Suppurative Pylephlebitis With Portal Vein Abscess Mimicking Portal Vein Thrombosis: A Report of Two Cases.

Suppurative pylephlebitis, that is, infected thrombosis of the portal vein and its branches is a rare condition with a high incidence of mortality and is often difficult to diagnose. We report two cases of suppurative pylephlebitis secondary to acute pancreatitis wherein the whole of the portal vein and its branches were transformed into an abscess cavity. The diagnosis was made after pus was seen coming out while the patient was taken up for portal vein thrombolysis. The pus was drained and the cavity was completely evacuated leading to recovery from this infection. These two cases highlight the fact that suppurative pylephlebitis is rare and extremely difficult to diagnose as it mimics portal vein thrombosis, but a high degree of suspicion in critically ill patients with thrombus-like appearance in portal vein having a uniform and homogeneous portal venous content on magnetic resonance imaging not responding to antibiotic therapy may be considered for aspiration for differentiating from thrombus and management.

Indian College of Radiology and Imaging Guidelines on Interventions in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common malignancies and a significant cause of cancer-related death. Treatment of HCC depends on the stage of the tumor. As many patients with HCC are not deemed fit for surgical resection or liver transplantation, locoregional therapies play an essential role in the management. Image-guided locoregional treatments include percutaneous ablative therapies and endovascular therapies. The choice of an individual or a combination of therapies is guided by the tumor and patient characteristics. As the outcomes of image-guided locoregional treatments depend on the ability to achieve necrosis of the entire tumor along with a safety margin around it, it is mandatory to follow standard guidelines. In this manuscript, we discuss in detail the various aspects of image-guided locoregional therapies to guide interventional radiologists involved in the care of patients with HCC.

Physiological response of the heel tissue on pressure relief between three alternating pressure air mattresses.

Heels have substantially higher tissue interface pressures and are prone to ulceration compared to other bony prominences. Although many different types of alternating pressure air mattresses (APAMs) are used for the prevention and treatment of pressure ulcers, a few high-quality randomised controlled trials (RCTs) are available on which to base purchasing decisions. Faced with this situation, physiological measurements are increasingly being used as a surrogate. A time-based technique, which calculates pressure relief index (PRI), has been previously reported for analysing the ability of such systems. This technique has demonstrated that different designs produce variable results in this regard. The aim of the present study is to investigate the performance of three APAMs using PRI and blood perfusion measurements. Eleven able-bodied adult volunteers (6 males and 5 females) participated in the study. Their age, weight, height and body mass index (BMI) were (mean +/- s.d.) 23.9 +/- 2.1 years, 65.6 +/- 12.4 kg, 1.76 +/- 0.84 m and 21.0 +/- 2.4 kg/m2, respectively. There was no statistically significant difference in maximum interface pressure for the three mattresses. However, the AUTOlogic produced a statistically significant lower minimum interface pressure (Duo Care Plus, p < 0.0001 and higher pressure relief index below 30 mmHg than either the Duo Care Plus, p = 0.002 or Proficare, p < 0.0001. The AUTOlogic also gave a statistically significant enhanced perfusion per cycle when compared to other two mattresses (Duo Care Plus, p = 0.03 or Proficare, p = 0.01).

Evaluation of intermittent pneumatic compression systems.

The operational characteristics of eight intermittent pneumatic compression systems were evaluated. Considerable differences between the pressure/time curves were found when different pumps were compared. The pressure attained in the garments varied from 6 to 124 mmHg and the rate of inflation from less than 1 to 9 mmHg per second.