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Early experience with transjugular intrahepatic portosystemic shunt (TIPS) creation
424
CLINICAL RADIOLOGY
bleeding (n = 7), infection at catheter site within 1 week (n = 6), catheter pulling back into the chest wall ( n = 1) and unsuccessful procedures (n=3). Complication rates were 4.4% for the first 20 insertions, 12.9% for the 21st to the 30th insertion, a n d 3.9% for any insertion beyond 30. This difference is statistically significant (P < 0.05). There is no significant difference between staff and non-staff members. In conclusion, there is a definite learning curve with a reduced rate of complications with increasing operator experience. This is most marked when an operator has performed over 30 procedures.
EARLY E X P E R I E N C E W I T H T R A N S J U G U L A R I N T R A H E P A T I C P O R T O S Y S T E M I C S H U N T (TIPS) CREATION P. F. J A Q U E S and M. A. M A U R O
Department of Radiology, UNC Hospitals, Chapel Hill, NC, USA Surgical management of massive recurrent variceal haemorrhage secondary to portal hypertension carries a high mortality rate. Sclerotherapy has been helpful, but eventually often fails. There is a growing experience with the alternative of pereutaneous TIPS. Technical details of the procedure continue to evolve, but short-to-intermediate term results appear consistent between centres. Our experience with TIPS procedure in nine patients is described. Technical details of the TIPS procedure are described elsewhere [1]. 8/ 9 cases were performed under general anaesthesia. The single failure was performed under intravenous sedation and was abandoned for extreme discomfort. We modified the procedure only insofar as once needle access to the portal vein is achieved, the track is dilated using a cannularstiffened 8F Van Andel catheter. Ten m m diameter shunts were stented with either one or two Wallstents. Pressure gradients fell from an average of 30 to 15 m m Hg. O f eight technical successes, one patient died within 48 h of general organ failure. The remaining seven patients were discharged within 3 7 days. There have been no known rebleeds with m a x i m u m follow-up of 150 days. One case of encephalopathy responded to diet and lactulose.
Reference
1 Richter GM, Noeldge G, Palmaz JC, Roessle M. The transjugnlar intrahepatic portosystemic stent-shunt (TIPSS): result of a pilot study. Cardiovascular Interventional Radiology 1990; 13:200-207.
P L A C E M E N T OF A N T E G R A D E J J S T E N T S C. T. K U N N E N K E R I L , I. B. N O C K L E R and H. N. W H 1 T F I E L D
Departments of Radiology and Urology, St Bartholomew's Hospital, London The placement of antegrade JJ stents is a realistic alternative to retrograde stent insertion which almost always requires a general anaesthetic and m a y be disadvantageous in patients with impaired renal function. We have adopted a policy of elective antegrade insertion of stents over the past year in those patients who do not require cytoscopic and/or ureteroscopic manoeuvres simultaneously. Twenty-five stents in 21 patients were attempted for a variety of pathologies. Ureteric obstruction or fistula (l 3), stone management pre or post ESWL (7), ureteric obstruction after renal transplantation (4) and ureteral stenosis (1). A description of the materials and methods adopted is presented. JJ stent placement was not successful in four cases. The reasons for failure and pitfalls are presented. Antegrade JJ stent placement as an alternative to percutaneous nephrostomy avoid external drainage and tube dislodgement. This is of particular value in patients with malignant disease where effective palliation with m i n i m u m morbidity is achieved. The advantage over retrograde placement of stents is that it does n o t require a general anaesthetic and has also reduced cost and length of hospitalization.
