Transarterial embolization of giant liver hemangiomas associated with Kasabach-Merritt syndrome: a case report

Of 22 patients with symptomatic giant liver hemangiomas referred for embolization, two females (52 and 74 years) had Kasabach-Merritt syndrome (KMS). Hematocrit values were observed to be 33% and 29%, platelets 4000 and 5400/mm(3), and fibrinogen 98 and 77 mg/dl, respectively. Lesion diameters were 7 and 14 cm, respectively. Hepatic angiography revealed excessive vascular lakes typical of cavernous hemangiomas. Microspheres of 40-300 microm were superselectively injected under fluoroscopic guidance until cessation of flow. Coil packing of the feeding hepatic artery was additionally used in one patient. The procedure was uneventful in both. Partial restoration of platelet count was observed immediately; fibrinogen levels and platelets were restored completely in one patient and partially in the other, without remissions at 2-year follow-up.

Cervical spine ROM measurements: optimizing the testing protocol by using a 3D ultrasound-based motion analysis system

The aim of this study was to evaluate the intra- and inter-examiner reliability and validity of neck range of motion (ROM) measurements. Thirty-five healthy subjects were assessed in all neck movements from two initial positions, sitting and standing, actively (open and closed eyes) and passively by using a 3D ultrasound-based motion analysis device (Zebris). Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. X-rays in neck flexion and extension were used to validate the Zebris system. The standing position yielded higher intraclass correlation coefficient (ICC) values (>0.86) with less error [smallest detectable difference (SDD)<13.8%] than sitting (ICC>0.79, SDD<14%). Passive assessment of neck ROM presented better reproducibility than active assessment with open or closed eyes in both positions. The inter-examiner reliability was moderate (ICC=0.43-0.68). The correlation between the Zebris system and X-rays was high in both flexion and extension movements. The results showed that the most reliable protocol for assessment of neck ROM is a passive measurement in the standing position. The measurements were well validiated against X-rays and the experience of the investigators must be considered before any comparison among studies is employed.

Effects of Superselective Embolization for Renal Vascular Injuries on Renal Parenchyma and Function

AIM

Our objective was to evaluate the outcome of superselective embolization used for treatment of renal vascular injuries on renal parenchyma and renal function.

MATERIALS AND METHODS

Between January 1999 and December 2001, 6 consecutive patients (five males, one female, mean age 45 years) underwent embolization to treat bleeding from renal vascular injuries, resulting from iatrogenic interventions (4) and blunt abdominal trauma (2). Five patients had increased serum creatinine. Angiography depicted a pseudoaneurysm (PA) in three, PA with arteriovenous fistula (AVF) in one, and active extravasation in two patients. Superselective catheterization was achieved using a 5-F catheter in three, and coaxial microcatheter in the remaining three cases. All lesions were successfully embolized with 0.035" or 0.018" coils.

RESULTS

Bleeding was ceased in all patients and did not recur. Mean post-embolization parenchymal ischemic area was 11.7% (range: 0-30%). Imaging follow-up (mean: 12 months, range: 5-23) showed that mean parenchymal infarcted area was 6% (range: 0-15%). Serum creatinine level was normal in all patients one week after the procedure and at the latest follow-up.

CONCLUSION

Superselective embolization resulted in permanent cessation of bleeding. Serious parenchymal infarction was prevented and serum creatinine level returned to the pre-bleeding values. Embolization should be considered as the treatment of choice in this patient population.

Ruptured adrenal artery aneurysm: a case report

A case of ruptured adrenal artery aneurysm is presented. The ultrasound, computed tomography and selective renal angiography findings are described in detail. Aneurysms of adrenal arteries are particularly rare. Early diagnosis is important because of their tendency towards rupture and subsequent high mortality rate.

CT portography and post-lipiodol CT in the preinterventional work-up of primary and secondary liver tumors. A single center experience

BACKGROUND/AIMS

The evaluation of the clinical use of CT portography (CTp) and post-lipiodol CT (CT post-lip) in terms of therapeutic implications in patients with liver malignancies, particularly hepatocellular carcinoma (HCC).

METHODOLOGY

We prospectively evaluated 130 patients with CTp and CT post-lip: 109 with HCC and underlying cirrhosis (group I) and 21 with liver metastases considered for surgical resection (group II). All patients also underwent hepatic angiography (hA). Mean lesion size was 4.6 cm and 2.2 cm for group I and II respectively. Previous contrast-enhanced CT studies were available for comparison.

RESULTS

Diagnostic CTp examinations resulted in only 84.4% of group I due to enhancement in homogeneities and in all patients from group II. In comparison with the referral CT, additional lesions were seen in 83.6% of the HCC group and in 66.6% of the metastatic group that implicated treatment alterations in 15.21% and in 23.8% of them, respectively. Hepatic angiography revealed hypervascularity in 91.3% of HCC lesions and in 33.3% of metastatic ones. CT post-lip images suitable for evaluation resulted in 104/130 patients (80%). At CT post-lip false negative results were observed in 33.73% patients with HCC and in 30.95% patients with liver metastases. Selective lipiodol retention was seen in only 50% of the biopsy proved satellites.

CONCLUSIONS

CTp reveals additional lesions that have therapeutic implications in at least 15% of HCC patients and in 20% of patients with metastatic disease, and should be routinely included in the preinterventional work-up particularly for cases in which intraarterial or percutaneous treatment is scheduled. By contrast, CT post-lip seems to be of limited value unless it is evaluated in combination with CTp and angiography.

