Interventional radiology in children with hepatobiliary rhabdomyosarcoma

A patient presented with severe bactrim-induced neutropenia with a reversed CD4+/CD8+ lymphocyte ratio. R-metHUG-CSF at 300 micrograms daily produced a dramatic neutrophil response and the therapy was discontinued after 2 weeks.     

Interventional radiology in postoperative recurrent goiter

Roentgeno-endovascular functional thyroidectomy was used to suppress the pathological activity of the thyroid in postoperative recurrent goiter. The method consists in vascular isolation of hyperplastic stump of the thyroid by catheterization of the left and right thyroid arteries, followed by their material occlusion. For embolization, a wide spectrum of nonlysed synthetic, organic, and inorganic materials were used. The results of roentgeno-endovascular functional thyroidectomy in 14 patients with postoperative recurrent goiter are analyzed. The advantages of roentgeno-endovascular occlusion of the thyroid arteries before subtotal thyroidectomy are emphasized. A stabile clinical and hormonal remission and reduction of the thyroid in size to stage 1 were observed during three years following roentgeno-endovascular intervention.     

Interventional radiology in the acute pediatric abdomen

This article addresses the most common types of interventional procedures performed in the pediatric abdomen. Nonvascular interventions are stressed because they are more common than vascular interventions.     

Interventional radiology in the treatment of pulmonary embolism

Percutaneous therapy of pulmonary embolism is performed by local administration of thrombolytic agents or by mechanical canalization. The latter is achieved by fragmentation of the embolus with angiographic catheters, or by aspiration or fragmentation of the thrombus with dedicated devices. The pharmacologic basis of locoregional administration of thrombolytic agents, as in the treatment of deep vein thrombosis, is the possibility of reaching a higher concentration of the drug at the level of the embolus by decreasing the activity of systemic fibrinolysis, thus lowering the incidence of hemorrhagic complications. In recent years, locoregional thrombolytic therapy has been used only combined with mechanical canalization. The easiest way is direct fragmentation of the embolus with an angiographic catheter. The system of aspiration of pulmonary emboli, experimented by Greenfield is based on the use of a flexible catheter the tip of which is equipped with a plastic radiopaque cup. Recently, several rotating devices have been designed. Some have already been used for the peripheral arterial system, others are specific for the venous system (Schmitz-Rode-Gunther device). The clinical effectiveness of these devices is however still to be assessed. Other non conventional possibilities for the mechanical canalization of pulmonary arterial system are represented by metal stents and angioplasty with balloon catheters. At present, interventional radiologic procedures represent an additional tool in the medical or surgical therapy of severe pulmonary embolism, when it is contraindicated or ineffective.     

Interventional radiology in central venous obstructions. Dilatation--stent implantation--thrombolysis

PURPOSE: Venous congestion of the superior or inferior caval system has to be considered as a medical emergency. The results of various recanalization procedures and their utility are analyzed. PATIENTS AND METHODS: 176 patients with superior and 28 with inferior caval obstruction were treated with Gianturco-Z (n = 39) and Wall Stents (n = 207) respectively. Balloon venoplasty was performed prior to stent implanation. In 27 cases, local thrombolysis with urokinase was employed. RESULTS: Interventional procedures were successful in 198 and without success in 6 patients. In most patients, symptoms were relieved during or early after recanalization. No major complications were found. DISCUSSION: Balloon angioplasty with stent placement and local thrombolysis are successful in the treatment of superior and inferior caval obstruction. Self-expanding Wallstents are superior to Gianturco-Z-stents. Oncologists should be made familiar with this type of treatment.     

