Diagnostic imaging of the upper airway.

Diagnostic imaging plays an essential role in the evaluation of disease processes that affect the upper airway. Imaging allows for the localization and characterization of various conditions that are often occult on physical examination. Plain radiography maintains a limited role in airway evaluation, whereas advanced imaging modalities, including computed tomography and magnetic resonance imaging, have emerged as indispensable tools in patient evaluation. Common disease entities affecting the upper airway in the adult population, including trauma, infectious/inflammatory diseases, and neoplastic diseases, as well as other common pathologic conditions are reviewed in this article.

Uterine artery embolization versus abdominal myomectomy: a long-term clinical outcome comparison.

PURPOSE: To assess long-term clinical effectiveness of uterine artery embolization (UAE) compared with abdominal myomectomy. MATERIALS AND METHODS: Women who received UAE (n = 87) or abdominal myomectomy (n = 98) for symptomatic uterine leiomyomata between 2000 and 2002 at a single institution were consecutively enrolled in this study. Patients whose procedures were performed within 5 years before the study were included. Symptom evaluations with symptom severity scores, pregnancy rates, and satisfaction with the procedures were obtained via institutional review board-approved questionnaires. Chart reviews were performed to supplement analyses. RESULTS: The retrospective cohort included 185 patients, of whom long-term follow-up was completed by 89 patients (48.1%), 48 being treated with UAE, and 41 with myomectomy. Follow-up ranged from 50 to 83 months. A higher but not statistically significant number of patients received repeat interventions after abdominal myomectomy (14%) versus UAE (8%; P = .204). Significantly higher symptom severity score improvements were seen in patients treated with UAE versus abdominal myomectomy (34 vs 31; P = .02). UAE recipients were less likely to attempt to get pregnant (P = .02), but those who did had a 66.7% success rate compared with 58.8% for patients who underwent myomectomy. Similar numbers of patients between groups were satisfied with the procedure (P = .57), reported effectiveness of symptom relief (P = .43), and would recommend the procedure to others (P = .37). CONCLUSIONS: UAE results in long-term clinical success with outcomes comparable or superior to those of abdominal myomectomy.

Skeletal muscle imaging and inflammatory myopathies.

PURPOSE OF REVIEW: A variety of modalities exist for the imaging of skeletal muscle including radiography, ultrasound, computed tomography, and MRI. This article highlights the utility of these modalities in evaluating skeletal muscle diseases. Newer techniques such as T2 mapping, blood oxygenation level dependent imaging, diffusion tensor imaging, and magnetic resonance spectroscopy are also explored. RECENT FINDINGS: Cross-sectional imaging including computed tomography and magnetic resonance is the current standard in skeletal muscle imaging. The advantages of these modalities include the ability to image in different planes and to evaluate the distribution of disease and disease burden. Newer magnetic resonance-based techniques also provide functional information in addition to anatomic information. Radiography and ultrasound have a more limited role and are mainly used to detect calcifications and evaluate the texture of skeletal muscle. SUMMARY: Magnetic resonance is a useful modality for evaluating skeletal muscle and allows for the assessment of disease burden. It can elucidate potential targets for biopsy. Newer magnetic resonance techniques can acquire functional information in addition to anatomic information and hold tremendous potential for detecting, characterizing, and monitoring treatment for inflammatory myopathies.

Catheter-directed thrombolysis and thrombectomy for the Budd-Chiari syndrome in paroxysmal nocturnal hemoglobinuria in three patients.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematopoietic stem cell disorder characterized by hemolytic anemia, hemoglobinuria, bone marrow failure, and hypercoagulability. Thrombosis is the leading cause of mortality and occurs in one-half of PNH patients, with the hepatic veins being the most common site. Patients with hepatic vein thrombosis (Budd-Chiari syndrome) can present with abdominal pain, hepatomegaly, jaundice, and ascites. Prognosis is poor for these patients; death may occur from liver failure, vessel rupture, intestinal ischemia, infarction, necrosis, or sepsis. The authors report three consecutive cases of successful treatment with catheter-directed thrombolysis and thrombectomy directly in the hepatic veins in patients with PNH who developed acute hepatic vein thrombosis. This treatment represents a potential bridge toward more curative therapies such as allogeneic bone marrow transplant.