Endovascular coil occlusion of 1811 intracranial aneurysms: early angiographic and clinical results

OBJECTIVE: We sought to evaluate the early angiographic and clinical outcomes of the first session of endovascular coil occlusion of a large number of patients with intracranial aneurysms treated by five neurointerventionalists during a decade at a single center. METHODS: We performed retrospective analyses of pre- and postprocedural angiographic studies and early clinical outcomes. Enrolled patients underwent endovascular treatment of intracranial aneurysms with detachable coils. RESULTS: A total of 1811 aneurysms in 1579 patients were treated with coil occlusion. Of these, 90 to 100% occlusion of 86.5% of the aneurysms was achieved. In 82.3% of the procedures, no complications occurred. The clinical outcome profile at primary discharge according to the Glasgow Outcome Scale was as follows: Grade V, 74.6%; Grade IV, 6.7%; Grade III, 11.1%; Grade II, 3.1%; and Grade I, 4.5%. In patients with large aneurysms with wide necks, a lower occlusion rate and an increased complication rate were encountered. The use of three-dimensional and fibered coils resulted in higher occlusion rates. Balloon remodeling and stent deployment increased the complication rate. Previous aneurysm rupture, procedural complications, and vasospasm correlated with poor outcome. Of the patients in poor grade after aneurysm rupture, 42% recovered to Glasgow Outcome Scale Grade IV or V, as opposed to 90% of patients who were treated for unruptured aneurysms. The ischemic complication rate was 9%, and the hemorrhagic complication rate was 3%. The early procedural morbidity rate was 5.3%, and the procedural mortality rate was 1.5%. The management mortality rate was 4.4%. CONCLUSION: These data confirm the safety and efficacy of endovascular coil occlusion for patients with intracranial aneurysms.     

Effects of an Er:YAG laser on mitochondrial activity of human osteosarcoma–derived osteoblasts in vitro

The aim of the present study was to investigate the collateral damage of an Er:YAG laser on bone cells in vitro using a special application tip designed for treatment of periimplantitis. Before laser irradiation, SaOs-2 osteoblasts (2×10⁴ cells) were inoculated into 96-well tissue culture plates and incubated for 48 h under standardised conditions. A total of 120 cell cultures were irradiated with an Er:YAG laser using a cone-shaped quartz glass fibre tip at energy settings of 40, 60, 80 and 100 mJ at 10 Hz (energy densities of 5.08, 7.62, 10.16 and 12.7 J cm^–2) for 10 s. Each energy setting was used at a distance of 1, 2 and 3 mm between the application tip and the bottom of the culture plate. Following irradiation, mitochondrial activity of the cells was measured using a luminescent cell viability assay. After laser irradiation, mitochondrial activity of SaOs-2 osteoblasts was significantly reduced when compared with nonirradiated cells (P<0.001), dependent on the energy setting used and the distance between the application tip and the bottom of the culture plate. Mitochondrial activity increased significantly with decreasing energy settings and increasing distances (P<0.001). Within the limits of the present study, it was concluded that an Er:YAG laser, used with a cone-shaped glass fibre tip designed for treatment of periimplantitis, has detrimental effects on mitochondrial activity of SaOs-2 osteoblasts in vitro at energy settings of 40, 60, 80 and 100 mJ (10 Hz).     

Prognosis of stage pT0 after prolonged neoadjuvant endocrine therapy of prostate cancer: a matched-pair analysis

OBJECTIVES: Stage pT0 following prolonged neoadjuvant endocrine therapy (PPNET) of prostate cancer is of great clinical interest, because this finding suggests maximum tumor damage. Therefore pT0 patients are expected to have an extremely favorable PSA progression rate. The purpose of this study was to assess whether the PSA progression rate of pT0 patients after PPNET is lower than that of non-pT0 patients after PPNET. METHODS: 174 patients with previously untreated, clinical stage cT1-3 carcinomas were submitted to PSA monitored complete androgen deprivation therapy followed by radical prostatectomy (RP). In 138 patients the RP specimens showed residual cancer, in 36 patients no residual cancer was found. Biochemical progression was defined as PSA >/=0.2ng/ml. To control for confounding prognostic factors (Gleason score, cT-stage) between both groups a matched-pair analysis for the cumulative risk of biochemical failure was performed, resulting in 30 matched pairs. RESULTS: With a median follow-up of 37.9 and 46.0 months in the matched non-pT0 and pT0 cohort respectively, matched-pair analysis failed to demonstrate significant differences in crude PSA relapse-free survival between both groups (p=0.7758). CONCLUSION: The results suggest that patients converted into pT0 after PPNET do not represent a subgroup with an extremely favorable prognosis. However our results have to be confirmed by the assessment of larger cohorts of pT0 patients with a longer follow-up. The presented data do not allow drawing any conclusions on the prognostic impact of PPNET in general.     

