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Taylor AKL, Bartels HC, Brophy DP, O'Brien D, Corcoran SM. Imaging and video of late preterm delivery by midline laparotomy due to incarcerated uterus: A case report and literature review of a rare but morbid condition. Int J Gynaecol Obstet 2024. [PMID: 38610116 DOI: 10.1002/ijgo.15536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Incarcerated gravid uterus (IGU) is a rare and serious obstetric complication. IGU is defined as the entrapment of the gravid uterus between the pubic symphysis and the sacral promontory. The incidence of IGU is 1 in 3000-10 000 cases. IGU is associated with significant obstetric complications, including preterm labor, intrauterine fetal death, growth restriction, renal failure, uterine ischemia/rupture and thrombosis. Here, we present the case of a primigravida with urinary retention at 14 weeks. On transabdominal ultrasound at 19+5/7 weeks the cervix was difficult to visualize, and the anterior uterine wall appeared thickened. The bladder was elongated superior to the uterus and the placenta was low-lying. Initially the patient was managed with intermittent self-catheterization, and subsequently indwelling catheterization was required from 22 weeks. At 30 weeks, the patient was transferred to a tertiary center and magnetic resonance imaging (MRI) was preformed due to challenging visualization of the cervix on ultrasound and the patient's continued symptoms of constipation and recurrent urinary infections. The MRI found a retroflexed gravid uterus, with vagina and endocervix displaced anteriorly and compressed by the gravid uterus. The findings were consistent with an incarcerated uterus. The patient subsequently had positive urinary cultures for Pseudomonas and rising creatinine. Given the obstructive uropathy and associated morbidity and mortality, a plan for elective pre-term delivery at 33+6/7 weeks was made. Delivery was by midline laparotomy, normal anatomy was restored after manual evacuation of the fundus from below the sacral promontory, and an uncomplicated lower segment transverse uterine cesarean section was performed.
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Affiliation(s)
- A K L Taylor
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
| | - H C Bartels
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
- Gynaecology Department, St Vincent's University Hospital, Dublin, Ireland
| | - D P Brophy
- Radiology Department, St Vincent's University Hospital, Dublin, Ireland
| | - D O'Brien
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
- Gynaecology Department, St Vincent's University Hospital, Dublin, Ireland
| | - S M Corcoran
- Obstetrics and Gynaecology Department, National Maternity Hospital, Dublin, Ireland
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Bartels HC, O'Doherty J, Wolsztynski E, Brophy DP, MacDermott R, Atallah D, Saliba S, Young C, Downey P, Donnelly J, Geoghegan T, Brennan DJ, Curran KM. Correction: Radiomics-based prediction of FIGO grade for placenta accreta spectrum. Eur Radiol Exp 2023; 7:73. [PMID: 37991638 PMCID: PMC10665277 DOI: 10.1186/s41747-023-00397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Helena C Bartels
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Jim O'Doherty
- Siemens Medical Solutions, Malvern, PA, USA
- Department of Radiology & Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Eric Wolsztynski
- Statistics Department, University College Cork, Cork, Ireland
- Insight Centre for Data Analytics, Dublin, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Souha Saliba
- Department of Radiology: Fetal and Placental Imaging, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Constance Young
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Paul Downey
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Jennifer Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donal J Brennan
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- University College Dublin Gynaecological Oncology Group (UCD-GOG), Mater Misericordiae University Hospital and St Vincent's University Hospital, Dublin, Ireland
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
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Bartels HC, O'Doherty J, Wolsztynski E, Brophy DP, MacDermott R, Atallah D, Saliba S, Young C, Downey P, Donnelly J, Geoghegan T, Brennan DJ, Curran KM. Radiomics-based prediction of FIGO grade for placenta accreta spectrum. Eur Radiol Exp 2023; 7:54. [PMID: 37726591 PMCID: PMC10509122 DOI: 10.1186/s41747-023-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a rare, life-threatening complication of pregnancy. Predicting PAS severity is critical to individualise care planning for the birth. We aim to explore whether radiomic analysis of T2-weighted magnetic resonance imaging (MRI) can predict severe cases by distinguishing between histopathological subtypes antenatally. METHODS This was a bi-centre retrospective analysis of a prospective cohort study conducted between 2018 and 2022. Women who underwent MRI during pregnancy and had histological confirmation of PAS were included. Radiomic features were extracted from T2-weighted images. Univariate regression and multivariate analyses were performed to build predictive models to differentiate between non-invasive (International Federation of Gynecology and Obstetrics [FIGO] grade 1 or 2) and invasive (FIGO grade 3) PAS using R software. Prediction performance was assessed based on several metrics including sensitivity, specificity, accuracy and area under the curve (AUC) at receiver operating characteristic analysis. RESULTS Forty-one women met the inclusion criteria. At univariate analysis, 0.64 sensitivity (95% confidence interval [CI] 0.0-1.00), specificity 0.93 (0.38-1.0), 0.58 accuracy (0.37-0.78) and 0.77 AUC (0.56-.097) was achieved for predicting severe FIGO grade 3 PAS. Using a multivariate approach, a support vector machine model yielded 0.30 sensitivity (95% CI 0.18-1.0]), 0.74 specificity (0.38-1.00), 0.58 accuracy (0.40-0.82), and 0.53 AUC (0.40-0.85). CONCLUSION Our results demonstrate a predictive potential of this machine learning pipeline for classifying severe PAS cases. RELEVANCE STATEMENT This study demonstrates the potential use of radiomics from MR images to identify severe cases of placenta accreta spectrum antenatally. KEY POINTS • Identifying severe cases of placenta accreta spectrum from imaging is challenging. • We present a methodological approach for radiomics-based prediction of placenta accreta. • We report certain radiomic features are able to predict severe PAS subtypes. • Identifying severe PAS subtypes ensures safe and individualised care planning for birth.