Interventional radiology in the treatment of primary and metastatic liver cancer

The data available in the literature and the authors' own treatment outcomes in 600 patients with primary and metastatic carcinoma of the liver (in 1983-1996) were analyzed. Systemic or intravascular therapy as regional drug infusion, embolization, chemoembolization of the hepatic artery (CEHA) and portal vein (CEPV) was performed in unresectable cases. Whether pre- and postoperative chemoembolization was evaluated in resectable tumors. It is concluded that X-ray endovascular interventions play an important role in the treatment of malignant hepatic tumors. Transcatheter CEHA alone and in combination with CEPV is the most effective current treatments of unresectable carcinoma of the liver. In some patients, preoperative CEHA makes it possible to remove the tumor previously considered to be unresectable. Resection in combination with adjuvant CEHA and CEPV reduces the incidence of postoperative recurrences. The combined approach to treating malignant hepatic neoplasms expands the possibilities of delivering care to patients and improving late outcomes.     

Interventional radiology for the non-surgical removal of sialoliths

OBJECTIVES: To clarify the usefulness and limitations of interventional radiology for sialolithiasis. METHODS: Sixteen patients (5 with parotid and 11 with submandibular sialolithiasis) were treated with a stone retrieval catheter (Dormia basket) under fluoroscopy. Digital subtraction sialography (DSS) and direct digital dental imaging (RVG) were performed in addition for 11 of the cases (DSS for 7 and RVG for 4 cases). RESULTS: The sialolith was successfully removed in 10 cases. DSS and RVG were useful. Four cases failed because the stone was adherent to the ductal wall and two because the catheter could not reach the stone because of the ductal anatomy. CONCLUSION: Interventional radiology is less invasive than surgical treatment and is the recommended first choice for treatment in the majority of cases of sialolithiasis.     

Somatostatin immunoreactivity in bone and joint tissues

Using immunoelectron microscopy we have investigated the presence of somatostatin in normal bone and joint tissues. We observed somatostatin labeling in the myelinated nerve fibers of the periosteum, the bone marrow cells and in the mature bone matrix but only slightly in the synovial cells. Quantification of somatostatin in bone tissue by radioimmunoassay showed highest levels in bone marrow followed by periosteum and cortical bone. These findings suggest a role for somatostatin in bone and joint physiology.     

Role of radiology in the diagnosis of joint chondrocalcinosis. Calcium pseudogout

Chondrocalcinosis is a really frequent clinicopathologic entity, which is caused by the penetration of calcium pyrophosphate dihydrate microcrystals into the structures of the joint, including hyaline cartilages and fibrocartilages--hense its name--as well as the synovial fluid and membrane. Calcium gout, which preferentially appears in the knees, is the most spectacular and characteristic symptom of chondrocalcinosis, expressing a crisis of acute microcrystal synovitis, of which it has all the usual clinical features, and thus simulating uratic gout. The positive diagnosis is based on: a) the radiologic demonstration of articular calcifications in the lining cartilages, forming a continuous or fragmented opaque border on the subchondral bone, from which it is separated by a light space, and/or in the fibrocartilaginous structures (most often the menisci, the symphysis pubis, the disk of the inferior radioulnar joint) where they appear as small, irregular clusters with blurred or cloudy margins. The knee is the most frequent site of calcium impregnation images, both in hyaline cartilages and in fibrocartilages. b) the presence of calcium pyrophosphate microcrystals in the synovial fluid; their nature is usually demonstrated convincingly enough with a conventional light microscope; c) needle biopsy findings of microcrystalline clusters embedded in the synovial membrane, that can be easily identified with routine staining. In practice, demonstrating radiologic signs, when these are characteristic and can be detected in their preferred sites, allows recognizing diffuse chondrocalcinosis in satisfactory safety conditions after a calcium gout crisis, as well as in the presence of the many atypical or misleading symptomatic aspects of this microcystal arthropathy, that will be the subject of a further paper.     

CT在腕骨、踝关节骨折检查中的价值研究

目的:研究腕骨和踝关节骨折CT检查的价值.方法:采用回顾方式分析相关的16例腕骨、踝骨骨折病例的CT资料.结果:全部病例CT检查全部阳性,典型表现为骨皮质掀起,有骨质中断现象.结论:CT在诊断腕骨、踝骨骨折中有重要的价值.