Confirmation of Age-dependence in the Leakage of Contrast Medium around the Cortical Veins into Cerebrospinal Fluid after Intravenous Administration of Gadolinium-based Contrast Agent

Purpose:It has been reported previously that intravenously administered gadolinium-based contrast agent (GBCA) leaks into the subarachnoid space around the cortical veins at 4 h after injection in all old people over 37 years, but not in younger people up to 37 years of age in 3D-real IR images. The purpose of this study was to investigate whether there was a strict threshold of 37 years of age for the leakage of the GBCA into the subarachnoid space.Methods:The subjects included 190 patients, that were scanned for 3D-real IR images at 4 hours after intravenous injection of GBCA as a diagnostic test for endolymphatic hydrops. The patient’s age ranged from 14 to 81 years. Two experienced neuroradiologists evaluated the images to determine whether the GBCA leakage around the cortical veins was positive or negative. Any discrepancies between the two observers were discussed and a consensus was obtained.A Mann–Whitney U test and receiver operating characteristic (ROC) curve analysis were used to compare the positive and the negative group and to set the age cut-off value for the prediction of GBCA leakage.Results:The GBCA leakage around the cortical veins was negative in 35 patients and positive in 155 patients. The average age was 33 ± 11 years in the negative group, and 55 ± 12 years in the positive group (P < 0.01). In the ROC analysis for the age and leakage of the GBCA, an area under the curve was 0.905 and the cut-off age was 37.317 years (sensitivity of 0.942 and specificity of 0.771).Conclusion:Intravenously administered GBCA leaks into the subarachnoid space around the cortical veins in most patients over 37 years of age. However, it should be noted that it can be found occasionally in patients under 37 years of age.     

Clinical Impact and Predictors of the Slow-Flow Phenomenon after Endovascular Treatment of Infrapopliteal Lesions Using the Crosser Catheter in Patients with Critical Limb Ischemia

PurposeTo determine the clinical impact and predictors of slow flow after endovascular treatment (EVT) using the Crosser catheter for debulking infrapopliteal lesions associated with critical limb ischemia.Materials and MethodsThis retrospective study included 65 patients with critical limb ischemia (70 limbs, 90 infrapopliteal lesions), who underwent EVT using the Crosser catheter between November 2011 and February 2017. The Crosser catheter was used when the balloon catheter could not be passed through the lesion or could not be dilated sufficiently. Slow flow was evaluated after atherectomy using Crosser and was defined as delayed antegrade flow to the foot (total number of cine frames >35).ResultsFollowing atherectomy, slow flow developed in 37 infrapopliteal lesions (41.1%). Despite secondary treatment, slow flow persisted in 29 of 37 lesions (78%). After atherectomy using the Crosser catheter, the balloon could be passed through the lesion in all cases. The wound healing rate at 1 year after EVT (overall, 67.8%) was significantly poorer in the presence of slow flow (rate with vs. without slow flow, 45.3% vs. 84.4%, respectively; P = .006), especially among patients with stage ≥3 baseline wound, ischemia, and foot infection. The active length of the Crosser catheter was a predictor of slow flow (odds ratio, 1.05; 95% confidence interval, 1.03–1.08; P < .001), with an optimal cutoff of 100 mm.ConclusionsSlow flow is associated with a poorer wound healing rate at 1 year, especially for patients with severe baseline ischemia. To reduce the risk of slow flow, the active length of the Crosser catheter should be kept at <100 mm.     

Inter-ocular asymmetry of retinal parameters in Caucasian healthy children and young adults measured with optical coherence tomography

AIM: To evaluate retinal parameters in a sample of healthy young Caucasian adults to define the normal or physiological range of inter-ocular asymmetry in this particular age and ethnic group. METHODS: Study sample consisted of 37 Caucasian children and young adults aged between 12 and 23y (spherical equivalent from -3.00 D to +4.00 D, anisometropia <0.5 D and axial length differences <0.3 mm). Normal inter-ocular asymmetry values were determined and 95% inter-ocular difference tolerance values were obtained. RESULTS: Statistically significant inter-ocular differences were found in mean (P=0.003) and superior (P=0.008) retinal nerve fiber layer (RNFL) thickness, as well as in central macular thickness (P=0.039), with larger values in the left eye in all instances, and with tolerance limits of inter-ocular asymmetry of -9.00 μm to 6.00 μm, -28.00 μm to 9 μm and -39.00 μm to 29.00 μm, respectively. In addition, statistically significant differences were found between males and females in mean thickness of the RNFL in the right eye (P=0.020). CONCLUSION: The exploration of the normal asymmetries of the retina may be an effective approach to further understand myopia onset and progression, which is particularly relevant in this age group. Differences in instrumentation and sample characteristics compromise direct comparison with published research and warrant the need for further studies.     

儿童重症监护病房患儿深静脉血栓的临床研究进展

近年来,儿童深静脉血栓发病逐渐增多。若栓子脱落,易引起肺栓塞等并发症,轻者致残,重者致死,严重危害患儿生活质量和生命,因此早期预防和及时治疗有助于提高存活率。由于儿童病情的复杂多变性和特殊性,且缺乏大规模试验和统计,目前国内外尚无统一的儿童预防和治疗标准。文章综合了目前有关的临床进展,介绍了深静脉血栓的特点,为深静脉血栓预防、诊断和治疗提供参考。     

A peripherally inserted central catheter misplacement into lateral thoracic vein: A case report

IntroductionCentral venous catheter applications and complications are closely related to the tip position. Previous studies have reported some rare cases of catheter misplacement. Here, we report a case of misplacement of a peripherally inserted central catheter into the lateral thoracic vein.Case reportA 56-year-old cancer patient underwent placement of a peripherally inserted central catheter through the left basilic vein under ultrasound-guided puncture. The catheterisation procedure was uneventful, so the catheter was believed to be in the superior vena cava. However, the post-anterior chest X-ray image revealed that after the catheter advanced towards the axilla, it turned downwards and outwards in the direction of the left lateral thoracic region, with the projection of the catheter tip giving the appearance of termination in the subcutaneous tissue of the lateral thoracic wall on the two-dimensional image. The catheter was then repositioned in the distal superior vena cava.DiscussionPeripherally inserted central catheters can be potentially misplaced into the lateral thoracic vein because these catheters can pass through the orifice of the lateral thoracic vein which flows into the axillary vein. Some pathological cases and clinical conditions can cause dilatation of the lateral thoracic vein, which increases the probability of catheter misplacement. Three principles were proposed to avoid this rare complication: a comprehensive review of the patients’ medical history, real-time image-guided catheterisation and routine radiographic identification of the tip position.