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Affiliation(s)
- Helena C Bartels
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Jim O'Doherty
- Siemens Medical Solutions, Malvern, PA, USA
- Department of Radiology & Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Eric Wolsztynski
- Statistics Department, University College Cork, Cork, Ireland
- Insight Centre for Data Analytics, Dublin, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Souha Saliba
- Department of Radiology: Fetal and Placental Imaging, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Constance Young
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Paul Downey
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Jennifer Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donal J Brennan
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- University College Dublin Gynaecological Oncology Group (UCD-GOG), Mater Misericordiae University Hospital and St Vincent's University Hospital, Dublin, Ireland
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
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Bartels HC, Brophy DP, Moriarty JM, Geoghegan T, McMahon G, Donnelly J, Thompson C, Brennan DJ. Use of an aortic balloon to achieve uterine conservation in a case of placenta accreta spectrum: A case report. Case Rep Womens Health 2023; 37:e00497. [PMID: 36992812 PMCID: PMC10041466 DOI: 10.1016/j.crwh.2023.e00497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Placenta accreta spectrum (PAS) is a rare complication of pregnancy associated with a high risk of massive haemorrhage and caesarean hysterectomy. This is a case report of abdominal aortic balloon occlusion, using intravascular ultrasound, to achieve uterine conservation in a case of severe PAS. The patient was a 34-year-old woman, G2P1, with one prior caesarean section. Antenatal imaging, consisting of transabdominal and transvaginal ultrasound, and magnetic resonance imaging, showed features of PAS. The risk of caesarean hysterectomy with PAS was explained, but the patient declared a desire to retain fertility. Following multi-disciplinary discussion, it was considered appropriate to attempt uterine conservation using en-bloc myometrial and placental resection. An elective caesarean delivery was performed at 36 weeks of gestation. An aortic balloon was inserted prior to surgery using intravascular ultrasound, which allowed for radiation-free, point-of-surgery, accurate balloon sizing, by measuring the aortic diameter, and correct placement of the balloon in the abdominal aorta below the renal vessels. Intraoperative findings confirmed PAS, and a myometrial resection was performed. There were no intraoperative complications. Estimated blood loss was 1000 mL and the patient had an uncomplicated postoperative course. This case demonstrates how the use of an intravascular intraoperative aortic balloon can facilitate uterine conservation in a case of severe PAS.
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Affiliation(s)
- Helena C. Bartels
- Dept of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
| | - David P. Brophy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - John M. Moriarty
- Division of Interventional Radiology, Department of Radiological Sciences David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Gabriela McMahon
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Jennifer Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, Ireland
| | - Claire Thompson
- University College Dublin Gynaecological Oncology Group (UCD-GOG), UCD School of Medicine, Mater Misericordiae University Hospital Dublin, Ireland
| | - Donal J. Brennan
- Dept of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- University College Dublin Gynaecological Oncology Group (UCD-GOG), UCD School of Medicine, Mater Misericordiae University Hospital Dublin, Ireland
- Corresponding author at: University College Dublin Gynaecological Oncology Group (UCD-GOG), UCD School of Medicine, Mater Misericordiae University Hospital Dublin, Ireland.
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5
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Broe MP, Ryan JPC, Ryan EJ, Murphy DJ, Mulvin DW, Cantwell C, Brophy DP. Spermatic vein embolization as a treatment for symptomatic varicocele. Can Urol Assoc J 2021; 15:E569-E573. [PMID: 33999803 DOI: 10.5489/cuaj.7077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Varicocele is a relatively common condition in men that causes pain in approximately 10% of cases. There have been few studies to date assessing the improvements in both pain and quality of life parameters associated with spermatic vein embolization (SVE) as a treatment for patients with symptomatic varicocele, so we aimed to assess this. METHODS A review was carried out of consecutive SVE procedures performed at our institution from 2013-2019. Only patients with painful varicocele were included after other causes of testicular pain were excluded. The technique employed was a combination of distal coil embolization of the spermatic vein with 4-6 mm coils at the level of the inguinal canal, as well as sclerotherapy to prevent reflux of sclerosant. Furthermore, a prospective validated Pain Impact Questionnaire-6 (PIQ-6) was performed to assess for improvement in quality of life. A matched pair Student two-tailed t-test was used to compare mean scores pre- and post-treatment, with 95% confidence intervals presented as T scores and their associated p-values. RESULTS Over six years, 62 SVE procedures were performed for symptomatic varicocele. Success rate was 95%, with a median follow up of nine months. Two patients had a failed procedure on two occasions requiring subsequent surgical ligation. There was one clinically significant recurrence. All components of PIQ-6 score showed a statistically significant reduction post-SVE, most noticeably pain severity and impact on leisure activities. CONCLUSIONS SVE is a safe, effective, and well-tolerated treatment for symptomatic varicocele, improving pain and quality of life.
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Affiliation(s)
- Mark P Broe
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - James P C Ryan
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eanna J Ryan
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David W Mulvin
- Deptartment of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Colin Cantwell
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
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6
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Creavin B, Ryan ÉJ, Kelly ME, Moynihan A, Redmond CE, Ahern D, Kennelly R, Hanly A, Martin ST, O'Connell PR, Brophy DP, Winter DC. Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection. Colorectal Dis 2019; 21:1364-1371. [PMID: 31254432 DOI: 10.1111/codi.14742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/18/2019] [Indexed: 12/12/2022]
Abstract
AIM Management of anastomotic leakage (AL) following rectal resection has evolved with increasing use of less invasive techniques. The aim of this study was to review the management of AL following restorative rectal cancer resection in a tertiary referral centre. METHOD A retrospective review of a prospectively maintained database was performed. The primary outcome was successful management of AL. The secondary outcome was the impact of AL on oncological outcome. RESULTS Five hundred and two restorative rectal cancer resections were performed during the study period. The incidence of AL was 9.9% (n = 50). AL occurred more commonly following neoadjuvant chemoradiotherapy (n = 31/252, 12.3%) than in those who did not receive neoadjuvant chemoradiotherapy (n = 19/250, 7.6%; P = 0.107); however, this was not statistically significant. Successful minimally invasive drainage was achieved in 28 patients (56%, radiological n = 24, surgical n = 4). Trans-rectal drainage was the most common drainage method (n = 14). The median duration of drainage was longer in the neoadjuvant group (27 vs 18 days). Surgical intervention was required in 11 patients, with anastomotic takedown and end-colostomy formation was most commonly required. Successful management of AL with drainage (maintenance of the anastomosis without the need for further intervention) was achieved in 26 of the 28 patients. There were no significant differences in overall or disease-free survival when patients with AL were compared with patients without AL (69.4% vs 72.6%, P = 0.99 and 78.7% vs 71.3%, P = 0.45, respectively). CONCLUSION In selected patients, AL following restorative rectal resection can be effectively controlled using minimally invasive radiological or surgical drainage without the need for further intervention.
