A study to establish international diagnostic reference levels for paediatric computed tomography.

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

Common hepatic artery pseudoaneurysm secondary to pancreatitis. Direct percutaneous embolization.

We report a patient with a common hepatic artery pseudoaneurism secondary to pancreatitis treated with direct percutaneous embolization as an alternative when transcatheter embolotherapy cannot be performed. Examination of the specimen revealed that the pseudoaneurism was completely trombosed with signs of embolization of its lumen.

Percutaneous transluminal angioplasty in patients with Takayasu arteritis: five-year experience.

PURPOSE: The authors report their 5-year experience with percutaneous transluminal angioplasty (PTA) for treatment of stenoses related to Takayasu arteritis. PATIENTS AND METHODS: Twenty patients were treated; 12 patients had renovascular hypertension at presentation, three patients had abdominal aortic coarctation syndrome, and five patients had aortoiliac occlusive disease. RESULTS: The initial success rate for patients with renovascular hypertension was 83%, with a 5-year patency of 33.3%. In patients with abdominal aortic coarctation, initial success rate was 100% but 5-year patency was 33.3%. In patients with aortoiliac occlusive disease, the initial success rate was 100%, with a 5-year patency of 60%. CONCLUSION: Despite the high initial success rate for PTA in these patients, the disease recurs in a substantial number of the, due to the fact that this technique does not treat the disease itself but only its consequences.

[Maternal mortality at the Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Review of 5 years]. / Mortalidad materna en el Hospital de Ginecobstetricia del Centro Médico de Occidente, IMSS. Revisión de 5 años.

This study was carried out in order to know the mortality rate and related factors at Hospital de Ginecobstetricia, Centro Médico de Occidente, and to analyze the problem and to propose solutions. The files and reports of the Maternal Mortality Committee, regarding 74 deaths in a five year period, were reviewed. The definitions and classification criteria proposed by tha International Federation of Gynecology and Obstetrics, were used. The average maternal death rate was 8.01 per 10,000 births. The main death causes were: hemorrhage, systemic hypertension, probable pulmonary thromboembolism and sepsis. Direct obstetrical deaths, were 82.4%; predictable deaths, 66.2%, and deaths on hospital arrival, 39.1%. There was professional liability in 66.2%, and hospital liability in 25.6%. These and other data, were analyzed and possible strategies to diminish maternal mortality, were proposed.