Complications and clinical outcome of hepatic artery embolisation in patients with hereditary haemorrhagic telangiectasia.

BACKGROUND: Hepatic artery embolisation (HAE) in patients with hereditary haemorrhagic telangiectasia (HHT) is controversial because of the associated complications and unproven long-term benefit. We present our results in 20 such patients over a time span of 17 years. METHODS: Staged HAE was performed using polyvinyl alcohol (PVA) particles and coils. Complications, clinical symptoms and cardiac output were assessed before and after therapy as well as at the end of follow-up (median 92 months, range 26-208 months). RESULTS: Two patients died within 30 days following HAE (10 %). Four further deaths resulted from causes unrelated to HAE. Ischaemic cholangitis, cholecystitis and focal hepatic necrosis with biliary sepsis necessitated re-intervention in four patients. In all but one patient, clinical symptoms resolved with mean cardiac output falling from 11.84 ± 3.22 l/min pre-treatment to 8.13 ± 2.67 l/min at the end of follow-up (P < 0.001). One patient required liver transplantation for de novo symptoms of portal hypertension 4 years after primary symptoms had been cured by HAE. CONCLUSION: The 30-day mortality of HAE in patients with HHT is 10 %. The rate of complications requiring re-intervention is 20 %. Clinical response at long-term follow-up is satisfactory.

Improved Contact X-Ray Microradiographic Method to Measure Mineral Density of Hard Dental Tissues.

Contact X-ray microradiography is the current gold standard for measuring mineral densities of partially demineralized tooth specimens. The X-ray sensitive film specified in the last J Res NIST publication on the subject is no longer commercially available. OBJECTIVES: Develop a new microradiographic method by identifying a commercially available film with greater than 3000 lines per millimeter resolution, which is sensitive to X rays, and develop correct film processing for X-ray microradiographic application. METHODS: A holographic film was identified as a potential replacement film. Proper exposure was determined utilizing a thick nickel plate to create test-strips. Film development was bracketed around manufacturer suggestions. Film linearity was determined with aluminum step-wedges. Microradiographs of 100 µm thick tooth sections, before and after acidic challenges, were a final test for film. Magnified images were captured with a digital microscope camera with 0.305 micrometers per pixel resolution. RESULTS: The appropriate film exposure was 30 minutes at 80 kV(p) and 3 mA with a development time of 2 minutes. Step-wedge experiments show the system to be linear in terms of pixel intensities with respect to x-ray attenuation for normalized pixel intensity values that are 10% to 90% of full scale (r(2) = 0.997) which encompasses the full exposure region of tooth tissue. Enamel sections were analyzed and show distinctive differences between erosion and demineralization. The image capture device resolution of 0.305 micrometers per pixel limits the system resolution. CONCLUSION: Use of the identified holographic film when combined with the described processing modifications has resulted in an improved X-ray microradiographic method for the measurement of mineral density of dental hard tissues. The method described can be further improved by using a higher resolution digitization system. The method is appropriate for quantitatively measuring changes in mineral density and erosion.

[Peripheral vascular disease of iliac and femoro-popliteal arteries: state-of-the-art endoluminal revascularization]. / Arterielle Verschlusskrankheit der Becken- und Oberschenkelarterien: State-of-the-art-Rekanalisation.

Endoluminal therapy is indicated in lower extremity ischaemia with Fontaine grades IIb, III and IV. In the presence of significant limitations, interventions are carried out even in grade IIa claudicants. In addition to the TASC A and B lesions, TASC C and D lesions are increasingly being treated endoluminally as well. Presently, technical success rates of revascularization procedures are above 90% in the iliac vessels and between 79% and 95% in the femoro-popliteal segments. Concentric, non-calcified iliac stenoses are primarily treated with balloon angioplasty (PTA) followed by optional stenting when necessary. For occlusions and heavily calcified lesions, primary stenting is recommended. Primary PTA is the mainstay of treatment in femoro-popliteal vessels with stents being used as a "bail-out" option in case of suboptimal PTA. However, initial reports proving the superiority of primary stenting over PTA with optional stenting have already appeared. Results of PTA with drug-coated balloons for prevention of early restenosis are promising. In the near future, primary PTA with optional stenting in the femoro-popliteal segments may give way to drug-coated balloon angioplasty or primary stenting.