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Affiliation(s)
- B Creavin
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - É J Ryan
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - M E Kelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - A Moynihan
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - C E Redmond
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - D Ahern
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - R Kennelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - A Hanly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - S T Martin
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - P R O'Connell
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - D P Brophy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - D C Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.,Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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7
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Dorcaratto D, Udupa V, Hogan NM, Brophy DP, McCann JW, Maguire D, Geoghegan J, Cantwell CP, Hoti E. Does neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization improve survival in patients undergoing liver transplant for hepatocellular carcinoma? Diagn Interv Radiol 2018; 23:441-447. [PMID: 29063856 DOI: 10.5152/dir.2017.17106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to compare the overall (OS) and disease-free survival (DFS) of patients undergoing orthotopic liver transplant (OLT) for hepatocellular carcinoma who did and did not have neoadjuvant doxorubicin drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODS This is a retrospective study of 94 patients with HCC transplanted between 2000 and 2014 in a single tertiary center. Pre- and postoperative features, DFS and OS were compared between patients who received pre-OLT DEB-TACE (n=34, DEB-TACE group) and those who did not (n=60, non-TACE group). Radiologic and histologic response to neoadjuvant treatment as well as its complications were also studied. RESULTS There were no significant differences in post-transplantation DFS and OS rates between groups (5-year DFS: 70% in DEB-TACE group vs. 63% in non-TACE group, P = 0.454; 5-year OS: 70% in DEB-TACE group vs. 65% in non-TACE group, P = 0.532). The DEB-TACE group had longer OLT waiting time compared with the non-TACE group (110 vs. 72 days; P = 0.01). On univariate and multivariate analyses, alpha-fetoprotein (AFP) levels >500 ng/mL prior to OLT were associated with decreased OS and DFS regardless of neoadjuvant approach (hazard ratio of 6, P = 0.001 and 5.5, P = 0.002, respectively). CONCLUSION Patients who underwent neoadjuvant DEB-TACE and OLT for hepatocellular carcinoma had no statistically different OS or DFS at 3 and 5 years from patients undergoing OLT alone.
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Affiliation(s)
- Dimitri Dorcaratto
- Hepatobiliary and Liver Transplant Surgical Unit, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.
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8
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Healy GM, Redmond CE, Gray S, Iacob L, Sheehan S, Dowdall JF, Barry M, Cantwell CP, Brophy DP. Midterm Analysis of Survival and Cause of Death Following Endovascular Abdominal Aortic Aneurysm Repair. Vasc Endovascular Surg 2017. [DOI: 10.1177/1538574417703268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To assess rates of complications, secondary interventions, survival, and cause of death following endovascular abdominal aortic aneurysm (AAA) repair over a 10-year period. Materials and Methods: Single-institution retrospective cohort study of all patients undergoing primary endovascular aortic aneurysm repair (EVAR) between July 2006 and June 2015. The population constituted 175 patients with 163 fusiform and 12 saccular AAAs. Of these, 149 (85%) were male, with mean age 75.4 (±7.1) years. Patients were followed up until June 30, 2016. Cause of death was determined from the national death register. Results: Mean follow-up was 34.4 (±24.4) months. The secondary intervention rate was 9.7%, and there were 4 aneurysm ruptures (0.8% annual incidence). Thirty-day mortality was 0.6%. Survival at 1, 3, and 5 years was 93.1%, 84%, and 64.9%, respectively. Forty-eight patients died during follow-up, 3 secondary to rupture, leading to overall and aneurysm-related death rates of 9.7 and 0.6 per 100 person-years. All other deaths were due to nonaneurysm causes, most commonly cardiovascular (n = 15), pulmonary (n = 13), and malignancy (n = 9). Baseline renal impairment ( P < .001), ischemic heart disease ( P < .05), age greater than 75 years ( P < .05), and urgent/emergency EVAR were associated with inferior long-term survival. Type II endoleak negatively influenced fusiform aneurysm sac regression ( P = .02), but there was no association between survival and occurrence of any complication or secondary intervention. Conclusion: The majority of deaths during medium-term follow-up post-EVAR are due to nonaneurysm-related causes. Survival is determined by the following baseline factors: renal impairment, ischemic heart disease, advanced age, and the presence of a symptomatic/ruptured aneurysm.
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Affiliation(s)
- Gerard M. Healy
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Ciaran E. Redmond
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Sam Gray
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - Lucian Iacob
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Stephen Sheehan
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Joseph F. Dowdall
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Mary Barry
- Department of Vascular Surgery, St. Vincent’s University Hospital, Dublin, Ireland
| | - Colin P. Cantwell
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
| | - David P. Brophy
- Department of Radiology, St. Vincent’s University Hospital, Dublin, Ireland
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9
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Redmond CE, Healy GM, Ryan DT, Conway R, Murphy CF, Ni Leidhin C, Power J, Brophy DP, Heffernan EJ. Ireland's recent contribution to the radiological literature; a bibliometric analysis. Ir Med J 2017; 110:544. [PMID: 28665083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The aim of this study was to identify and analyse all articles published by Irish radiology departments in the medical literature since the year 2000. The PubMed database was searched to identify and review all articles published by radiologists based in the Republic of Ireland or Northern Ireland. Citation counts were then obtained and the top ten most cited articles were identified. There were 781 articles published during the study period. Of these, 558 (71%) were published in radiology journals and the remaining 223 (29%) were published in general medical journals. Abdominal radiology was the most represented sub-specialty (33% of all articles). There was a general trend of increased publications per year. Only 75 (9.6%) of articles were collaborative efforts by more than one radiology department. Irish radiology departments have a considerable research output and this has increased since the year 2000. More collaborative research between Irish radiology departments is encouraged.
