Onyx,a New Liquid Embolic Material for Peripheral Interventions: Preliminary Experience in Aneurysm,Pseudoaneurysm, and Pulmonary Arteriovenous Malformation Embolization

Purpose To describe our preliminary experience with a new liquid embolization agent, Onyx, in peripheral interventions. Methods and results We successfully treated two peripheral aneurysms (one in an internal iliac artery, one in a thoracic collateral artery of an aortic coarctation), two peripheral pseudoaneurysms (one in a lumbar artery, one in a renal artery), and one pulmonary arteriovenous malformation. Conclusion Onyx is a promising alternative embolic material for peripheral interventions. It can be combined with coils in selected cases, and balloon catheters can be effectively used during slow injection of embolic material to control flow and protect the aneurysm neck.     

Erdheim-Chester disease: radiographic findings in five patients

We present the case histories of five patients with Erdheim-Chester disease, a rare lipoidosis that has several typical radiographic features. In all the patients, the diaphyses and metaphyses of the extremities demonstrated a symmetric pattern of diffuse or patchy increased density, a coarsened trabecular pattern, medullary sclerosis, and cortical thickening. The epiphyses were spared in four patients and partially involved in one. The axial skeleton was involved in one patient. Radiotracer ^99mTc accumulated in areas of radiographic abnormalities in all patients. In one patient, MRI demonstrated an abnormal signal, corresponding to radiographic abnormalities. The signal was hypointense to muscle on T1-weighted sequences and heterogeneously hyperintense and hypointense to normal bone marrow on T2-weighted sequences. Xanthogranulomatous lesions infiltrated the retroperitoneum in one patient, the testes in one patient, the eyelids in one patient, and the orbits in two patients.     

The trouble with spectroscopy papers.

Writing a critique and guide for authors of clinical spectroscopy research papers is a likely way of ensuring that one never sees another of one's own papers published in this field. Nevertheless, it is disappointing, though perhaps predictable, that despite its historical foundations in quantitative spectroscopy, the field has its fair share of findings that are not so obviously reconciled. Here is the view of one author, one referee, and one spectroscopy protagonist about what might be expected of a clinical spectroscopy paper. In addition to novelty, the fundamental criteria for acceptance should be that the conclusions are supported by properly and objectively quantified results, and that sufficient experimental detail is provided so that one skilled in the art could reproduce the study and its findings.     

Clinical usefulness of <Superscript>99m</Superscript>Tc-EDDA/HYNIC-TOC scintigraphy in oncological diagnostics: a preliminary communication

This study assessed the clinical usefulness of a new technetium-99m labelled somatostatin analogue from the standpoint of oncological diagnostics. The study group comprised 40 patients in whom malignant neoplasms (32 primary and 8 metastatic) had been diagnosed. Among the primary tumours there were 21 cases of lung cancer (2 small cell and 19 non-small cell), seven pituitary adenomas (five hormonally active and two inactive), one liposarcoma, two carcinoids and one breast carcinoma. The metastatic tumours consisted of three malignant melanomas, one phaeochromocytoma, one prostatic cancer, one leiomyosarcoma, one pancreatic carcinoma ectopically secreting ACTH and one carcinoid of the thymus. The radiopharmaceutical ^99mTc-EDDA/HYNIC-Tyr³-octreotide was administered i.v. at an activity of 740–925 MBq. The imaging comprised a whole-body scan and a single-photon emission tomography acquisition. Positive scintigrams were obtained in all cases of small cell and non-small cell lung cancer, four out of five hormonally active pituitary adenomas, one out of two cases of carcinoid, the liposarcoma and the breast cancer. Neoplastic metastases were visualised in two out of three patients with melanoma and in patients with phaeochromocytoma, ACTH-secreting pancreatic carcinoma and thymic carcinoid. Scintigrams were negative in both hormonally inactive pituitary adenomas, in one case of metastatic malignant melanoma, in the leiomyosarcoma and in the case of metastasis from prostatic carcinoma. The results of this pilot study indicate that ^99mTc-EDDA/HYNIC-TOC is a potentially useful radiopharmaceutical for imaging of a wide range of primary and metastatic tumours. Special attention should be paid to the successful imaging of all cases of non-small cell lung cancer .     

