Staff radiation doses in a real-time display inside the angiography room.

METHODS: The evaluation of a new occupational Dose Aware System (DAS) showing staff radiation doses in real time has been carried out in several angiography rooms in our hospital. The system uses electronic solid-state detectors with high-capacity memory storage. Every second, it archives the dose and dose rate measured and is wirelessly linked to a base-station screen mounted close to the diagnostic monitors. An easy transfer of the values to a data sheet permits further analysis of the scatter dose profile measured during the procedure, compares it with patient doses, and seeks to find the most effective actions to reduce operator exposure to radiation. RESULTS: The cumulative occupational doses measured per procedure (shoulder-over lead apron) ranged from 0.6 to 350 µSv when the ceiling-suspended screen was used, and DSA (Digital Subtraction Acquisition) runs were acquired while the personnel left the angiography room. When the suspended screen was not used and radiologists remained inside the angiography room during DSA acquisitions, the dose rates registered at the operator's position reached up to 1-5 mSv/h during fluoroscopy and 12-235 mSv/h during DSA acquisitions. In such case, the cumulative scatter dose could be more than 3 mSv per procedure. CONCLUSION: Real-time display of doses to staff members warns interventionists whenever the scatter dose rates are too high or the radiation protection tools are not being properly used, providing an opportunity to improve personal protection accordingly.

Patient dose reference levels for interventional radiology: a national approach.

A set of patient dose reference levels (RLs) for fluoroscopically guided interventional procedures was obtained in a survey launched by the National Society of Interventional Radiology (IR), involving 10 public hospitals, as recommended by the European Medical Exposures Directive. A sample of 1391 dose values (kerma area product [KAP]) was collected randomly during clinical procedures for seven of the most frequent procedures. Third quartiles of the KAP distributions were used to set the RLs. A regular quality control of the X-ray systems and a calibration of the dose meters were performed during the survey. The fluoroscopy time and total number of digital subtraction angiography images per procedure were also analyzed. The RL values proposed were 12 Gy cm(2) for fistulography (hemodialysis access; sample of 180 cases), 73 Gy cm(2) for lower limb arteriography (685 cases), 89 Gy cm(2) for renal arteriography (55 cases), 80 Gy cm(2) for biliary drainage (205 cases), 289 Gy cm(2) for hepatic chemoembolization (151 cases), 94 Gy cm(2) for iliac stent (70 cases), and 236 Gy cm(2) for uterine embolization (45 cases). The provisional national RL values are lower than those obtained in a similar survey carried out in the United States from 2002 to 2004. These new values could be used to improve the practice of centers consistently working with doses higher than the RLs. This national survey also had a positive impact, as it helped increase the awareness of the members of the National Society of IR on a topic as crucial as patient dose values and programs on radiation protection.

A pilot experience launching a national dose protocol for vascular and interventional radiology.

The design of a national dose protocol for interventional radiology has been one of the tasks during the European SENTINEL Coordination Action. The present paper describes the pilot experience carried out in cooperation with the Spanish Society on Vascular and Interventional Radiology (SERVEI). A prospective sample of procedures was initially agreed. A common quality control of the X-ray systems was carried out, including calibration of the air kerma area product (KAP) meters. Occupational doses of the radiologists involved in the survey were also included in the survey. A total of 10 Spanish hospitals with interventional X-ray units were involved. Six hundred and sixty-four patient dose data were collected from 397 diagnostic and 267 therapeutic procedures. Occupational doses were evaluated in a sample of 635 values. The obtained KAP median/mean values (Gy.cm2) for the gathered procedures were: biliary drainage (30.6/68.9), fistulography (4.5/9.8), lower limb arteriography (52.2/60.7), hepatic chemoembolisation (175.8/218.3), iliac stent (45.9/73.2) and renal arteriography (39.1/59.8). Occupational doses (mean monthly values, in mSv) were 1.9 (over apron); 0.3 (under apron) and 4.5 (on hands). With this National experience, a protocol was agreed among the SENTINEL partners to conduct future similar surveys in other European countries.

Fiebre botonosa mediterránea: a propósito de dos casos en área de asistencia primaria urbana / Mediterranean boutonneuse fever: based on two cases in urban primary care area

La fiebre botonosa mediterránea es una enfermedad infecciosa causada por la Rickettsia conorii que, habitualmente, tiene un curso benigno, aunque sólo un 10% suele presentar complicaciones graves. Su incidencia es en países de la cuenca mediterránea y sobre todo en épocas estivales, donde coincide con el ciclo biológico de su vector, la garrapata Ixodes

Mediterranean boutonneuse fever is an infectious disease caused by Rickettsia conorii which generally has a benign course, although only 10% generally have serious complications. Its incidence is in countries of the Mediterranean Basin and, above all, in summer period, where it coincides with the biological cycle of its vector, the Ixodes tick

[Thomas' shunt for hemodialysis: dysfunction and its percutaneous treatment]. / Shunt de Thomas para hemodiálisis: disfunción y su tratamiento percutáneo.

PURPOSE: To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). MATERIALS AND METHODS: Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). RESULTS: A total of 61 interventions were performed during the period of follow-up. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a "jet" of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or "flap" at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a "valve" effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0.01 (table II). CONCLUSIONS: Percutaneous treatment of TS dysfunction was proved to be effective in maintaining long-term patency. This type of fistula affords an alternative to tunneled central venous catheters.

