Summary
Background
Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long‐term cardiopulmonary outcomes.
Aim
To ...evaluate the long‐term cardiopulmonary outcome after TIPSS.
Methods
We evaluated cardiopulmonary parameters including echocardiography during long‐term follow‐up after TIPSS. Results at 1–5 years after TIPSS were compared to those of cirrhotic controls. Pulmonary hypertension (PH) diagnoses rates were included. Endothelin 1, thromboxane B2 and serotonin were measured.
Results
We found significant differences 1–5 years after TIPSS compared to pre‐implantation values: median left atrial diameter (LAD) increased from 37 mm interquartile range (IQR): 33–43 to 40 mm (IQR: 37–47, P = 0.001), left ventricular end‐diastolic diameter (LV‐EDD) increased from 45 mm (range: 41–49) to 48 mm (IQR: 45–52, P < 0.001), pulmonary artery systolic pressure (PASP) increased from 25 mmHg (IQR: 22–33) to 30 mmHg (IQR: 25–36, P = 0.038). Comparing results 1–5 years post‐implantation to the comparison cohort revealed significantly higher (P < 0.05) LAD, LV‐EDD and PASP values in TIPSS patients. PH prevalence was higher in the shunt group (4.43%) compared to controls (0.91%, P = 0.150). Thromboxane B2 levels correlated with PASP in the TIPSS cohort (P = 0.033). There was no transhepatic gradient observed for the vasoactive substances analysed.
Conclusions
TIPSS placement is accompanied by long‐term cardiovascular changes, including cardiac volume overload, and is associated with an increased rate of pulmonary hypertension. The need for regular cardiac follow‐up after TIPSS requires further evaluation.
Purpose
This study was designed to investigate the benefit of percutaneous interventional management of patients with postoperative bile leak on clinical outcome. Primary study endpoints were closure ...of the bile leak and duration of percutaneous transhepatic biliary drainage (PTBD) treatment. Secondary study endpoints were necessity of additional CT-guided drainage catheter placement, course of serum CRP level as parameter for inflammation, and patients’ survival.
Methods
Between January 2004 and April 2008, all patients who underwent PTBD placement after upper gastrointestinal surgery were analyzed regarding site of bile leak and previous attempt of operative bile leak repair, interval between initial surgery and PTBD placement, procedural interventional management, course of inflammation parameters, duration of PTBD therapy, PTBD-related complications, and patients’ survival.
Results
Thirty patients underwent PTBD placement for treatment of postoperative bile leaks. In 12 patients (40%), PTBD was performed secondary to a surgical attempt of bile leak repair. Additional percutaneous drainage of bilomas was performed in 14 patients (47%). CRP serum level decreased from 138.1 ± 73.4 mg/l before PTBD placement to 43.5 ± 33.4 mg/l 30 days after PTBD placement. The mean duration of PTBD treatment was 55.2 ± 32.5 days in the surviving patients. In one patient, a delayed stenosis of the bile duct required balloon dilation. Two PTBD-related complications (portobiliary fistula, hepatic artery aneurysm) occurred, which were successfully treated by embolization. Overall survival was 73% (22 patients).
Conclusions
PTBD treatment is an effective therapy. PTBD treatment and additional CT-guided drainage of bilomas helped to reduce intraabdominal inflammation, as shown by reduction of inflammation parameters.
Abstract
On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the ...rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology – with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient’s health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient’s consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law.
Key points:
• On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice.
• Regarding a physician‘s liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent.
• Forensic practice shows that patients frequently enforce both offences concurrently.
Citation Format:
• Sommer SA, Geissler R, Stampfl U et al. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology. Fortschr Röntgenstr 2016; 188: 353 – 358
The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT ...angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 ± 10.3 h (range, 0.2–34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients 9%, selective angiography in 16 of 43 patients 37%, and superselective angiography in 39 of 43 patients 91%). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (
P
< 0.001) and increased significantly after intervention (
P
< 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection and localization of arterial renal hemorrhage and appropriate for guidance of the embolization procedure.
Purpose
To evaluate the effect of previous transarterial iodized oil tissue marking (ITM) on technical parameters, three-dimensional (3D) computed tomographic (CT) rendering of the electroporation ...zone, and histopathology after CT-guided irreversible electroporation (IRE) in an acute porcine liver model as a potential strategy to improve IRE performance.
Methods
After Ethics Committee approval was obtained, in five landrace pigs, two IREs of the right and left liver (RL and LL) were performed under CT guidance with identical electroporation parameters. Before IRE, transarterial marking of the LL was performed with iodized oil. Nonenhanced and contrast-enhanced CT examinations followed. One hour after IRE, animals were killed and livers collected. Mean resulting voltage and amperage during IRE were assessed. For 3D CT rendering of the electroporation zone, parameters for size and shape were analyzed. Quantitative data were compared by the Mann–Whitney test. Histopathological differences were assessed.
