MRCP in the diagnosis of iatrogenic bile duct injury

Postoperative biliary tract lesions are becoming increasingly common. The diagnosis is made by direct cholangiography via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). The present comparative study evaluates the diagnostic efficacy of magnetic resonance cholangiopancreatography (MRCP) in application to iatrogenic bile duct injury. A prospective blind study was performed, contrasting MRCP and ERCP in 10 patients with suspected postoperative biliary tract lesions. MRCP was performed less than 72 h before ERCP. Final diagnosis was made on the basis of findings at surgery and ERCP. The presence of biliary dilatation, excision injury, stricture, fluid collection and free fluid was analyzed. The mean patient age was 66.5 years. There were three males and seven females. The type of postoperative lesion (Bergman classification) are five patients type C, three type D, one type B and one type A. Diagnostic failure was recorded in two cases with ERCP, while in five patients it was unable to define a therapeutic approach. In contrast, MRCP correctly diagnosed all patients. MRCP is effective in diagnosing postoperative biliary tract lesions, and can help decide the best therapeutic approach.     

Diagnostic value of Doppler ultrasound in the assessment of liver cirrhosis in children: Histopathological correlation

We have correlated flow abnormalities in the hepatic vasculature with histological findings in the liver to determine the accuracy of Doppler ultrasound in the diagnosis of liver cirrhosis in children. Eighteen children admitted for evaluation of unknown liver disease were examined prospectively and blindly with Doppler ultrasound prior to liver biopsy. Biopsy specimens showed established cirrhosis in 9 of 18, early cirrhosis in 5 of 18, and no cirrhosis in 4 of 18 children. Doppler studies were also performed on 20 control subjects. The portal vein velocity was decreased (p < 0.0005) and the arterio-portal velocity ratio was increased (p < 0.0005) in the established cirrhosis cohort relative to the controls. For the criteria of the established cirrhosis cohort, the sensitivities of the loss of the reverse flow component in the hepatic veins, the arterio-portal velocity ratio being greater than 3.0, the portal vein velocity being less than 20 cm/s, and the existence of focal flow acceleration in the hepatic veins were 100%, 78%, 67%, and 44%, respectively. The specificity of all of these criteria was 100%. The indicators were not useful in the diagnosis of early cirrhosis. © 1996 John Wiley & Sons, Inc.     

Percutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis

Purpose

To evaluate the benefits of computed tomography (CT)–guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy.

Clinical outcome of immediately loaded dental implants bioactivated with plasma rich in growth factors: a 5-year retrospective study

BACKGROUND: The aims of this study were to describe a procedure for the immediate loading of dental implants, evaluate the long-term survival rates of 1,139 immediately loaded dental implants, and analyze the influence of different factors on implant survival. METHODS: A retrospective cohort study design was used. A total of 241 patients received 1,139 immediately loaded implants between 2001 and 2005 in Vitoria, Spain. All implants were placed by one experienced surgeon, and rehabilitations were done by four prosthodontists. Each implant failure was analyzed carefully. The potential influence of demographic, clinical, and surgery-dependent factors and prosthetic variables on implant survival was studied. Implant survival was analyzed using a life-table analysis. RESULTS: The overall survival rates were 99.3%, 96.8%, and 96.9% for the implant-, surgery-, and patient-based analyses, respectively. The mean follow-up period was 28 +/- 15 months. Five of 1,139 implants were lost during the observation period. No variable studied was statistically associated with implant failure. CONCLUSION: Based on these results, the procedure described for the immediate loading of implants can be considered safe and predictable if used under strict clinical protocols.