RESUMO
Various image-guided ablative procedures include chemical and thermal ablation techniques and irreversible electroporation. These have been used for curative intent for small tumours and palliative intent for debulking, immunogenicity and pain control. Understanding these techniques is critical to avoiding complications and achieving superior clinical outcomes. Additionally, combination with immunotherapy and chemotherapies is rapidly evolving. There are numerous opportunities in interventional radiology to advance ablation techniques and seamlessly integrate into current treatment regimens for both benign and malignant tumours.
Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Delaware , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Nódulo Pulmonar Solitário/patologiaRESUMO
Radioguided surgery has slowly gained acceptance since the first gamma probe directed sentinel node lymph node biopsy in a patient with melanoma in 1993. We describe how the intraoperative gamma probe is used to localize a rib with abnormal uptake on the bone scan in a patient with rib pain.
Assuntos
Costelas/diagnóstico por imagem , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Período Intraoperatório , Pessoa de Meia-Idade , Dor/cirurgia , Medição da Dor , Radiografia , Cintilografia , Costelas/patologia , Costelas/cirurgiaRESUMO
The use of transcatheter uterine artery embolization as a treatment for uterine fibroids represents a new approach to the management of this common problem. Early reports of uterine artery embolization as a treatment of symptomatic fibroids have indicated significant symptomatic improvement as well as reduction in the size of fibroids. We have been performing this procedure for two years at the Christiana Care Hospital. We describe two representative cases with clinical follow up on 12 of our patients and briefly review the literature on uterine artery embolization for uterine fibroids.
Assuntos
Embolização Terapêutica/métodos , Leiomioma/terapia , Neoplasias Uterinas/terapia , Adulto , Angiografia , Feminino , Humanos , Leiomioma/diagnóstico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Uterinas/diagnóstico , Útero/irrigação sanguíneaRESUMO
Recent advances in microcatheter technology, refinements in embolic agents and improvements in navigational techniques have allowed for endovascular embolization to become an important adjunct in the treatment of vascular head and neck lesions. We describe several case reports where endovascular embolization was utilized in the treatment of such lesions.
Assuntos
Embolização Terapêutica/métodos , Doenças Vasculares/terapia , Adolescente , Adulto , Idoso , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Artéria Carótida Primitiva/diagnóstico por imagem , Epistaxe/terapia , Feminino , Humanos , Masculino , Artéria Maxilar/anormalidades , Artéria Maxilar/diagnóstico por imagem , Paraganglioma/terapia , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/terapiaAssuntos
Traumatismos Abdominais/complicações , Hérnia Inguinal/complicações , Perfuração Intestinal/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico por imagem , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/lesões , Hérnia Inguinal/diagnóstico por imagem , Humanos , Perfuração Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
Since 1993, 14 cases of central line guide wires becoming entangled with vena cava filters have been reported. We present three additional cases and review the 14 cases in the literature. Obtaining a detailed patient history is important in identifying patients with a vena cava filter. A low threshold of suspicion is needed and immediate radiograph obtained. Entangled guide wires required fluoroscopic manipulation and or retrieval of the dislodged filter. Of all reported cases, only one sustained an arrhythmia. With no signs and symptoms, conservative management of the dislodged filter is a viable option.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Filtros de Veia Cava/efeitos adversos , Adulto , Idoso , Falha de Equipamento , Fluoroscopia , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Síndrome de Brown-Séquard/diagnóstico , Imageamento por Ressonância Magnética , Lesões do Pescoço/diagnóstico , Pneumocefalia/diagnóstico , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico , Adulto , Vértebras Cervicais/lesões , Vértebras Cervicais/patologia , Humanos , Masculino , Medula Espinal/patologia , Traumatismos da Medula Espinal/diagnóstico , Tentativa de SuicídioRESUMO
The development of orthotopic liver transplantation represents this century's most significant advance in the management of liver disease. In the 1980s the vast majority of liver transplants were performed at several large centers; however, in this decade, improvements in techniques and success rates have allowed live transplantation to expand to regional centers across the country, particularly in the southeast. This proliferation of regional centers and the widening disparity between organ availability and numbers of recipients have created tremendous controversy at the national level regarding the allocation scheme used to distribute livers to recipients. The large programs today are advocating change to a national waiting list which would eliminate local priority and jeopardize the existence of smaller regional centers. Furthermore, the large programs favor establishing a limited number of megacenters where all liver transplants would take place, arguing that low volume centers cannot perform liver transplants with acceptable complication and survival rates. At the Regional Transplant Center of Willis-Knighton Hospital and Louisiana State University Medical Center in Shreveport (WK/LSUMC) we performed 122 liver transplants between July 1, 1991 and December 31, 1997. The purpose of this study was to examine our complication and survival rates and compare them to national averages. The actuarial graft survival at 1, 2, and 3 years in this series compared to the national average respectively was 76% and 70%, 66% and 66%, 62% and 62%. The actuarial patient survival (WK/LSUMC vs National) at 1, 2, and 3 years was 80% and 80%, 75% and 75%, 70% and 74%. The rate of retransplantation was 8% with a national average of 10% to 20%. Our rate of graft primary non-function was 5% with the national average being 2% to 10%. The rate of vascular thrombosis of the graft in this series was 2% with a national rate of 5%. The differences in these results were not statistically significant (P < .05). Low volume transplant centers can perform liver transplant successfully, allowing the regionalization of the treatment of choice for end-stage liver disease.
Assuntos
Transplante de Fígado/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Análise Atuarial , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Humanos , Lactente , Hepatopatias/etiologia , Hepatopatias/cirurgia , Transplante de Fígado/mortalidade , Louisiana , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Synovial cysts are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. To our knowledge, all the reported cases of synovial cysts in literature were posterolateral in location (1-4). This case report describes the previously unreported midline location of the synovial cyst in the spinal canal and to increase the level of awareness of diagnosing these lesions in a central location, especially in light of the evaluation of lumbar radiculopathy.