Lumbar false aneurysms following image-guided interventive procedures for spondylodiskitic abscesses

Pseudoaneurysms of the lumbar arteries are infrequent, and are most often found incidentally after trauma to the lumbar spine. More rarely, they are an iatrogenic complication from diagnostic or therapeutic procedures, particularly of the kidney. Their rupture can cause rapid clinical deterioration by retroperitoneal hemorrhage, and therefore their diagnosis and treatment must be rapid. We report two cases of lumbar artery false aneurysms arising as a complication during the treatment of infectious disciitis. The diagnoses were established via CT and immediately followed by expeditious treatment by selective arterial embolization.     

Effective techniques for reduction of radiation dosage to patients undergoing invasive cardiac procedures

The goal of this study was to improve radiation dose reduction techniques in invasive cardiology and after patients' radiation data had approached minimal levels, to evaluate predictors of their radiation exposure resulting from invasive cardiac procedures. Over the course of 1 year (and 1996 procedures) we minimized cinegraphic frames and runs, as well as fluoroscopy time, and trained ourselves to achieve effective fluoroscopy-saving positioning of blinds and filters toward the regions of interest. We were consequently able to reduce the mean dose-area products (DAP) for coronary angiography and angioplasty, combined interventions, high-frequency rotational atherectomy, and excimer laser angioplasty: from levels of 53.9 Gy cm(2), 79.6 Gy cm(2), 112.3 Gy cm(2), 119.4 Gy cm(2), and 168.0 Gy cm(2) as currently reported in the literature, to 12.9 Gy cm(2), 13.3 Gy cm(2), 25.9 Gy cm(2), 33.0 Gy cm(2), and 27.1 Gy cm(2), respectively. The mean DAP due to interventions in acute myocardial infarction was 38.3 Gy cm(2). DAP was influenced by body mass index, complexity of coronary artery disease, tube angulation, documented structure, coronary recanalization, emergency circumstances, and the percutaneous transluminal coronary angioplasty (PTCA) target vessel involved, but not by stent implantation. By favouring radiation-reducing cranial posteroanterior views over standard left anterior oblique views for visualization of the left anterior descending and the diagonal artery, we consequently achieved mean PTCA-DAPs of 10.4 Gy cm(2) and 8.6 Gy cm(2), respectively: levels significantly lower than those for PTCA of the right coronary artery (13.3 Gy cm(2)), left circumflex artery (13.7 Gy cm(2)), and obtuse marginal branch (16.9 Gy cm(2)). In conclusion, enhanced knowledge of radiation dose-reduction techniques significantly reduces patient radiation hazards in invasive cardiology.     

Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer

Purpose

In this work, the treatment tolerance of elderly patients (≥70?years) undergoing intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) and chemotherapy for locally advanced head and neck cancer was assessed.

Patients and methods

A retrospective review of 112?patients undergoing concurrent chemoradiation for locally advanced head and neck cancer was performed. Treatment toxicity, protocol violations, long-term complications, and survival were compared between 85?younger patients (Results Grade 3–4 treatment toxicity was observed in 88.2% and 88.8% for younger and older patients, respectively. Mean weight loss and treatment break were 5.9 and 3.9?kg (p?=?0.03) and 7.3 and 7.8?days (p?=?0.8) for younger and older patients, respectively. Seven patients (8.2%) did not complete treatment in the younger group compared to 1?patient (3.7%) in the older group (p?=?0.6). No significant differences in protocol violations and survival were found between the two groups.

Conclusion

Compared to younger patients, elderly patients with locally advanced head and neck cancer tolerated chemoradiation with IMRT and IGRT well, and should not be denied curative treatment based solely on age.     

Selection criteria for patients undergoing transjugular intrahepatic portosystemic shunt procedures: current status

The transjugular intrahepatic portosystemic shunt (TIPS) procedure has a well-established role in the management of patients with complications of portal hypertension such as variceal bleeding or refractory ascites. Several clinical variables have been described to be associated with a poor prognosis after a TIPS procedure, including the presence of uncontrollable ascites, the number of sclerotherapy sessions to control a bleeding episode, the use of drugs for hemodynamic support, the use of balloon tamponade to control bleeding, the need for an emergency TIPS procedure, the need for mechanical ventilation, prothrombin time, increased serum creatinine, increased serum bilirubin, encephalopathy, and sepsis. In addition, several scoring systems have been developed and applied to patients undergoing TIPS procedures in an attempt to improve patient selection criteria for this invasive procedure. This article reviews the most important scoring systems that have been developed and applied to patients undergoing emergency or elective TIPS procedures, with particular emphasis on the prognostic index designed for patients undergoing emergency TIPS procedures and the Model for End-stage Liver Disease score designed for patients undergoing elective TIPS procedures. The most practical application of these scoring systems is probably that, with the information provided, the operator is able to discuss with referring physicians, patients, and family members the expected outcomes of this challenging procedure.     

