Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study

Introduction: Acute gastrointestinal bleeding (AGIB) is a serious and life‐threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64‐slice multi‐detector computerised tomography (MDCT) in the diagnosis of lower AGIB. Methods: Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64‐slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded. Results: Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24–88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty‐four‐slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5‐min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases. Conclusion: The study supports the high accuracy of 64‐slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.     

多排CT对肝细胞癌动门脉分流诊断能力研究

目的 评价多排CT(MDCT)技术诊断肝细胞癌(HCC)合并动门脉分流(APS)的能力。方法 282例HCC接受MDCT肝动脉早期、晚期和门脉期薄层增强扫描和数字减影血管造影(DSA)检查。APS的诊断标准;(1)门脉主干和(或)1级分支增强早于肠系膜上静脉或脾静脉,或门脉主干和(或)1级分支显影密度大于肠系膜上静脉或脾静脉;(2)门脉2级及以下分支增强早于门脉主干,或门脉2级及以下分支显影密度大于门脉主干。采用双盲法分析、比较MDCT和DSA显示APS的结果。结果 全组有56例HCC合并APS。MDCT显示中央型APS 48例,其中重度41例,中度7例,有1例HCC病灶巨大,DSA未能显示合并的中度分流;轻度周围型APS7例,有2例因分流量小DSA未能显示。1例中度混合型APS MDCT和DSA均显示。结论 MDCT是一种简便、有效、非侵入性诊断HCC合并APS的新技术。     

The prevalence and clinical significance of 18F–2‐fluoro‐2‐deoxy‐D‐glucose (FDG) uptake in the thyroid gland on PET or PET‐CT in patients with lymphoma

F¹⁸–2‐fluoro‐2‐deoxy‐D‐glucose (FDG) positron emission tomography (PET) has become a well established tool in staging and assessing therapy response in lymphoma. Incidental thyroid uptake on PET is not uncommon and can pose a diagnostic and management challenge. We retrospectively evaluate the prevalence and clinical significance of incidental FDG uptake in the thyroid gland in patients with lymphoma. 1868 lymphoma patients underwent PET and PET‐CT between August 2002 and August 2008. 52 patients (2.8%) demonstrated FDG thyroid uptake (M = 17, F = 35; mean age 63 yr). Thyroid uptake was determined as focal or diffuse, maximum standardized uptake values (SUVmax) recorded as well as SUV max ratio compared to background mediastinum activity (SUVR). Corresponding CT findings on PET‐CT were evaluated independently. Results were correlated with clinical, histopathological and imaging follow‐up. 30 (1.6%) patients had focal thyroid uptake. 16 (53%) had histological confirmation either by surgery (n = 7) or FNA under USS (n = 9). The final diagnosis was benign in 12/30 patients and malignant in 9/30. The malignancy risk for focal thyroid uptake was 30%. Five patients had intercurrent thyroid cancer (four papillary, one microinvasive follicular) and four had lymphomatous involvement. There was no significant difference between the mean sizes of benign (23.7 mm, range 12–34) and malignant nodules (23.6 mm, range 8–48). The mean SUVmax of malignant and benign nodules was 4.4 (range 1.8–10.1) and 3.2 (range 1.8–6.9) respectively with no statistically significant difference. 22 (1.2%) patients had diffuse FDG uptake in thyroid and benign aetiology was found in all with adequate follow‐up (15/22). Focal FDG thyroid uptake on PET or PET‐CT in lymphoma patients warrants further investigations. The malignancy risk is 30% either due to intercurrent thyroid cancer or lymphomatous involvement. SUVmax, SUVR and CT attenuation characteristics are not helpful in distinguishing between benign and malignant aetiologies. Diffuse thyroid uptake has a benign aetiology. Copyright © 2010 John Wiley & Sons, Ltd.     

