Radiofrequency Ablation: Temperature Distribution in Adjacent Tissues.

PURPOSE: This clinical study investigates the use of a radiofrequency ablation system specifically developed for the ablation of spinal metastases. The investigation examines possible temperature-associated risks for the adjacent tissues. MATERIAL AND METHODS: A tumour model was simulated for 8 lumbar and 8 thoracic vertebrae of a human cadaveric spine. The tumour mass was ablated with the SpineSTAR electrode (SpineSTAR, DFINE Inc., CA), which has been specifically developed for the ablation of spinal metastases. During the ablation procedure, the temperatures of the vertebra, the epidural space, and the neural foramen were measured with thermocouples. These temperatures were documented as means with standard deviations. Possible differences between lumbar and thoracic vertebrae were analysed with the Mann-Whitney U test. RESULTS: The maximal temperature of the lumbar vertebrae was 46.4 ± 3.3 °C near to the ablation zone, the temperature of the neural foramen was 37.0 ± 0 °C, and the temperature of the epidural space was 37.3 ± 0.7 °C. In the thoracic vertebrae, the temperature was 44.4 ± 1.7 °C near to the ablation zone, 7.9 ± 1.7 °C in the neural foramen, and 37.25 ± 0.7 °C in the epidural space. There was no significant difference in temperature distribution between treated lumbar and thoracic vertebrae. CONCLUSION: Ablation of spinal metastases in a cadaveric model using the SpineSTAR electrode was shown to be a safe method with respect to possible temperature-related risks for the adjacent tissues.

Lymphatic Interventions for Treatment of Chylothorax.

PURPOSE: To determine effectiveness of lymphatic interventional procedures for treatment of chylothorax. MATERIAL AND METHODS: Analysis of interventions performed from 2001 to 2014. RESULTS: In 21 patients with therapy resistant chylothorax a lymphatic radiological intervention was attempted, which could be performed in 19 cases: 17 thoracic duct embolizations (15 transabdominal, one transzervical and one retrograde transvenous procedure), 2 percutaneous destructions of lymphatic vessels, one CT-guided injection of ethanol next to a duplicated thoracic duct. Fourteen of seventeen (82.3 %) of the technically successful embolizations lead to clinical cure. This encluded three patients with prior unsuccessful surgical thoracic duct ligation. Also the injection of ethanol was clinically effective. Complications were a bile peritonitis requiring operation, and one clinical deterioration of unknown cause. CONCLUSION: Interventional lymphatic procedures allow for effective treatment in many cases of chylothorax, and should be considered early during treatment. KEY POINTS: • Thoracic duct embolization is an effective treatment method for chylothorax. • If embolization is impossible, percutaneous lymphatic destruction or injection of sclerosants/tissue adhesive next to the thoracic duct may be tried.

Endobronchial valve-induced pneumatocele: a case report.

We report a 75-year old female patient with advanced emphysema. After endoscopic lung volume reduction with endobronchial valves (EBV), a huge pneumatocele has occured and resolved spontaneously within a few weeks. Albeit rare, pneumatoceles should be considered in patients with relapsing dyspnoe after EBV treatment.

[Long-term efficacy and safety of balloon kyphoplasty for treatment of osteoporotic vertebral fractures]. / Langzeitwirksamkeit und Sicherheit der Ballon-Kyphoplastie zur Behandlung osteoporotischer Wirbelkörperfrakturen.

OBJECTIVE: The aim of the evaluation of treatment protocols was an extension of the documentation regarding efficacy, duration of action and safety of balloon kyphoplasty. In addition, the data analysis should be used to clarify whether differences arise concerning the treatment success, depending on the number and/or position of the augmented vertebral bodies. MATERIALS AND METHODS: The data of all patients who were admitted and operated on for vertebral body fractures between 2004 and 2009 were collected and evaluated for this study. The patients were examined pre-operatively and during the control visits clinically and radiologically. The intensity of pain was recorded on a visual analogue scale (VAS: 0-100 mm). To determine the functional limitations the Oswestry questionnaire was used. In addition, the middle and anterior heights of the vertebral body and the kyphosis angle were measured. To perform the balloon kyphoplasty the Kyphon® system was applied. The findings of all patients were documented in order to evaluate the efficacy and safety of balloon kyphoplasty for up to 3 years and to compare them with regard to the differences depending on the number and/or location of vertebral fractures (T = 1, T > 1, L = 1, L > 1, T + L). RESULTS: The overall evaluation of all patients (n = 464) in whom a balloon kyphoplasty was carried out showed an average improvement in VAS scores by 53 mm and the Oswestry scores by 47 percentage points. It was possible to demonstrate a significant improvement of the vertebral body height (mean 1.6 mm) and the kyphosis angle (1.3 degrees) in long-term controls up to 3 years. When comparing the findings in the groups that had been operated on a different number of vertebrae and/or at different positions in the spinal region (n = 466) it could be proven that the average decrease in pain intensity did not differ in all 5 groups (> 50 mm). Also for the Oswestry scores the reduction was almost comparable in all 5 groups. The radiological findings did not show striking differences between the 5 groups. CONCLUSIONS: Balloon kyphoplasty was proven to be a safe and effective procedure. Thus, the balloon kyphoplasty in carefully selected patients can yield better results than a non-invasive conservative treatment. It contributes decisively a better quality of life for the operated patients and diminishes the risks of long-lasting treatment with drugs.

