Sustainability within interventional radiology: opportunities and hurdles.

BACKGROUND: Healthcare is a highly polluting industry and attention to the need for making this sector more sustainable is growing. The interventional radiology (IR) department is a relatively unique department in the hospital because of its synergetic use of both imaging equipment and medical instruments. As a result, the interventional radiology department causes a significant environmental burden in terms of energy usage, waste and water pollution. The aim of this study was to explore the current state of sustainability within IR by conducting a survey and interviews among IR specialists in the Netherlands. RESULTS: The main findings of this study were that there is a high awareness for the need of sustainability within IR, but that there is still limited action. Previous studies point towards the various opportunities in the field of energy, waste and water pollution, yet our study unveils these opportunities are often not implemented because of (1) sustainability not being a priority, (2) a dependency on employees, and (3) factors that simply cannot be changed by an individual IR department or hospital. Generally, our study indicates that there is a willingness to become more sustainable, but that the current system involves a wide range barriers that hinder true change. Furthermore, it seems that no one is currently taking the lead and a leading role from higher management, government, healthcare authorities or professional societies is lacking. CONCLUSIONS: Despite the hurdles found in our study, IR departments can implement several improvements. An important factor is that sustainability should not lead to lower convenience for employees, which can be ensured by a sufficiently designed waste infrastructure and behavioral nudges. Furthermore, there lies an opportunity in more collaboration between IR departments in knowledge sharing and open innovation.

Three cases of spontaneous major bleeding in patients with a COVID-19 infection.

In addition to the respiratory compromise typical for COVID-19 many papers reported on the thromboembolic complications in these often critically ill patients. In this report, three cases of patients that developed spontaneous major bleeding following treatment with therapeutic anticoagulation for thromboembolic complications of COVID-19 were described. Two cases were treated with coil-embolization and one patient could be treated conservatively. These cases illustrate the presence of a relevant bleeding risk against the background of the well-known thromboembolic complications associated with COVID-19. The increased risks of thromboembolic complications in COVID-19 warrant adequate prophylactic anticoagulation. The optimal dose to obtain a significant risk reduction without a significant increase in the incidence of major bleeding requires further research.

Cerebral biometry at birth and at 4 and 8 months of age. A prospective study using US.

BACKGROUND: Although longitudinal reference intervals for ventricular size are crucial for the diagnosis of dilated ventricles, such data are sparse. OBJECTIVE: To establish references for ventricular measurements at birth, and at 4 and 8 months follow-up, and to examine the inter-observer variation of the measurements. MATERIALS AND METHODS: This prospective, longitudinal study included 120 term newborns (boys 65, girls 55), mean age 1.5 days on initial scans, with re-examination at 4 months and 8 months of age. One examiner performed all the examinations, measuring: ventricular index, frontal horn width, third ventricle width, frontal subarachnoid space depth, optic nerve sheath diameter and resistive index. RESULTS: One hundred eight (90%) and 90 (75%) of the infants, respectively, attended for follow-up at 4 and 8 months of age. All measures increased with age, except for the depth of the subarachnoid spaces that showed an initial rise, followed by a mild drop at 8 months, and for the resistive index that remained stable at 0.6. The increase was particularly significant for frontal horn width with an increase from 2.2 mm at birth to 6.5 mm at 4 months in boys, and 2.1-5.8 mm in girls. The agreement between two observers was fair to moderate for most of the measurements. CONCLUSION: The increase in the width of the frontal horns between birth and 4 months of age, as well as the wide normal range found among all three age groups are noteworthy and should inform future diagnostics.

Local intra-arterial thrombolysis in a 4-year-old male with vertebrobasilar artery thrombosis.