Imaging for Crohn disease: Use of 3‐T MRI in a paediatric setting

This study was carried out to review our experience with 3‐T MRI in the assessment of Crohn disease in a paediatric population. Twenty‐four patients with biopsy proven Crohn disease identified on the radiology information system underwent abdominal MRI, with or without pelvic MRI. Twenty‐eight studies were carried out on a 3‐T scanner at a tertiary paediatric hospital. Eight of 24 of these (30%) had a gastrointestinal barium study, 2 of 24 (8%) a CT and 9 of 24 (38%) an abdominal ultrasound. The different MRI sequences were rated for observation of the bowel wall and abnormalities (0–5). The findings were correlated to relevant findings on endoscopy, examination under anaesthesia (EUA) and where available surgery, barium studies, CT and ultrasound. In this study, the colon was involved in 5 of 28 (18%), small bowel in 7 of 28 (25%), terminal ileum in 5 of 28 (18%). All the perineal studies (9 of 9) showed abnormalities. Sinus tracts or fistulas were identified in 7 of 28 (25%) studies. The mean rating of the different MRI sequences in showing bowel wall and changes of Crohn disease was T2 TSE 3.6, T2 half fourier aquisition single shot turbo spin echo (HASTE) with a long TE 3.6, T2 HASTE with short TE 3.4, true fast imaging with steady state precession (FISP) 2.7, T1 4.1 and Post‐contrast T1 4.3. The T2 HASTE sequences with thinner slices improved observation. Detection of superficial abnormalities was similar on the 3D VIBE images and on the post‐contrast T1 spin‐echo (SE) sequences. In five of nine (56%) of those that had ultrasound, both studies were abnormal, with incomplete correlation of the abnormalities. Computed tomography and MRI were abnormal in two of two (100%) patients with good correlation of the abnormalities in one; in the other there was a minimal discrepancy in the estimation of the length of involved bowel. In 7 of 11 (64%) the barium study was abnormal. Good correlation to MRI findings was found in five of seven (71%) of patients. In two of seven (29%) both studies were abnormal, with incomplete correlation of the abnormalities. Barium underestimated the length of involved segment in these patients with inflammatory ileal thickening and ulceration. Notably, in both studies compression was limited because of patient discomfort and the involved segments obscured by overlap. Abdominal and pelvic MRI at 3 T is a useful imaging technique for evaluation of Crohn disease in the children. The extent of bowel wall involvement and extra‐intestinal complications, such as abscesses and fistulas can be accurately assessed non‐invasively, without the use of ionizing radiation or sedation.     

‘Benign’ hepatic portal venous gas

The presence of portal venous gas within the hepatic parenchyma is usually associated with a guarded prognosis and a mortality rate approaching 75%. However, there are infrequent causes of portal venous gas not associated with dire clinical outcomes. We describe three patients who made uneventful clinical recoveries after presenting with clinical and imaging manifestations of ischaemic bowel and hepatic portal venous gas, two of which had distended but non‐necrotic bowel at laparotomy.     

Use of intra‐arterial multi‐detector row CT angiography for the evaluation of an ischaemic limb in a patient with renal impairment

The vastly improved scanning speed and z‐axis resolution afforded by multi‐detector technology has allowed CT to refine its traditional roles and to explore many new applications in imaging. We present a case report of a patient with renal failure and an ischaemic leg, which illustrates a useful new CT vascular imaging application. By carrying out 16‐channel multi‐detector row CT angiography through a sheath introduced into the common femoral artery, we obtained a high‐quality angiographic image of the affected leg, using only 30 mL of iodinated contrast material. The examination definitively showed the number, distribution and patency of the tibial run‐off arteries, with significant influence on the patient‘s subsequent clinical management. This simple and relatively minimally invasive technique is useful in peripheral vascular imaging, when conventional CT angiography using a large volume of i.v. contrast and MR angiography are unsuitable or unavailable.     

Quercetin‐3‐methyl ether inhibits lapatinib‐sensitive and ‐resistant breast cancer cell growth by inducing G2/M arrest and apoptosis

Lapatinib, an oral, small‐molecule, reversible inhibitor of both EGFR and HER2, is highly active in HER2 positive breast cancer as a single agent and in combination with other therapeutics. However, resistance against lapatinib is an unresolved problem in clinical oncology. Recently, interest in the use of natural compounds to prevent or treat cancers has gained increasing interest because of presumed low toxicity. Quercetin‐3‐methyl ether, a naturally occurring compound present in various plants, has potent anticancer activity. Here, we found that quercetin‐3‐methyl ether caused a significant growth inhibition of lapatinib‐sensitive and ‐resistant breast cancer cells. Western blot data showed that quercetin‐3‐methyl ether had no effect on Akt or ERKs signaling in resistant cells. However, quercetin‐3‐methyl ether caused a pronounced G₂/M block mainly through the Chk1‐Cdc25c‐cyclin B1/Cdk1 pathway in lapatinib‐sensitive and ‐resistant cells. In contrast, lapatinib produced an accumulation of cells in the G₁ phase mediated through cyclin D1, but only in lapatinib‐sensitive cells. Moreover, quercetin‐3‐methyl ether induced significant apoptosis, accompanied with increased levels of cleaved caspase 3, caspase 7, and poly(ADP‐ribose) polymerase (PARP) in both cell lines. Overall, these results suggested that quercetin‐3‐methyl ether might be a novel and promising therapeutic agent in lapatinib‐sensitive or ‐resistant breast cancer patients. © 2011 Wiley Periodicals, Inc.     