Shunt de Thomas para hemodiálisis: disfunción y su tratamiento percutáneo / Thomas hemodialysis shunt: dysfunction and percutaneous treatment

Propósito: Valorar la utilidad del tratamiento percutáneo de las anomalías de la rarna venosa, en la supervivencia de las fístulas externas de Thomas o Shunt de Thomas (ST). Material y método: Dentro de un programa general de vigilancia de la disfunción de las fístulas de hemodiálisis se incluyeron 12 casos de ST, que se siguieron durante 51 meses. La edad media de los pacientes era de 61 años (27-77), el tiempo medio en hemodiálisis de 151 meses (24-300), y el número de accesos previos de 6 (3-9). Las anomalías encontradas se trataron mediante angioplastia (ATP) o trombolisis y ATP. Se analizaron mediante curvas de supervivencia según el método de Kaplan-Meier, la probabilidad de permeabilidad primaria (PI), secundaria (P2) y acumulada (PA). Resultado: Durante el período de seguimiento se realizaron 61 intervenciones. En doce ocasiones (19,7%) la fístula estaba trombosada y en el resto se detectó aumento de la presión venosa, 150 mm de Hg o superior, durante la diálisis. Previa desobstrucción de las fístulas trombosadas con Uroquinsa se realizó fistulografía, detectándose una estenosis corta mayor del 50% en la anastomosis o en la vena adyacente a la anastomosis. Se realizó ATP, tras la que se consiguió el éxito anatómico y funcional en el 100% de los casos. La Pl fue de 58%, 33%, 8% y 0% a seis, doce, veinticuatro, y treinta y seis meses, y la P2 de 100%, 75%, 58% y 25% respectivamente a iguales períodos de tiempo. La PA fue de 100%, 83%, 66%, 50%, 41% y 33%, a seis, doce, veinticuatro, treinta y seis, cuarenta ocho y setenta y dos meses. Al cerrar el estudio seis pacientes seguían dializándose por su fístula, dos habían sido trasplantados, dos habían fallecido y en los dos restantes se había perdido la fístula. Conclusión: El tratamiento percutáneo de la disfunción en los ST, que se lleva acabo de manera ambulatoria, es eficaz para mantener a largo plazo su permeabilidad. Este tipo de fístula puede representar una alternativa a los catéteres venosos centrales tunelizados

Purpose: To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). Materials and methods.:Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). Results: A total of 61 interventions were performed during the period of followup. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a «jet» of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or «flap» at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a «valve» effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0.01 (table II). Conclusions: Percutaneous treatment of TS dysfunction was proved to be effective in maintaining long-term patency. This type of fistula affords an alternative to tunneled central venous catheters

Molecular and biomarker analyses of salivary duct carcinomas: comparison with mammary duct carcinoma.

Salivary duct carcinoma (SDC) is a rare high-grade aggressive neoplasm that manifests close histologic features with invasive ductal carcinoma of the breast (IDC). In contrast to SDC, extensive molecular studies have been performed on IDC and led to the identification of certain biological markers. To investigate the underlying molecular and biologic characteristics of SDC, we performed molecular analyses using microsatellite markers on chromosomal arms 6q, 16q, 17p, and 17q, DNA flow cytometry and immunohistochemical staining for androgen receptor (AR) and p53 expression on 28 examples of these tumors in comparison to 24 IDC cases. Our results show that generally similar allelic alterations, elevated p53 and androgen receptor expressions, and high frequency of DNA aneuploidy are manifested in both SDCs and IDCs. Differences at certain markers on 6q, 17p and 17q chromosomal loci, however, were observed between the two entities. Certain loci on 6q were more frequently altered in SDC than IDC which loci on chromosomes 17p and q arms were more seen in IDCs than SDCs. The majority of SDCs had high AR expression while most of IDCs were AR negative. Our study indicates that: i) SDC may share some genetic alterations with IDC, ii) high AR expression in SDC may play a role in tumor progression, and iii) p53 overexpression and DNA aneuploidy in both entities reflect their aggressive behavior.

Differential expression of galectin-1 and galectin-3 in benign and malignant salivary gland neoplasms.

Galectins are a family of non-integrin beta-galactosidase-binding lectins. Altered expression of galectins has been associated with neoplastic transformation and progression in several human tumors. In this study, we examined the distribution patterns of galectin-1 and galectin-3 in normal (n=45), benign (n=16), and malignant (n=49) salivary gland specimens using immunohistochemistry to determine their diagnostic and/or biological implications in salivary gland tumorigenesis. In normal salivary glands, galectin-3 expression was limited to ductal cells, and galectin-1 was usually faintly detected in ductal cells and strongly positive in myoepithelial cells. In benign tumors, galectin-3 maintained the ductal localization, but galectin-1 showed variable expression in ductal and myoepithelial cells. In malignant tumors, most of the polymorphous low-grade adenocarcinomas and carcinoma ex-pleomorphic adenomas expressed both galectins, whereas adenoid cystic and acinic cell carcinomas showed dramatically reduced galectin-3 expression and heterogeneous galactin-1 staining. Our data demonstrated altered localization and expression of galectin-3, and to lesser extent, galectin-1 in salivary gland carcinomas. These findings may assist in the differential diagnosis of some salivary gland malignancies, especially when using small and limited fine-needle aspiration materials.