CIRSE Clinical Practice Manual.

BACKGROUND: Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care. PURPOSE: To provide principles for delivering high quality of care in IR. METHODS: Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services. RESULTS: There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient's condition with the interventional radiologists taking ultimate responsibility for the patient's outcomes. CONCLUSIONS: The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.

Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience.

PURPOSE: We evaluate our experience in the management of empyemas and haemothoraces by means of intracavitary trans-catheter instillation of urokinase (UK). MATERIAL AND METHODS: We reviewed 54 patients (44 men and 10 women) ranging in age from 12 to 86 years (average 56.3) admitted between May 1999 and April 2001 with loculated pleural effusions (45 empyemas and 9 haemothoraces) and treated by percutaneous drainage and intrapleural urokinase instillation. The criteria for withdrawal of the catheter were: ceased drainage or the drainage of <80-100 ml of clear liquid per day. RESULTS: The duration of the drainage ranged from 2 to 15 days (average: 5.9). Total remission of symptoms occurred in 40 patients (74.07%); 7 patients presented a slight reduction in lung function tests (12.96%); 4 patients required surgery (7.4%); 3 displayed persistent pleural loculated effusions (5.55%) and 1 developed a bronchopleural fistula (1.85%); 2 patients were lost to our review (3.7%). CONCLUSIONS: In our experience percutaneous drainage with intrapleural UK instillation is an effective approach to the management of loculated pleural effusions (empyemas and haemothoraces), able to obviate the need for other more invasive pulmonary interventions.