Comparison of fluoroscopic operator eye exposures when working from femoral region, side, or head of patient.

Operator radiation exposure is an important occupational hazard compounded over the course of an interventional radiologist's career. This study compared operator radiation dose to the eye and head for different positions around the patient. Compared with cases performed from the femoral region, exposures were 1.

Benign endobronchial granular cell tumor resulting in right middle lobe collapse.

Granular cell tumors (GCTs) are generally benign neoplastic tumors of neural origin that have little malignant potential. These tumors may occur in any location, including the tracheobronchial tree. Although an endobronchial location is believed to represent a small percentage of cases, GCTs should be included in the differential considerations of any endobronchial lesions leading to airway collapse.

Endovascular caudal retraction of the cranial end of a misplaced Viatorr TIPS prior to liver transplantation.

Transjugular intrahepatic portosystemic shunt (TIPS) extension far into the inferior vena cava (IVC) or the right atrium may complicate or preclude orthotopic liver transplantation depending on the space available for placement of a hemostatic clamp in the suprahepatic IVC. Until 2004, most TIPS were performed with bare metal stents, which integrate into the vessel wall, making percutaneous or intraoperative repositioning uncertain. Most TIPS are currently created with stent grafts that have an outer fabric to increase shunt patency and prevent endothelial ingrowth.

Determination of minimum effective height of transparent radiation face shielding for fluoroscopy.

During interventional procedures, the vast majority of scatter radiation originates from the patient and table and travels in all directions in straight lines. Because the operator's head is much higher than the patient and at an angle upward and to the side of the patient (not directly above), the scatter received by the operator's head is projected in an upward angle. Thus a face shield could potentially be lower than the object it is shielding, e.

Comparison of a suspended radiation protection system versus standard lead apron for radiation exposure of a simulated interventionalist.

Purpose: To evaluate the radiation protective characteristics of a system designed to enhance operator protection while eliminating weight to the body and allowing freedom of motion.

Materials And Methods: Radiation doses to a mock interventionalist were measured with calibrated dosimeters in a clinical interventional suite. A standard lead apron (SLA; Pb equivalent, 0.

Left colic artery pseudoaneurysm from pancreatitis presenting as upper gastrointestinal hemorrhage.

Visceral pseudoaneurysms resulting from pancreatitis occur in approximately 10% of cases. The present report describes a left colic artery pseudoaneurysm from pancreatitis presenting with active duodenal bleeding. Based on the clinical and endoscopic demonstration of duodenal bleeding, celiac and superior mesenteric arteriograms were initially obtained, and their findings were negative.

Transjugular intrahepatic portosystemic shunt creation for recurrent gastrointestinal bleeding during pregnancy.

Treatment of bleeding esophageal varices during pregnancy is a rare clinical dilemma. Primary therapy remains endoscopy and band ligation. Refractory variceal hemorrhage treated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure potentially exposes the fetus to radiation.

High-frequency percussive ventilation with systemic heparin improves short-term survival in a LD100 sheep model of acute respiratory distress syndrome.

We undertook an assessment of high-frequency percussive ventilation (HFPV) and systemic heparin on survival in our LD100 sheep model of smoke/burn-induced acute respiratory distress syndrome (ARDS). This was a prospective controlled outcomes study in a large animal critical care laboratory. ARDS was induced in 13 sheep by a combination of 48 cotton smoke breaths and 40% full-thickness cutaneous burn (LD100) followed by mechanical ventilation (15 ml/kg tidal volume).

Imaging of bilateral ureteropelvic junction laceration from blunt trauma.

Bilateral ureteropelvic junction (UPJ) injury from blunt abdominal trauma is rare, with only seven previously reported cases, all of which were complete avulsions. Early and delayed computed tomography (CT) for visualization of the nephrographic and excretory renal phases, respectively, is essential to distinguish parenchymal from collecting system injury. Once UPJ injury is detected by CT, differentiation between laceration and avulsion is mandatory since laceration is treated nonoperatively, whereas avulsion requires surgical repair.

St Thomas Hospital Cardioplegia #2 fails to suppress slow reaction pacemaker cell electrical activity.

Background: Inadequate right atrial myocardial preservation during cardioplegic arrest may promote postoperative supraventricular arrhythmias (SVA). We determined (1). if oxygenated St.

Transthoracic image-guided biopsy of lung nodules: when is benign really benign?

Purpose: A pathologic diagnosis of malignancy by image-guided transthoracic fine needle aspiration (FNA) with or without (+/-) core biopsy is definitive. However, a benign diagnosis of a lung nodule by FNA +/- core biopsy presents a management dilemma of resection for confirmation versus follow-up imaging and/or medical treatment. We propose three separate pathologic categories of benign diagnosis after FNA +/- core biopsy: (i) benign specific (ie, aspergillosis); (ii) benign nonspecific (ie, fibrosis); and (iii) nondiagnostic.