Dual‐energy contrast‐enhanced CT to evaluate scaphoid osteonecrosis with surgical correlation

To evaluate the validity of contrast enhanced dual energy CT using a lung perfusion algorithm in assessing for post‐traumatic scaphoid proximal pole avascular necrosis. From Aug 2013 to Aug 2016, 18 patients (19 wrists, 16 males, 2 females, mean age 28 years) were assessed as high‐risk for proximal pole scaphoid avascular necrosis by a single surgeon following a scaphoid fracture and were referred for contrast‐enhanced dual energy CT. 8 wrists had specimens sent for correlative histological analysis and 11 were correlated with operative notes. Eight surgical specimens were sent to histology and showed a 100% correlation (8/8) with the DECT findings. The remaining 11 wrists that did not have a specimen sent had in‐surgery findings that also correlated with DECT. A single case was discrepant (1/11) due to presence of an intra‐osseous ganglion, which was reported as osteonecrosis on CT, but considered viable at surgery. No case was called viable on CT that proved to be necrotic at either surgery or histologically. Contrast‐enhanced dual energy CT using a perfusion algorithm is an innovative and promising method in evaluating viability of the post‐trauma proximal pole of scaphoid.     

Cerebral hyperperfusion syndrome post‐carotid artery stenting

Cerebral hyperperfusion syndrome is increasingly recognized as a complication in carotid artery stenting for severe internal carotid artery stenosis. This study reviews the cases of hyperperfusion syndrome occurring after this procedure. We reviewed our database of 170 cases of internal carotid artery stenting carried out at our hospital between January 1999 and June 2006. A radiology search was also carried out to identify those who had CT or MRI within 1 month of post‐carotid artery stenting. We had four patients who developed cerebral hyperperfusion syndrome. One patient developed cerebral oedema, one patient had petechial intracerebral haemorrhage and two patients had large intracerebral haemorrhages, one of whom died. This gives a risk of 2.3% (95% confidence interval 2.27–2.323). All patients with cerebral haemorrhage presented within 6 h. Both patients with large intracerebral haemorrhage had carotid stenting within 3 weeks after presentation of symptoms and all had critically severe stenosis of 95% or more. In our series, large intracerebral haemorrhage has occurred only in patients who have been treated early. Cerebral hyperperfusion is an uncommon but serious complication post‐carotid stenting. Further studies comparing early treatment of endarterectomy and carotid stenting are awaited.     

Detection of melanoma‐derived cancer‐testis antigen CT16 in patient sera by a novel immunoassay

Cancer‐testis antigens (CTAs) are expressed mainly in various cancer tissues and in testis or placenta. Because of their restricted expression pattern, the CTAs can be potentially used for vaccine development and diagnostic applications. CTA CT16 has been found to be expressed in lung and renal cancers as well as in melanomas. Detection of CT16 protein directly from patient serum could facilitate monitoring of tumor growth and response to therapy in CT16‐positive patients. A highly sensitive time‐resolved fluorescence‐based immunoassay measuring CTA CT16 in serum was developed. Generally, CTAs have not been measured directly from body fluids. CT16 level was detectable in 14 of 23 (61%) patients with metastatic melanoma, whereas none of the nine healthy volunteers collected by us had measurable CT16 level. For an unknown reason, 1 of 20 commercial control serum samples gave a positive result. The Wilcoxon‐Mann‐Whitney exact test showed statistically significant difference when patients with metastatic melanoma were compared to our control group (p = 0.006) or to the commercial set (p < 0.001). Four melanoma patients had exceptionally high serum CT16 level. CT16 did not correlate either with S100B, a recognized marker of progressing melanoma, or with unspecific serum marker lactate dehydrogenase. Elevation of CT16 titers preceded or followed the clinical diagnosis of disease progression in four patients with metastatic melanoma. As a conclusion, our results show that CT16 protein can be measured directly from patient serum, and the developed assay has a potential for clinical use.     

