[Treatment of a renal artery stab wound with selective embolization].
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Adult↗
Biomedical subjects
M Soiva
Publications and source records attributed to M Soiva.
Postoperative discitis: outcome and late magnetic resonance image evaluation of ten patients.
BACKGROUND AND AIMS: MRI has proven to be the most effective method for demonstrating suspected postoperative discitis. The prognosis of discitis varies markedly in different series. The purpose of this study was to analyze the clinical outcome and late MRI findings of the patients with postoperative discitis. MATERIAL AND METHODS: The medical records of ten patients with discitis and of ten patients without infectious findings following lumbar discectomy in 1993 to 1995 were reviewed. A clinical follow-up investigation with a detailed questionnaire and MRI was performed. Without knowledge of the clinical history, a radiologist selected the cases of discitis based on evaluation of the MRI pictures, and thereafter after a combined analysis of preoperative CT scans and of the MRI pictures. RESULTS: The follow-up MRI demonstrated characteristic findings in every discitis case. However, similar changes were seen in four cases of the control group. The discitis group had more symptoms, a longer sick leave and less return to previous occupation than the control group. CONCLUSION: As a late examination, MRI is insufficient in itself for diagnosis of earlier discitis. Postoperative discitis lengthens the sick leave markedly. Patients with postoperative discitis are rarely capable to return to a physically strenuous work. Every effort, including antibiotic prophylaxis, should be undertaken to reduce the risk of this serious complication.
Adult↗
Complications following high-dose percutaneous ethanol injection into hepatic tumors.
PURPOSE: Percutaneous ethanol injection therapy (PEIT) with a 2-10 ml ethanol dose per session is widely used in the treatment of small hepatocellular carcinoma. Larger doses have been restricted for fear of complications. The aim of the present study was to make a retrospective evaluation of the complications following treatment of hepatic tumors with high doses of ethanol (up to 200 ml). MATERIAL AND METHODS: The medical records of 15 patients treated repeatedly with PEIT were reviewed retrospectively to detect side effects or complications. Eleven of these patients had undergone transarterial chemoembolization (TAE) prior to PEIT. Of 173 ethanol injections in doses of 2-200 ml (mean 49 ml), more than 10 ml had been injected on 138 occasions. The chi-square test was used to evaluate the differences in pain frequency among the various dosage groups. RESULTS: Serious complications did not occur. Pain was a common side effect, occurring in 48% of the procedures. Immediate pain during the treatment was related to the ethanol dose and increased significantly with increasing doses (p < 0.01). Other side effects were rare. CONCLUSION: PEIT with doses higher than previously reported seems to be safe. This should encourage further clinical studies that aim at fully working out the clinical value of such treatment.
Chemoembolization, Therapeutic↗
Double reading of mammography screening films--one radiologist or two?
The effect of double reading on the number of breast cancers detected and the number of women recalled was examined in 15,457 women aged 50-59 years attending for mammographic breast screening. All the screening mammograms were interpreted independently by two radiologists without knowledge of each other's findings. All the cases selected by either radiologist were then reviewed by both radiologists and a consensus decision made on whom to recall for further studies. This method of double reading increased the number of breast cancers detected by 9% (P < 0.05) and decreased the number of women recalled by 45% (P < 0.001). Double reading of mammography screening films together with consensus decisions on the selected cases is recommended.
Breast Neoplasms↗
Postoperative graft incorporation after aortic reconstruction--comparison between computerised tomography and Tc-99m-HMPAO labelled leucocyte imaging.
Aortic graft infection may result in high mortality ranging up to 88%. Therefore, early diagnosis is imperative in the treatment of this serious complication. Computerised tomography (CT) is considered as a sensitive tool in the diagnosis of aortic graft infection. Some findings used as the criteria for infection, such as periprosthetic gas and fluid are, however, normal postoperative findings. The aim of this prospective study was to compare CT-scan and Tc-99m-HMPAO labelled leucocytes in the early diagnosis of aortic graft infection. The present study includes 24 consecutive patients (all men, age 70 +/- 8 years, range 55-85 years), who were operated on for abdominal aortic aneurysm. Prosthetic and suture materials were the same in all operations. Each patient was examined with the aid of CT-scan and imaged with Tc-99m-HMPAO labelled leucocytes 2 weeks and 3, 6 and 12 months after the reconstructive aortic surgery. Two radiologists and two specialists in nuclear medicine examined the data independently without knowing the clinical picture of the results of any other examinations of the patients. Seven patients (7/24; 29%) showed significant accumulation of labelled leucocytes in the first imaging (2 weeks postoperatively) with Tc-99m-HMPAO labelled leucocytes. Three months after the surgery only four patients (4/24; 17%) were positive in this respect. One of these patients had clinically proven aortic graft infection and another positive was a patient with resected and reconstructed mycotic aneurysm. CT-examination in all scans was suggestive for aortic graft infection in two cases (2/24; 8%), but neither of these patients showed any signs of infection.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Thyroid nodule and its study in Finland].
