Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication.

Objective: The purpose of this study was to compare the diagnostic performance of four radiographic signs of gastric band slippage: abnormal phi angle, the "O sign," inferior displacement of the superolateral gastric band margin, and presence of an air-fluid level above the gastric band.

Materials And Methods: A search of the electronic medical record identified 21 patients with a surgically proven slipped gastric band and 63 randomly-selected asymptomatic gastric band patients who had undergone barium swallow studies. These studies were evaluated for the four signs of band slippage by two independent radiologists who were blinded to clinical data.

Review of outside studies by radiology residents: national survey of chief residents.

The purpose of this study was to establish practice patterns of radiology residents in regards to interpretation and reporting of outside studies for transferred patients. We performed a national survey of radiology residency chief residents, administered by email through the Association of Program Directors in Radiology (APDR). There were 81 chief resident respondents, representing 42.

Injuries from ingesting wire bristles dislodged from grill-cleaning brushes--Providence, Rhode Island, 2009-2012.

Foreign object ingestion is a common reason for visiting an emergency department; however, wire grill-cleaning brush bristles are an uncommon foreign object. This report describes a series of twelve cases identified in a single hospital system from July 2009 through June 2012. Patients included six males and six females; ages ranged from 11 to 75 (mean: 47 years).

Prevalence and nature of excluded findings at reduced scan length CT angiography for pulmonary embolism.

Background: Scan length reduction effectively decreases radiation dose at CT pulmonary angiography (CTPA) for pulmonary embolism (PE) but may exclude important incidental scan findings.

Objective: We aimed to determine the prevalence and nature of excluded findings with the use of reduced scan length CTPA.

Methods: We reviewed 335 consecutive emergency department CTPA studies performed on 16- or 64-detector row scanners with the use of a standard scan range.

Scan length optimization for pulmonary embolism at CT angiography: analysis based on the three-dimensional spatial distribution of 370 emboli in 100 patients.

Aim: To determine the size and three-dimensional spatial distribution of pulmonary emboli (PE) at computed tomography angiography (CTA) to optimize the scan length.

Materials And Methods: Two experienced radiologists jointly reviewed 100 consecutive, positive PE CTA studies performed in the Emergency Department (53 women; age 61±17 years). All studies were conducted on a 16-detector row CT machine.

Do emergency physicians use serum D-dimer effectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients.

Objective: The purpose of our study was to investigate whether D-dimer screening is being used effectively to determine the need for MDCT in diagnosing acute pulmonary embolism (PE) in emergency department patients.

Materials And Methods: We performed a retrospective review of all patients who underwent D-dimer testing or MDCT in the emergency department from January 1, 2003, through October 31, 2005. A D-dimer value of > 0.

Utilization patterns and diagnostic yield of 3421 consecutive multidetector row computed tomography pulmonary angiograms in a busy emergency department.

Objective: To compare examination volume and diagnostic yield of computed tomography (CT) pulmonary angiography (CTPA) and ventilation-perfusion (V/Q) scintigraphy for detection of suspected pulmonary embolism (PE) in emergency department patients.

Methods: Every CTPA and V/Q scan result for emergency department patients between October 2001 and September 2005 were reviewed. Patients with prior PE and follow-up examinations were excluded.

Outcomes in 74 patients with an appendicolith who did not undergo surgery: is follow-up imaging necessary?

The objective of this study was to report the clinical outcome of patients with an appendicolith on computed tomography (CT) who did not undergo appendectomy on initial presentation. Reports from 45,901 abdominal CT examinations performed between March 2000-March 2004 containing the words "appendicolith" or "fecalith" were identified. Patients with appendicoliths not initially undergoing appendectomy were followed to assess re-presentation with abdominal pain ultimately requiring appendectomy.

Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries.

Background: In light of their potential for devastating consequences, a liberalized screening approach for blunt cerebrovascular injuries (BCVI) is becoming increasingly accepted. The gold standard for diagnosis of BCVI is arteriography (ART), but noninvasive diagnostic alternatives offer clear advantages. Prospective comparative studies found that computed tomographic angiography (CTA) was unreliable in detecting BCVI.

Fibrin sheath stripping versus catheter exchange for the treatment of failed tunneled hemodialysis catheters: randomized clinical trial.

Purpose: To compare the effectiveness of two treatments for tunneled hemodialysis catheter malfunction: percutaneous fibrin sheath stripping (PFSS) and over-the-wire catheter exchange (EX).

Materials And Methods: Adult patients with poorly functioning tunneled hemodialysis catheters (flow rates < 200 mL/min) were randomly assigned to receive either PFSS or EX. Over the course of 20 months, 30 patients (37 encounters) referred to a single institution met the inclusion criteria and consented to participate.

Embolotherapy of large pulmonary arteriovenous malformations: long-term results.

Background: The purpose of this study was to document the long-term results of transcatheter embolotherapy of large pulmonary arteriovenous malformations (PAVMs).

Methods: From a data base of 221 consecutive patients with PAVMs treated by embolotherapy between 1978 and 1995, 45 patients with 52 PAVMs, supplied by feeding arteries 8 mm in diameter or larger, were selected for a retrospective investigation.

Results: Of 45 patients with 52 large PAVMs, 38 patients (84%) with 44 PAVMs (85%) were cured by the first embolotherapy (mean follow-up, 4.

Replacement of accidentally removed tunneled venous catheters through existing subcutaneous tracts.

Purpose: The authors describe their experience with reinsertion of accidentally removed tunneled venous catheters using existing subcutaneous tracts.