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Affiliation(s)
- C E Redmond
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - G M Healy
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - D T Ryan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - R Conway
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - C F Murphy
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - C Ni Leidhin
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - J Power
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - D P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
| | - E J Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4
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10
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McGarry JG, McEvoy SH, Brophy DP. Endovascular recanalisation of an acute superior mesenteric artery occlusion. A case report and review of the literature. Ann Med Surg (Lond) 2014; 4:76-9. [PMID: 25834731 PMCID: PMC4372641 DOI: 10.1016/j.amsu.2014.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction Acute mesenteric ischaemia (AMI) continues to have a high mortality, ranging from 60 to 80%. Presentation of case A 78-year-old male presented with a 20-hour history of abdominal pain, secondary to a superior mesenteric artery (SMA) thromboembolic occlusion diagnosed on computed tomography (CT) angiography. Following confirmation of bowel viability at laparotomy, endovascular intervention using combined thrombolysis, angioplasty and thromboaspiration was performed. Despite successful recanalisation of the occlusion, his condition continued to deteriorate fatally due to progressive sepsis. Discussion We discuss the role of biphasic CT in diagnosis of AMI, and review the evidence for endovascular interventions now increasingly used in the emergent management of thromboembolic AMI. Conclusion Early diagnosis using CT angiography is essential, as it is highly sensitive in detecting a visceral arterial occlusion. However, laparotomy is often required to accurately determine bowel viability and the need for resection. Endovascular interventions appear to be effective alternatives to open surgery with appropriate patient selection. Early diagnosis by CT angiography is essential in acute mesenteric ischaemia. CT is limited in detecting non-specific secondary signs of bowel ischaemia. Endovascular interventions are safe alternatives to surgical revascularisation. Laparotomy is often required to determine bowel viability and need for resection.
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Affiliation(s)
- James G McGarry
- Department of Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sinead H McEvoy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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11
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Redmond CE, O'Donohoe R, Breslin D, Brophy DP. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique. Ir Med J 2014; 107:292-293. [PMID: 25417392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration.
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12
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Tamagno G, Sheahan K, Skehan SJ, Geoghegan JG, Fennelly D, Collins CD, Maguire D, Traynor O, Brophy DP, Cantwell C, Swan N, McGowan L, O'Toole D, O'Shea D. Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor. Endocrine 2013; 44:504-9. [PMID: 23471696 DOI: 10.1007/s12020-013-9910-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/19/2013] [Indexed: 12/27/2022]
Abstract
According to the international guidelines, a multidisciplinary approach is currently advised for the optimal care of patients with a gastroenteropancreatic neuroendocrine tumor (GEP NET). In our institution (tertiary care center), a systematic multidisciplinary approach was established in May 2007. In this study, we have aimed to assess the initial impact of establishing a systematic multidisciplinary approach to the management of GEP NET patients. We have collected and compared the biochemical, imaging, and pathological data and the therapeutic strategies in GEP NET patients diagnosed, treated, or followed-up from January 1993 to April 2007 versus GEP NET patients attending our institution after the multidisciplinary approach starting, from May 2007 to October 2008. Data of 91 patients before and 42 patients after the establishment of the multidisciplinary approach (total: 133 consecutive GEP NET patients) have been finally collected and analyzed. Before the establishment of the multidisciplinary approach, a lack of consistency in the biochemical, imaging, and pathological findings before treatment initiation as well as during follow-up of GEP NET patients was identified. These inconsistencies have been reduced by the systematic multidisciplinary approach. In addition, the therapeutic management of GEP NET patients has been altered by the multidisciplinary approach and became more consistent with recommended guidelines. We think that a systematic multidisciplinary approach significantly impacts on GEP NET patient care and should be established in all centers dealing with these tumors.
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Affiliation(s)
- Gianluca Tamagno
- Department of Endocrinology & Diabetes Mellitus, St Vincent's University Hospital-University College Dublin, 4 Elm Park, Dublin 4, Ireland,
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13
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Gerstenmaier JF, McCarthy CJ, Brophy DP, Cantwell CP. Evaluation of the particulate concentration in a gelatin-based phantom for sonographically guided lesion biopsy. J Ultrasound Med 2013; 32:1471-1475. [PMID: 23887958 DOI: 10.7863/ultra.32.8.1471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the particulate concentration in a gelatin-based ultrasound phantom for lesion biopsy at 6 cm in depth to reduce visualization of the biopsy needle in the near field, simulating subcutaneous fat and tissue echogenicity, and maintain target lesion visualization. METHODS Four gelatin-based phantoms with cornstarch at concentrations of 4, 8, 12, and 16 g/L and an anechoic gelatin target at 7 cm in depth were rated on a 5-point scale by readers for visibility of the target lesion, similarity of near-field to abdominal subcutaneous fat echogenicity, and visibility of a 22-gauge spinal needle in the phantom. A timed sonographically guided localization task was performed on the anechoic target by 4 radiology residents using the 22-gauge spinal needle. Results were analyzed by comparative statistical analysis. RESULTS An increasing particulate concentration did not alter the similarity of near-field to abdominal subcutaneous fat echogenicity (P = .6) but did significantly reduce visibility of the anechoic target at a cornstarch concentration of 16 g/L (P = .04) and the 22-gauge needle at 12 g/L (P = .03). Decreased visualization of the needle or target lesion did not affect the time for needle localization of the anechoic target (P = .96). CONCLUSIONS The optimal ultrasound phantom cornstarch concentration was 12 g/L to reduce visualization of the spinal needle, simulating subcutaneous fat echogenicity while maintaining target lesion visualization.
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Affiliation(s)
- Jan F Gerstenmaier
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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14
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Redmond CE, O'Donohoe R, Brophy DP, Maguire D, Beddy D. Successful arterial reconstruction and colectomy to treat severe visceral arterial disease with concomitant colon cancer. Tech Coloproctol 2013; 17:601-3. [PMID: 23681299 DOI: 10.1007/s10151-013-1006-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/24/2013] [Indexed: 11/25/2022]
Affiliation(s)
- C E Redmond
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland,
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15
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Hegarty C, Heaslip I, Murphy M, McDermott EW, Brophy DP. Percutaneous Removal of a Dropped Appendicolith Using a Basket Retrieval Device and Concomitant Abscess Drainage. J Vasc Interv Radiol 2012; 23:568-70. [DOI: 10.1016/j.jvir.2011.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/01/2011] [Accepted: 12/08/2011] [Indexed: 11/28/2022] Open
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16
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Rogers A, Moloney MA, O'Donnell DH, Sheehan S, Brophy DP. Deep Venous Thrombosis in a Patient with Atresia of the Infrarenal Inferior Vena Cava. J Vasc Interv Radiol 2010; 21:754-6. [DOI: 10.1016/j.jvir.2010.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 12/15/2009] [Accepted: 01/02/2010] [Indexed: 11/25/2022] Open
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17
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Killeen RP, Moloney MA, O'Donnell DH, Sheehan S, Brophy DP. Secondary aortoenteric fistula presenting with small bowel obstruction. Emerg Med J 2009; 26:640. [DOI: 10.1136/emj.2008.062257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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O’Daly BJ, Ridgway PF, Keenan N, Sweeney KJ, Brophy DP, Hill AD, Evoy D, O’Higgins NJ, McDermott EW. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention. Can J Surg 2009; 52:201-206. [PMID: 19503664 PMCID: PMC2689745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2008] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.