肝脏局灶性结节增生的螺旋CT平扫及三期增强扫描

目的 分析肝脏局灶性结节增生（FNH）的螺旋CT平扫及三期增强扫描表现,以提高对FNH的诊断准确率。方法对21例21个经手术病理证实的FNH进行螺旋CT平扫及增强的动脉期、门脉期、延迟期扫描。其中2例行肝动脉血管造影。结果 21个FNH,平扫16个为低密度,5个为等密度,其中12个病灶中央有点状、条状、放射状低密度影。动脉期21个FNH除中央疤痕外,均明显均匀强化,9例见明显增粗的供血动脉;门脉期病灶密度下降,但均高于或略高于肝实质;延迟期病灶呈等密度或略低于肝实质,3例见包膜强化。血管造影可见粗大的供血动脉及引流静脉。结论 FNH在螺旋CT平扫及三期增强扫描中的特征性表现,对FNH的确诊及治疗方案的选择有重要价值。     

A TGF‐β1 genetic variant at the miRNA187 binding site significantly modifies risk of HPV16‐associated oropharyngeal cancer

TGF‐β1rs1982073 polymorphism at the miRNA‐187 binding site may alter TGF‐β1 expression and function, and thereby this polymorphism (genotype CT/CC) increases cancer susceptibility. HPV16 L1 seropositivity is associated with the risk of oral squamous cell carcinoma (OSCC), including oropharyngeal squamous cell carcinoma (OPSCC) and oral cavity squamous cell carcinoma (OCSCC). Thus, we hypothesized that TGF‐β1rs1982073 polymorphism at the miRNA‐187 binding site combined with HPV16 L1 seropositivity may have a joint effect on OSCC susceptibility. We determined the genotypes of TGF‐β1rs1982073 and HPV16 status in 325 OSCC subjects and 335 cancer‐free controls in the non‐Hispanic white population, and used logistic regression models to evaluate the joint effects on OSCC susceptibility. TGF‐β1rs1982073 polymorphism (CT/CC genotype) combined with HPV16 L1 seropositivity increased the risk of OSCC via joint effects, particularly in OPSCC subjects who were never‐smokers (OR, 165.9; 95% CI, 28.6–960.4) or never‐drinkers (OR, 196.0; 95% CI, 28.2–1,000.0), respectively. Younger subjects had a higher risk of OPSCC than older subjects (OR, 23.5; 95% CI, 6.3–87.0 vs. OR, 6.0; 95% CI, 1.7–17.9, respectively). The significant associations between this polymorphism and HPV16‐associated OSCC and OPSCC were also observed. However, OCSCC subjects did not have similar results. Our findings suggest that the joint effects of TGF‐β1rs1982073 and HPV16 L1 seropositivity can increase risk of HPV16‐associated oral cancer, particularly in OPSCC subjects who are never‐smokers, never‐drinkers and young. This result may help us understand the tumorigenesis process and improve early detection, which are critical for prevention and intervention strategies. However, larger studies are needed to validate our findings.     

Identification and staging of pancreatic tumours using computed tomography,endoscopic ultrasound and mangafodipir trisodium‐enhanced magnetic resonance imaging

Pancreatic malignancy can be staged by a number of different investigations, either alone or in combination. The purpose of the present study was to compare the use of endoscopic ultrasound, CT and mangafodipir trisodium‐enhanced MRI for the staging of pancreatic malignancy, particularly with respect to determining resectability prior to surgery. Twenty‐seven patients referred for the investigation of a suspected pancreatic malignancy were entered into the trial. All patients had contrast‐enhanced CT, gadolinium and mangafodipir trisodium‐enhanced MRI, and endoscopic ultrasound (EUS). Images were assessed for nodal staging, tumour staging and resectability for each investigation, and the results compared with findings at surgery. The results for the accuracy of MRI, CT and EUS, in detecting T4 disease versus T3 or lower was 78, 79 and 68%, respectively; nodal involvement was 56, 63 and 69%, respectively; and overall resectability (including the T stage, presence of involved nodes and metastases) was 83, 76 and 63%, respectively. There was no significant difference demonstrated between the three tests. The present study suggests that for patients referred for investigation and staging of pancreatic malignancy, EUS and MRI scanning convey little advantage over contrast‐enhanced CT. Furthermore, although mangafodipir trisodium improved the conspicuity of pancreatic tumours, it has little influence on T staging.     

