Semi-dynamic MRI of climbing-associated injuries of the finger.

OBJECTIVE: Injuries of the flexor-tendon-pulley system are common in rock climbers. The status of the A3 pulley ligament is crucial for grading such injuries. As standard MRI may miss lesions of the A3 pulley ligament, we introduce a semi-dynamic MRI sequence. MATERIALS AND METHODS: Twenty-two fingers (14 volunteers, 3 injured climbers) were scanned using a sagittal T1 turbo spin echo sequence (repetition time: 400 ms, echo time: 14 ms, slice thickness: 5 mm) in six consecutive finger positions from stretched to maximum possible flexion. RESULTS: No pulley lesion was found in volunteers. Bowstringing was detected in 3 injured fingers including the A3 pulley. CONCLUSION: Semi-dynamic MRI is an technique that is easy to perform to identify injuries of the A3 pulley ligament that were not seen on standard imaging.

Good scent in MRI: can scent management optimize patient tolerance?

BACKGROUND: Psychological distress for patients undergoing magnetic resonance imaging (MRI) may range from mild anxiety to serious panic attacks. Scents associated with a sense of wellbeing have been used to diminish psychological stress in various clinical conditions. PURPOSE: To evaluate the influence of inhalation aromatherapy in the reduction of artifacts in patients undergoing MRI. MATERIAL AND METHODS: Based on the assumption aromatherapy will lead to significant reduction of patient-related motion artifacts (PRMA) in MRI, a randomized controlled trial with two groups of 54 patients was enrolled. The primary endpoint was the number of sequences with PRMAs. Secondary outcomes were improvements of mood measured with the ASTS questionnaire as well as patient's recommendation to fellow patients tested by a visual analogue scale. Incidence and intensity of adverse events were documented. RESULTS: Ninety-five patients were included in the statistical analysis. We were not able to detect a significant reduction of PRMAs. There were also no significant differences in mood or in relation to the feeling before and after examination. The only differences that neared significance were "positive mood" and "recommendation". No adverse reaction was observed. CONCLUSION: Although aromatherapy has been effective in enhancing patient's mood or wellbeing in a variety of stressful clinical settings, we were not able to find a similar effect. Neither the primary nor the secondary endpoints reached a clinical meaningful magnitude.

Minimally invasive application of thrombin in the treatment of pseudoaneurysms following open aortic surgery.

BACKGROUND: Anastomotic leaks are uncommon complications following aortic surgery. To avoid the morbidity associated with a second surgical procedure, minimally invasive techniques have become increasingly popular. PURPOSE: To evaluate the feasibility and safety of thrombin in interventional treatment of postoperative pseudoaneurysms. MATERIAL AND METHODS: CT-guided percutaneous injection was chosen in four cases. Endovascular access using an occlusion balloon catheter placed in the orifice of the pseudoaneurysm was utilized in one case. RESULTS: The average volume of all pseudoaneurysms was 178 ± 190 mL with a volume of the patent lumen of 25 ± 28 mL. All aneurysms thrombosed after injection of 600 ± 237 IU of thrombin. During the follow-up period of an average of 10 months all pseudoaneurysms remained occluded. CONCLUSION: Our series demonstrates the feasibility of thrombin in the treatment of aortic anastomotic pseudoaneurysms. In combination with occlusion balloon catheters, even wide-necked pseudoaneurysms may be treated successfully. However, further investigations are warranted.

Periportal edema in trauma patients: correlation with trauma severity.

BACKGROUND: Periportal edema (PPE) can be seen in different clinical settings, including in patients following trauma. However, the underlying mechanisms and clinical significance in trauma patients still remain unclear. PURPOSE: To determine the incidence of PPE in CT scans of trauma patients and to correlate PPE with trauma severity and different patterns of injury. MATERIAL AND METHODS: We retrospectively analyzed contrast-enhanced spiral CT scans of 127 trauma patients that were referred to our Trauma Center Level I between January 2006 and June 2007. According to the Injury Severity Score (ISS), 70 patients with an ISS < 16 (minor trauma) were assigned to group 1 and 57 patients with an ISS ≥16 (major trauma) to group 2. RESULTS: The presence of PPE was significantly (p < 0.01) higher in group 2 (22 of 57 patients [38.6%]) than in group 1 (10 of 70 patients [14.3%]). In 29 patients PPE presented with a diffuse pattern and in three patients with a focal pattern, affecting only one liver lobe. In 14 patients PPE was found in absence of abdominal injuries. In addition, PPE was present in five patients with abdominal injuries but without liver injury. CONCLUSION: PPE is seen significantly more often on abdominal CT scans following major traumas (ISS ≥ 16), but is not necessarily associated with liver injury.

Surgical access to jejunal veins for local thrombolysis and stent placement in portal vein thrombosis.

Portal vein thrombosis is an infrequent entity, which may cause high morbidity and mortality. We report a case of portal vein thrombosis due to benign stenosis following partial pancreatoduodenectomy with segmental replacement of the portal vein by a Gore-tex graft. Using a surgical access to jenunal veins, local thrombolysis, mechanical fragmentation of thrombus, and stent placement were successfully performed.

Minimally invasive therapy of pseudoaneurysms of the trunk: application of thrombin.

Thrombin injection has been proven to be successful in postcatheterization pseudoaneurysms. However, there are only a few reports on the treatment of pseudoaneurysms of the trunk. We report our first experiences using a percutaneous as well as an endovascular access. Eight iatrogenic pseudoaneurysms of the trunk (aorta, n = 4; pulmonary artery, n = 1; gastroduodenal artery, n = 1; left gastric artery, n = 1, renal artery, n = 1) were treated either percutaneously using CT guidance (n = 3) or via an endovascular access (n = 5). Noninvasive control angiograms were performed at day 1 and weeks 1 and 3 by either CT or MR angiography. The total volume of the pseudoaneurysms was 31.2 +/- 23.1 ml on average, with a mean volume of the perfused aneurysmal lumen of 12.9 +/- 7.2 ml. The maximum diameter was 4.1 +/- 1.39 cm on average. In each case, the aneurysmal neck was not wider than 2 mm. One pseudoaneurysm occluded spontaneously following selective catheterization. The remaining pseudoaneurysms were successfully treated by injection of 765 +/- 438.1 IU thrombin. In one individual, a nontarget embolization occurred, as well as an intervention-associated rupture of a pseudoaneurysm. High-grade stenoses of the donor artery were found in a different case. Only once was the endoluminal access converted to a percutaneous one. Thrombin injection might be a future first-line treatment of vascular lesions such as pseudoaneurysms of the trunk. In our experience both percutanous and endoluminal access are technically feasible and safe. However, further experiences are mandatory, especially concerning the question of dosage and long-term results.