Percutaneous retrieval of chronic intravascular foreign bodies.

To evaluate the feasibility of intravascular retrieval of chronic foreign bodies, we retrospectively reviewed an 8 year experience (1993-2001) of percutaneous retrieval of chronically retained intravascular foreign bodies (n = 6). In 6 of 6 cases (4 catheter fragments, 2 guidewires), 5-90 days elapsed before retrieval via the femoral or internal jugular vein. Under fluoroscopy, we determined the foreign body's course, position and size.

Short term performance evaluation of a perfluorocopolymer coated gas exchanger for arteriovenous CO2 removal.

A new perfluorocopolymer coating for micropore hollow fiber gas exchangers was developed to improve gas exchange, reduce plasma leakage, and reduce blood-surface interactions. The present authors evaluated gas exchanger performance using this new coating in a prospective, randomized, controlled, unblinded, large animal model of CO2 retention. Adult sheep (30-40 kg), under general anesthesia, underwent cannulation of the carotid artery (12 F) and jugular vein (14 F).

The effect of the Varian amorphous silicon electronic portal imaging device on exit skin dose.

Measurements have been made of the increase in exit surface dose resulting from backscattered radiation generated by the Varian amorphous silicon electronic portal imaging device (EPID). An increase of < or = 14% was demonstrated at both 6 MV and 10 MV, in a manner which suggests that backscatter from the EPID acts to re-establish electronic equilibrium at the exit surface, normally absent in the build-down region. The magnitude of this effect was influenced by field size, measurement depth and exit surface to EPID distance.

Toward ambulatory arteriovenous CO2 removal: initial studies and prototype development.

Extracorporeal arteriovenous carbon dioxide removal (AVCO2R) using percutaneous cannulae and a low resistance gas exchanger achieves near total CO2 removal, allowing lung rest and potentially improving survival. AVCO2R, redesigned to allow ambulation, has potential as treatment for severe chronic obstructive pulmonary disease or rehabilitation before lung transplant. The purposes of this study were to 1) determine the optimal ambulatory access for AVCO2 removal and 2) develop a prototype Ambulatory-AVCO2R gas exchanger.

Postthoracotomy pain management.

The following techniques appear efficacious in controlling postthoracotomy pain and reducing the amount of systemic opioids consumed: continuous intercostal blockade, paravertebral blockade, and epidural opioids and/or anesthetics. The combination of thoracic epidural opioid and local anesthetic is very effective at relieving postthoracotomy pain, however, considerable experience is required for insertion of the thoracic epidural catheter and postoperative respiratory monitoring. Intercostal and paravertebral catheters can be inserted intraoperatively under direct visualization, to reduce complications of insertion.

Thoracic imaging in the ICU. Interventional radiology.

Radiology in the intensive care unit (ICU) patient is dominated by plain x-rays, with noteworthy findings prompting further imaging and possible intervention. This chapter discusses interventional and minimally invasive techniques used to treat pleural, mediastinal and pulmonary parenchymal problems commonly encountered in the ICU.

Salinoma window technique for mediastinal lymph node biopsy.

Computed tomographic-guided transthoracic needle biopsy can access virtually all mediastinal lymph node stations, but is limited by the potential for pneumothorax and bleeding. To avoid these possible complications, the extrapleural "salinoma" technique was used for computed tomographic-guided mediastinal biopsies in 15 patients. Sampling methods were coaxial (8), tandem (5), and single pass (2).

Malignant eccrine acrospiroma with metastasis to the parotid.

Malignant eccrine acrospiromas are rare. Clinically, they resemble other cutaneous lesions. A high index of suspicion must be maintained in cases of histologically benign eccrine acrospiromas for three reasons: (1) malignant transformation can occur, (2) the presence of both benign and malignant tissue can lead to a false-negative diagnosis if only the benign component is obtained in the biopsy specimen, and (3) benign-appearing tumors can recur locally or metastasize.

Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy?

Study Objectives: Primary assessment of mediastinal lymph nodes (N2 or N3) for staging lung cancer by transthoracic needle with or without core biopsy. Mediastinoscopy only performed after FNA failed to yield a diagnosis.

Design And Settings: A retrospective study in a university setting.

Arterio-venous CO2 removal (AVCO2R) perioperative management: rapid recovery and enhanced survival.

Percutaneous arteriovenous CO2 removal (AVCO2R) uses a simple arteriovenous (A-V) shunt for near-total CO2 removal that allows significant reductions in minute ventilation. We critically reviewed our algorithm-directed perioperative anesthesia management in our LD40 ovine smoke-burn injury model of acute respiratory distress syndrome (ARDS) treated with AVCO2R. General anesthesia is required for: (1) Vascular access followed by ARDS model development by smoke insufflation (36 breaths) plus 40% TBSA III degrees burn with mechanical ventilation.