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Affiliation(s)
| | | | | | | | - David P. Brophy
- Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
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19
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Killeen RP, Torreggiani WC, Malone DE, Brophy DP. Hemobilia as a potential complication in patients treated with photodynamic therapy for unresectable cholangiocarcinoma. Gastrointest Cancer Res 2009; 3:80. [PMID: 19461912 PMCID: PMC2684720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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20
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Affiliation(s)
- Ronan Ryan
- St. Vincent's University Hospital, Dublin 4, Ireland.
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21
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Roche-Nagle GM, Barry MC, Ryan R, Brophy DP. Considerations in the diagnosis and therapy for deep vein thrombosis. Am J Emerg Med 2007; 25:860.e1-4. [PMID: 17870507 DOI: 10.1016/j.ajem.2007.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 01/28/2007] [Accepted: 02/04/2007] [Indexed: 10/22/2022] Open
Affiliation(s)
- Graham M Roche-Nagle
- Department of Vascular Surgery, St Vincent's University Hospital, Dublin 4, Ireland.
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22
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Tuite DJ, Ryan JM, Johnston C, Brophy DP, McEniff N. Ureteroiliac fistula: a late sequela of radiotherapy and long-term ureteric stent placement. Clin Radiol 2006; 61:531-4. [PMID: 16713425 DOI: 10.1016/j.crad.2006.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 01/23/2006] [Accepted: 02/03/2006] [Indexed: 11/21/2022]
Affiliation(s)
- D J Tuite
- Department of Interventional Radiology, St James's Hospital, Dublin, Ireland.
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23
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Brophy DP. Tendons and Joints–Injection Therapy. J Vasc Interv Radiol 2003. [DOI: 10.1016/s1051-0443(03)70249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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24
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Sheiman RG, Vrachliotis T, Brophy DP, Ransil BJ. Transmitted cardiac pulsations as an indicator of transjugular intrahepatic portosystemic shunt function: initial observations. Radiology 2002; 224:225-30. [PMID: 12091687 DOI: 10.1148/radiol.2241011348] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine if cardiac pulsations are visible and quantifiable on spectral waveforms during Doppler ultrasonographic (US) evaluation of transjugular intrahepatic portosystemic shunts (TIPS), and if so, whether their magnitude declines with shunt dysfunction. MATERIALS AND METHODS Baseline and pre-revision US images obtained in 15 patients with venographically confirmed TIPS malfunction were retrospectively examined for spectral waveform pulsation. Cardiac pulsatility was quantified by using the venous pulsatility index (VPI), the venous equivalent of resistive index. VPIs were obtained at four locations from the main portal vein to the stent-hepatic venous junction. Baseline and follow-up examination results in 11 patients with functional TIPS acted as controls and were evaluated similarly. Baseline and follow-up mean VPIs at all four locations were compared for both sets of patients by using the Newman-Keuls pairwise multiple sample comparison test. The chi(2) test was used to determine if a VPI threshold that would result in an acceptable sensitivity and specificity for shunt dysfunction existed. RESULTS One hundred twenty mean VPIs were obtained in the study group, and 88 mean VPIs were obtained in the control group. Pre-revision VPIs at each location were significantly lower (P <.01) than all baseline values and than the follow-up values in the control group. A VPI less than 0.16 was 94% sensitive and 87% specific for shunt dysfunction. CONCLUSION The VPI, a quantitative measure of cardiac pulsation obtained with Doppler US, may be a useful parameter for assessing TIPS function.
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Affiliation(s)
- Robert G Sheiman
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
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25
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Leigh L, Rabkin D, Berbaum K, Vrachliotis TG, Brophy DP, Lang EV. Impact of graft material configuration on stent-graft endoleak in vitro. J Vasc Interv Radiol 2001; 12:1423-7. [PMID: 11742018 DOI: 10.1016/s1051-0443(07)61702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the effect of different attachment patterns between graft materials and stents on type I endoleak. MATERIALS AND METHODS Nitinol stents were covered with a coating of Tegaderm in either a straight-edged pattern across the stent cells or a contoured zigzag pattern conforming to the stent skeleton's honeycomb-shaped cells. The stent-grafts were deployed in an ex vivo circuit across a gap of tubing to simulate an aneurysm cavity. Fluid leaking from the gap for more than 30 minutes was recorded as endoleak. Two contoured attachment patterns (short and long necks) and four straight-edged patterns with necks of varying length were tested. Each experiment was repeated 15 times. RESULTS The length of the aneurysm neck covered by the graft material was inversely related to the rate of endoleak. The zigzag pattern of graft attachment demonstrated significantly less endoleak than the straight-edged pattern in the setting of a short aneurysm neck (0.25 mL vs 47.3 mL). CONCLUSION Adopting the contoured (zigzag) attachment of graft material to stents minimizes endoleak in vitro, particularly in the setting of a short aneurysm neck.
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Affiliation(s)
- L Leigh
- Department of Radiology, Beth Israel Deaconess Medical Center-West Campus, 330 Brookline Avenue, Boston, Massachusetts 02215, USA
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26
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Vrachliotis TG, Sheiman RG, Brophy DP. Re: Internal mammary artery pseudoaneurysm complicating central venous line placement: treatment with percutaneous thrombin injection. Cardiovasc Intervent Radiol 2001; 24:449-51. [PMID: 11907761 DOI: 10.1007/s00270-001-0072-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Spontaneous dissection of the superior mesenteric artery (SMA) is a rare occurrence, especially when not associated with aortic dissection [1]. Currently, only 28 cases appear to have been reported. Due to the scarcity of cases in the literature, the natural history of isolated, spontaneous SMA dissection is unclear. CT has been reported to be useful for the initial diagnosis of SMA dissection [2-5]. We present two recent cases of spontaneous SMA dissection in which enhanced spiral CT was instrumental in following the disease process and guiding clinical decision making.