对比剂肾病的预防——介入治疗围手术期处理

对比剂肾病的预防是介入诊疗界研究的热门课题。对比剂肾病目前尚无有效治疗措施,对于存在高危因素的患者,在进行介入治疗时采取必要的预防策略显得尤为重要。本文就介入治疗围手术期如何降低对比剂肾病的发生进行讨论。     

C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis

Introduction  

The aim of this study is to report our early clinical experience using C-arm cone beam computed tomography with fluoroscopic overlay for image guidance during percutaneous needle procedures of the spine and pelvis.     

Current status and future prospects of multi-dimensional image-guided particle therapy

In this review article we emphasize the importance of “imaging” and “image guidance” in advanced particle therapy from a clinical point of view. Although the image-guided radiotherapy (IGRT) technology used for photon and particle therapy is closely similar, the focus of its application in the two modalities differs. Here, we emphasize the challenges of IGRT for charged particle beams. Radiological Physics and Technology (RTPE) readers interested in the common technologies of IGRT for photons and protons are referred to the plentiful articles already published. Our present deeper insight into IGRT arose through the collaboration of two particle therapy centers, the National Institute of Radiological Sciences (NIRS) in Japan and the Paul Scherrer Institute (PSI) in Switzerland. We believe that international collaboration in rapidly developing fields such as IGRT provides a broad perspective over a wide range of the uses of such technology.     

Evaluation of a model to predict poor survival in patients undergoing elective TIPS procedures

PURPOSE: To validate a previously published model to predict the probability of patient death within 3 months after an elective transjugular intrahepatic portosystemic shunt (TIPS) procedure. The model is implemented with use of a nomogram or a formula. MATERIALS AND METHODS: Patients who underwent an elective TIPS procedure between May 1, 1999, and May 1, 2001, were selected. Patients who underwent emergency TIPS creation and patients with serum creatinine levels greater than 3.0 mg/dL were excluded. A total of 72 patients met the inclusion criteria. The patients were divided into two groups: group A (ethanol-induced cirrhosis; n = 23) and group B (non-ethanol-induced cirrhosis; n = 49). The model was applied and the predicted probability of death was compared to actual patient survival. A high risk score (R > or = 1.8) is associated with a high risk of death within 3 months after TIPS creation. Survival curves were estimated with use of Kaplan-Meier product limit estimates and were compared with use of the log-rank test. The model's accuracy was evaluated with use of the c-statistic. P values lower than.05 indicated statistical significance. RESULTS: The technical success rate was 98.7%. The 3-month survival rate for the whole group was 79.7%. The predicted mortality rate was higher than the observed mortality rate. The c-statistic was 0.65 for the formula and 0.66 for the nomogram. Patients with a risk score of at least 1.8 had a 3-month survival rate of 54.6% and patients with a risk score lower than 1.8 had a 3-month survival rate of 84.9% (P =.037). CONCLUSION: These results confirm that, after an elective TIPS procedure, patients with risk scores of at least 1.8 have a significantly lower 3-month survival rate than patients with risk scores lower than 1.8.     

非体外循环冠状动脉旁路移植术的麻醉管理

目的探讨非体外循环下冠状动脉旁路移植术病人的麻醉管理。方法择期非体外循环下冠状动脉旁路移植术病人20例,采用静吸复合全麻。硝酸甘油、艾司洛尔、去氧肾上腺素、多巴胺等用于调控血流动力学指标。观察术后患者血中心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)含量的变化。结果所有患者均顺利完成麻醉和手术,无麻醉并发症,预后良好。术后各时间点血中cTnI和CK-MB含量与术前比均有一定程度升高。结论非体外循环下冠状动脉旁路移植术心肌损伤轻,麻醉管理的关键是维持血流动力学平稳和心肌氧供与氧耗的平衡。     

Case management of asthma for family practice patients: a pilot study

OBJECTIVE: Asthma is a chronic inflammatory disease of the airways that affects between 14 and 15 million persons in the United States. It is responsible for more than 470,000 hospitalizations annually and an estimated $6 billion in total medical cost. The Asthma Case Management Program instituted at our hospital is based on the concept of patient self-management. It involves patient education, a home treatment plan (HTP), and physician/nurse follow-up. This study was performed to determine whether an organized case management program improves outcomes and cost in family practice asthma patients. STUDY DESIGN: A prospective cohort study of 48 asthmatic patients was conducted with a retrospective review. Data were obtained from health, pharmacy, and computer records. PATIENTS AND METHODS: Forty-eight asthma patients, ages 1 year to adult, assigned to the Family Practice Department were enrolled in the Asthma Case Management Program. This cohort was offered asthma education from a provider trained in national asthma guidelines. Most of these patients received a coordinated HTP completed by their primary care provider. The asthma case manager initiated regularly scheduled nursing follow-up. Hospital admissions, emergency department and clinic visits, number of chest radiographs, and use of beta 2 agonists and anti-inflammatory drugs were recorded for a mean of 6 months before and 6 months after the intervention. Twenty-eight patients who had received the HTP as part of their intervention were compared with 12 patients who did not. A cost analysis was completed. RESULTS: All measured parameters showed favorable changes after intervention. Statistically significant decreases in clinic visits, chest radiographs ordered, beta 2 agonists, and oral anti-inflammatory drugs were obtained with the 28 patients who received the HTP. Six-month resource savings after intervention were estimated at $19,677.42 ($491.90 per patient). Ninety-three percent of these savings are attributed to those patients with the HTP. There were no statistically significant improvements and considerably fewer savings for those patients not on the HTP. CONCLUSION: A combined intervention consisting of patient education, a coordinated self-monitoring plan, and patient follow-up was associated with improved care and economic outcomes in this group. The greatest clinical improvement and resource savings are clearly seen in those patients who have received the HTP as part of their asthma case management. Every effort should be made to include the HTP as the central part of asthma case management.     

