RESUMO
Interventional radiologic techniques offer many options and benefits in the care of patients with thoracic disorders. Imaging-guided catheter techniques provide heretofore unsurpassed precision and accuracy in performance of these procedures. Improved efficacy, with reduced morbidity is the goal and usually the result for the patient.
Assuntos
Radiologia Intervencionista/métodos , Doenças Torácicas/diagnóstico por imagem , Biópsia/métodos , Humanos , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Punções/métodos , Radiografia Intervencionista/métodos , Doenças Torácicas/terapia , TóraxRESUMO
This report summarizes diagnostic and therapeutic radiologic procedures in 45 patients who suffered major complications from cholecystectomy. Complications were divided into (1) bile duct injury or ligation and (2) a variety of pathologic fluid collections. Specific lesions were bile duct injury (n = 6), accidental bile duct ligation (n = 12), ductal stricture (n = 12), abscess (n = 11), biloma (n = 7), hematoma (n = 5), infected pancreatic pseudocyst (n = 3), and stones (n = 2). Presenting problems were sepsis, jaundice, and intermittent cholangitis. The patients underwent 104 interventional radiologic procedures including 29 percutaneous transhepatic cholangiograms, 21 percutaneous biliary drainages, 12 balloon dilatations of strictures, drainage of 11 abscesses, 8 bilomas, 5 hematomas, and 3 pancreatic pseudocysts. Stones were removed by baskets in 2 patients; 12 pressure and perfusion studies were performed. One hundred of 104 procedures were successful; there was one failed biliary drainage, one unsuccessful stricture dilatation, one unsuccessful hematoma drainage, and one recurrent biloma. Thirty patients were spared another operation. The percutaneous procedures were beneficial although not curative in 14 of 15 patients who underwent reoperation; in those patients the procedures helped to establish a diagnosis, improve the patient's preoperative status, or serve as a landmark for the surgeon to locate and repair the ligated or injured duct. One patient died after reoperation, a 2.2% mortality rate. Sectional imaging studies combined with interventional radiologic procedures help to diagnose promptly and effectively treat major complications of cholecystectomy. These interventional procedures either cure the complication and obviate reoperation or aid the surgeon by relieving sepsis and jaundice before reoperation and providing an intraoperative guide for bile duct reconstruction.
Assuntos
Doenças dos Ductos Biliares/terapia , Colecistectomia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiologia Intervencionista , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças dos Ductos Biliares/etiologia , Cateterismo , Colangiografia , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Sixty-two cases of oligohydramnios diagnosed by ultrasound between 13-28 weeks' gestation were reviewed. Three experienced ultrasonographers used a subjective scale to rate the oligohydramnios as mild, moderate, severe, or anhydramniotic. Interobserver reliability was excellent (intraclass correlation coefficient 0.81). The overall perinatal mortality rate was 43%, and the incidence of pulmonary hypoplasia was 33%. One-third had lethal congenital anomalies. The frequency of adverse outcome correlated strongly with the most severe degrees of oligohydramnios; 88% of the fetuses with severe oligohydramnios or anhydramnios had lethal outcomes, compared with 11% in the mild/moderate group. The presence of an anuric urinary tract anomaly was associated with the most severe grades of oligohydramnios and was uniformly fatal. Pulmonary hypoplasia was diagnosed in 60% of the severe group versus 6% in the moderate group. We conclude that subjective grading of oligohydramnios by experienced observers is both reliable and predictive of outcome. The finding of severe oligohydramnios in the second trimester is highly predictive of poor fetal outcome and should stimulate a thorough search for etiology and consideration of intervention. Moderate grades of reduced amniotic fluid may be managed with relative optimism.
Assuntos
Líquido Amniótico/análise , Ultrassonografia , Análise de Variância , Anormalidades Congênitas/embriologia , Feminino , Doenças Fetais/epidemiologia , Humanos , Pulmão/anormalidades , Pulmão/embriologia , Tamanho do Órgão , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Segundo Trimestre da GravidezRESUMO
This retrospective case-controlled study compares the morbidity and mortality of 27 percutaneously drained (PD) abscesses with 27 that were surgically drained (SD). Patients were matched for age, sex, diagnosis, and abscess etiology and location. There was no difference in severity of illness (acute physiology score [APS] = 8.3 vs 10.2), comparable morbidity (29.6% vs 40.7%), or mortality (11.0% vs 7.4%) between PD and SD groups. Duration of drainage was significantly longer in the PD group; however, this is explained in part by the 48% vs 18.5% difference in associated fistulae. Failures of the SD group had a higher mean APS (15) than both failures of the PD group (APS = 9.3) and successes of the SD group (APS = 8.6). All three PD group deaths and half of the SD group deaths were related to ongoing sepsis. Surgical drainage of intra-abdominal abscess is as successful as PD. Percutaneous drainage is reasonable initial treatment for intra-abdominal abscess; however, early assessment of clinical status and frequent reassessment are mandatory to ensure that failures are dealth with early. We present a drainage algorithm.