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Adolescent↗
Iohexol, ioxaglate and iopamidol in coronary angiography. A double-blind comparative study of 300 patients.
A randomized, double-blind study was carried out in 300 consecutive coronary angiography examinations to investigate the clinical safety of three low osmolar contrast media, iohexol 300, ioxaglate 320 and iopamidol 300, and the electrocardiographic changes that occurred with them. The ECG from electrode V5/V6 or AVF and intra-arterial pressure were monitored continuously, and recorded before and after the first contrast injections into the left and right coronary arteries. Of the variables tested, no statistically significant changes occurred in systolic arterial pressure, PR interval or ventricular extrasystole. The QT interval increased in the ioxaglate group (p = 0.001). Heart rate decreased in all groups, but slightly less in the ioxaglate group than in the iopamidol group (p = 0.02). The ST segment depression (mean 0.67m) was more marked in the ioxaglate group than in the other treatment groups (p = 0.0001) during right coronary angiography. The same characteristics, but less marked, were observed during left coronary angiography, the ioxaglate group (mean 0.251mm) differing from the iopamidol group (mean 0.050mm) (p = 0.04). No significant difference in severe adverse reactions were detected between these groups (ioxaglate 1, iopamidol 1). Ioxaglate produced mild side effects (nausea, vomitus, urticaria) in 16% of the patients, the other two contrast agents producing side effects in 1%.
Coronary Angiography↗
Classification of findings in mammography screening--a method to minimise recall anxiety?
STUDY OBJECTIVE: The aim was to find out if it is possible, by classifying screening mammograms according to the likelihood of malignancy, to divide the recalled women to a group in which there is high suspicion of malignancy, most having breast cancers, and a group with more obscure findings. DESIGN: Screening mammograms of recalled women were classified according to the likelihood of malignancy. 0 = technically insufficient, 1 = normal, 2 = benign tumour, 3 = malignancy cannot be excluded, 4 = strongly suspicious for malignancy, 5 = malignant. SETTING: This study was a population based survey of mammography screening in Helsinki and surroundings in Finland. PATIENTS: 21,417 women (aged 50-59 years) were invited to be screened, 18,012 (84.10%) participated. Of these 579 (3.21% of those screened) were recalled for further studies; 124 of these were referred for surgical biopsy and 82 had breast cancer. MEASUREMENTS AND MAIN RESULTS: All cases classified as 5, 60% of the cases classified as 4, 6.5% of the cases classified as 3, 0% of the cases classified as 2 or 1, and 1.2% of the cases classified as 0 proved to have breast cancers. However classification 5 represented 5.9% of all recalled women and 41.5% of all screening detected breast cancers; classification 4, 6.0% of all recalled women and 25.6% of all screening detected breast cancers; classification 3, 68.9% of all recalled women and 31.7% of all screening detected breast cancers; classification 2, 11.7% and classification 1, 2.9% of all recalled women. No breast cancers were detected with these classifications. Classification 0 represented 4.5% of all recalled women and 1.2% of all screening detected breast cancers. Classifications 5 and 4 represented only 11.9% of all recalled women but 67.1% of all screening detected breast cancers. CONCLUSIONS: By classifying screening mammograms according to the likelihood of malignancy, recalled women can be divided into two groups: (1) a quite small subgroup in which everyone or almost everyone will be shown to have breast cancer; and (2) a much larger subgroup in which only a few will be proven to have breast cancer. The invitation procedure for the further studies should be improved on this basis of minimising anxiety among recalled women.
Anxiety↗
Ultrasonography of breast lesions detected in mammography screening.