基于互联网平台对肝癌肝动脉化疗栓塞术患者的延续性护理实践

【摘要】 目的 探讨护士通过互联网平台对肝癌TACE治疗患者实施延续性护理的效果。方法 选取中国医科大学附属第一医院介入病房从2019年10月8日至2019年12月31日符合肝癌诊断标准102名患者,按入院先后顺序分成对照组和干预组,给予不同的方法进行延续性护理。对照组延续以往出院患者发放健康教育宣传单的方法,内容包括疾病相关知识、并发症发生的原因、敏感化验指标的标准以及居家自护的方法等。干预组将健康教育宣传单正常发放,并将相关内容转为文字、图片及视频等形式通过互联网平台于患者出院后的2、3和7 d时推送至患者手机端。两组均于出院14 d评估患者在对疾病知识的掌握程度、生命质量及对延续性护理满意度上的差异。结果 调查患者对疾病知识掌握程度及其对延续性护理的满意度的结果中,各项结果干预组均优于对照组,数据结果有统计学意义（P＜0.05）。在生命质量方面,两组在躯体功能上的差别无统计学意义（P＞0.05）。结论 利用互联网手机APP对肝癌行TACE患者进行出院后的延续性护理,使患者更加清晰地了解疾病相关知识,有利于提升患者的自护能力和生命质量,提高患者对护理工作的满意度。     

Clinical radiation management for fluoroscopically guided interventional procedures

The primary goal of radiation management in interventional radiology is to minimize the unnecessary use of radiation. Clinical radiation management minimizes radiation risk to the patient without increasing other risks, such as procedural risks. A number of factors are considered when estimating the likelihood and severity of patient radiation effects. These include demographic factors, medical history factors, and procedure factors. Important aspects of the patient's medical history include coexisting diseases and genetic factors, medication use, radiation history, and pregnancy. As appropriate, these are evaluated as part of the preprocedure patient evaluation; radiation risk to the patient is considered along with other procedural risks. Dose optimization is possible through appropriate use of the basic features of interventional fluoroscopic equipment and intelligent use of dose-reducing technology. For all fluoroscopically guided interventional procedures, it is good practice to monitor radiation dose throughout the procedure and record it in the patient's medical record. Patients who have received a clinically significant radiation dose should be followed up after the procedure for possible deterministic effects. The authors recommend including radiation management as part of the departmental quality assurance program.     

老年患者冠状动脉旁路移植术围术期处理策略

目的总结65岁以上老年患者行冠状动脉旁路移植术(CABG)的结果,研究围术期处理策略。方法对65岁以上患者行CABG术394例进行总结,其中357例(90·6%)为不稳定型心绞痛,364例(92·4%)合并其他疾病;246例(62·4%)采用非体外循环心脏不停跳下CABG(OPCAB),148例(37·6%)选择常规体外循环下CABG(CCABG)。胸膜外技术游离左乳内动脉(LIMA),保持胸膜腔完整,常规将LIMA与左前降支吻合,其余桥用大隐静脉。术中使用即时超声血流仪测量移植血管血流,保证吻合口通畅。术后加强物理治疗和营养支持,严格控制血糖于6~10mmol/L。结果移植血管数行CCABG患者为3·1±0·6支,行OPCAB患者为2·4±0·8支;379例(96·2%)使用LIMA。全组死亡3例(0·76%),发生并发症9例(2·28%)。术后呼吸机使用时间OPCAB患者为9·7±5·4h,CCABG患者为20·3±15·0h。术后住ICU时间2·7±1·0天,住院时间11·8±5·0天。结论术前充分评估手术风险,选择恰当的手术方案,围术期进行精细处理,老年患者亦可取得良好手术效果。     

Method for automatic localization of MR-visible markers using morphological image processing and conventional pulse sequences: feasibility for image-guided procedures

PURPOSE: To evaluate the feasibility and accuracy of an automated method to determine the 3D position of MR-visible markers. MATERIALS AND METHODS: Inductively coupled RF coils were imaged in a whole-body 1.5T scanner using the body coil and two conventional gradient echo sequences (FLASH and TrueFISP) and large imaging volumes up to (300 mm(3)). To minimize background signals, a flip angle of approximately 1 degrees was used. Morphological 2D image processing in orthogonal scan planes was used to determine the 3D positions of a configuration of three fiducial markers (FMC). The accuracies of the marker positions and of the orientation of the plane defined by the FMC were evaluated at various distances r(M) from the isocenter. RESULTS: Fiducial marker detection with conventional equipment (pulse sequences, imaging coils) was very reliable and highly reproducible over a wide range of experimental conditions. For r(M) 相似文献