Materials And Methods: Replacement of 13 dislodged tunneled venous catheters was attempted a median of 12 hours (range, 3 hours to 5 days) after accidental removal. The catheters were needed for hemodialysis (n = 11), plasmapheresis (n = 1), or antibiotic therapy (n = 1).

Cost-effectiveness of stereotactic core needle biopsy: analysis by means of mammographic findings.

Purpose: To determine the cost savings of stereotactic core needle biopsy over open surgical biopsy in patient subgroups defined according to mammographic findings.

Materials And Methods: From July 1992 through February 1995, stereotactic core needle biopsy was performed in 356 women with 405 nonpalpable breast lesions (254 were masses and 151 were calcification). Lesions were classified according to mammographic finding, size, and level of suspicion.

Context bias. A problem in diagnostic radiology.

Objective: To determine whether radiologists' interpretations of images are biased by their context and by prevalence of disease in other recently observed cases.

Methods: A test set of 24 right pulmonary arteriograms with a 33% prevalence of pulmonary emboli (PE) was assembled and embedded in 2 larger groups of films. Group A contained 16 additional arteriograms, all showing PE involving the right lung, so that total prevalence was 60%.

Renal artery pseudoaneurysm after blunt abdominal trauma: case report and literature review.

Renal vascular injuries such as transection, thrombosis, dissection, and arteriovenous fistula formation are unusual but well-recognized consequences of blunt abdominal trauma. We discuss a rare case of renal artery pseudoaneurysm presenting 6 weeks after blunt abdominal trauma that was successfully treated with selective embolization.

The case for better research standards in peripheral thrombolysis: poor quality of randomized trials during the past decade.

Rationale And Objectives: We assessed how well published randomized controlled trials (RCTs) of peripheral thrombolysis have been designed and how they adjusted for patient characteristics that may influence responses to therapy.

Methods: RCT studies published between 1984 and 1994 were reviewed to determine whether they included nine crucial elements: sample size calculations, description of unenrolled eligible participants, homogeneous samples, balanced experimental groups, equal potency therapies, equal follow-up of outcomes, appropriate statistical inference, multivariable or subgroup analyses, and anonymous review of subjective endpoints.

Results: The nine RCTs complied with a median of three of nine standards (range = 2-6).

Complications of peripheral arteriography: a new system to identify patients at increased risk.

Purpose: The most quoted literature on arteriographic complications is based on self-reports collected during the mid 1970s. We sought to determine whether those results remain valid despite changes in arteriographic practice and whether patient subgroups at increased risk could be identified.

Methods: Five hundred forty-nine consecutive patients were examined after arteriography and twice over 72 hours.

Retrieval of intravascular foreign bodies: experience in 32 cases.

Objective: Recent reports suggest that both the nature of intravascular foreign bodies and the tools available to retrieve them have changed substantially in the past decade. We reviewed our recent experience with percutaneous retrieval of intravascular foreign bodies to determine the efficacy and safety of the procedure using currently available devices.

Materials And Methods: Between 1990 and 1994, we attempted retrieval of 35 intravascular foreign bodies in 32 patients.

Treatment of ureteral obstructions with the Wallstent endoprosthesis: preliminary results.

Purpose: To evaluate the efficacy of the Wallstent endoprosthesis in the treatment of ureteral strictures.

Patients And Methods: Wallstents with diameters of 10 mm were placed across five malignant and six benign ureteral strictures in eight patients. All patients were believed to have poor surgical options, and their strictures were being maintained with catheter drainage.

Peripheral vascular occlusive disease: accuracy and reliability of time-of-flight MR angiography.

Purpose: To determine the accuracy and reliability of magnetic resonance (MR) angiography for identification of stenosis and patent distal vessels in patients with peripheral vascular disease.

Materials And Methods: Two-dimensional time-of-flight MR angiography and conventional arteriography were performed in 22 patients. Four blinded radiologists independently graded multiple anatomic segments.

Clinical results of transvenous systemic embolotherapy with a neuroradiologic detachable balloon.

Purpose: To evaluate the efficacy of transvenous systemic embolotherapy with a neuroradiologic detachable balloon.

Materials And Methods: As part of a clinical trial, a detachable silicone balloon was used to occlude pulmonary arteriovenous malformations (PAVMs) in 35 patients and varicocele in 14 patients. In patients with PAVM, the indications for embolotherapy were prophylaxis against paradoxic embolization (n = 35) and dyspnea, fatigue, or both (n = 26); in patients with varicocele, they were pain or a discomforting lesion (n = 8) or infertility (n = 6).

Extension of saphenous thrombophlebitis into the femoral vein: demonstration by color flow compression sonography.

Five cases are presented in which compression and color flow sonography were used to diagnose extension of superficial saphenous thrombophlebitis into the deep system at the saphenofemoral junction. In one case thrombus originated in the calf, demonstrating an unusual mode of propagation into the deep venous system above the knee. Color Doppler imaging is especially helpful in diagnosing this complication of superficial thrombophlebitis.

Variance of the position of the cerebellar tonsils with age: preliminary report.

The position of the cerebellar tonsils relative to the foramen magnum was measured with sagittal magnetic resonance (MR) images in 221 patients aged 5 months to 89 years who were considered not to have disorders that would affect tonsillar position. All patients were grouped according to age. All measurements of the tonsils were obtained directly from the video console.

Transfemoral venous catheterization through inferior vena caval filters: results in seven cases.

Use of the transfemoral route for venous catheterization has been considered contraindicated in patients with inferior vena caval (IVC) filters. The transjugular route has been used instead in such patients when subsequent diagnostic or therapeutic procedures are required. Many radiologists, however, are more accustomed to the transfemoral approach, and may not find the transjugular route a desirable alternative.