Mammography screening was carried out in 18,012 women (aged 50-59) of whom 579 (3.21%) had to be recalled for clinical mammography. After completion of the clinical mammography each woman also had ultrasonography (US) with a hand-held real-time apparatus using a 7.5 MHz probe. There were 79 verified breast cancers; 32 of these were palpable and were also depicted at US, but only 29 (61.7%) of non-palpable breast cancers (n = 47) were found at US. Twenty-two of the non-palpable breast cancers were seen at US as a tumor-like lesion, 2 because of local echo-architecture distortion, and 5 only because of acoustic shadowing. The US image did not help to differentiate between malignant and benign lesions.
Breast Neoplasms↗
Mammography screening--reasons for recall and the influence of experience on recall in the Finnish system.
The reasons for recall and the influence of experience on recall were studied in 579 women (3.21%) recalled from mammography screening. The proportion of recalls for further studies was the greatest (6.30%) at the onset of screening. With increased experience, the proportion decreased by stages and in the second screening round it was only 2.04%. The proportion of cases referred for surgical biopsy in the first screening round was 0.7% and the proportion of screening-detected breast cancers was 0.52%. These change little with increasing experience. In the second screening round, however, the proportion of referrals for surgical biopsy (0.43% of those screened) and of screening-detected breast cancers, (0.30%) were both low. A tumour-like density was the commonest finding resulting in recall for further studies, and the number caused by superimposition of normal parenchymal structures decreased with experience, while the proportion of breast cancers and benign tumours increased. The proportion of cases with parenchymal distortion resulting in recall for further studies was similar in both screening rounds but the number of those referred for biopsy fell dramatically in the second screening round. The number of recalls for microcalcification also fell with experience and the proportion of breast cancers in this group increased over the two screening rounds. A high ratio of malignancies in surgical biopsies can be expected when the radiologists undertaking primary screening also perform all further studies.
Biopsy↗
Mammography screening for breast cancer: first year results from Helsinki and surroundings.
11,789 women aged 50-59 years were invited for screening by the mammography screening centre of the Cancer Society of Finland in Helsinki. 9829 women (83.37%) attended and 3.85% of those were recalled for further studies. After complete examination seventy-one women (0.72%) were referred for surgical biopsy and breast cancer was histologically detected in 44 (0.45%) of those screened. The proportion of Stage I + TIS breast cancers detected was 75%, and of Stage II or more advanced, 25%. With modern mammography techniques and proper training of technicians and radiologists, with double reading of all the films, it is possible to minimise both the recall rate and the number of women who are referred for surgical biopsy, and still find cancers in their early stages.
Breast Neoplasms↗
Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients.
The axillary node status is important in the prognosis of breast cancer. To evaluate the accuracy of various preoperative examination methods in detecting metastatic axillary lymph nodes, we compared the findings of clinical examination, axillary ultrasonography, and axillary mammography of 41 breast cancer patients who underwent axillary dissection and histological examination. The sensitivity was 72.7% for ultrasonography, 38.9% for axillary mammography, and 32.3% for clinical examination. Ultrasonography provides good information about the axillary nodal status. The specificity can be increased by fine-needle biopsy under ultrasound guidance.
Adult↗
Baseline screening mammography with one versus two views.
Two-view baseline screening mammograms (oblique and cranial views) of 303 women recalled for further studies from among 7,245 women screened were reviewed by four experienced radiologists separately to evaluate the importance of the number of views taken for screening. As compared with the oblique view only, two views, increased the number of cancers detected and decreased the number of false-positive cancer diagnoses of two radiologists, but increased that of the other two.
Breast Neoplasms↗
The value of routine sonography in clinically suspected acute cholecystitis.
Upper abdominal sonography was used as a routine emergency study to diagnose acute cholecystitis in 135 patients clinically suspected of having the disease. Ten radiologists with various experience in sonography performed the studies. Fifty-six patients had acute cholecystitis. Altogether 52 cholecystectomies were performed, mainly within 48 h of admission. Acute cholecystitis was diagnosed correctly in 52 cases (sensitivity, 93%) and excluded correctly in 75 cases (specificity, 95%; overall accuracy, 94%). Of the four patients with a false-negative study, calculi without signs of cholecystitis were detected in three, and distention and tenderness without calculi in one case. The final diagnoses in four false-positive studies were chronic cholecystitis in two cases, carcinoma of the gallbladder in one case, and pancreatitis in one case. The results of sonography as a continual emergency service provided by a staff with various experience are equal to those published in other studies performed mainly by an expert staff with long experience.
Acute Disease↗
Ultrasonography of the gallbladder in patients with a clinical suspicion of acute cholecystitis.
