植入式静脉输液港导管断裂预防与处理

目的 探讨植入式静脉输液港(IVAP)导管断裂及其预防处理.方法 回顾性分析2012年1月至12月单中心878例IVAP植入患者中发生导管断裂7例患者临床资料,结合相关文献对导管断裂原因和预防措施进行讨论.结果 截至2016年11月31日,经颈内静脉植入IVAP术后导管断裂发生率为0.8％(7/878);断裂时间为术后855～1 412 d,平均1 133 d;断裂部位为导管进入颈内静脉交界处、导管与底座接头处和皮下隧道部位.结论 导管断裂是IVAP植入后长期使用过程中严重并发症之一.规范手术操作流程、加强维护和护理宣教、适时取出等措施,有助于降低IVAP导管断裂发生率,保障患者生命安全.     

Bard PowerPICC Solo2 vs Cook Turbo-Ject: A Tale of Two PICCs

Purpose

To compare the complications experienced for 2 different brands of peripherally inserted central venous catheters (PICC), Cook Turbo-Ject and the Bard PowerPICC Solo2. The rationale for this project revolved around concern that one of the PICCS in question had high rates of complications.

Methods

A prospective clinical trial was conducted after obtaining approval from the University of Saskatchewan Human Research Ethics Committee. All PICCs were implanted at the Royal University Hospital Medical Imaging Department by an interventional radiologist. Patient randomization was achieved by alternating the brand of PICC implanted in sequential patients. All the subjects were inpatients from a single surgical ward. Patients were excluded from the study if they had a known uncorrected coagulopathy, or if they were being treated for venous thrombosis. This project was financially supported by the Summer Student Research Fund, College of Medicine, University of Saskatchewan.

Results

A total of 53 PICCs (25 Bard and 28 Cook) were inserted over the study period. The mean PICC dwell time was 23.3 days for both the Bard and Cook PICCs, respectively. No statistically significant differences were detected in study group demographics, technical placement of the PICCs, or in the complications encountered.

Discussion

Both the Cook Turbo-Ject and the Bard PowerPicc Solo2 PICCs provided acceptable venous access for a wide variety of clinical indications.     

右侧头臂静脉入路植入静脉输液港临床应用

目的 探讨右侧头臂静脉入路行完全植入式静脉输液港(TIVAP)植入的可行性及安全性.方法 回顾性分析2013年3月至2015年12月采用BCV入路植入TIVAP共493例患者临床资料,其中男137例,女356例;年龄29～78岁,平均(47.3±13.2)岁.总结穿刺成功率及留置过程相关并发症.结果 手术成功率为100％,首次穿刺成功率为99％ (488/493).手术时间18～35 min,平均(22.5±8.3) min.术中误穿动脉3例(0.61％,3/493),未见血胸、气胸等严重并发症.术后患者携TIVAP时间为124～986 d,平均(271.1±53.8)d;并发症发生率为2.25％(11/488),包括港穴出血2例,导管相关感染1例,部分血栓形成2例,纤维蛋白鞘形成6例,未见导管异位、断裂、置管相关夹闭综合征(POS)等严重并发症.结论 经右侧BCV入路行TIVAP植入,穿刺成功率高,安全可靠,可为临床植入TIVAP提供另一入路选择.     

完全植入式静脉输液港术后港体翻转临床分析

目的探讨完全植入式静脉输液港(TIVAP)术后港体翻转的发生原因、确诊方法、处理措施及预防策略。方法回顾性分析2015年12月至2018年10月428例接受TIVAP植入术患者临床资料。记录术后港体翻转率、发生时间、原因分析和处理措施。结果428例患者术中港体均未缝合固定,术后6例发生港体翻转,均经影像学检查证实,港体翻转率为1.4%(6/428)。其中男2例,女4例;年龄55~71岁,平均(65.0±6.3)岁。术后23~451 d出现港体翻转,2例考虑与皮下组织过剩/疏松相关,1例考虑为囊袋尺寸过大,其余3例原因不明。处理措施:单纯手法复位3例,囊袋内注射0.9%氯化钠溶液后手法复位1例,囊袋内注射0.9%氯化钠溶液手法复位失败后切开复位1例,直接切开复位1例。结论TIVAP植入术后港体翻转发生率低,易于确诊和复位,因此没有必要常规缝合固定港体。建议选择宽基底、凸缘设计港体。港体翻转原因尚需进一步研究探讨。     