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Affiliation(s)
- P J Sheldon
- Department of Radiology, University of California San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA
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28
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Abstract
PURPOSE To assess the clinical success of ultrasonography (US)-guided thrombin injection for the treatment of iatrogenic femoral pseudoaneurysms and to identify criteria that may predispose to treatment failure. MATERIALS AND METHODS Fifty-four iatrogenic femoral pseudoaneurysms were treated with US-guided thrombin injection. Forty-five were classified as simple (single lobe) and nine, as complex (at least two lobes and a single neck to the native vessel). Pseudoaneurysm volume, classification, thrombin dose, anticoagulation therapy status, and sheath size were compared between failed and successful cases. Seven- to 10-day follow-up US and a minimum 4-month clinical follow-up were also performed to evaluate success. RESULTS Fifty of 54 pseudoaneurysms were successfully treated with topical thrombin without complication and included all 45 simple and five of nine complex pseudoaneurysms. US follow-up in all 50 successful cases and clinical follow-up in 37 of these revealed no recurrence. Only a complex pseudoaneurysm classification was significantly associated with failure (P<.01). Among the complex pseudoaneurysms, successful cases involved two injections and a total thrombin dose of at least 1,500 units. In failed cases, pseudoaneurysms were treated with a single injection of 1,000 units, initially thrombosed, and recurred. CONCLUSION Simple iatrogenic femoral pseudoaneurysms, regardless of size or concomitant anticoagulation therapy, can be treated with a single injection of up to 1,000 units of topical thrombin and require no follow-up. Complex pseudoaneurysms will likely require a second injection (total thrombin dose of at least 1,500 units) and short-term clinical and US follow-up to ensure successful treatment.
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Affiliation(s)
- R G Sheiman
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
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29
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Brophy DP, Vrachliotis T, Chavali R, Rabkin DJ. SCVIR annual meeting film panel session: diagnosis and discussion of case 2: Left hepatic arterioportal fistula. J Vasc Interv Radiol 2001; 12:535-9. [PMID: 11287546 DOI: 10.1016/s1051-0443(07)61898-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A 65-year-old man with cryptogenic cirrhosis initially underwent transjugular intrahepatic portosystemic shunt (TIPS) creation for variceal bleeding. For the following 16 months, variceal bleeding and intractable ascites persisted despite TIPS revision with variceal embolization. A surgical distal splenorenal shunt was then created, but, although there was initial improvement, intractable ascites recurred. At presentation at a different hospital, the patient gave a history of dyspnea on exertion and orthopnea. Physical examination demonstrated a distended abdomen, consistent with severe ascites, a large right pleural effusion, and bilateral peripheral edema.
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Affiliation(s)
- D P Brophy
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, One Deaconess Rd., Boston, MA 02215, USA.
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30
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Leoni CJ, Potter JE, Rosen MP, Brophy DP, Lang EV. Classifying complications of interventional procedures: a survey of practicing radiologists. J Vasc Interv Radiol 2001; 12:55-9. [PMID: 11200354 DOI: 10.1016/s1051-0443(07)61403-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine the variability of radiologists' classification of complications from interventional procedures. MATERIALS AND METHODS Fifteen test cases were selected from a database of morbidity and mortality cases that occurred in our department during the past 2 years. Ten cases were selected randomly, and five were chosen because of classification difficulties within our department. A survey with the case descriptions was presented to 145 SCVIR members via the World Wide Web and 48 were distributed to participants at a statewide angiography club meeting. Participants were asked to complete a short assessment of the their clinical background and to classify each case as "no complication," "minor complication," or "major complication." RESULTS Thirty-eight percent (74 of 193) of the surveys were completed. Seventy percent (52 of 74) of the respondents were affiliated with an academic program, 12% (nine of 74) were affiliated with private practice groups, and 18% (13 of 74) claimed both academic and private affiliation. The consensus rate in classifying the complications for the randomly selected cases varied from 50% to 95%, with a median of 69%, and the consensus rate in classifying the selected cases varied from 46% to 95%, with a median of 85%. The lowest consensus rates occurred when (i) a significant procedural event was followed by a normal outcome, (ii) when a procedure was aborted, and (iii) when a significant event occurred but did not prolong hospital stay. CONCLUSION Current criteria for reporting complications are associated with moderate rates of disagreement among interventional radiologists.
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Affiliation(s)
- C J Leoni
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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31
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Li W, Brophy DP, Chen Q, Edelman RR, Prasad PV. Semiquantitative assessment of uterine perfusion using first pass dynamic contrast-enhanced MR imaging for patients treated with uterine fibroid embolization. J Magn Reson Imaging 2000; 12:1004-8. [PMID: 11105042 DOI: 10.1002/1522-2586(200012)12:6<1004::aid-jmri27>3.0.co;2-#] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The feasibility of using first pass dynamic contrast-enhanced MRI to monitor semiquantitatively the perfusion changes of the uterus after uterine arterial embolization is demonstrated. Ten women, who underwent uterine arterial embolization for fibroid treatment, were included in this study. To derive a perfusion index, an additional axial slice through the abdominal aorta was obtained simultaneously when acquiring MR perfusion data. This technique may prove valuable in monitoring the outcome of uterine arterial embolization and documentation of preserved uterine perfusion after this procedure. J. Magn. Reson. Imaging 2000;12:1004-1008.