The prevalence of ultrasonographic (US) signs described in the literature in cases of acute cholecystitis (wall thickening, increased volume, roundness and local tenderness of the gallbladder, an anechoic layer in the gallbladder wall and cholelithiasis were studied in 136 consecutive patients referred for US examination with clinically suspected acute cholecystitis (AC). Of the patients, 56 had AC, 21 chronic cholecystitis, 2 carcinoma of the gallbladder, and 57 extrabiliary diseases. In AC, frequent findings in addition to cholelithiasis were wall thickening (79%) and an increased volume (64%). Almost one third of the patients had local tenderness (sonographic Murphy sign) (29%), and 27% of the gallbladders had a rounded form. All these features were, however, rather frequently detected also in chronic cholecystitis (5-33%) and in the 2 carcinoma patients, and also sporadically in extrabiliary diseases. A anechoic layer in the gallbladder wall was the only sign confined to AC, but was detected only in 2 cases. Roundness of the gallbladder occurred only in either acute or chronic cholecystitis. The combination of at least two diagnostic findings was noticed in 91% in AC, rather frequently in chronic cholecystitis (43%) and in both carcinoma patients, but only in 1 patient in the extrabiliary disease group. Three or more signs were seen only in gallbladder diseases (48%), but AC, chronic cholecystitis or carcinoma groups could not be completely differentiated (prevalences 63, 10 and 50%).
Acute Disease↗
Combination of multiple pencil-beam imaging to computed storage phosphor radiography: a new method.
Computed radiography (CR) with storage phosphors offers a wide dynamic range and improved sensitivity compared to film-screen technology. CR was combined in this study with a prototype multiple pencil-beam (MPB) imaging device which has been shown to be very effective in scatter reduction. The combination was analyzed and compared to the standard technique of grid screening in two ways: a free-response ROC (FROC) analysis was first performed followed by a blinded test arrangement for visual analysis of image quality in a series of computed radiography of the lumbar spine by both the MPB and grid modalities. The results of the FROC study showed a statistically significant (P less than or equal to 0.01) improvement in signal detection. The MPB-CR images of the lumbar spine had more contrast but also a slightly mottled or grainy appearance. Image quality was found good but contrast processing was criticized because it seemed to result in a too steep display of contrast in MPB imaging. This should be avoidable by changing the image processing parameters.
Adult↗
Ultrasonic guidance for percutaneous puncture and drainage in acute cholecystitis.
Thirteen patients presenting with acute cholecystitis and considered high surgical risks were treated with a percutaneous needling procedure under ultrasonic guidance. The gallbladder was drained following simple needle puncture in six cases while a drainage catheter was inserted in seven. A premedication of 0.5 mg of atropine and 50 mg of pethidine was given. The gallbladder became decompressed in all cases, and pain was instantly relieved. Impacted stones were freed from the cystic duct in two cases and from the papilla of Vater in another two cases. The patients' condition improved and elective cholecystectomy was performed in four cases, while a further three patients await surgery. In five cases the acute stage of the disease subsided; surgical treatment was refrained from because of gallbladder carcinoma with metastases in one patient and other diseases in the remainder. One patient died of gastric carcinoma. One patient with ischemic heart disease had systemic hypotension for six hours after the drainage and one had slight haemorrhage for four hours. No other complications were noted. In addition, the procedure was also carried out as a diagnostic study in one patient in whom the site of bile leakage was determined by filling the biliary tree with contrast medium from the gallbladder. Guided aspiration and percutaneous drainage of the gallbladder is helpful in patients with severe acute cholecystitis attended with a high surgical risk.
Aged↗
Ultrasonography of the gallbladder in acute pancreatitis.
The sonographic appearance of the gallbladder in 52 patients with acute pancreatitis (AP) was evaluated and compared with the findings in acute cholecystitis (AC) and in normal gallbladder (N). The mean gallbladder wall thickness in the AP group, 3.2 mm, was significantly different from the thickness in the N group, 2.3 mm (p less than 0.001), and from that in the AC group, 5.2 mm (p less than 0.001). Wall edema, distension, tenderness (sonographic Murphy sign) and pericholecystic fluid collections were occasional findings in AP, and were not seen in normal gallbladders. A significant difference between the AP and AC groups was found in the prevalence of maximal local tenderness of the gallbladder (in only 2/52 in AP, but in 28/31 in AC).
Adult↗