Indwelling angiographic catheters to facilitate placement of ureteric stents

In 16 of 191 patients the initial attempt to place a double-pigtail internal ureteric stent by conventional methods was unsuccessful. These patients had cancers of the rectum (nine patients), bladder (two patients), vagina (one patient), cervix (one patient) or spermatic cord (one patient) or radiation strictures (two patients). When a guide wire could be advanced beyond the stricture, placement of a small angiographic catheter for 7 to 10 days allowed delayed placement of the stent in all but one case.     

Radiographic appearance of the esophagus and stomach after laser treatment of obstructing carcinoma

Nd:YAG laser therapy is an attractive palliative treatment for carcinoma of the esophagus and gastric cardia. Twenty-five patients with these tumors underwent laser therapy over a 2-year period, receiving a total of 52 courses of therapy with 189 treatments. Treatments per course averaged 3.6, with a mean of two courses per patient. Luminal diameter is increased with this method; symptomatic improvement in dysphagia occurred in all patients after one course of therapy. Radiographic improvement also is seen. The complication rate in this series was four (2.1%) of 189 procedures, consisting of one perforation, one tracheoesophageal fistula, one pneumopericardium, and one pneumoperitoneum without leak.     

Ultrasound findings of ganglions of the wrist.

Fifty-one patients with a palpable swelling of a wrist or finger of suspected ganglion origin were examined by ultrasound (US). Forty-five were operated on, and a ganglion was found in 35. The ganglions took the form of cysts 0.4-4 cm in diameter (mean 1.4 cm) with a projection into the joint or tendon in 19 cases. Two patients had multiple ganglia, and two a wrist lipoma, one echo-rich and the other echo-poor with a thick wall. One patient had a giant cell tumour of the tendon sheath which was moderately echogenic in appearance, one had carpal tunnel syndrome and a ganglion-like finding at US, one had tenosynovitis and negative US and one had a prominent tendon due to postoperative sequelae, with US showing a longish echo-poor lesion. Two had hypertrophied muscle forming a long echo-poor structure, one had an exostosis and one had no abnormality in the wrist at operation. Our experiences suggest that ultrasound is useful in many cases with impression of a ganglion at palpation showing multiplicity of a lesion or for assisting in differential diagnosis, although a physical examination is mostly sufficient for diagnostic purposes.     

The uses of corpus cavernosography. A review

In a series of 18 corpus cavernosograms (CC) we encountered 12 patients with Peyronie's disease, four normals, one with hypoplastic corpora and one with penile fracture. All examinations were successful and there was one complication, a case of post-procedural priapism. CC is a valuable procedure in the evaluation of impotence.     

Pneumosinus dilatans and multiplex: report of three rare cases and review of the literature

Pneumosinus dilatans is a term used to describe a localized abnormal dilatation of one or more paranasal sinuses without radiological evidence of localized bone destruction, hyperostosis or mucous membrane thickening. The involvement of all paranasal sinuses and mastoid air cells has been named pneumosinus dilatans multiplex. Although the involvement of one or more paranasal sinuses has been reported widely, all paranasal sinuses and the concomitant involvement of mastoid air cells has been reported in only one case. Herein, we present three unusual cases of pneumosinus dilatans (one is a second case of pneumosinus dilatans multiplex in English literature, another is the first reported case of a frontal pneumosinus dilatans case associated with frontoethmoidal meningocele, mental retardation and facial asymmetry and the third one is pneumosinus dilatans with a huge arachnoid cyst) along with the review of relevant literature.     

X-UV lamellar multilayer amplitude gratings

The concept of X-UV Lamellar Multilayer Amplitude Grating (LMAG) is introduced and a method of fabrication is given. Dynamical and kinematic theories of the diffraction by a LMAG are presented. Different applications of the LMAGs are considered. The first one is the achievement of a narrow bandpass multilayer monochromator for the X-UV domain. The second one is the reduction of specular background in the reflectivity curve of a multilayer structure. The third one is the polychromator system which allows one to split spatially and to perform a spectral sampling of a polychromatic beam. Finally we studied experimentally the behavior of an LMAG in conical mounting.     

