Hypersplenism in liver disease and SLE revisited: current evidence supports an active rather than passive process.

Background: Active and passive theories have been advanced to explain splenomegaly and cytopenias in liver disease. Dameshek proposed active downregulation of hematopoiesis. Doan proposed passive trapping of blood components in a spleen enlarged by portal hypertension.

Ultrasound guided ureteroscopy for the definitive management of ureteral stones: a randomized, controlled trial.

Purpose: Ureteroscopy is central to the surgical management of ureteral stones. Fluoroscopy is conventionally used for intraoperative guidance, although there is growing effort to decrease the exposure of patients and staff to ionizing radiation. We developed a radiation-free approach to ureteroscopy using ultrasound guidance to manage ureteral stones.

Evaluation of the Pericardium with CT and MR.

The pericardium plays an important role in optimizing cardiac motion and chamber pressures and serves as a barrier to pathology. In addition to pericardial anatomy and function, this review article covers a variety of pericardial conditions, with mention of potential pitfalls encountered during interpretation of diagnostic imaging. Normal and abnormal appearance of pericardium on CT and MR imaging is emphasized, including dynamic imaging correlates of pericardial pathophysiology.

Single-institution results of image-guided nonplugged percutaneous versus transjugular liver biopsy.

Purpose: To retrospectively review patients who underwent transjugular and image-guided percutaneous biopsy and compare the relative risk of ascites, thrombocytopenia, and coagulopathy.

Materials And Methods: From August 2001 through February 2006, a total of 238 liver biopsies were performed. The radiologist reviewed all patient referrals for transjugular biopsy.

Complication rates and outcomes of 536 implanted subcutaneous chest ports: do rates differ based on the primary operator's level of training?

Rationale And Objectives: Totally implanted subcutaneous central venous access devices (chest ports) are an attractive option for patients in need of intermittent, recurrent venous access. In our department, these are placed by different operator types including interventional radiology (IR) attending physicians, dedicated IR nurse practitioners (NP), and IR fellows/radiology residents. The purpose of our study is to assess the rate of complications of subcutaneous chest port placement among the different operator types.

Implantable subcutaneous venous access devices: is port fixation necessary? A review of 534 cases.

Conventional surgical technique of subcutaneous venous port placement describes dissection of the port pocket to the pectoralis fascia and suture fixation of the port to the fascia to prevent inversion of the device within the pocket. This investigation addresses the necessity of that step. Between October 8, 2004 and October 19, 2007, 558 subcutaneous chest ports were placed at our institution; 24 cases were excluded from this study.

Summation of CT scans during radiofrequency ablation for assessing target lesion coverage.

Objective: In radiofrequency ablation of lesions that require probe repositioning, distinguishing between treated and untreated regions can be difficult. We describe a method of using existing CT equipment to summate images of a current probe placement with those of earlier placements or scans of transiently enhancing targets.

Conclusion: Summation of CT scans during radiofrequency ablation involving multiple probe placements is feasible and results in a better appreciation of probe positioning relative to the target lesion.

Sclerosis of postoperative lymphoceles: avoidance of prolonged catheter drainage with use of a fibrin sealant.

Purpose: To review experience with fibrin-based tissue sealant sclerosis of postsurgical lymphoceles at a single institution.

Materials And Methods: Fifteen patients who presented with postsurgical lymphoceles were treated with injection of fibrin tissue sealant. Procedures were performed under fluoroscopic and sonographic guidance.

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients.

Objective: Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques.

Methods: Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed.

Dialysis needle puncture of Wallgrafts placed in polytetrafluoroethylene hemodialysis grafts.

This study evaluates the effect of routine venipuncture at hemodialysis on the durability of Wallgraft covered stents. Thirteen covered stents were placed in six aging, failing polytetrafluoroethylene grafts for treatment of pseudoaneurysms and recurrent stenoses. Four patients did not experience significant graft complications.

Liver biopsy 2005: when and how?

Clinical imaging and serologic testing are increasingly replacing biopsy for diagnosing hepatic diseases. However, more biopsies are being done to stage and grade hepatitis C and fatty liver disease, to diagnose space-occupying lesions (typically with fine-needle aspiration biopsy), and to assess response to therapy. If biopsy is planned, it is important to evaluate its indications and risks and, if other physicians are involved, who is responsible for what.

Utility of covered stents for revision of aging failing synthetic hemodialysis grafts: a report of three cases.

Three aging failing hemodialysis polytetrafluoroethylene bypass shunts, average age 44 months, previously percutaneously revised with balloon angioplasty, presented with pseudoaneurysms and recurrent thrombosis. All were treated with percutaneous covered stent placement within their affected limbs. One graft was ligated 1 month after treatment for infected overlying skin ulcer, though this graft was subsequently surgically revised with interposition graft and the covered stent portion remains functional at 19 month follow-up.