arteriovenous malformation.

Control of "normal perfusion pressure breakthrough" is difficult and controversial. We describe a case in which indomethacin was used with success. We recommend extensive cerebral monitoring including regional cerebral oximetry when using indomethacin to detect impending cerebral ischemia.

[Cerebral arteriovenous malformations. 10 years of therapeutic results]. / Cerebrale arteriovenøse misdannelser. Ti års behandlingsresultater.

Results of treatment of 92 supratentorial and 19 infratentorial cerebral arteriovenous malformations from a 10 year period are discussed. The role of interventional embolization is emphasized. The results seems comparable to major international centres. Danish incidence evaluations indicate that it will be possible to gain further experience and thus better results by centralizing the treatment of larger arteriovenous malformations.

[Interventional neuroradiology. A presentation with preliminary results]. / Interventionel neuroradiologi. En proesentation med egne proeliminoere resultater.

During two periods (1.1.1981-3.1.1985 and 1.1.1988-31.12.1992) 57 patients were treated or attempted treated with endovascular embolization. The patients suffered either from arteriovenous malformations (AVM), dural arteriovenous malformations (DAVM), carotico-cavernous fistulas (CCF), giant aneurysms or meningenomas. During the first period the balloon-technique was mainly employed and only one isobutyl-2-cyanoacrylate (IBCA) embolization was carried out. Six AVMs and 11 CCFs were treated, and the complication rate was 33%. During the second period histoacryl/N-butyl-cyanoacrylate (NBCA) embolization was the treatment of choice for AVM and DAVM, and the balloon technique reserved for CCF and test occlusions. The complication rate was 8%. In 83% of the AVMs occlusion of more than 50% of the nidus was achieved. Three of five CCFs were occluded with one occluded internal carotid artery. There were no complications in test occlusions. Two DAVMs were reduced in size and the symptoms reduced. The patient material during this period consisted of 19 AVMs, two DAVMs, five CCFs, nine giant aneurysms (test occlusion) and five basal meningenomas with involvement of the internal carotid artery (test occlusion). The treatment of these relatively rare patients consists of close cooperation between the interventional neuroradiologist and the neurosurgical team.

Percutaneous catheterization of the peritoneal cavity guided by ultrasonography in the treatment of intraabdominal carcinoma of the ovary.

The authors investigated the catheterization of the peritoneal cavity guided by ultrasound for second line chemotherapy in minimal residual intraabdominal ovarian carcinoma. They analyzed the effectiveness, patient compliance and complications of these methodology. Intraperitoneal chemotherapy used was carboplatin 200 mg/m2 dissolved in 1000 ml 5% glucose solution. After 6 course of treatment, relaparotomy was performed. Toxicity analysis shows this treatment is safe and low toxic. Only 2/11 patients developed progressive disease during treatment.

Incidence of ureteral obstruction after aortic grafting: a prospective analysis.

In this prospective analysis of the incidence of ureteral obstruction after aortic bifurcation grafting, 120 patients were entered into the study: 19 were subsequently excluded for cause, and 101 patients were studied by isotope renography. The renographic findings were indicative for subsequent intravenous pyelography, which was performed in 26 patients. In two cases supplementary retrograde pyelograms were done. Two patients (2%) had ureteral obstruction related to the vascular prosthesis, and in one of these patients the process was bilateral. The lesions were asymptomatic in both patients.

Multiple brain abscesses: treatment by a conservative approach--a case report.

A 57-year-old male with six brain abscesses was successfully treated with metronidazole and ampicillin under close CT-control. To exclude possible tuberculosis a cortical abscess was excised for culture and microscopy. Hydrocephalus which developed was drained and subsequently treated with a permanent ventriculo-peritoneal shunt. Within 42 weeks the remaining five abscesses all showed complete resolution on the CT-scan.

Fine needle aspiration biopsy of the thoracic cage including the pleura--clinical value.

