Injection of Saline Into the Biopsy Tract and Rapid Patient Rollover Decreases Pneumothorax Size Following Computed Tomography-Guided Transthoracic Needle Biopsy.

PURPOSE: To determine if saline tract injection and rapid patient rollover following computed tomography (CT)-guided transthoracic needle biopsy (TTNB) affects pneumothorax incidence and size. METHODS: A retrospective cohort design was used to compare 278 patients who underwent post-biopsy saline injection and rapid rollover so that the biopsy site was dependent (N = 180) to a control group with routine post-biopsy care (N = 98). Post-procedure radiographs and CT were assessed for presence and size of pneumothorax, as well as requirement for chest tube placement. RESULTS: Pneumothorax size as estimated on post-procedure CT was 3.33% in the treatment group and 6.63% in the control group (P < .05). There was also a reduction in chest tube placements in the treatment group (3.9% vs 10%, P < .05). On post-procedure radiographs, pneumothorax rates were 20% in the treatment group, and 25% in the control group (P > .05). CONCLUSION: Saline injection with rapid patient rollover following TTNB significantly decreased pneumothorax size and chest tube placement but not incidence.

Widespread cerebral haemodynamics disturbances occur early in amyotrophic lateral sclerosis.

We wished to longitudinally assess early changes in cerebral perfusion (CP) and its relationship to cognitive impairment (CI) in ALS. Fourteen ALS patients at time of diagnosis and 11 spousal controls, both without CI, were longitudinally assessed to determine a relationship between CP and incidence of CI in early stage disease. Neuropsychological testing and CP measurements were performed in both ALS and control groups at the initial assessment (T0) and two time-periods post initial assessment, T1 and T2, taken on average 6.1 and 17.0 months after initial assessment (T0), respectively. CT perfusion was used to measure cerebral blood flow, blood volume, and mean transit time (MTT) for all cortical lobes, and subcortical grey and white matter. Two of 14 ALS patients progressed to CI. No differences in CP measurements existed at T0 or T1 between the ALS and control groups. At T2, widespread cortical differences in MTT were present between the two groups. The ALS group had significantly increased MTT in all cortical regions, as well as the thalamus, compared with the control group. Our findings suggest early widespread changes in CP occur outside the motor area in the absence of CI in ALS.

Cerebral haemodynamic changes accompanying cognitive impairment in primary lateral sclerosis.

Our objective was to elucidate the relationship between cognitive decline and cerebral haemodynamics in patients with PLS. We examined 18 patients with PLS and contrasted both neuropsychological and cerebral perfusion findings with seven age- and education-matched non-PLS controls. PLS patients were stratified into two groups based on the number of abnormal neuropsychological test scores: 1) cognitively intact PLS patients (PLS; those having zero or one abnormal scores (n =14)), and 2) cognitively-impaired PLS patients (PLSci; those having two or more abnormal test scores (n =4)). There was considerable heterogeneity in level of cognitive functioning with four patients meeting the criteria for cognitive impairment. The findings were highly consistent with a frontotemporal lobar dysfunction. Using CT perfusion to assess cerebral haemodynamics, the PLSci group had increased cerebral blood volume (CBV) and mean transit time (MTT) with reduced cerebral blood flow (CBF). More specifically, MTT was significantly increased (p<0.05) in the PLSci group compared with controls in all regions and affected both grey and white matter, with the exception of the temporal lobe and subcortical parietal white matter. These observations suggest that a subset of PLS patients is subject to cognitive decline and that this process is associated with changes in cerebral haemodynamics.

Improving quality of care for patients undergoing arterial embolization for uterine fibroids: case report and review.

BACKGROUND: Uterine artery embolization (UAE) is an effective and accepted management option for symptomatic uterine fibroids. This case report presents a complication following UAE and is followed by a review outlining the need to monitor quality of care for women who undergo this procedure. CASE: A 37-year-old woman presented with fever and general malaise refractory to medical treatment 16 days after UAE was performed to treat a symptomatic fibroid. At hysterectomy, 20 days after UAE, a 10 cm necrotic and infected submucosal fibroid with cervicitis was identified. CONCLUSION: Complications of UAE for treatment of fibroids will be minimized if patients are selected appropriately, if the procedure is performed correctly, and if outcomes, efficacy, and complication rates are monitored.