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Affiliation(s)
- W Li
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA
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Abramson RG, Rosen MP, Perry LJ, Brophy DP, Raeburn SL, Stuart KE. Cost-effectiveness of hepatic arterial chemoembolization for colorectal liver metastases refractory to systemic chemotherapy. Radiology 2000; 216:485-91. [PMID: 10924575 DOI: 10.1148/radiology.216.2.r00au26485] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To calculate the cost-effectiveness of hepatic arterial chemoembolization (HACE) for the treatment of colorectal liver metastases (CLM) over a range of survival benefits and to determine the survival benefit that HACE must confer to meet three thresholds of cost-effectiveness. MATERIALS AND METHODS A spreadsheet model was used to estimate the marginal direct cost of HACE compared with palliative care from a payer's perspective. Medicare reimbursement amounts represented costs, while probabilities of reembolization and complications were obtained from records of patients who underwent HACE. Marginal cost-effectiveness was calculated from marginal direct cost by varying the survival benefit of HACE compared with palliative care from 0 to 24 months. Break-even analyses were conducted to determine the survival benefit at which the cost-effectiveness of HACE would decrease below three threshold values derived from a literature review. RESULTS The marginal cost-effectiveness of HACE compared with palliative care, given survival benefits of 3, 6, and 12 months, was $82,385, $41,193, and $21,045 per life-year (LY) gained, respectively. Cost-effectiveness thresholds of $20,000 (strict), $50,000 (moderate), and $100,000 (generous) per LY gained required survival benefits of 12.63, 4.94, and 2.47 months, respectively, more than the expected baseline. CONCLUSION The cost-effectiveness of HACE for the treatment of CLM varies considerably according to the anticipated survival benefit. Results of future randomized controlled trials must demonstrate a survival benefit of nearly 5 months for HACE to meet the moderate cost-effectiveness standard of $50,000 per LY gained.
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Affiliation(s)
- R G Abramson
- Harvard Medical School, Boston, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Abstract
PURPOSE Central venous catheters (CVC) may fail for many reasons, though "fibrin sheaths" blocking catheter ports are usually implicated. We examined the sheaths removed from dialysis catheters to determine their histopathology. METHODS Ten catheter strippings were performed and the removed material was studied grossly and microscopically. RESULTS The histologic specimens showed thrombus both with and without a proteinaceous sheath. CONCLUSION Dialysis catheters fail because of thrombus formation. This can occur in either the absence or presence of a protein coating on the catheter, the so-called "fibrin sheath."
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Affiliation(s)
- J N Suojanen
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA 02215, USA
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Affiliation(s)
- D P Brophy
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
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35
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Affiliation(s)
- D J Rabkin
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
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36
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Abstract
Fifteen iatrogenic femoral pseudoaneurysms failed ultrasonography (US)-guided compression treatments. Despite concomitant antiplatelet or anticoagulation treatment, the 15 pseudoaneurysms were successfully and definitively treated without complication with US-guided thrombin injection. Results in this preliminary study suggest US-guided thrombin injection is a safe, expeditious, low-cost, and comfortable definitive treatment for femoral pseudoaneurysms that has advantages over both US-guided compression and open surgical repair.
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Affiliation(s)
- D P Brophy
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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37
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Li W, Brophy DP, Chen Q, Edelman RR, Prasad PV. Semiquantitative assessment of uterine perfusion using first pass dynamic contrast-enhanced MR imaging for patients treated with uterine fibroid embolization. J Magn Reson Imaging 2000. [DOI: 10.1002/1522-2586(200012)12:6<1004::aid-jmri27>3.0.co;2-%23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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38
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Shibata D, Brophy DP, Gordon FD, Anastopoulos HT, Sentovich SM, Bleday R. Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension. Dis Colon Rectum 1999; 42:1581-5. [PMID: 10613477 DOI: 10.1007/bf02236211] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE In the setting of hepatic failure and portal hypertension, hemorrhage from stomal and rectal varices is a well-described problem. It has recently been suggested that transjugular intrahepatic portosystemic shunting may be useful in the therapy of bleeding from parastomal or anorectal varices in patients unresponsive to conservative therapy. METHODS We retrospectively review our institution's experience of five patients with parastomal varices and seven patients with anorectal varices who underwent transjugular intrahepatic portosystemic shunting for hemorrhage refractory to conservative management between 1994 and 1998. RESULTS The study group consisted of four Child's A, five Child's B, and three Child's C patients. The mean age of the patients was 60.3 (range, 37-85) years. Mean follow-up was 15 (range, 5-27) months. The mean portosystemic pressure gradient before transjugular intrahepatic portosystemic shunting was 17.4+/-3.1 mm Hg. After transjugular intrahepatic portosystemic shunting, the mean portosystemic pressure gradient was reduced to 5.8+/-1.8 mm Hg (P<0.05). Transjugular intrahepatic portosystemic shunting were successful in complete resolution of bleeding in all patients. Three patients had encephalopathic changes after transjugular intrahepatic portosystemic shunting. Two patients died within 30 days of transjugular intrahepatic portosystemic shunting of causes unrelated to the procedure. Four patients required shunt revision within one year of placement. CONCLUSION The transjugular intrahepatic portosystemic shunting procedure is an effective modality in the therapy of cirrhotic patients with bleeding stomal or anorectal varices unresponsive to conservative management. There is an acceptable procedure-related morbidity and mortality.
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Affiliation(s)
- D Shibata
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Affiliation(s)
- R G Sheiman
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Hartnell GG, Gates J, Stuart K, Underhill J, Brophy DP. Hepatic chemoembolization: effect of intraarterial lidocaine on pain and postprocedure recovery. Cardiovasc Intervent Radiol 1999; 22:293-7. [PMID: 10415218 DOI: 10.1007/s002709900391] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine if intraarterial lidocaine reduces pain during and after chemoembolization, and whether it influences postprocedure recovery. METHODS Two patient cohorts undergoing selective hepatic chemoembolization were compared. Chemoembolization was performed without lidocaine (control group) in 27 patients and intraarterial lidocaine was used (lidocaine group) in 29 similar patients. Objective changes in patient management were assessed. Pain reduction in 31 more procedures with lidocaine (total 60) was assessed and related to tumor type. RESULTS During chemoembolization, intraarterial lidocaine reduced the need for additional intravenous analgesics from 69% to 19%. After chemoembolization the mean Dilaudid dose in the first 24 hr was reduced from 9.5 mg to 4.15 mg; accordingly, the mean length of hospital stay was reduced from 67.5 to 53.5 hr. During the day of chemoembolization, the mean oral fluid intake increased from 420 ml (control group) to 487 ml (lidocaine group); the percentage of patients taking solid food on the day of chemoembolization increased from 3% to 43%. CONCLUSION Intraarterial lidocaine during chemoembolization reduces the severity and duration of pain after chemoembolization resulting in faster recovery thus reducing the length of hospitalization.