In a series comprising 122 patients with a lesion localized to the thoracic cage or pleura the value of fine needle aspiration biopsy has been analyzed. In 53 patients the cytological reports were decisive for further clinical evaluation and management. Two false negative reports were recorded. No complications occurred. Fine needle aspiration biopsy is recommended as first diagnostic step since it is well tolerated by the patients, without complication and has a fair diagnostic safety.

Nonsurgical treatment of a traumatic brain abscess in a child.

A large traumatic brain abscess in a 9-year-old white boy was successfully treated conservatively with antibiotics, including metronidazole and ampicillin. No neurological or psychological sequelae, except for unilateral loss of the olfactory sense, were revealed at follow-up 5 years later, and on CT two minor hypodense areas remained in the right frontal lobe. Our treatment protocol includes metronidazole (0.5 g 3 times a day) and ampicillin (1 g 6 times a day) for adults. This seems to be the treatment of choice in cases of intracranial brain abscesses.

Early rehabilitation following osteosynthesis with the sliding hip screw for trochanteric fractures.

A prospective study of 104 patients with throchanteric hip fractures was undertaken with particular regard to postoperative complications and rehabilitation at the follow-up 3 months later. The mortality was 20%, depended more on the social function prior to the fracture than on the patient's age. Osteosynthesis was performed with the Richards sliding screw-plate system. The most frequent clinical complications were of a cardiovascular and pulmonary nature. Technical failure was encountered in 10%. Hip function was excellent or good in 69%. In 40% the ability to walk remained unchanged after the operation. Seventy-five per cent of the patients returned to their own homes, although 51% were more dependent on the social welfare system than before the fracture. The social function prior to the fracture determined the social function after the fracture to a greater extent than did the patient's age.

Fine-Needle aspiration biopsy of bone lesions in the spine: diagnostic value.

Fine-needle aspiration biopsy was performed in 92 patients with back pain and a lesion confirmed via x-ray of the spine. In 31 patients in whom x-ray findings had suggested spondylitis, fine-needle aspiration biopsy showed the presence of a tumour in three patients. Of 61 patients with radiographic findings suggestive of malignancy, 26 had benign unspecific lesions, and 35 patients had neoplastic lesions. There were four false negative cytological reports and one false positive report. Additional ESR determination was of no clinical value. There were no complications. Fine-needle aspiration biopsy of bone lesions is recommended as an easy, safe and very often a valuable diagnostic complement.

Instability of trochanteric hip fractures following internal fixation. A radiographic comparison of the Richards sliding screw-plate and the McLaughlin nail-plate.

A comparison was made of the McLaughlin nail plate and the Richards sliding screw-plate techniques for fixation of trochanteric hip fractures. The series included 96 patients in each group. The fractures were followed radiographically for 3 months. Technical failures were encountered in 31 per cent of the McLaughlin fractures and in 8 per cent of the Richards fractures; reoperation was performed in 9 per cent in McLaughlin vs none in the Richards fractures. The main failure was varus displacement in both groups, always combined with lateral cutting of the screw in the Richards fractures, and often combined with failure of the nail-plate junction in McLaughlin fractures. Our study has shown that the sliding screw-plate is superior to the nail plate in both stable and unstable fractures.

Histiocytosis X. Recurrent otitis media as a presenting symptom in children with special references to cholesteatoma.

Ten children with histiocytosis X and recurrent otitis media as a presenting symptom were compared to children with otitis media complicating cholesteatoma. When radiography and biopsy findings were not diagnostic a low age (less than 3 years) and a remaining elevated ESR were characters that most effectively separated the histiocytosis X group from the cholesteatoma group.

Clinical value of percutaneous fine-needle aspiration biopsy of mediastinal masses. An analysis of 132 cases.

The clinical value of fine-needle aspiration biopsy of mediastinal lesions was evaluated in 132 patients. The method was of conclusive clinical value in 88 cases, in 53 of which the further management was based only on the needle biopsy findings, radiographic observations and clinical status. Fine-needle aspiration biopsy of mediastinal lesions is therefore recommended as an early step in diagnostic procedures.