Stent placement is a widely used bail-out treatment for dissection of peripheral arteries. Below the level of the superficial femoral artery permanent stenting is complicated by a high incidence of subacute thrombosis and restenosis. We present two cases of arterial occlusion due to acute iatrogenic dissection of the popliteal and distal fibular arteries. Successful treatment was achieved with a new bail-out procedure. Strecker stents were implanted to seal off the dissection flap. Stents were retrieved easily after 24 hr using a myocardial biopsy forceps. After stent retrieval the temporarily stented segments were patent and showed a larger lumen compared with segments treated by balloon dilatation alone. Temporary stenting is a simple and safe procedure and offers the advantage of tacking up dissection membranes and preventing recoil. Persistent presence of a metallic implant as a source of continued injury and stimulus for intimal proliferation is avoided.

Aged↗

PubMedDate not supplied

MRI of the hypopharynx with provocative maneuvers.

The purpose of this study was to assess the validity of magnetic resonance (MR) functional images of the hypopharynx. Following T2-weighted spin-echo sequences during quiet respiration, contrast enhanced 2D-Turbo-FLASH sequences were obtained during Valsalva-maneuver, quiet respiration, A- and U-phonation, respectively. Tumor detection was clearly improved using functional MRI (sensitivity of 97.4%, specificity 83.3%, accuracy 95.5%) when compared with MRI during quiet respiration (sensitivity of 87.1%, specificity 33.3%, accuracy 80%). Rapid MR sequences such as 2D-Turbo FLASH allow functional imaging of the hypopharynx, thereby improving MR diagnosis of hypopharyngeal tumors.

Adult↗

PubMedDate not supplied

Signal, contrast, and resolution in optimized PD- and T2-weighted turbo SE images of the knee.

OBJECTIVE: Signal and contrast behavior, delineation of anatomical details, and flow artifacts were compared in dual echo SE and turbo SE (TSE) sequences. Results were correlated with theoretical aspects of the TSE technique. MATERIALS AND METHODS: A TSE sequence (TR = 3,500 ms, TEeff = 19, 93 ms, ETL = 3) and a conventional SE sequence (TR = 2,500 ms, TE = 20, 70 ms) were applied to 64 patients with knee injuries. Signal intensities of anatomical structures were measured in regions of interest. Contrast and edge sharpness of menisci and posterior cruciate ligament were evaluated by three independent observers. RESULTS: The TSE sequence yielded similar signal and contrast behavior compared with SE. Visual evaluation revealed nearly equivalent contrast and edge sharpness of menisci and posterior cruciate ligament in proton-density (PD)-weighted TSE images. Contrast and edge sharpness of menisci were significantly lower in T2-weighted TSE images. Reduced flow artifacts were found in PD- and especially in T2-weighted TSE images. Differences between both techniques are interpreted, taking into account influence of TEeff, ETL, k-space trajectory, magnetization transfer effects, and J-coupling. CONCLUSION: The TSE sequence yielded good image quality in PD-weighted, but slightly inferior quality in T2-weighted, images, reducing the time of acquisition by 50%.

Adult↗

PubMedDate not supplied

[Regulating animal diseases by law in reference to veterinary surveillance of free ports and airports in the Federal Republic of Germany].

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Animal Diseases↗

PubMedDate not supplied

Spiral-CT in diagnosis of vascular involvement in pancreatic cancer.

BACKGROUND/AIMS: The purpose of this prospective study was to evaluate the efficacy of spiral-CT for the identification of portal venous, superior mesenteric artery and celiac trunk infiltration in the staging of pancreatic (n = 29) and periampullary (n = 6) cancers. MATERIALS AND METHODS: All patients were examined by contrast enhanced spiral-CT using a total volume of 240 ml contrast medium i.v. With a slice thickness of 5 mm and a table increment of 7 mm/sec a overlapping data set, representing a total volume of 21 cm, was covered. The images were reconstructed in 4 mm intervals. In 28 patients the spiral CT results were correlated with surgical findings. RESULTS: Regarding portal venous infiltration spiral-CT had a sensitivity of 91% (10/11), a specificity of 9.4% (16/17), a positive predictive value of 91% (10/11), a negative predictive value of 94% (16/17) and, an overall accuracy of 92.8% (26/28). Spiral CT correctly identified arterial involvement in 5 patients, and no false negative result compared to surgical findings was observed. CONCLUSIONS: These results indicate that spiral-CT reliably verifies occlusion, stenosis and encasement of the major peripancreactic vessels caused by pancreatic cancer.

Aged↗

PubMedDate not supplied

Auditory event-related cerebral potentials (P300) in hepatic encephalopathy--topographic distribution and correlation with clinical and psychometric assessment.

BACKGROUND/AIMS: Early cognitive disturbances in patients with cirrhosis (Ci) are difficult to assess. Therefore, we evaluated the role of topographic auditory evoked cerebral potentials (P300-EP). METHODOLOGY: Prospective longitudinal study. SETTING: Tertiary clinical care institution. PARTICIPANTS: 45 patients with cirrhosis were compared to 22 healthy subjects. MAIN OUTCOME MEASURES: Hepatic Encephalopathy (HE) was assessed using the clinical grading, standardized psychometric tests, and auditory evoked P300-EP by multichannel EEG recordings. RESULTS: In the patients, the mean P300 peak latency was significantly increased (386.7 +/- 26.7 versus 318.6 +/- 22.2 ms in controls, p < 0.00001). Even in patients with cirrhosis but no HE (n = 18) the P300 peak latency was abnormally prolonged (> 384 ms) in 8 cases (44%). In addition, P180 peak latency was significantly longer in patients with liver cirrhosis as compared to controls (p = 0.021). The maximal P300 amplitude was significantly lowered in patients with liver cirrhosis in the frontocentral and central cortical regions (FZ: p < 0.008; Cz: p < 0.04). Liver function and etiology of liver disease were not related to the increased peak latencies of the P300 and P180 peaks. CONCLUSIONS: P300-EP is a sensitive measure to detect functional cognitive impairment in cirrhotic patients with subclinical HE and clinically apparent HE. Typical changes include latency prolongation and decreased central peak amplitude. Some 40% of patients with no clinical evidence of HE and normal psychometric tests show abnormal results during P300 testing, which is likely to reflect early impairment of cognitive function. Auditory evoked P300 potentials are more sensitive than psychometric testing alone.

Adult↗