CT-Guided Biopsy of Small Liver Lesions: Visibility,Artifacts, and Corresponding Diagnostic Accuracy

Purpose Our study aimed to determine the visibility of small liver lesions during CT-guided biopsy and to assess the influence of lesion visibility on biopsy results. Material and Methods Fifty patients underwent CT-guided core biopsy of small focal liver lesions (maximum diameter, 3 cm); 38 biopsies were performed using noncontrast CT, and the remaining 12 were contrast-enhanced. Visibility of all lesions was graded on a 4-point-scale (0 = not visible, 1 = poorly visible, 2 = sufficiently visible, 3 = excellently visible) before and during biopsy (with the needle placed adjacent to and within the target lesion). Results Forty-three biopsies (86%) yielded diagnostic results, and seven biopsies were false-negative. In noncontrast biopsies, the rate of insufficiently visualized lesions (grades 0–1) increased significantly during the procedure, from 10.5% to 44.7%, due to needle artifacts. This resulted in more (17.6%) false-negative biopsy results compared to lesions with good visualization (4.8%), although this difference lacks statistical significance. Visualization impairment appeared more often with an intercostal or subcostal vs. an epigastric access and with a subcapsular vs. a central lesion location, respectively. With contrast-enhanced biopsy the visibility of hepatic lesions was only temporarily improved, with a risk of complete obscuration in the late phase. Conclusion In conclusion, visibility of small liver lesions diminished significantly during CT-guided biopsy due to needle artifacts, with a fourfold increased rate of insufficiently visualized lesions and of false-negative histological results. Contrast enhancement did not reveal better results.     

婴幼儿超声辅助下颈内静脉穿刺植入完全植入式静脉输液港评价

目的 探讨超声辅助下颈内静脉穿刺在婴幼儿完全植入式静脉输液港(TIVAP)植入术中的效果.方法 回顾性分析2009年1月至2016年7月在上海交通大学医学院附属儿童医学中心(单中心)治疗的446例TIVAP植入术患儿临床资料,患儿平均年龄1.3岁(4个月～2.8岁).比较传统颈内静脉盲穿刺和超声辅助下颈内静脉穿刺耗时、一次穿刺成功率、穿刺并发症发生率,并作统计学分析.结果 446例患儿中颈内静脉盲穿刺265例,平均需时7.6 min,一次穿刺成功201例(75.85％),发生穿刺并发症15例(5.66％);超声辅助下颈内静脉穿刺181例,平均需时4.2 min,一次穿刺成功176例(97.24％),发生穿刺并发症3例(1.70％).结论 婴幼儿TIVAP植入术时采用超声辅助下颈内静脉穿刺,可缩短手术时间,提高一次穿刺成功率并减少穿刺并发症发生,是一种安全有效、简单可行的技术,值得临床推广.     

Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement

The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40–81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief. Received 21 March 1997; Revision received 4 June 1997; Accepted 6 June 1997     

The Inflammatory Response to Femoral Arterial Closure Devices: A Randomized Comparison Among FemoStop,AngioSeal, and Perclose

The objectives of this study were to investigate whether the systemic inflammatory response differs, in patients undergoing coronary angiography, among the arterial closure devices FemoStop, AngioSeal, and Perclose. The study is a prospective and randomized study. We measured pre- and postprocedural C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) plasma levels and collected clinical and procedural data on 77 patients who underwent coronary angiography because of stable angina pectoris. Patients were randomized to the following device: FemoStop (mechanical compression), AngioSeal (anchor and collagen sponge), or Perclose (nonabsorbable suture). No patient group experienced an increased incidence of vascular complications. There were no differences among the three groups regarding CRP, fibrinogen, or IL-6 values before or after coronary angiography. IL-6 levels increased 6 h after the procedure in all groups (p < 0.01), however, the increase did not differ among the groups. After 30 days there were no increased values of CRP or fibrinogen. We conclude that the femoral arterial closure devices AngioSeal and Perclose do not enhance an inflammatory response after a diagnostic coronary angiography, measured by CRP, fibrinogen, and IL-6, compared to femoral arterial closure using a mechanical compression device.     