We report the case of a 4-year-old male with vertebrobasilar artery thrombosis for which he was treated with local intra-arterial urokinase 60 hours after onset of symptoms. Initially the patient had dysarthria and dysphagia. Brain magnetic resonance imaging (MRI) in a community hospital showed abnormalities in the pons, and vertebrobasilar artery thrombosis was suspected. The patient was transferred to the university hospital because of neurological deterioration. Just before thrombolysis, his physical examination revealed a downward ocular deviation, stretching of the arms, and spontaneous movements of the legs. Brain MRI showed recent ischaemia in the pons and caudal part of the mesencephalon, and magnetic resonance angiography showed occlusion of the basilar artery. Intra-arterial thrombolysis with urokinase (total dose 36 000U/kg) was performed 60 hours after onset of symptoms. After thrombolysis he was treated with heparin for 10 days, followed by aspirin. The patient recovered well. After 1 year he had only minor ataxia and performed all activities at school. Local vasculitis due to an infection with Borrelia burgdorferi was thought to be the cause of the local thrombosis. A review of the literature revealed 11 other case reports of successful local intra-arterial thrombolysis in children and adolescents with ischaemic stroke. This suggests that intra-arterial thrombolysis is feasible and safe in selected paediatric patients with ischaemic stroke.

Embolization therapy of bone metastases from epithelial thyroid carcinoma: effect on symptoms and serum thyroglobulin.

BACKGROUND: Selective embolization therapy (SET) has been employed to treat a number of malignant tumors, but experience with its use in metastatic epithelial thyroid carcinoma (ETC) is limited. Here we report our experience with the effect of SET on symptoms and serum thyroglobulin (Tg) in patients with bone metastases from ETC. METHODS: This was a retrospective study of 13 patients with bone metastases from ETC who underwent 65 embolizations for bone metastases in 43 sessions. In the treated patients, symptoms considered related to bone metastases were compared before and about 4-7 weeks after the embolization session. Embolization sessions were excluded for analysis if concomitant therapy had taken place within 4-7 weeks before and/or after the session. Serum Tg concentrations were employed as an index of tumor debulking by SET. We attempted to estimate the influence of SET on survival time in patients with disseminated ETC who did, and an historical control group of patients with disseminated ETC who did not receive SET. RESULTS: After exclusion of 12 (of which 3 sessions failed) out of 43 sessions, clinical symptoms, such as pain, and neurological symptoms decreased after 17, increased after 6, and did not change after 8 procedures. In 43 sessions, 20 of which were excluded (including the 3 sessions that failed), serum Tg decreased after 14 and increased after 9. The median standardized survival time of the group that received embolization was not significantly different to that of the group that did not receive embolization. CONCLUSIONS: Embolization therapy does not appear to improve life expectancy, but in selected patients can achieve palliation of pain, prevent neurological damage, reduce tumor burden, and give devascularization of the tumor before surgery.

Severe delayed posttonsillectomy haemorrhage due to a pseudoaneurysm of the lingual artery.

A 3.5-year-old child is presented with severe, recurrent haemorrhages after a tonsillectomy. The haemorrhages were caused by a pseudoaneurysm of the lingual artery, which was visualised more than 2 weeks postoperatively by angiography. The pseudoaneurysm was successfully embolised by coils. Coiling is an adequate therapeutic option for severe posttonsillectomy haemorrhage due to arterial damage.

FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases.

Treatment of the clinical N0 neck in squamous cell carcinoma (SCC) of oral cavity and oropharynx remains a dilemma. None of the current imaging modalities are able to detect the presence of micrometastases in the lymph nodes of clinical N0 necks reliably. The aim of this study was to determine the diagnostic properties of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients clinically staged as N0. FDG PET results of 38 patients were compared to histologic specimens obtained with neck dissections or to follow-up. FDG PET performance was compared to computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography-guided fine needle aspiration cytology (USgFNAC). Sensitivity and specificity of FDG PET in detecting occult cervical metastases were 50% and 97% respectively. Although FDG PET performed better than conventional imaging modalities, sensitivity was lower than desired. As a consequence, clinical application of FDG PET in the patient staged as N0 is limited.