Usefulness of dual‐phase cone‐beam computed tomography during arteriography and automated tumour‐feeder detection software in transarterial embolization for obscure arterial bleeding in the abdomen

We report the usefulness of dual‐phase cone‐beam computed tomography during angiography (CBCTA) and automated tumour‐feeder detection software (AFD) in transarterial embolization (TAE) for three consecutive cases of obscure arterial bleeding in the abdomen. Two patients presented with lower gastrointestinal bleeding and one showed bleeding into the pancreatic pseudocyst. Superior mesenteric or common hepatic angiography did not demonstrate extravasation, but dual‐phase CBCTA and AFD could identify extravasation and an access route to the bleeding point. TAE with gelatin sponge particles and a microcoil was successfully performed under AFD guidance in all patients without any complication, and haemostasis could be achieved.     

Detection rate of fluorine‐18‐fluorodeoxyglucose positron emission tomography in patients with marginal zone lymphoma of MALT type: a meta‐analysis

The aim of this article is to meta‐analyse published data about the detection rate (DR) of fluorine‐18‐fluorodeoxyglucose (¹⁸F‐FDG) positron emission tomography (PET) and PET/computed tomography (CT) in the evaluation of patients with marginal zone lymphoma of the mucosa‐associated lymphoid tissue (MALT). A comprehensive literature search of studies published through February 2014 was performed. Pooled DR of ¹⁸F‐FDG PET or PET/CT including 95% confidence intervals (95% CI) was calculated on a per‐patient‐based analysis. Twenty studies including 376 patients with MALT lymphoma were selected. The pooled DR of ¹⁸F‐FDG PET or PET/CT was 71% (95% CI: 61–80%). A significant difference between the DR of PET/CT (69%; 95% CI: 61–80%) and that of PET alone (73%; 95% CI: 60–84%) was not demonstrated. A better DR of ¹⁸F‐FDG PET or PET/CT in bronchial (94%; 95% CI: 85–99%) and head‐and‐neck (90%; 95% CI: 78–98%) MALT lymphomas compared with gastric (62%; 95% CI: 46–77%) and ocular (49%; 95% CI: 36–63%) MALT lymphomas was found. This meta‐analysis demonstrates that MALT lymphoma is an ¹⁸F‐FDG‐avid tumour in most of the cases, suggesting a potential clinical role of ¹⁸F‐FDG PET or PET/CT in the initial evaluation of these patients. In particular, the DR of ¹⁸F‐FDG PET or PET/CT is related to the primary site of the MALT lymphoma. Copyright © 2014 John Wiley & Sons, Ltd.     

Diagnostic accuracy of 16‐slice CT coronary angiography in the evaluation of coronary artery disease

Multislice CT coronary angiography (CT‐CA) has emerged as a potential imaging method for coronary artery disease. This study aimed to ascertain the accuracy of 16‐slice CT in the diagnosis of significant coronary stenosis (≥50% reduction of lumen diameter). This mixed retrospective/prospective observational study compared 95 paired 16‐slice CT‐CA and fluoroscopic coronary angiography (FCA) sets. A cardiologist and a radiologist blinded to the FCA findings evaluated CT‐CA images independently by visual estimation. Disagreement between these reporters was arbitrated by a third CT reporter (a cardiologist). A separate cardiologist blinded to CT‐CA findings assessed FCA by visual estimation. Of 1161 coronary segments assessable on FCA, 1103 segments (95%) were assessable on CT‐CA. The CT‐CA correctly diagnosed 147/180 segments with significant stenoses (sensitivity = 82%) and correctly identified 874/923 coronary segments without significant stenoses (specificity = 95%). The positive and negative predictive values of CT‐CA in the diagnosis of coronary segment with significant stenosis were 75 and 96%, respectively. On patient‐based analysis, CT‐CA correctly identified all 68 studies with at least one vessel with significant stenosis (sensitivity = 100%; specificity = 83%). The positive and negative predictive values of CT‐CA in identifying patients with significant coronary stenosis were 94 and 100%, respectively. The 16‐slice CT‐CA showed moderately good sensitivity but very high specificity and negative predictive value in the diagnosis of significant coronary stenosis. The CT‐CA would appear to be a useful ‘rule‐out’ test for patients with low‐risk profile for ischaemic heart disease.     

Bevacizumab in association with de Gramont 5‐fluorouracil/folinic acid in patients with oxaliplatin‐, irinotecan‐, and cetuximab‐refractory colorectal cancer

BACKGROUND:

The aim of the current study was the investigation of the value of bevacizumab + 5‐fluorouracil(5–FU)/folinic acid in patients with advanced colorectal cancers who have exhausted standard chemotherapy options.