Results
Mean resulting voltage and amperage were 2,545.3 ± 66.0 V and 26.1 ± 1.8 A for RL, and 2,537.3 ± 69.0 V and 27.7 ± 1.8 A for LL without significant differences. Short axis, volume, and sphericity index were 16.5 ± 4.4 mm, 8.6 ± 3.2 cm
3
, and 1.7 ± 0.3 for RL, and 18.2 ± 3.4 mm, 9.8 ± 3.8 cm
3
, and 1.7 ± 0.3 for LL without significant differences. For RL and LL, the electroporation zone consisted of severely widened hepatic sinusoids containing erythrocytes and showed homogeneous apoptosis. For LL, iodized oil could be detected in the center and at the rim of the electroporation zone.
Conclusion
There is no adverse effect of previous ITM on technical parameters, 3D CT rendering of the electroporation zone, and histopathology after CT-guided IRE of the liver.
Tips und Tricks bei der Durchführung Stampfl, U
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren,
04/2015
Conference Proceeding
Purpose: To describe angiographic, computed-tomography (CT) and pathologic features of ETHIBLOC_Reloaded as a re-designed zein-based fluid embolic agent. Materials and methods: In eight pigs, both ...kidneys underwent selective transarterial embolization (with complete embolization as embolization endpoint). Each group consisted of two pigs with four embolized kidneys: I-pure ETHIBLOC_Reloaded, II-ETHIBLOC_Reloaded/iodized oil mixture (1:1), III-ETHIBLOC_Reloaded/ethanol-60% mixture (8:2) and IV-Histoacryl/iodized oil mixture (1:3). One hour after embolization, CT imaging, sacrifice and kidney harvest followed. Angiographic (visibility and vascular occlusion pattern), CT (visibility) and pathologic (vascular occlusion pattern) features were compared. Results: The embolization endpoint was reached in all animals. Applying Angiography, embolic agents were definitely visible during embolization in all study groups. Vascular occlusion occurred from distal (arcuate and interlobar arteries) to proximal (renal artery), whereby the most distal levels were reached in II and III. Applying CT imaging, embolic agents were definitely visible in hilar and intraparenchymal arteries in all groups. Pathology proved occlusion of segmental, interlobar and arcuate arteries in all groups, and additionally occlusion of interlobular arteries, pre-glomerular arterioles and glomerular capillaries in I, II and III. Conclusion: ETHIBLOC_Reloaded is a promising re-designed zein-based embolic agent that can be used safely and effectively for transarterial embolization of the pig kidney.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To evaluate trisacryl-gelatin microspheres (40-120 microm) for acute and chronic tissue embolization in mini-pig livers.
Thirteen animals were divided into four groups: group 1 (n = 3), total ...arterial bed occlusion with acute procedure; groups 2 to 4, chronic superselective embolization with follow-up of 1 week (group 2, n = 1), 4 weeks (group 3, n = 4) or 14 weeks (group 4, n = 5). Key endpoints were homogeneity and particle distribution in acute embolizations (group 1) and necrosis and inflammation in chronic embolizations (groups 2-4) as assessed microscopically and angiographically.
After liver embolization, parenchymal necrosis did not occur; only signs of vessel wall disintegration were evident. The bile ducts remained intact. A distinct foreign body reaction with sparse leukocytic infiltration and giant cells was found at 14 weeks, but no signs of major inflammation were found. Particles were seen at the presinusoidal level, but no particle transportation into the sinusoids was observed.
Embolization in mini-pig livers, using small trisacryl-gelatin microspheres, results in vessel fibrosis without parenchymal or bile duct necrosis. The most likely explanation for preservation of the parenchyma is portal inflow. Small trisacryl-gelatin microspheres may be ideal as an adjunct for chemoembolization.
Purpose
This study was designed to compare technical parameters during ablation as well as CT 3D rendering and histopathology of the ablation zone between sphere-enhanced microwave ablation (sMWA) ...and bland microwave ablation (bMWA).
Methods
In six sheep-livers, 18 microwave ablations were performed with identical system presets (power output: 80 W, ablation time: 120 s). In three sheep, transarterial embolisation (TAE) was performed immediately before microwave ablation using spheres (diameter: 40 ± 10 μm) (sMWA). In the other three sheep, microwave ablation was performed without spheres embolisation (bMWA). Contrast-enhanced CT, sacrifice, and liver harvest followed immediately after microwave ablation. Study goals included technical parameters during ablation (resulting power output, ablation time), geometry of the ablation zone applying specific CT 3D rendering with a software prototype (short axis of the ablation zone, volume of the largest aligned ablation sphere within the ablation zone), and histopathology (hematoxylin-eosin, Masson Goldner and TUNEL).
Results
Resulting power output/ablation times were 78.7 ± 1.0 W/120 ± 0.0 s for bMWA and 78.4 ± 1.0 W/120 ± 0.0 s for sMWA (n.s., respectively). Short axis/volume were 23.7 ± 3.7 mm/7.0 ± 2.4 cm
3
for bMWA and 29.1 ± 3.4 mm/11.5 ± 3.9 cm
3
for sMWA (
P
< 0.01, respectively). Histopathology confirmed the signs of coagulation necrosis as well as early and irreversible cell death for bMWA and sMWA. For sMWA, spheres were detected within, at the rim, and outside of the ablation zone without conspicuous features.
Conclusions
Specific CT 3D rendering identifies a larger ablation zone for sMWA compared with bMWA. The histopathological signs and the detectable amount of cell death are comparable for both groups. When comparing sMWA with bMWA, TAE has no effect on the technical parameters during ablation.
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