Unusual presentations of benign intrathoracic neurogenic tumors

Three patients with benign neural sheath tumors (two neurofibromata, one schwannoma) are reported here. One is known to have von Recklinghausen's disease. All presented in an atypical manner providing a diagnostic challenge. The series comprises one patient with a schwannoma of the left vagus nerve, one with submucosal neurofibromata of the lower one-third of the esophagus and one with an endobronchial neurofibroma. The plain film findings suggested aortic aneurysm, esophageal varices and endobronchial carcinoma respectively.     

Endovascular treatment of brain-stem arteriovenous malformations: safety and efficacy

Our purpose was to evaluate the safety and efficacy of endovascular treatment of brain-stem arteriovenous malformations (AVMs), reviewing six cases managed in the last 5 years. There were four patients who presented with bleeding, one with a progressive neurological deficit and one with obstructive hydrocephalus. Of the six patients, one showed 100%, one 90%, two 75% and two about 50% angiographic obliteration of the AVM after embolisation; the volume decreased about 75% on average. Five patients had a good outcome and one an acceptable outcome, with a mild postprocedure neurological deficit; none had further bleeding during midterm follow-up. Endovascular management of a brain-stem AVM may be an alternative to treatment such as radiosurgery and microsurgery in selected cases. It may be not as risky as previously thought. Embolisation can reduce the size of the AVM and possibly make it more treatable by radiosurgery and decrease the possibility of radiation injury.     

Sonography of gallbladder duplication and differential considerations

With the routine use of sonography in the evaluation of suspected gallbladder disease, the familiarity of gallbladder duplication and its differential considerations are essential. Three cases are presented: one surgically proven duplication of the gallbladder, one case in which the sonographic findings were compatible with duplication of the gallbladder, and one surgically proven intraperitoneal fibrous band mimicking a gallbladder duplication. Gallstones were present in all cases and were confined to only one of the two lobes identified in each case. The gallstones did not communicate between individual gallbladder lobes despite multiple patient positions. Contraction of the non-stone-containing lobe was present in one nonfasting patient, which is probably the best indirect sign of a double gallbladder.     

The trouble with spectroscopy papers

Writing a critique and guide for authors of clinical spectroscopy research papers is a likely way of ensuring that one never sees another of one's own papers published in this field. Nevertheless, it is disappointing, though perhaps predictable, that despite its historical foundations in quantitative spectroscopy, the field has its fair share of findings that are not so obviously reconciled. Here is the view of one author, one referee, and one spectroscopy protagonist about what might be expected of a clinical spectroscopy paper. In addition to novelty, the fundamental criteria for acceptance should be that the conclusions are supported by properly and objectively quantified results, and that sufficient experimental detail is provided so that one skilled in the art could reproduce the study and its findings.     

前牙急性根尖周炎根管治疗一次法后并发症及疗效的临床观察

目的探讨前牙急性根尖周炎患者应用根管治疗一次法是否优于多次治疗。方法随机将140例急性根尖周炎患者分为两组,每组70例,分别行根管一次法治疗和多次治疗。观察比较两组患者术后1 d和术后5 d并发症情况及术后1年临床和X线检查结果。结果一次性根管治疗术后1 d并发症显著高于多次疗法(P<0.05),术后5 d疗效显著好于多次疗法(P<0.05),术后1年两组间疗效无显著性差异(P>0.05)。结论对于前牙急性根尖周炎患者可选择一次性根管治疗和多次疗法,但应用一次性根管治疗应慎重。     

Cortical bone metastases

The data on 26 patients with solitary metastatic lesions arising in cortical bone were studied. Nineteen patients were over 50 years of age. In 19 patients, the cortical metastasis was the first indication of the presence of a primary malignant condition. In seven cases, cortical metastases developed in patients with a known primary tumor. The primary tumors involved were eight renal cell carcinomas, six bronchogenic carcinomas, two carcinomas of the gastrointestinal tract, one osteosarcoma, one neuroblastoma, one melanoma, one hepatoma, one carcinoma of the breast, and one thyroid carcinoma. In four cases, the primary tumor remained unknown. A metastatic origin should be considered in the differential diagnosis of an osteolytic lesion arising in the cortex of a long bone, especially in older patients and in patients with a known primary malignant condition. The cortical bone metastases encountered in this study did not originate solely from bronchogenic carcinoma, as has been reported by other authors. Cortical metastases are probably less rare than has been hitherto assumed.     