Assuntos
Abdome , Abscesso/cirurgia , Drenagem/métodos , Abscesso/complicações , Abscesso/microbiologia , Abscesso/mortalidade , Adulto , Idoso , Cateterismo/efeitos adversos , Cateterismo/métodos , Drenagem/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções/efeitos adversos , Punções/métodos , Estudos Retrospectivos , Fatores de TempoRESUMO
Interventional radiologic procedures in the gallbladder are influencing both the diagnosis and therapy of many gallbladder disorders. Current diagnostic and therapeutic percutaneous techniques offer important alternatives for their management. This article highlights the spectrum of interventional radiologic techniques available for gallbladder diseases.
Assuntos
Colecistografia , Éteres Metílicos , Radiografia Intervencionista , Biópsia por Agulha/métodos , Colecistostomia/métodos , Éteres/uso terapêutico , Vesícula Biliar/patologia , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/terapia , HumanosRESUMO
This article highlights the multiple applications of ultrasound as a guidance modality for interventional procedures in the musculoskeletal system. The percutaneous aspiration, drainage, and biopsy of musculoskeletal abscesses, masses, and focal muscular pathology in the extremities, trunk, and neck using ultrasound as the guidance system is described. Techniques for biopsy, fluid aspiration, catheter insertion, and needle visualization by ultrasound are discussed.
Assuntos
Biópsia por Agulha/métodos , Drenagem/métodos , Extremidades , Ultrassonografia , Abscesso/cirurgia , HumanosRESUMO
Complications of pancreatitis are common, protean in their manifestations, and can be catastrophic. When complications occur, the morbidity and mortality are high. Expeditious radiologic detection of the complication, together with the plethora of nonoperative interventional techniques, offers new and improved methods for diagnosis and treatment. This article focuses on the essential role of radiology and the natural integration of imaging and interventional radiology for pancreatitis and its complications.
Assuntos
Diagnóstico por Imagem/métodos , Pancreatite/diagnóstico , Abscesso/terapia , Drenagem/métodos , Humanos , Pancreatopatias/terapia , Pseudocisto Pancreático/terapia , Pancreatite/complicações , Pancreatite/terapiaRESUMO
Fine-needle biopsy and large-needle core biopsy of inaccessible and deep-space lesions of the head and neck are difficult and sometimes hazardous to perform. Patients subsequently may have to undergo a major surgical procedure with exploration of the neck and open biopsy. We describe our experience with computed tomography and ultrasound-guided fine-needle and core-needle biopsy for 11 patients with inaccessible lesions in the head and neck. Carcinoma was diagnosed in three patients and nonmalignant pathologic findings in eight patients. Three of the needle biopsy findings were confirmed by surgical excision. The initial diagnoses made from the cytopathologic findings have remained unchanged in all patients. Compared with the alternative of open biopsy, we have found this method to be technically easy, diagnostically expeditious, and safe. Head and neck surgical oncologists should be familiar with image-guided biopsy techniques, since many of their patients may benefit from these diagnostic procedures.
Assuntos
Biópsia por Agulha/métodos , Pescoço/patologia , Adulto , Idoso , Transtornos de Deglutição/patologia , Esôfago/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Radiologically guided aspiration and drainage of thoracic fluid collections is an improvement on standard "blind" techniques for chest-tube insertion. Specific indications for radiologic drainage are broadening, and instead of failed surgical cases only, patients now are commonly referred for drainage. Most of these procedures are effective and the complication rate vis-à-vis alternatives is acceptable. Soft 12-F catheters suffice in most cases and are relatively comfortable to large-bore tubes.
Assuntos
Drenagem/métodos , Empiema/cirurgia , Abscesso Pulmonar/cirurgia , Derrame Pleural/cirurgia , Fluoroscopia , Humanos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Contact dissolution with MTBE is an effective and safe method to treat symptomatic patients with cholesterol gallstones. Personnel, time, and safety factors have limited widespread use of the procedure. With current competing methods to treat gallstones, it is likely that MTBE use will be reserved for those patients who elect percutaneous therapy due to fear of surgery or anesthesia and in those elderly patients who are compromised by underlying medical conditions.
Assuntos
Colelitíase/terapia , Éteres/uso terapêutico , Éteres Metílicos , Éteres/administração & dosagem , Éteres/efeitos adversos , HumanosRESUMO
Reticulated platelets (RP) are newly-formed platelets with a greater mass, a residual amount of RNA and an increased prothrombotic potential. No studies investigating the association between RP and the risk of cardiovascular death in acute coronary syndrome (ACS) patients are available. In the frame of the AMI-Florence 2 study, we investigated RP in 229 (154 M/ 75 F) ACS patients (125 ST-elevation myocardial infarction [STEMI]; 104 Non-STEMI/Unstable Angina). RP were measured by using the Sysmex XE-2100 haematology analyzer and were expressed as the percentage of RP out of the total optical platelet count (immature platelet fraction; IPF) and as the percentage of RP highly fluorescent (H-IPF). At one-year follow-up, 22 out of 229 patients (9.6%) died from cardiovascular causes. Higher values of IPF (p=0.05) and H-IPF (p=0.006) were detected in dead compared to alive patients. A receiver operating characteristics curve analysis identified IPF ≥3.3% and H-IPF ≥0.9% as optimal cut-off values to predict cardiovascular death. At the multivariate model adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score, the association between RP and cardiovascular death remained significant for both IPF [OR (95%CI) : 4.15 (1.24-13.91) p=0.02] and H-IPF [OR (95%CI): H-IPF 5.03 (1.38-18.38) p=0.01]. In conclusion, RP are independent predictors of cardiovascular death and may be useful in improving risk stratification for ACS patients. Future prospective studies to evaluate the role of RP in determining cardiovascular events are warranted.