Ovarian Artery: Angiographic Appearance,Embolization and Relevance to Uterine Fibroid Embolization

Purpose: To describe the angiographic appearance of the ovarian artery and its main variations that may be relevant to uterine fibroid embolization. Methods: The flush aortograms of 294 women who had been treated by uterine artery embolization for fibroids were reviewed. Significant arterial supply to the fibroid, and the origin and diameter of identified ovarian arteries were recorded. In patients with additional embolization of the ovarian artery, the follow-up evaluation also included hormonal levels and Doppler imaging of the ovaries. Results: A total of 75 ovarian arteries were identified in 59 women (bilaterally in 16 women and unilaterally in 43 women). All ovarian arteries originated from the aorta below the level of the renal arteries with a characteristic tortuous course. Fifteen women had at least one enlarged ovarian artery supplying the fibroids. Fourteen women (14/15, 93%) presented at least one of the following factors: prior pelvic surgery, tubo-ovarian pathology or large fundal fibroids. Conclusion: We advocate the use of flush aortography in women with prior tubo-ovarian pathology or surgery or in cases of large fundal fibroids. In the case of an ovarian artery supply to the fibroids, superselective catheterization and embolization of the ovarian artery should be considered.     

Central venous infusion port inserted via high versus low jugular venous approaches: Retrospective comparison of outcome and complications

Purpose

To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches.

Materials and methods

The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n = 7), operation scar (n = 6), radiation scar (n = 5), failure of low jugular vein puncture (n = 2), and abnormal course of right subclavian artery (n = 1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port.

Results

The procedure-related complications were all minor (n = 14, 8.6%) in both groups; hematoma (n = 4, 2.8% in low jugular puncture group and n = 1, 4.8% in high jugular puncture group, p = 0.6295), air embolism (n = 2, 1.4% in low jugular puncture group and n = 0 in high jugular puncture group, p = 0.5842) and minor bleeding (n = 5, 3.5% in low jugular vein puncture group and n = 2, 9.5% in high jugular vein puncture group, p = 0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p = 0.0349).The reasons for catheter removal were patients’ death (59 in low jugular puncture group and 14 in high jugular puncture group, p = 0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p = 0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p = 0.6583). The catheter tip migrated upward an average of 1.86 cm (range, −0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p = 0.4232).

Conclusions

Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.     

Concentric versus eccentric cycling at equal power output or effort perception: Neuromuscular alterations and muscle pain

This study aimed to compare neuromuscular alterations and perceptions of effort and muscle pain induced by concentric and eccentric cycling performed at the same power output or effort perception. Fifteen participants completed three 30-min sessions: one in concentric at 60% peak power output (CON) and two in eccentric, at the same power output (ECC_POWER) or same perceived effort (ECC_EFFORT). Muscle pain, perception of effort, oxygen uptake as well as rectus femoris and vastus lateralis electromyographic activities were collected when pedaling. The knee extensors maximal voluntary contraction (MVC) torque, the torque evoked by double stimulations at 100 Hz and 10 Hz (Dt100; Dt10), and the voluntary activation level (VAL) were evaluated before and after exercise. Power output was higher in ECC_EFFORT than CON (89.1 ± 23.3% peak power). Muscle pain and effort perception were greater in CON than ECC_POWER (p < 0.03) while muscle pain was similar in CON and ECC_EFFORT (p > 0.43). MVC torque, Dt100, and VAL dropped in all conditions (p < 0.04). MVC torque (p < 0.001) and the Dt10/ Dt100 ratio declined further in ECC_EFFORT (p < 0.001). Eccentric cycling perceived as difficult as concentric cycling caused similar muscle pain but more MVC torque decrease. A given power output induced lower perceptions of pain and effort in eccentric than in concentric yet similar MVC torque decline. While neural impairments were similar in all conditions, eccentric cycling seemed to alter excitation-contraction coupling. Clinicians should thus be cautious when setting eccentric cycling intensity based on effort perception.     

Observed kneeling ability after total,unicompartmental and patellofemoral knee arthroplasty: perception versus reality

Kneeling is an important function of the knee, but little information is available on ability to kneel after different knee arthroplasty procedures. Previous work has asked patients about their kneeling ability; in this study it was objectively assessed. One hundred and twenty two patients — 38 having had total knee replacement (TKR), 53 unicompartmental knee replacement (UKR), 31 patello-femoral replacement (PFR) — were observed trying to kneel at 90° on a chair, at 90° on the floor, and at 120° on the floor. Only 37% of patients thought they could kneel, whereas 81% were actually able to kneel (p <0.001). Ability to kneel on the chair and on the floor at 90°was significantly better than perceived ability for all prosthesis types (p <0.001). Kneeling at 120° showed no difference between perception and reality except for the PFR group (p <0.05). In all positions, increased range of movement significantly improved kneeling ability (p <0.001). Kneeling ability in men was significantly better than in women (p <0.001). Patient-centred questionnaires do not accurately document kneeling ability after knee arthroplasty.     