Splenic aneurysm with arteriovenous fistula. A case report

BACKGROUND/AIM

Fistulous communication between the splenic artery and the vein is rare. We present one such case.

PATIENT AND METHODS

A 50 year old woman was admitted to the hospital complaining of abdominal pain and diarrhea, both unrelated to the meals. Physical examination, laboratory testing, computed tomography, and aortogram were performed.

RESULTS

The patient was treated by surgical resection of splenic artery and vein, as well as with splenectomy. Pathological examination showed a 5x5 cm aneurysm of the splenic artery that was connected to the splenic vein through a fistulous tract.

A bleeding renal artery pseudo-aneurysm complicating renal biopsy. Treatment with transcatheter embolization

We report the treatment of a bleeding renal artery pseudoaneurysm by transcatheter embolization. The patient, a 30 years old woman, developed macroscopic hematuria following renal biopsy. The presence of a leaking pseudoaneurysm of the lower pole segmental artery was confirmed by left selective renal angiogram; subsequently successful transcatheter embolization was performed using a 5.0 french Cobra catheter and 3 mm steel coils.

A modified per os double contrast examination of the colon in the elderly

A modified per os double contrast examination of the colon was used in 62 elderly patients in whom conventional barium enema had been unsuccessful. We created endogenous gas generation instead of air insufflation by per os administration of a special mixture containing barium sulfate, lactulose and gastrografin. Good quality double contrast images of the colon were obtained after 12 hours in 59 of the 62 patients. The sensitivity of the method was 100% in 6 patients suffering from carcinoma and in 15 patients suffering from diverticular disease. However, the method failed to demonstrate small solitary polyps in 5 patients and it was also negative in another 27 patients. 7 of these had negative endoscopy and in the remaining a definite diagnosis was not established by any other method. It seems that this method may become an alternative for investigation of suspected colonic pathology in the elderly patients with difficulty in retaining the barium enema.

[Selective transcervical tubal recanalization under DSA]

The results of selective transcervical tubal recanalisation by means of a catheter in 20 patients with tubal occlusions are reported and discussed. The advantages of tubal recanalisation under DSA are stressed. In 18 (90%) of the 20 patients treated, it was possible to recanalize at least one tube. Nine of these 18 women (50%) became pregnant during the period of observation, averaging 12 months. Selective transcervical recanalisation of obstructive tubes is a rapid, reliable, cheap and hardly invasive treatment of sterility, when compared with laparoscopy or laparotomy. In the majority of patients it makes surgery unnecessary.

Hemiazygous vein thrombosis as a cause of unexplained left-sited pleural effusion. A new syndrome?

In seven cases with pleural effusion transosseal azygography has been performed, in order to specify any cause for the fluid accumulation that could be related to the azygous system. In 4 cases azygography appeared normal and further laboratory work-up revealed collagen disease, heart failure and lung cancer. In the remaining 3 cases (2 with recent myocardial infarction and 1 with unstable angina) azygography discerned thrombosis of the hemiazygous vein. It is suggested that in cases with an otherwise unexplained left-sited thoracic transudate a thrombosis of the hemiazygous vein may be visualized by transosseal azygography.

The collateral arterial network of the spleen following ligation of the splenic artery in traumatic rupture of the spleen; an arteriographic study

Ligation of the splenic artery, combined with splenorrhaphy, was used successfully on eight children with splenic trauma involving major segmental vessels. Evaluation of the collateral arterial network and of its adequacy was done by means of arteriography on four out of the eight patients. Aortographies were carried out on the twentieth day, the first month, the third month, and the fourth month following the ligation. A collateral arterial network, deriving mainly from the short gastric arteries was detected, dyestream disruption and retrograde filling of the artery. No complications after aortography were noted. Findings demonstrate that collateral blood supply develops rapidly and its pattern is rather uniform.

Thoracopagus twins studied with computed tomography

Chest and abdominal computed tomography (CT) was performed preoperatively in a case of thoracopagus twins. Although in this case some information regarding the joined hearts and livers and the separate pairs of kidneys was obtained by CT, it is evident that other examinations are still needed to evaluate the various organ systems. This is particularly true for angiocardiography.

Length of main left coronary artery in relation to atherosclerosis of its branches. A coronary arteriographic study

The relation between the length of the main left coronary artery and the presence of atherosclerosis in its branches or the presence of complete left bundle-branch block was studied by selective coronary arteriography in 43 persons. The length of the main left coronary artery was found to be significantly shorter in patients with coronary atherosclerosis than in subjects without angiographic evidence of coronary artery disease. In patients with electrocardiographic evidence of complete left bundle-branch block, the length of the left main coronary artery was significantly shorter than that in both previous groups. In view of these findings, it is suggested that a short main left coronary artery should be considered as a congenital factor predisposing to the development of coronary artery disease. The possible mechanisms leading to atherosclerosis of the left coronary arterial branches in the presence of a short main trunk are discussed.

[Our experience with functional ascending cinephlebography]

Over the last three years, ascending, functional cine-phlebography has been used on 43 patients with different lesions of the venous system. The patient is placed in the decubitus dorsal position, on a radiological table inclined at 70 degrees. The opaque liquid is injected into the dorsal vein of the foot. Its movement is helped by the flexing of the muscles of the leg, and is followed on a screen. This method makes it possible to follow the morphological and functional aspects of the veins of the lower limbs. In this way it is possible to assess valvular function, the location of the perforating veins and their competence, the limits of a thrombosis, and the therapeutic results. This examination, which is painless and harmless, makes it possible to improve the precision of the diagnosis in patients with different vein lesions, and gives most valuable information on the functioning of the venous system of the lower limbs.