Renal ablation in patients with end-stage renal disease.

BACKGROUND: Transarterial catheter embolization of the kidneys (TAE) is a minimally invasive, image-guided procedure. In this study outcome and TAE-related complications of the patients who underwent TAE of the kidneys were evaluated retrospectively. PATIENTS AND METHODS: Between August 2003 and August 2009, 11 patients underwent selective percutaneous transarterial renal embolization for end stage renal disease associated with uncontrolled hypertension, nephrotic syndrome, bleeding or malignancy. TAE of renal arteries was performed using different embolization agents. RESULTS: Successful renal embolization was possible in all 21 kidneys. All patients became anuric. Non-target embolization was not detectable. Nevertheless, all patients developed some degree of postembolization symptoms including nausea, vomiting, fever or pain. A typical finding after embolization was an increase in the C-reactive protein. CONCLUSIONS: Renal embolization is rarely done but should be considered as an alternative to surgical nephrectomy in patients with end stage renal disease due to the lesser invasiveness. Our study confirms the safety and effectivity of percutaneous renal embolization in patients with ESRD. We were able to control the hypertension, nephrotic syndrome, and bleeding caused by ESRD.

Transarterial catheter embolization of a sarcoma for preoperative conditioning.

This paper presents a case of an undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic - storiform malignant fibrous histiocytoma) of the lower leg, of a huge tumor causing ulceration of the cutaneous surface. To improve preoperative conditions, selective transarterial devascularization of the tumor feeders was performed. At operation the tumor was completely ischaemic allowing for clear tumor demarcation with little blood loss during surgery.

[Management of acute basilar artery occlusion]. / Management des akuten Basilarisverschlusses.

Basilar artery thrombosis is a life-threatening condition whose unfavorable spontaneous prognosis can only be improved by early detection and subsequent aggressive recanalization therapy. The therapeutic approach has not yet been standardized and ranges from intravenous thrombolytic therapy with pharmacological agents to experimental procedures of mechanical endovascular recanalization, but the availability of the treatment approach and location of the occlusion determine the procedure in individual cases. Multicenter studies will have to clarify which bridging therapy (single administration of i.v. rt-PA or in combination with GPIIbIIIb inhibitors) before endovascular treatment is superior in terms of effectivity and complication rate.

Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery.

Cerebral embolization of particles after cardiac surgery is frequently associated with neurological deficits. Aortic crossclamp manipulation seems to be the most significant cause of emboli release during cardiac surgery. The goal of this study was to demonstrate whether the use of an intra-aortic filter device has an effect on the magnet resonance imaging (MRI) and functional neurological outcome. Twenty-four patients undergoing cardiosurgical procedures using cardiopulmonary bypass (CPB) were selected: coronary artery bypass graft (CABG) surgery (n = 17), aortic valve replacement (AVR) surgery (n = 4) or combined procedures (n = 3). Patients were evaluated by diffusion weighted MRI of the brain, neurological examination and neuropsychological assessment regarding alertness as well as divided and selective attention before and five to seven days after surgery. The patients were divided into two groups. In group I, 12 patients received a filter through a modified 24 F arterial cannula immediately before the aortic crossclamp was released. Filters remained in the aorta until CPB was discontinued. Intraoperatively, bilateral middle cerebral artery transcranial Doppler (TCD) was monitored at baseline, at the beginning of CPB, at a timepoint when the aorta was crossclamped, when the filter was inserted and while the crossclamp was switched to partial clamping until the CPB was discontinued. TCD was used for detection of microembolic signals (MES). The captured material in the filter was examined histologically. Twelve patients served as controls without aortic filtration (group II). The MRI of the brain did not show any diffusion alterations in either group before or after surgery. No patient developed a focal neurological deficit or stroke. Intraoperative quantitative MES detection revealed a four to tenfold increase in patients of group I compared with group II (5-6 versus 0.5-1 MES/min) during the filter dwell time. There was no consistent pattern regarding the neurobehavioural sequelae. Filters showed arteriosclerotic debris in 75% of the patients. The use of the intra-aortic filter device did not show a positive effect on neurological, neuroradiographical and neuropsychological outcomes. The increase of the MES rate in group I patients may be due to microbubbles generated as microcavitations by the filter or the aortic filter cannula. The intra-aortic filter was able to capture atheromatous material in 75% of the patients.

High-resolution CT of the temporal bone in dysplasia of the auricle and external auditory canal.

PURPOSE: To determine CT findings in the external, middle, and inner ear of patients with microtia and external auditory canal dysplasia. METHODS: We used high-resolution CT, with multiplanar or axial 1-mm continuous sections, coronal or sagittal reformations, or low-dose spiral acquisitions, to examine 184 temporal bones of children with microtia. RESULTS: In cases of minor microtia, auditory canal stenosis was the most common associated abnormality; in those with major microtia, atresia was predominant. Middle ear malformations depended on the severity of the auricular anomalies. Inner ear changes could also be noted. Ossicle dysplasias occurred in 98% of patients (stapes, 72%), absence of the oval window in 36%, labyrinthine malformations in 13%, closed round window in 6%, facial canal displacement in up to 75%, and aberrations of the vascular canal in 38% of patients with third-grade auricular deformity. CONCLUSION: A variety of external, middle, and, less frequently, inner ear changes were detected in connection with microtia.