Echo-guided percutaneous coil embolization of a symptomatic massive metastasis of a renal cell carcinoma in the right ventricular outflow tract.

We present the case of a 41-year-old woman who was admitted to our centre with progressive symptoms of congestive heart failure (NYHA class III) 5 years after a radical nephrectomy for renal cell carcinoma. Magnetic resonance imaging demonstrated a 5 x 3 cm homogeneous intracardial mass causing right ventricular outflow tract obstruction, not accessible to surgical resection. Serial echo-guided, percutaneous coil embolization of the cardial metastasis was performed with Contour SE Microparticles (150-250 or 300-500 microm) after identification of the target region of the metastasis by contrast injection (Levovist) through the balloon catheter into the coronary artery under transoesophageal echocardiographic control prior to induction of the necrosis, corresponding to the technique which has been described for septal ablation in hypertrophic obstructive cardiomyopathy. Follow-up after serial embolization showed a good haemodynamic and a marked clinical response (dyspnoea NYHA I-II) which lasted during the 19 month of survival after the index procedure.

Noninvasive quantification of left-to-right shunt in pediatric patients: phase-contrast cine magnetic resonance imaging compared with invasive oximetry.

BACKGROUND: Blood flow can be quantified noninvasively by phase-contrast cine MRI (PC-MRI) in adults. Little is known about the feasibility of the method in children with congenital heart disease. METHODS AND RESULTS: In 50 children (mean age 6.2 years, range 1.1 to 17.7 years) with an atrial- or ventricular-level shunt, blood flow rate in the great vessels was determined by PC-MRI, and the ratio of pulmonary to aortic flow (Qp/Qs) was compared with Qp/Qs by oximetry. We found a difference of 2% and a range of -20% to +26% (limits of agreement, mean +/-2 SD). In another 7 children with congenital heart disease but no cardiac shunting (mean age 7.9 years, range 1.3 to 13.5 years), Qp/Qs by PC-MRI was 1.02 (SD +/-0.06). No difference between systemic venous and aortic flow volumes was found (range -17% to +20%, n=37). Blood flow through a secundum atrial septal defect as assessed by PC-MRI (n=24) overestimated the shunt compared with the difference between pulmonary and aortic flows. The mean difference between 3 repeated PC-MRI measurements in each location was 5.3% (SD +/-4.0%, n=522), demonstrating good precision. The interobserver variability was low. The accuracy of PC-MRI was confirmed by in vitro experiments. CONCLUSIONS: Determination of Qp/Qs by PC-MRI in children is quick, safe, and reliable compared with oximetry. Systemic venous flow can be quantified by PC-MRI, whereas through-plane shunt measurement within an atrial septal defect is inaccurate.

[Clean field-technique to reduce the local air contamination level in operating rooms. Clinical experiences in accident surgery (author's transl)]. / Das Reinfeldverfahren zur lokalen Keimreduzierung in Operationsräumen. Klinische Erfahrungen in der Unfallchirurgie.

A newly developed technique to reduce the local air contamination level in operating rooms is described. After physical and hygienic evaluations a mobile clean field-equipment has been used at 97 traumatic operations. At 66 operations about 300 aerobiological samples of the contaminated room air and simultaneously of clean field-air at the wound site were collected. It is shown that the bacterial level of clean field-air is comparable with those levels in a sterile operating enclosure. The advantages of the new technique and first experiences under practical operating conditions are discussed.