CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment.

Massive haemoptysis is a respiratory emergency. Computed tomography angiography (CTA) can play a crucial role in assessing the cause and origin of the haemoptysis and directing the interventional radiologist prior to treatment. The bronchial arterial supply and to a lesser extent the non-bronchial systemic arterial supply are responsible for the majority of cases of massive haemoptysis, but uncommon causes of massive haemoptysis should be considered to avoid misdiagnosis and delayed treatment. Failure to assess the imaging appropriately prior to endovascular treatment may result in early recurrent massive haemoptysis or patient death.

Multidisciplinary approach to carotid stenting.

BACKGROUND: Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. METHODS: A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. RESULTS: From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). CONCLUSION: A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme.

Mechanical thrombectomy in acute venous thrombosis using an Amplatz thrombectomy device.

Three cases of percutaneous mechanical thrombectomy using the Amplatz thrombectomy device are presented. All cases involve the application of the device in a major thoracic or abdominal vein in situations in which chemothrombolysis was contraindicated. The method of operation of the Amplatz thrombectomy device, as well as a brief overview of its clinical applications, are presented.

Availability humanization expert model.

AH model as a tool for estimation in the occupational health care is presented. This is an expert model connecting data from the working environment with human availability and health status data. In this paper the idea of model and its components are presented.

Event-related potentials (ERPs) and intelligence in neonatally identified 47,XXY males.

The event-related potentials (ERPs) of 18 extra X males (mean age 18.1 years) were recorded during the course of phonemic and orthographic discrimination tasks. The N2 and P3 latencies and amplitudes of subjects were examined in relation to their verbal and nonverbal intelligence test scores based on assessments at three ages: prior to puberty, during puberty and at sexual maturity. The results indicated that verbal abilities at most test occasions were significantly related to P3 latencies. Nonverbal abilities were largely uncorrelated with ERPs. The findings suggest that the verbal deficits of extra X males are the result of unlateralized individual differences in neural cognitive processing.

A comparison of colour duplex ultrasound with venography and varicography in the assessment of varicose veins.

Ninety-three legs in 68 consecutive patients presenting for preoperative assessment of varicose veins were examined by a combination of ascending venography with varicography and also by colour duplex ultrasound. Ninety-one to ninety-two per cent of incompetent sapheno-femoral and sapheno-popliteal communications were demonstrated by ascending venography/varicography and 92-95% by ultrasound. Ascending venography/varicography demonstrated 83-90% of incompetent perforators whilst ultrasound demonstrated only 40-63%. We conclude that ultrasound is an accurate method of assessing primary and recurrent sapheno-femoral and sapheno-popliteal incompetence but is of limited value in assessing perforator incompetence. This is a significant limitation of ultrasound in view of the importance of perforator disease, and it is likely that this technique can only be used in combination with other venographic methods.

[Peritoneal splenosis. Report of a case and pathogenetic considerations]. / Splenosi peritoneale. Segnalazione di un caso e considerazioni patogenetiche.

A clinical case of splenosis recently observed in a young man subjected at the age of 8 to splenectomy for rupture of the spleen and operated at 19 for intestinal occlusion is reported. The pathogenetic aspects of the condition, characterised by the presence of nodules of splenic tissue in the abdominal cavity, are examined through a review of the literature.

A palpable spleen is not necessarily enlarged or pathological.

It is widely accepted that a palpable spleen in the adult population is always enlarged and pathological. The aim of this study was to assess the validity of this statement. As a routine, our protocol for liver-spleen studies includes liver pliability, which demonstrates the level of the hemidiaphragms at full inspiration and expiration, as well as splenic size and colloidal uptake. Sixteen hundred 99mTc sulphur colloid liver-spleen studies, which had been performed in our Department, were reviewed. In 21 patients, who had been referred with "splenomegaly for investigation", the scintigraphic splenic size was 13 cm posterior length or less. In this group, splenic palpability was confirmed by at least two clinicians. Follow-up did not reveal any evidence of splenic disease in 18 of the 21 patients. In a separate postmortem follow-up of 123 sequential liver-spleen scans, 100 patients were noted to have a scintigraphic splenic size of 13 cm posterior length or less. This was shown to be a reliable upper limit of normal because 98% of spleens in this group weighed 250 g or less and were normal at post-mortem examination. This study demonstrates that a palpable spleen is not necessarily enlarged or pathological.

[ Thrombogenic risk in phlebography. Personal studies ]. / Rischio trombogenico della flebografia. Personali osservazioni.

Personally observed signs of venous thrombosis arising in 19 patients given ascending phlebography are described with reference to certain clinical signs and a surgical investigation.