Abstract
Contracting is an important part of running the business of private practice interventional radiology. A basic knowledge of contracting is vital for the practicing interventionalist to best ...position him or herself to excel in private practice. Exclusive contracts are common in interventional, diagnostic, and radiology practices. Such contracts, however, may significantly limit the practice of individual interventional radiologists and impede the growth of interventional procedures in communities at large. This article outlines the role of exclusive contracts in interventional practices, and describes the limitations of such contracts.
Autologous blood patch pleurodesis (ABPP) offers an alternative to surgery when conservative management is ineffective for treating a persistent air leak (PAL). In the traditional technique, ...autologous venous blood is introduced into the affected pleural cavity via a blindly inserted large-bore surgical chest tube. Herein, we present a case of an 18 year old male with a PAL following video assisted thorascopic bleb resection and talc pleurodesis who underwent successful ABPP using a small-bore pigtail catheter placed under computed tomography (CT) guidance. As compared to the traditional technique, this approach may potentially offer several advantages, such as more precise chest tube placement over the air leak site and reduced pain with chest tube insertion. Although image-guided chest tube insertion is a commonly performed procedure, its use for the specific indication in this patient's case has not been described in the literature, to the best of our knowledge.
•Persistent air leak (PAL) is a commonly encountered complication following thoracic surgery.•Autologous blood patch pleurodesis (ABPP) may be performed to treat a PAL if conservative management is unsuccessful.•Traditionally, ABPP involves instilling venous blood into the pleural space via a blindly inserted large-bore chest tube.•We report a case in which ABPP was performed using a small-bore catheter placed under Computed Tomography (CT) guidance.•The use of CT-guided small-bore catheter insertion may offer several advantages as compared to the traditional technique.
To determine whether there is significant quality of life score improvement after uterine artery embolization (UAE) and to compare UAE and myomectomy outcomes.
Prospective cohort controlled study.
...Sixteen medical centers in the United States.
One hundred forty-nine UAE patients and 60 myomectomy patients. Patients were assigned to myomectomy or UAE on the basis of a best treatment decision made by the patient and her physician. All patients were observed for 6 months. The UAE patients also had follow-up examinations at 1 year.
Myomectomy or UAE.
Quality of life score changes, menstrual bleeding score changes, uterine size differences, time off, and adverse events.
Both groups experienced statistically significant improvements in the uterine fibroid quality of life score, menstrual bleeding, uterine volume, and overall postoperative quality of life. The mean hospital stay was 1 day for the UAE patients, compared with 2.5 days for the myomectomy patients. The UAE and myomectomy patients returned to their normal activities in 15 days and 44 days, respectively, and returned to work in 10 days and 37 days, respectively. At least one adverse event occurred in 40.1% of the myomectomy patients, compared with 22.1% in the UAE group.
The uterine fibroid quality of life score was significantly improved in both groups. No significant differences were observed in bleeding improvement, uterine volume reduction, uterine fibroid quality of life score improvement, and overall quality of life score improvement between groups. Patients receiving UAE required fewer days off work, fewer hospital days, and experienced fewer adverse events.
To determine the imaging appearance and frequency of detection of bile duct calculi in patients with primary sclerosing cholangitis.
Images (169 computed tomographic CT scans, 155 sonograms, and 109 ...cholangiograms) of 189 patients with primary sclerosing cholangitis, five of whom were prospectively included, were reviewed. Pathologic records were reviewed for proof of the presence of calculi.
Bile duct calculi were visualized on images in 14 (7.6%) of the 184 retrospective patients and in all five of the prospective patients. The presence of calculi was confirmed with pathologic or imaging findings in 19 patients, in whom calculi were visible on 16 of 18 CT scans, 15 of 19 sonograms, and 14 of 17 cholangiograms. Calculi were in the intrahepatic ducts in 11 patients and in the intra- and extrahepatic bile ducts in eight patients. At CT, calculi appeared as foci of faint high attenuation or as coarse calcifications in nondilated or variably dilated ducts. At sonography, they appeared as unique echogenic casts with variable posterior acoustic shadowing or as discrete, echogenic, variably shadowing foci in variably dilated ducts. Calculi were depicted at cholangiography as rounded filling defects.
Intrahepatic bile duct calculi are present in approximately 8% of patients and can have a unique imaging appearance.
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