Assuntos
Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/mortalidade , Angina Instável/sangue , Angina Instável/mortalidade , Plaquetas , Infarto do Miocárdio/sangue , Infarto do Miocárdio/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Distribuição de Qui-Quadrado , Feminino , Humanos , Itália , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Sistema de Registros , Fatores de Risco , Fatores de TempoAssuntos
Tumor Carcinoide/patologia , Tumor Carcinoide/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias do Timo/patologia , Tumor Carcinoide/diagnóstico , Vértebras Cervicais , Humanos , Vértebras Lombares , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Ultrasound and computed tomographic images are described in a patient who underwent renal transplantation and presented with hydronephrosis and partial ureteral obstruction secondary to herniation of the transplant ureter into a left inguinal hernia. To our knowledge, this is the first report of herniation of a transplanted ureter in the inguinal canal resulting in or exacerbating ureteral obstruction.
Assuntos
Hérnia Inguinal/complicações , Transplante de Rim , Rim/patologia , Complicações Pós-Operatórias/diagnóstico por imagem , Ureter/transplante , Obstrução Ureteral/etiologia , Adulto , Hérnia Inguinal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ultrassonografia , Obstrução Ureteral/diagnóstico por imagemRESUMO
A patient experienced severe cutaneous pain and excoriation during acetylcysteine infusion at percutaneous abscess drainage. The mucolytic agent leaked back along the catheter track, causing the local reaction. Cessation of the acetylcysteine treatment, and catheter exchange resulted in improvement within a few days.
Assuntos
Abscesso/terapia , Acetilcisteína/efeitos adversos , Drenagem/métodos , Pele/efeitos dos fármacos , Cateterismo/métodos , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Current heightened awareness and concern about accidental needle puncture prompted design of a device to reduce this risk. Holes are made in the top of a prepurchased film cannister; these allow placement of all sharp objects used for angiographic and interventional radiology procedures. This protective cannister is recommended for routine use on all instrument trays, since it lessens the likelihood of inadvertent puncture.
Assuntos
Síndrome da Imunodeficiência Adquirida/transmissão , Agulhas , Doenças Profissionais/prevenção & controle , Tecnologia Radiológica/instrumentação , HumanosRESUMO
Although spermatic cord torsion in the neonate is uncommon, early recognition with prompt surgical exploration and detorsion of the cord can result in preservation of some testicular tissue. Palpation of the infantile testes can be difficult, and distinguishing testicular from extratesticular abnormalities may not be possible. High-resolution real-time ultrasonography is an effective, noninvasive method of differentiating between the two. If sonography demonstrates and abnormal testicle, prompt surgical exploration is indicated.
Assuntos
Torção do Cordão Espermático/diagnóstico , Ultrassonografia , Feminino , Doenças Fetais , Humanos , Recém-Nascido , Masculino , Gravidez , Torção do Cordão Espermático/cirurgiaRESUMO
Intragastric balloon techniques were used to achieve direct gastric distention and efferent loop obstruction in order to perform percutaneous gastrostomy on two occasions in a patient with a partial gastrectomy and Billroth II anastomosis. Previous attempts at percutaneous endoscopic gastrostomy and conventional radiologic percutaneous gastrostomy had been unsuccessful. Although a history of partial gastrectomy has been considered an impediment to both percutaneous gastrostomy and percutaneous endoscopic gastrostomy, this experience demonstrates that percutaneous gastrostomy can be performed safely in this setting with balloon assistance.
Assuntos
Cateterismo/métodos , Gastrectomia , Gastrostomia/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Radiografia , Estômago/diagnóstico por imagemRESUMO
The subplacental complex, which represents vascular channels at the placental-myometrial junction, is a structure that is routinely seen sonographically in patients with posteriorly placed placentas, but not in those with anteriorly placed placentas. This study shows that the subplacental complex is a constant anatomic feature of the placenta regardless of whether it develops on the anterior or posterior uterine wall, and can be visualized in most patients if the subplacental complex is in the focal plane of the transducer. This has important implications in patients with anterior placentas that are being evaluated for abruption or in patients in whom fetal parts lie just beneath the anterior myometrial wall.
Assuntos
Placenta/anatomia & histologia , Ultrassonografia , Feminino , Humanos , GravidezRESUMO
We report two cases in which the umbilical cords of fetuses were large on prenatal ultrasound scans. The pregnancies terminated uneventfully, however, and the babies were healthy at birth and on follow-up visits. We discuss the various etiologies of a large umbilical cord and conclude that, although a large cord may suggest the presence of an underlying abnormality, in some instances it may represent a normal finding.