Image-guided Ablative Procedures.

Various image-guided ablative procedures include chemical and thermal ablation techniques and irreversible electroporation. These have been used for curative intent for small tumours and palliative intent for debulking, immunogenicity and pain control. Understanding these techniques is critical to avoiding complications and achieving superior clinical outcomes. Additionally, combination with immunotherapy and chemotherapies is rapidly evolving. There are numerous opportunities in interventional radiology to advance ablation techniques and seamlessly integrate into current treatment regimens for both benign and malignant tumours.

Intraoperative gamma probe directed rib resection.

Radioguided surgery has slowly gained acceptance since the first gamma probe directed sentinel node lymph node biopsy in a patient with melanoma in 1993. We describe how the intraoperative gamma probe is used to localize a rib with abnormal uptake on the bone scan in a patient with rib pain.

Uterine fibroids: primary treatment with therapeutic embolization.

The use of transcatheter uterine artery embolization as a treatment for uterine fibroids represents a new approach to the management of this common problem. Early reports of uterine artery embolization as a treatment of symptomatic fibroids have indicated significant symptomatic improvement as well as reduction in the size of fibroids. We have been performing this procedure for two years at the Christiana Care Hospital. We describe two representative cases with clinical follow up on 12 of our patients and briefly review the literature on uterine artery embolization for uterine fibroids.

Endovascular therapy in the treatment of head and neck lesions.

Recent advances in microcatheter technology, refinements in embolic agents and improvements in navigational techniques have allowed for endovascular embolization to become an important adjunct in the treatment of vascular head and neck lesions. We describe several case reports where endovascular embolization was utilized in the treatment of such lesions.

Entanglement of guide wires by vena cava filters during central venous catheter insertion: report of three cases and a review of the literature.

Since 1993, 14 cases of central line guide wires becoming entangled with vena cava filters have been reported. We present three additional cases and review the 14 cases in the literature. Obtaining a detailed patient history is important in identifying patients with a vena cava filter. A low threshold of suspicion is needed and immediate radiograph obtained. Entangled guide wires required fluoroscopic manipulation and or retrieval of the dislodged filter. Of all reported cases, only one sustained an arrhythmia. With no signs and symptoms, conservative management of the dislodged filter is a viable option.

Can low volume liver transplant centers be successful? The Regional Transplant Center of Willis-Knighton & Louisiana State University Medical Center. The first 120 liver transplants.

The development of orthotopic liver transplantation represents this century's most significant advance in the management of liver disease. In the 1980s the vast majority of liver transplants were performed at several large centers; however, in this decade, improvements in techniques and success rates have allowed live transplantation to expand to regional centers across the country, particularly in the southeast. This proliferation of regional centers and the widening disparity between organ availability and numbers of recipients have created tremendous controversy at the national level regarding the allocation scheme used to distribute livers to recipients. The large programs today are advocating change to a national waiting list which would eliminate local priority and jeopardize the existence of smaller regional centers. Furthermore, the large programs favor establishing a limited number of megacenters where all liver transplants would take place, arguing that low volume centers cannot perform liver transplants with acceptable complication and survival rates. At the Regional Transplant Center of Willis-Knighton Hospital and Louisiana State University Medical Center in Shreveport (WK/LSUMC) we performed 122 liver transplants between July 1, 1991 and December 31, 1997. The purpose of this study was to examine our complication and survival rates and compare them to national averages. The actuarial graft survival at 1, 2, and 3 years in this series compared to the national average respectively was 76% and 70%, 66% and 66%, 62% and 62%. The actuarial patient survival (WK/LSUMC vs National) at 1, 2, and 3 years was 80% and 80%, 75% and 75%, 70% and 74%. The rate of retransplantation was 8% with a national average of 10% to 20%. Our rate of graft primary non-function was 5% with the national average being 2% to 10%. The rate of vascular thrombosis of the graft in this series was 2% with a national rate of 5%. The differences in these results were not statistically significant (P < .05). Low volume transplant centers can perform liver transplant successfully, allowing the regionalization of the treatment of choice for end-stage liver disease.

Unusual case of lumbar synovial cyst.

Synovial cysts are extradural degenerative lesions associated with symptoms of lower back pain and radiculopathy. To our knowledge, all the reported cases of synovial cysts in literature were posterolateral in location (1-4). This case report describes the previously unreported midline location of the synovial cyst in the spinal canal and to increase the level of awareness of diagnosing these lesions in a central location, especially in light of the evaluation of lumbar radiculopathy.