A biomechanical comparison between the central one-third patellar tendon and the residual tendon.

The purpose of this study was to compare the tensile strength of the central one third patellar tendon--as used for reconstruction of the anterior cruciate ligament--to that of the residual patellar tendon. Ten matched pairs of human cadaveric knees were used for this study, each specimen consisting of an intact patella-patellar tendon-proximal tibial unit. One knee from each pair was randomly selected for removal of both the medial and lateral one third of the patellar tendon, leaving the central one third intact. The contralateral knee of each pair underwent removal of the central one third of the patellar tendon, leaving the residual two thirds intact. Each specimen was then mounted in a materials testing machine and tensile tested to failure at a strain rate of 100%.s-1. The most important result to emerge from these experiments was that there was no significant difference in maximum force to failure for the residual patellar tendon compared to the central one third. Thus any thought that removal of the central one third as a graft still leaves a tendon twice as wide and therefore twice as strong as a graft is dispelled by these experiments.     

Percutaneous ipsilateral portal vein embolization using a modified four-lumen balloon catheter with fibrin glue: initial clinical experience

Purpose The purpose of the present study was to show the feasibility and safety of ipsilateral portal vein embolization (PVE) using an improved four-lumen balloon catheter with fibrin glue. Materials and methods To improve the ipsilateral PVE with fibrin glue, we modified a commercially available four-lumen balloon catheter to create a catheter comprising one lumen with a catheter tip for a guidewire, one lumen for an occlusion balloon, and two lumens, each with a side-hole just proximal to the balloon. Eight patients had hepatobiliary disease (three with bile duct carcinoma, two with gallbladder carcinoma, one with hepatocellular carcinoma, one with Caroli disease, and one with metastatic carcinoma). Results All embolization procedures were technically successful. After embolization, the volume of the future remnant liver increased a mean of 131%. There was no inadvertent embolization of portal vein branches and no major procedure-related complications. Conclusion Our method is potentially easier and safer than the traditional ipsilateral method with fibrin glue using a three-lumen balloon catheter because the fourth lumen makes possible the use of a guidewire to access the targeted portal vein and measurement of any portal vein pressure elevation following PVE via the fourth lumen.     

Massive hemoptysis of pulmonary arterial origin: diagnosis and treatment

Among 189 patients treated for massive or repeated hemoptysis by transcatheter techniques between 1973 and 1983, a prospective study was attempted between 1979 and 1983 (72 patients) to search for bleeding of pulmonary arterial origin. Among these 72 patients, six were treated by surgical (one) or angiographic (five) occlusion of segmental pulmonary arteries. Pulmonary erosive pseudoaneurysms were seen in five cases (one with intracavitary aspergilloma, two with cavitary tuberculosis, and two with pyogenic abscesses). Among these six cases, one patient died from massive hemoptysis, one from unknown causes, and four are still alive. They are compared with five other patients who died from massive hemoptysis among 117 patients treated only by embolization of their systemic arteries between 1973 and 1979 (one with cavitary tuberculosis, two with intracavitary aspergillomas, one with an abscess of the lung, and one with a necrotic hilar cancer). A pulmonary arterial source of bleeding should be considered in addition to systemic arterial sources in the setting of destructive lung disease.     

H7在脑损伤后血脑屏障损害中的作用

目的 探讨蛋白激酶Ｃ（ＰＫＣ）抑制剂Ｈ７在脑损伤后血脑屏障损害中的作用。方法 雄性ＳＤ大鼠４８只,随机分为正常对照组、假手术组、脑损伤组织和治疗组。治疗组于大鼠脑损伤后０．５小时腹腔注射ＰＫＣ抑制Ｈ７（１ｍｇ／ｋｇ）,１２小时重复注射１次,伤后２４应用分光光度计定量检测伊文氏兰渗出。结果 脑损伤后伊文氏兰明显渗出,治疗组渗出明显减少。结论 应用ＰＫＣ抑制剂Ｈ７能明显阻止血脑屏障开放,可望在血脑屏障