[Faster diagnostics by digital X-ray imaging in the emergency room: a prospective study in multiple trauma patients]. / Schnellere Diagnostik mit digitaler Röntgentechnik im Schockraum: eine prospektive Studie bei Schwerverletzten.

AIM: The object of this study was to provide evidence for a time-reduced diagnostic space in multiple trauma patients by use of a digital X-ray system in the emergency suite. METHOD: The same algorithm was used in the first attention of 66 severely injured patients. For 21 patients from October 2000 to March 2001 (group 1) conventional X-rays (thorax, pelvis, spine and extremities) were performed in the analogue way, for 45 patients from April to December 2001 (group 2) the new digital system (Philips Optimum and Philips PCR AC 500) was used. RESULTS: The two groups were similar concerning age, sex and injury severity. The time-space from the patient's delivery in the emergency suite to the handing over in the operation theatre or intensive care unit was significantly lower in group 2 (87 +/- 33 min, p < 0.001) than in group 1 (121 +/- 49 min). CONCLUSION: Digital imaging with conventional X-rays in the first attention of multiple trauma patients reduces the diagnostic time by more than half an hour, when applying the same diagnostic algorithm.

Evaluation of polyurethane nasolacrimal duct stents: in vivo studies in New Zealand rabbits.

The purpose of this study was to evaluate the radiographic and biological effects of different polyurethane nasolacrimal duct stents in an animal model. Fifteen polyurethane nasolacrimal duct stents (n = 5 mushroom-type stents, n = 5 newly designed S-shaped TearLeader stents without hydrophilic coating, and n = 5 S-shaped TearLeader stents with hydrophilic coating) were implanted in the nasolacrimal ducts of eight unaffected New Zealand rabbits. One nasolacrimal system served as control. Clinical and radiographic follow-up was performed at 1-, 2-, and 4-week intervals, then after a 3-month interval, after which the animals were euthanized. All stents were implanted without major periprocedural complications. The stents proved to be patent by the end of the procedure. During follow-up, all mushroom-type stents were occluded at 4 weeks. None of these stents opened to forced irrigation. Clinically, all rabbits demonstrated severe dacryocystitis. Three out of five TearLeader stents without hydrophilic coating were blocked at 4 weeks; one out of five was open to irrigation. Best results were observed in the stent group with hydrophilic coating. Follow-up dacryocystography demonstrated patent stents in nasolacrimal ducts of all animals after 4 weeks. In only one of five cases, the coated stent became partially occluded after 2 months. These animals were free of clinical symptoms. After 3 months, at least three out of five stents still opened to forced irrigation and only one stent was completely blocked. Dislocation of the stents was not observed. Refinement of the stent surface and stent design improves the results of nasolacrimal duct stenting in this animal model. Implantation of hydrophilic-coated S-shaped stents is highly superior to conventional mushroom-type stents and noncoated stent types. Hydrophilic coating seems to prevent foreign-body reactions, resulting in maximized stent patency.

Radiation dose in vertebroplasty.

We wished to measure the absorbed radiation dose during fluoroscopically controlled vertebroplasty and to assess the possibility of deterministic radiation effects to the operator. The dose was measured in 11 consecutive procedures using thermoluminescent ring dosimeters on the hand of the operator and electronic dosimeters inside and outside of the operator's lead apron. We found doses of 0.022-3.256 mGy outside and 0.01-0.47 mGy inside the lead apron. Doses on the hand were higher, 0.5-8.5 mGy. This preliminary study indicates greater exposure to the operator's hands than expected from traditional apron measurements.

Nonsurgical fluoroscopically guided dacryocystoplasty of common canalicular obstructions.

PURPOSE: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus. METHODS: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months). RESULTS: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed. CONCLUSION: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results.

Dacryoliths: nonsurgical fluoroscopically guided treatment during dacryocystoplasty.

PURPOSE: To evaluate dacryocystoplasty with fluoroscopically guided nonsurgical removal of dacryoliths in the treatment of dacryolithiasis. MATERIALS AND METHODS: Ten patients with severe epiphora due to partial (n = 8) or complete (n = 2) obstruction of the nasolacrimal duct system associated with dacryolithiasis underwent fluoroscopically guided removal of dacryoliths during dacryocystoplasty. Balloon dilation was performed initially to widen the nasolacrimal duct obstructions and to fragment dacryoliths. This was followed by forced irrigation with saline solution through the canaliculi. In patients with incomplete dacryolith washout, a 6.3-F sheath was advanced in a retrograde fashion into the nasolacrimal sac, and forced irrigation was repeated with aspiration of the fragments through the sheath. In two patients with therapy-resistant dacryoliths, additional fragmentation of the concrements was performed with a gooseneck snare. RESULTS: Removal of dacryoliths was technically successful in all patients (complete removal, n = 6; partial removal, n = 4). During a follow-up period of up to 18 months, complete resolution of epiphora was achieved in five patients, and five patients showed partial resolution of their symptoms. CONCLUSION: Fluoroscopically guided removal of dacryoliths during dacryocystoplasty is a feasible nonsurgical therapy with good clinical results and may be used as an alternative to dacryocystorhinostomy.

High-temperature tenderizing of beef sides: bacterial considerations.

A microbiological study of an experimental beef-tenderizing treatment, in which lean sides are held at 37 degrees C until transfer to a chiller at 3 h postmortem, was made. The treatment did not cause a significant increase in bacterial numbers or a proliferation of potential pathogens or food-spoiling organisms.