Prospective randomized comparative evaluation of proximal valve polyurethane and distal valve silicone peripherally inserted central catheters.

PURPOSE: The objective of this study was to evaluate and compare the relative durability and complications between the proximal valve polyurethane and distal valve silicone peripherally inserted central catheters (PICCs). METHODS: Institutional review board approval was obtained. A total of 326 patients (mean age, 50.4 years) was assigned randomly to receive either a proximal valve polyurethane PICC (n = 198) or a distal valve silicone Groshong PICC (n = 194). All PICCs were inserted under radiologic guidance by interventional radiologists. Follow-up data were collected until catheter removal because of complications or treatment completion. RESULTS: The mean catheter dwell time was 25.6 days (range, 1-245 days). Complications were encountered in 26.8% and 47.9% of the proximal valve polyurethane PICCs and distal valve silicone PICCs, respectively (P < .001). Significantly higher incidences of phlebitis (23.2% versus 11.6%, P = .003) and catheter-related infection (6.2% versus 2%, P = 0.043) were noted in the distal valve silicone PICCs. No significant differences in the incidence of catheter occlusion, fracture, or dislodgement were found. Multivariate logistic regression analysis showed a higher complication rate in the distal valve silicone PICCs corrected for patients' age, sex, underlying morbidity, indication, peripheral vein accessed, arm used, catheter tip placement, and the number of venepunctures attempted. CONCLUSIONS: Proximal valve polyurethane PICCs were more durable than distal valve silicone PICCs, which were associated with a higher incidence of phlebitis and infection, probably related to the materials of the catheters and the designs and placements of the catheter valves.

Catastrophic delayed rupture of a traumatic aneurysm of the distal superior cerebellar artery in a child.

Traumatic aneurysms of the superior cerebellar artery are rare, especially in children. We report a 3-year-old boy who had a catastrophic delayed rupture of a traumatic aneurysm arising from the superior vermian branch of the left superior cerebellar artery. The aneurysm was likely caused by arterial wall laceration following contusion against the free edge of the tentorium. The aneurysm and the superior vermian artery were successfully embolised endovascularly, but the child never recovered and died 3 days later. The pathogenesis, natural history and treatment options of these aneurysms are discussed.

Imaging of carcinoma of the external auditory canal: a pictorial essay.

Carcinoma of the external auditory canal presents a challenge in management, largely due to limited experience in treating this rare disease and the lack of a universally accepted staging system. Prognosis is most dependent on the extent of local disease at presentation, while resection margin status is also a strong determinant of survival in post-operative patients. The intent of this pictorial essay is to review the pattern of tumour spread and highlight the value of imaging, particularly magnetic resonance imaging in pre-operative tumour mapping.

Imaging of tongue carcinoma.

The tongue enables taste and plays a critical role in formation of food bolus and deglutition. The tongue is also crucial for speech and the earliest sign of tongue paresis is a change in the quality of speech. Given the importance of the tongue, tongue carcinoma should be accurately staged in order to optimise treatment options and preserve organ function. The intent of this review is to familiarize radiologists with the pertinent anatomy of the tongue and the behaviour of tongue carcinoma so as to map malignant infiltration accurately.