Cardiac pacing systems and implantable cardiac defibrillators (ICDs): a radiological perspective of equipment, anatomy and complications

Cardiac pacing is a proven and effective treatment in the management of many cardiac arrhythmias. Implantable cardiac defibrillators (ICDs) are beneficial for certain patient groups with a history of serious, recurrent ventricular dysrhythmias, with a high risk of sudden cardiac death. Pacemaker devices take many forms and are highly visible on the chest radiograph. The radiographic appearances of ICDs and pacemakers can be similar and are subject to similar complications. The anatomical approach to the implantation, the type of device used and anatomical variations will all affect the appearance of these devices on the chest film. Pacemaker complications identified radiographically include pneumothorax, lead malpositioning, lead displacement or fracture, fracture of outer conductor coil, loose connection between the lead and pacemaker connector block, lack of redundant loops in paediatric patients and excessive manipulation of the device by the patient (Twiddler's syndrome). This pictorial review highlights the role of chest radiography in the diagnosis of post-cardiac pacing and ICD insertion complications, as well as demonstrating the normal appearances of the most frequently implanted devices.     

Comparison of complications between transjugular and axillosubclavian approach for placement of tunneled, central venous catheters in patients with hematological malignancy: a prospective study

This study was designed to compare the incidence of mechanical, thrombotic and infective complications in transjugular (IJV) and axillosubclavian (SCV) central venous catheters (CVC) in patients with hematological malignancy. In a prospective observational trial, 131 consecutive patients were classified into two groups: Group A included those with IJV catheter insertions under sonography guidance (n=61) and group B included those with SCV insertions under venography guidance (n=70). After catheter placement, patients were prospectively acquired and recorded to obtain the following data: success rates, total catheter days, and complication episodes per 100 catheter days. All procedures were technically successful. Total catheter days were 7800 (group A) versus 8391(group B). Mechanical complications were observed in three cases from group A and 11 from group B, with an incidence rate of 0.04 per 100 catheter days versus 0.13 (P=0.043), respectively. Two symptomatic thrombotic complications were observed in group B. The number of infective complications was not significantly different between the two groups (P=0.312). There was no difference in infective complication incidence between the two groups. To minimize catheter-related mechanical and thrombotic complications, however, the IJV approach is superior to the SCV approach.     

Single-Use versus Reusable Endoscopes for Percutaneous Biliary Endoscopy with Lithotripsy: Technical Metrics,Clinical Outcomes,and Cost Comparison

PurposeTo compare procedure and fluoroscopy time, technical and clinical success, and costs between single-use and reusable endoscopes in patients undergoing percutaneous biliary endoscopy (PBE) with lithotripsy.Material and MethodsThirty-four patients (67 procedures) were retrospectively included in the study. The patients were treated with PBE for gallstone removal from October 24, 2014, to February 12, 2020, using reusable (28 procedures) or single-use (39 procedures) endoscopes. The procedure time, fluoroscopy time, technical success rate (accessing the biliary system and locating the gallstone), clinical success rate (at least partial gallstone removal), complication rate, and cost of use were compared between the procedures.ResultsThe mean (± standard deviation) procedure time was not significantly different between single-use (136 minutes ± 45) and reusable endoscopes (136 minutes ± 51) (P = .47). The mean fluoroscopy time was significantly shorter for single-use endoscopes (11 minutes ± 8.4) than for reusable endoscopes (18 minutes ± 12) (P = .01). When comparing single-use versus reusable endoscopes, the technical success (95% [n = 37] vs 93% [n = 26]) and the clinical success (90% [n = 35] vs 75% [n = 21]) rates were not significantly different (both, P > .05). Only 1 complication was noted in the reusable endoscope group (P = .42). The cost per case was lower for single-use ($1,500) than for reusable ($3,987) endoscope procedures, primarily due to differences in capital costs and repair costs.ConclusionsSingle-use endoscopes offer the potential for lower patient radiation exposure and lower cost per case, which may reduce the financial barriers to offering PBE in interventional radiology practices. The clinical and technical success rates did not differ by endoscope type.