Internal fixation of complex fractures of the proximal humerus

We treated 34 consecutive articular fractures of the proximal humerus in 33 patients with good bone quality by open reduction and internal fixation. Anatomical or nearly anatomical reduction was achieved in 30, at a mean follow-up of 63 months (25 to 131), complete or partial avascular necrosis had occurred in 12 cases (35%). Two patients subsequently underwent arthroplasty and six further patients required additional surgery. The 32 patients who did not require arthroplasty obtained a mean Constant score of 78 points or 89% of an age- and gender-matched normal score (66 points or 76% in the presence and 83 points or 96% in the absence of avascular necrosis (p < 0.0005)); 22 were painfree, and seven had mild pain and three moderate pain. The mean active anterior elevation was 156 degrees. Internal fixation of complex fractures of the proximal humerus restored good shoulder function if avascular necrosis did not develop.     

Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal massive bleeding

We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved.     

Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

OBJECTIVE: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. MATERIALS AND METHODS: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers = group 1; 49 histologically proven benign lesions = group 2 and 100 screening cases (4 years-follow up = group 3). Mammograms were evaluated by a CAD system (Second Look, CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). RESULTS: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. CONCLUSION: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid.     

Multiplanar functional imaging of the larynx and hypopharynx with multislice spiral CT

The purpose of this study is to evaluate multislice spiral CT (MSCT) in multiplanar functional imaging of the larynx and hypopharynx and to define the optimal image planes for the delineation of the tumor and specific anatomical structures. Forty patients with suspected tumors of the larynx or hypopharynx were examined with MSCT during quiet breathing (QB), E-phonation (EP) and modified Valsalva maneuver (VM). Images were read in the axial, coronal and sagittal planes. Overall image quality, delineation of the tumor and anatomic structures for different conditions and orientations were graded using a three-point scale; the conditional permutation test was applied to detect quality differences. Differences between image types were statistically significant. The axial plane was superior in overall image quality and the delineation of the tumor, pyriform sinus, vocal cords and fat within the parapharyngeal/visceral space. The coronal plane was best for delineating the ventricle and the paraglottic space, the sagittal plane for the retropharyngeal and the preepiglottic space. For tumor detection, sensitivity, specificity and accuracy were 0.92, 1.0 and 0.93 for QB.ax, 0.94, 0.8 and 0.92 for EP.ax and 0.85, 1.0 and 0.87 for VM.ax, respectively. Examination during QB should be the standard procedure; additional scanning with EP improved tumor assessment.     

2D SPLASH: a new method to determine the fatty infiltration of the rotator cuff muscles

The objective of this paper is to quantify the fatty degeneration (infiltration) of rotator cuff muscles with a new spectroscopic FLASH (SPLASH) sequence. Before planned surgery (reconstruction or muscle transfer), 20 patients (13 men, 7 women; 35–75 years) with different stages of rotator cuff disease underwent an MR examination in a 1.5-T unit. The protocol consists of imaging sequences and a newly implemented SPLASH, which allows an exact quantification of the fat/water ratio with a high spatial resolution in an arbitrarily shaped region of interest (ROI). The percentages of fat in the rotator cuff muscles were determined. To determine statistically significant differences between the different stages of rotator cuff tear, a Kruskal-Wallis H test was used. Fatty infiltration of the supraspinatus muscle was correlated with cross-sectional area (CSA) measures (Bravais-Pearson). We found significant differences between different stages of rotator cuff disease, the fatty infiltration and the volume loss (determined by the occupation ratio) of the supraspinatus muscle. With the increasing extent of rotator cuff disease, fatty infiltration increases significantly, as does the volume loss of the supraspinatus muscle. Comparing fatty infiltration and the occupation ratio individually, there was only a moderate inverse correlation between fatty infiltration and the occupation ratio, with considerable variation of data. Fatty infiltration of the infraspinatus muscle occurred when the infraspinatus tendon was involved to a lesser extent. The SPLASH sequence allows exact quantification of fatty infiltration in an arbitrarily shaped ROI. The extent of atrophy and fatty infiltration correlates with the size of the tear. Atrophy and fatty infiltration correlate only moderately and should be evaluated separately.     

Can pre-operative contrast-enhanced dynamic MR imaging for prostate cancer predict microvessel density in prostatectomy specimens?

The aim of this study was to correlate quantitative dynamic contrast-enhanced MRI (DCE MRI) parameters with microvessel density (MVD) in prostate carcinoma. Twenty-eight patients with biopsy-proven prostate carcinoma were examined by endorectal MRI including multiplanar T2- and T1-weighted spin-echo and dynamic T1-weighted turbo-FLASH MRI during and after intravenous Gd-DTPA administration. Microvessels were stained on surgical specimens using a CD31 monoclonal antibody. The MVD was quantified in hot spots by counting (MVC) and determining the area fraction by morphometry (MVAF). The DCE MRI data were analyzed using an open pharmacokinetic two-compartment model. In corresponding anatomic locations the time shift (t) between the beginning of signal enhancement of cancer and adjacent normal prostatic tissue, the degree of contrast enhancement and the contrast exchange rate constant (k₂₁) were calculated. The MVC and MVAF were elevated in carcinoma (p<0.001 and p=0.002, respectively) and correlated to k₂₁ (r=0.62, p<0.001 and r=0.80, p<0.001, respectively). k₂₁-values of carcinoma were significantly higher compared with normal peripheral but not central zone tissue. t was longer in high compared with low-grade tumors (p=0.025). The DCE MRI can provide important information about individual MVD in prostate cancer, which may be helpful for guiding biopsy and assessing individual prognosis.