Practical advance in obtaining an emergency airway via cricothyroidotomy

By the time a cricothyroidotomy is deemed necessary, the patient is in critical need of an emergency airway before anoxic damage ensues. Two things are necessary for the delivery of the requisite oxygen. First, an airway must be rapidly established. Second, the airway must be large enough to facilitate ventilation. Present methods for emergency cricothyroidotomy include needle cricothyroidotomy, which suffers from difficulties in both establishment and ventilation. We describe here a practical and widely available method for establishing a timely effective airway that has been used successfully for five patients since 1992.     

Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to ...     

Digital mammography performed with computed radiography technology.

Introduced by Fuji Photo Film Japan in the early 1980s, computed radiography (CR) technology has developed considerably since then to become the mature widely installed technology it is today (about 7500 systems worldwide). Various mammographic examinations require high performance results to which CR complies on demand or following some procedures such as geometrical magnification carried out during the examination. The basic CR principles and digital image processing as well as technical improvements are detailed in this study, which also includes a synthesis of the articles on CR mammographic applications referenced in the bibliography, focusing on strong points, limits and current methods of surpassing these limits. New CR technology development perspectives in mammography and computed assisted diagnosis (CAD) algorithms will allow wider use of this method in the near future.     

Homicide by improvised explosive device made out of firecrackers.

Explosion is a phenomenon resulting from a sudden release of energy dissipated by: (1) blast wave; (2) translocation of objects; and (3) generation of heat. There are different types of explosive devices varying from sophisticated military bombs to simple firecrackers. These are made from various kinds of explosive materials. Sophisticated bombs are used in war and military operations to kill one's enemies, while simple firecrackers are meant for expressing joy and celebration. Here, the author reports an unusual case of homicide by the manufacture of an improvised explosive device from simple firecrackers. In India, these firecrackers are widely and freely available all over the country. The case highlights the fatal hazard resulting from easy access to these potentially dangerous devices, apart from the environmental pollution produced by their large scale use at the time of festivals in this country.     

Confirmation of needle cricothyroidotomy using an esophageal detector device in a porcine model

The difficult intubation is one of the most trying situations encountered in airway management. Transtracheal jet ventilation via needle cricothyroidotomy can provide temporary oxygenation in this critical situation in a minimally invasive fashion. The esophageal detector device (EDD) has been previously shown to be effective in determining the tracheal placement of endotracheal tubes. In this experiment, three commonly available EDDs are utilized to accurately identify 15 of 15 intratracheal placements of a 16-gauge i.v. catheter in five cadaveric domestic swine. The incorporation of EDDs in i.v. catheter placement for needle cricothyroidotomy is shown to be effective and merits further study. Likewise, further investigation is needed to identify a standardized apparatus for needle cricothyroidotomy in emergent situations.     

Computed tomography of the head in children: experience with 1024 scans performed in an outpatient facility.

Our experience in 1,024 computed tomography examinations of the head in 954 infants and children performed in a private office is reported. Immobilization in infants was achieved using relatively large dosages of chloral hydrate (as high as 75 mg/kg) supplemented, when necessary, by I.M. Benadryl. The usual dose of chloral hydrate recommended for children is 25 mg/kg as a sedative and 50 mg/kg as a hypnotic. Satisfactory immobilization was accomplished in 350 of the 360 children under 6 years of age. Thus, routine general anesthesia was avoided. The wide spectrum of conditions demonstrated has been tabulated and selectively illustrated.     

Radiographer performed abscess drainage via an anastomotic leak post-anterior resection

Anastomotic leaks following stapled laparoscopic anterior resection can be clearly demonstrated by a Gastrografin enema. Abscesses that might develop are usually drained via an invasive interventional procedure. This case demonstrates how in certain instances such abscesses can be treated successfully by a minimally invasive, radiographer performed technique using a combination of fine bore tubes and guide wires and a ‘Pigtail’ drainage catheter inserted via the anus.     

Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young Patients with and those without obstructive sleep apnea

PURPOSE: To compare the patterns of dynamic airway motion depicted on cine magnetic resonance (MR) images obtained during sleep between young patients with and those without obstructive sleep apnea (OSA). MATERIALS AND METHODS: Fast gradient-echo sequences were performed in the sagittal midline by using a 1.5-T unit to create cine MR images. Cine MR images obtained during sleep in 16 young patients with OSA were compared with those obtained in 16 young patients with no airway symptoms of airway disease. The nasopharynx, oropharynx, and hypopharynx were characterized in terms of airway motion as static patent (SP), dynamic patent, intermittent collapsed (IC), or static collapsed (SC); and the maximal diameter and greatest change in diameter (in millimeters) of these airways were calculated. Adenoid tonsil size and mouth position (ie, opened or closed) were determined. Differences in the frequency of MR imaging parameters in the different anatomic regions were evaluated by using Fisher exact, chi 2, and sample t tests. RESULTS: There were statistically significant differences in the following parameters between the two groups: nasopharynx SP (P <.001) and IC (P <.001); hypopharynx SP (P <.001) and IC (P <.001); and mean change in airway diameter of the nasopharynx (P <.001) and hypopharynx (P <.001). The mean adenoid tonsil size in the patients with OSA was larger (P =.006). CONCLUSION: There are significant differences in the patterns of dynamic airway motion between young patients with and those without OSA.     

Prostatic MR imaging performed with the three-point Dixon technique. Work in progress

The three-point Dixon technique is an enhancement of the original Dixon method for the creation of water- and fat-proton magnetic resonance (MR) images. With the three-point Dixon technique, three measurements of phase shift at 0, pi, and -pi between the fat and water resonances are employed. Compensation for B0 inhomogeneity leads to an error-free decomposition into water- and fat-proton images; an accurate B0 map is also created. The lack of chemical shift artifact in the water- and fat-selective MR images permits the application of narrow receive bandwidth for the creation of T2-weighted images with a high signal-to-noise ratio. The technique was applied in vivo with four healthy subjects, seven patients with prostatic carcinoma, and one patient with benign prostatic hypertrophy and compared with conventional T2-weighted imaging. The three-point technique yielded images with improved definition of normal intraprostatic structures and zonal anatomy and, in some cases of prostatic carcinoma, provided better visualization of extraprostatic spread of tumor.     

Analysis of cystic intracranial lesions performed with fluid-attenuated inversion recovery MR imaging.

BACKGROUND AND PURPOSE: T1-, T2-, and proton density (PD)-weighted sequences are used to characterize the content of cystic intracranial lesions. Fluid-attenuated inversion recovery (FLAIR) MR sequences produce T2-weighted images with water signal saturation. Therefore, we attempted to verify whether FLAIR, as compared with conventional techniques, improves the distinction between intracranial cysts with a free water-like content versus those filled with a non-free water-like substance and, consequently, aids in the identification of these lesions as either neoplastic/inflammatory or maldevelopmental/porencephalic. METHODS: Forty-five cystic intracranial lesions were studied using T1-weighted, T2-weighted, FLAIR, and PD-weighted sequences. By means of clustering analysis of the ratio in signal intensity between the cystic intracranial lesions and CSF, the intracranial lesions were classified as filled with a free water-like content or with a non-free water-like substance. The results were compared with their true content as evaluated either histologically or on the basis of clinical, neuroradiologic, and follow-up features (necrotic material, 13 cases; accumulation of intercellular proteinaceous/myxoid material, eight cases; keratin, five cases; CSF, 19 cases). Cystic intracranial lesions were divided into two clinical groups, neoplastic/inflammatory and maldevelopmental/porencephalic, to evaluate the level of accuracy of each MR technique. The difference in absolute value signal intensity between CSF and cystic intracranial lesion content was calculated on FLAIR and PD-weighted images. RESULTS: PD-weighted and FLAIR sequences, unlike T1- and T2-weighted sequences, accurately depicted all cystic intracranial lesions containing necrotic or myxoid/proteinaceous intercellular material (non-free water-like) and most CSF-containing cystic intracranial lesions (free water-like). All imaging techniques inaccurately showed some of the keratin-containing cystic intracranial lesions and pineal cysts. The overall error rate was 22% for T1-weighted, 27% for T2-weighted, 9% for FLAIR, and 13% for PD-weighted sequences. The signal intensity difference between CSF and cystic intracranial lesion content was higher with FLAIR imaging. CONCLUSIONS: FLAIR imaging depicts far more accurately the content of cystic intracranial lesions and better reveals the distinction between maldevelopmental/porencephalic and neoplastic/inflammatory lesions than do conventional sequences. FLAIR has the added advantage of a higher signal intensity difference between cystic intracranial lesions and CSF.     