METHODS:

The authors included 48 heavily pretreated patients (colon:rectum, 33:15; men:women, 23:25; median age, 63 years; range, 27‐79 years) whose disease had progressed during or within an oxaliplatin‐based first‐line chemotherapy, an irinotecan‐based second‐line regimen, and a third‐line treatment with cetuximab plus weekly irinotecan. Bevacizumab was given at a dose of 5 mg/kg. 5‐FU/folinic acid was administered according to the de Gramont schedule.

RESULTS:

The response rate was 6.25%, and 30.4% of patients demonstrated stable disease as the best response. The median time to disease progression was 3.5 months (95% confidence interval [95% CI], 2.3‐6.9 months), and the median survival time was 7.7 months (95% CI, 3.9‐11.9 months). The most common grade 3 to 4 side toxicities (graded according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) were: diarrhea (20.8%), fatigue (14.5%), and stomatitis (12.5%). Grade 3 to 4 hemorrhage occurred in 8 patients (16.6%), including 4 cases of bleeding in the gastrointestinal tract. Other relatively common adverse events such as hypertension, thrombosis, and bowel perforation were reported in 50%, 18.7%, and 4.16%, of patients respectively.

CONCLUSIONS:

The data from the current study suggest a modest but significant clinical benefit of bevacizumab + de Gramont schedule in heavily pretreated colorectal cancer patients. Cancer 2009. © 2009 American Cancer Society.     

Image‐guided video assisted thoracoscopic surgery (iVATS) ‐ phase I‐II clinical trial

Purpose

To facilitate localization and resection of small lung nodules, we developed a prospective clinical trial ( ClinicalTrials.gov number NCT01847209) for a novel surgical approach which combines placement of fiducials using intra‐operative C‐arm computed tomography (CT) guidance with standard thoracoscopic resection technique using image‐guided video‐assisted thoracoscopic surgery (iVATS).

Methods

Pretrial training was performed in a porcine model using C‐arm CT and needle guidance software. Methodology and workflow for iVATS was developed, and a multi‐modality team was trained. A prospective phase I‐II clinical trial was initiated with the goal of recruiting eligible patients with small peripheral pulmonary nodules. Intra‐operative C‐arm CT scan was utilized for guidance of percutaneous marking with two T‐bars (Kimberly‐Clark, Roswell, GA) followed by VATS resection of the tumor.

Results

Twenty‐five patients were enrolled; 23 underwent iVATS, one withdrew, and one lesion resolved. Size of lesions were: 0.6–1.8 cm, mean = 1.3 ± 0.38 cm.. All 23 patients underwent complete resection of their lesions. CT imaging of the resected specimens confirmed the removal of the T‐bars and the nodule. Average and total procedure radiation dose was in the acceptable low range (median = 1501 μGy*m², range 665–16,326). There were no deaths, and all patients were discharged from the hospital (median length of stay = 4 days, range 2–12). Three patients had postoperative complications: one prolonged air‐leak, one pneumonia, and one ileus.

Conclusions

A successful and safe step‐wise process has been established for iVATS, combining intra‐operative C‐arm CT scanning and thoracoscopic surgery in a hybrid operating room. J. Surg. Oncol. 2015 111:18–25. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.     

Superselective coil embolization in gastrointestinal haemorrhage: Early experience

This is a retrospective study to evaluate our early experience of using selective microcoil embolization in patients who had gastrointestinal (GI) haemorrhage. From December 2002 to December 2003, six patients with GI haemorrhage (upper GI, n = 1; lower GI, n = 5) underwent superselective microcoil embolization. Microcatheters were used to carry out embolizations in branches of the superior mesenteric artery. Microcoils were used in five patients and a combination of microcoils and embolospheres was used in one patient. Technical success (bleeding target devascularization) was achieved in all patients who showed active bleeding at the time of angiography. Two patients had recurrent bleeding within 24 h of embolization, of which one (16.7%) died. The other patient did not require active intervention as bleeding was minimal and resolved with conservative management. Satisfactory clinical success (no rebleeding after 30 days) was achieved in five patients. No clinical signs and symptoms of bowel ischaemia occurred in these patients. Follow‐up colonoscopy carried out in two patients did not show any signs of ischaemia in the affected bowel segments. Superselective microcoil embolization is an effective and safe method of controlling and arresting bleeding in GI haemorrhage.