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Affiliation(s)
- G G Hartnell
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Road, Boston, MA 02215, USA
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Brophy DP, Patel SA. Optimal digital subtraction angiography of dorsalis pedis artery: effect of foot positioning on angiographic demonstration. J Vasc Interv Radiol 1999; 10:376-7. [PMID: 10102207 DOI: 10.1016/s1051-0443(99)70048-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Brophy DP, Hartnell GG, McEniff NJ. Re: Percutaneous treatment of a symptomatic brachiocephalic artery stenosis with a Palmaz stent. Cardiovasc Intervent Radiol 1997; 20:405-6. [PMID: 9271658 DOI: 10.1007/s002709900180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Eustace JA, Brophy DP, Gibney RP, Bresnihan B, FitzGerald O. Comparison of the accuracy of steroid placement with clinical outcome in patients with shoulder symptoms. Ann Rheum Dis 1997; 56:59-63. [PMID: 9059143 PMCID: PMC1752250 DOI: 10.1136/ard.56.1.59] [Citation(s) in RCA: 191] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the effect of accuracy on the clinical outcome of local steroid injections to the shoulder. METHODS 37 patients with shoulder symptoms of at least two months' duration received local injections of a mixture of triamcinolone and radiographic contrast material using a standardised technique. Radiographs of the joint were taken immediately afterwards. Details of the patients' symptoms (assessed by visual analogue scales) and range of movement at the joint were obtained before and two weeks after the injection. At follow up the patients were also assessed by means of a five point global rating scale of maximum and current benefit. RESULTS 14 of the 38 procedures (37%) were judged to be accurately placed: four of the 14 attempted subacromial injections (29%) and 10 of the 24 attempted glenohumeral injections (42%). There were significant differences in relation to outcome between the accurately placed and the inaccurately placed groups. CONCLUSIONS Accuracy of steroid placement by injection in patients with shoulder symptoms may significantly affect the clinical outcome.
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Affiliation(s)
- J A Eustace
- Department of Rheumatology, St Vincent's Hospital, Dublin, Ireland
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Abstract
Magnetic resonance (MR) images of five patients with acute tibial plateau fractures are presented and correlated with both clinical examination and findings at surgical intervention. The role of MR imaging in the evaluation of both osseous and soft tissue deformity in acute trauma, specifically in patients with tibial plateau fractures is discussed. The value of MR imaging as an alternative to computed tomography and arthroscopic evaluation of these patients is emphasized.
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Affiliation(s)
- D P Brophy
- Boston Medical Center, Boston University, MA 02118, USA
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Abstract
The authors examined the role of ultrasound (US) in diagnosis and management of heel pain in chronic inflammatory arthritis. Nineteen patients underwent US examination. Eight patients (2 with previously unsuccessful nonguided injections), had 11 US-guided corticosteroid injections for treatment of retrocalcaneal bursitis (n = 6), plantar fasciitis (n = 3), and posterior tibial tenosynovitis (n = 2). US-demonstrated Achilles tendon rupture (n = 2), Achilles tendinitis (n = 8), posterior tibial tenosynovitis (n = 6), peroneus longus tenosynovitis (n = 2), retrocalcaneal bursitis (n = 13), and plantar fasciitis (n = 4). Loss of smooth bone contour (n = 13) correlated with bone erosions on plain radiographs in all but one case. Ten of 11 guided injections resulted in full resolution of heel pain. The diverse causes of heel pain are highlighted, and the ability of US to provide information with management implications is confirmed. US-guided corticosteroid injection is beneficial, especially after failure of nonguided injection.
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Affiliation(s)
- G Cunnane
- University Department of Rheumatology, University College Dublin, St. Vincent's Hospital, Ireland
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Abstract
PURPOSE To examine the value of real-time ultrasonography (US) in the assessment of traumatized eyes with opaque ocular media. MATERIALS AND METHODS Sixty-one eyes in 60 patients were prospectively examined with US; findings were correlated with findings of clinical and surgical follow-up. Patients with an intraocular foreign body (IOFB) also underwent computed tomography (CT). RESULTS US demonstrated 56 vitreous hemorrhages, 21 retinal detachments, 12 vitreous detachments, five choroidal detachments, seven IOFBs, three dislocated lenses, and two retrohyaloid hemorrhages. Findings of US and surgery or clinical follow-up were in complete concurrence in 55 cases (90%) and partial concurrence in two cases (3%). US findings were incorrect in four cases (7%). In four cases, US allowed diagnoses that were unsuspected clinically. CONCLUSION US accurately demonstrates ocular damage and may reveal unsuspected problems. US was superior to CT in demonstration of intraocular damage associated with IOFBs, although CT was superior in determination of the size and site of the IOFB. The presence of dense vitreous traction bands may indicate impending retinal detachment.
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Affiliation(s)
- M M McNicholas
- Department of Radiology, Saint Vincent's Hospital, Dublin, Ireland
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Brophy DP, Cunnane G, Fitzgerald O, Gibney RG. Technical report: ultrasound guidance for injection of soft tissue lesions around the heel in chronic inflammatory arthritis. Clin Radiol 1995; 50:120-2. [PMID: 7867262 DOI: 10.1016/s0009-9260(05)82995-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe the use of ultrasound guidance for local steroid injection of the retrocalcaneal bursa and the tibialis posterior tendon sheath in patients with chronic inflammatory arthropathy. Ultrasound guidance may be the injection technique of choice but is particularly indicated for patients with lesions unresponsive to injections guided by palpation.
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Affiliation(s)
- D P Brophy
- University Department of Radiology, University College Dublin, St Vincent's Hospital, Ireland
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Abstract
High-frequency ocular sonography is the ideal method for imaging the eye and intraocular structures. In the presence of opaque ocular media, a complete view of the fundus may be impossible ophthalmoscopically, and in these cases sonography is invaluable. Although high field strength MR imaging with surface coils provides excellent detail of normal and pathologic ocular structures, major shortcomings are lack of spatial resolution and poor specificity with certain lesions. Sonography is superior to CT or MR imaging in detecting ocular lesions such as small melanomas that are 2 mm or less in thickness. The eye can be examined dynamically during eye movements, which is of value in localizing abnormalities. The sonographic appearance of a variety of ocular pathologic conditions is illustrated in this essay.
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Affiliation(s)
- M M McNicholas
- Department of Radiology, University College Dublin, Ireland
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