Aids to successful shoulder arthrography performed with a fluoroscopically guided anterior approach.

One method for performing effective shoulder arthrography with a fluoroscopically guided anterior approach is described. The technique can ensure success while injury to the cartilaginous labrum is avoided, which is essential when arthrography is performed in conjunction with magnetic resonance (MR) imaging. The key features of the technique include supine positioning of the patient with the shoulder in external rotation, marking the skin just lateral to the humeral head cortex, inserting the needle perpendicular to the fluoroscopy beam, testing the injection with an anesthetic agent, and confirming intraarticular needle placement with iodinated contrast material. The procedure can be followed by an injection of dilute gadolinium solution for subsequent MR imaging. Proper patient and needle positioning as well as accurate confirmation of intraarticular needle placement are critical to a successful and atraumatic shoulder arthrographic examination.     

Comparison of airway diameter measurements from an anthropomorphic airway tree phantom using hyperpolarized 3He MRI and high-resolution computed tomography.

An anthropomorphic airway tree phantom was imaged with both hyperpolarized (HP) 3He MRI using a dynamic projection scan and computed tomography (CT). Airway diameter measurements from the HP 3He MR images obtained using a newly developed model-based algorithm were compared against their corresponding CT values quantified with a well-established method. Of the 45 airway segments that could be evaluated with CT, only 14 airway segments (31%) could be evaluated using HP 3He MRI. No airway segments smaller than approximately 4 mm in diameter and distal to the fourth generation were adequate for analysis in MRI. For the 14 airway segments measured, only two airway segments yielded a non-equivalent comparison between the two imaging modalities, while eight more had inconclusive comparison results, leaving only four airway segments (29%) that satisfied the designed equivalence criteria. Some of the potential problems in airway diameter quantification described in the formulation of the model-based algorithm were observed in this study. These results suggest that dynamic projection HP 3He MRI may have limited utility for measuring airway segment diameters, particularly those of the central airways.     

An evaluation of the 24-hour RAIU test performed with an Anger camera and a pinhole collimator

RAIU measurements obtained with a conventional thyroid uptake probe have been compared with those obtained with an Anger camera and a pinhole collimator. Although the field distribution for the pinhole collimator deviates markedly from the IAEA recommendations, the group data from the comparative measurements in this series were identical, with a confidence level of 99%. However, in several cases the data from differing measurement regimes for individuals varied markedly.     

Periganglionic foraminal steroid injections performed under CT control.

PURPOSEThe purpose of our study was to evaluate the efficacy of direct intraforaminal steroid injections into the periganglionic space in the treatment of radicular pain.METHODSPeriganglionic infiltrations were performed in 41 patients with acute or chronic radicular pain. Neuroradiologic imaging in all patients showed foraminal stenosis due to degenerative disorders or herniated disk. All injections were performed under CT control.RESULTSSeventy percent of patients had significant pain reduction, with the greatest success (90% of patients) in those whose foraminal stenosis was due to degenerative disorders; 45% of patients with foraminal herniated disks had pain relief.CONCLUSIONIntraforaminal steroid injection is useful in the treatment of radicular pain, particularly in cases of foraminal degenerative stenosis.