O R O G A S T R I C M A G N E T R E M O V A L OF I N G E S T E D DISC BATTERIES V. G. M c D E R M O T T , T. T A Y L O R , S. M a c K E N Z I E and G. M. A. H E N D R Y
Between 1987 and 1991, 21 children presented to the Royal Hospital for Sick Children with a history of disc battery ingestion. Abdominal Xray was performed to show the position of the battery. If the battery was in the stomach a 5 m m cylindrical magnet attached to an 18 inch, 8 F orogastric tube was swallowed by the patient and manipulated close to the battery under fluoroscopy. W h e n the magnet gripped the battery it was withdrawn. Following successful removal the patient was discharged. The 21 children had swallowed 23 batteries. In three cases the abdominal X-ray showed the battery to be in small bowel. In two cases the patient refused to swallow the magnet. In one of these cases the battery, was removed by magnet under general anaesthesia; in the other it passed spontaneously into small bowel. Eighteen batteries were removed by magnet without anaesthesia. In one case the battery fragmented in the oesophagus during removal. The fragments were extracted successfully using a Foley catheter but the serum mercury level was 65 nmol/l (Normal < 35 nmol/1). Orogastric magnet removal is a minimally invasive, welt tolerated method of removing ingested disc batteries. T H E EFFECT OF C O N T R A S T M E D I A O N W H I T E C E L L C H E M O T A X I S IN VITRO: A N E W L Y R E C O G N I Z E D ADVERSE EFFECT C. A. R O O B O T T O M , R. F A R R O W and I. P. W E L L S
Department of Radiodiagnosis, DerriJord General Hospial, Plymouth The adverse effects of radiographic contrast media (RCM) are diverse. Their effects, however, on white cell function have been little studied, especially in vivo. Using an under agarose technique we examined the effect of R C M on white cell chemotaxis in patients undergoing angiography. Fifteen patients were given 100 ml of Iohexol 300 arterially during angiography. Heparinized venous blood samples were obtained both pre and post injection of the RCM. After an incubation of 4 h the under agarose motility of the granulocytes was assessed via light microscopy. Migration was assessed for each cell and from this an overall motility score was obtained. A comparison of the motility score pre and post R C M administration was made.Results show a statistically significant reduction in white cell motility (P < 0.05) fo'llowing RCM. Whilst R C M have been shown to reduce chemotaxis in vitro this is the first time the effects in vivo have been studied. These results suggest that the use of R C M in patients with concurrent infection or immunosuppression may be hazardous. THE PLAIN CHEST RADIOGRAPHIC CHANGES OF THE ABSENT P U L M O N A R Y VALVE S Y N D R O M E C. M. OWENS, P. DEES and D. S H A W
Departments of Radiology and Cardiology, The Hospital for Sick Children, Great Ormond Street, London The absent pulmonary valve syndrome is a relatively rare condition, representing approximately 3% of cases of the Tetralogy of Fallot in autopsy series and clinical reviews. The syndrome is characterized by a ring-like, and usually stenotic malformation of the pulmonary valve, with failure of development of the valve cusps rather than true absence. We have analysed the plain chest radiographs in 40 patients with this syndrome, who underwent corrective surgery in our hospital. We found the conventional posteroanterior projection to show characteristic changes of massively dilated central pulmonary arteries, with normal peripheral vascular markings in all of the infant group, with hyperinflation of the upper and middle lobes in the majority. All of the patients had the intracardiac features of the Tetralogy of Fallot. The plain chest radiograph provided both valuable diagnostic information and aided in the post-operative assessment of these patients who are prone to obstructive emphysema.
F O U R Q U A D R A N T T R A N S R E C T A L U L T R A S O U N D (TRUS) BIOPSY O F T H E P R O S T A T E : I M P L I C A T I O N S F O R DIAGNOSIS AND S T A G I N G OF C A N C E R J. SPENCER, A. A L E X A N D E R , T. M A T T E U C C I and B. G O L D B E R G
Department of Diagnostic Radiology, Royal Hospital for Sick Children, Edinburgh
Division of Diagnostic Ultrasound, Thomas Jefferson University Hospital, Philadelphia. PA 19107, USA
Purpose: To evaluate orogastric magnet removal in the management of ingested disc batteries.
Purpose: To investigate the efficacy of ultrasound guided four quadrant biopsy (4QB) of the prostate for the diagnosis and staging of prostate
CLINICAL RADIOLOGY
bleeding (n = 7), infection at catheter site within 1 week (n = 6), catheter pulling back into the chest wall ( n = 1) and unsuccessful procedures (n=3). Complication rates were 4.4% for the first 20 insertions, 12.9% for the 21st to the 30th insertion, a n d 3.9% for any insertion beyond 30. This difference is statistically significant (P < 0.05). There is no significant difference between staff and non-staff members. In conclusion, there is a definite learning curve with a reduced rate of complications with increasing operator experience. This is most marked when an operator has performed over 30 procedures.
EARLY E X P E R I E N C E W I T H T R A N S J U G U L A R I N T R A H E P A T I C P O R T O S Y S T E M I C S H U N T (TIPS) CREATION P. F. J A Q U E S and M. A. M A U R O
Department of Radiology, UNC Hospitals, Chapel Hill, NC, USA Surgical management of massive recurrent variceal haemorrhage secondary to portal hypertension carries a high mortality rate. Sclerotherapy has been helpful, but eventually often fails. There is a growing experience with the alternative of pereutaneous TIPS. Technical details of the procedure continue to evolve, but short-to-intermediate term results appear consistent between centres. Our experience with TIPS procedure in nine patients is described. Technical details of the TIPS procedure are described elsewhere [1]. 8/ 9 cases were performed under general anaesthesia. The single failure was performed under intravenous sedation and was abandoned for extreme discomfort. We modified the procedure only insofar as once needle access to the portal vein is achieved, the track is dilated using a cannularstiffened 8F Van Andel catheter. Ten m m diameter shunts were stented with either one or two Wallstents. Pressure gradients fell from an average of 30 to 15 m m Hg. O f eight technical successes, one patient died within 48 h of general organ failure. The remaining seven patients were discharged within 3 7 days. There have been no known rebleeds with m a x i m u m follow-up of 150 days. One case of encephalopathy responded to diet and lactulose.
Reference
1 Richter GM, Noeldge G, Palmaz JC, Roessle M. The transjugnlar intrahepatic portosystemic stent-shunt (TIPSS): result of a pilot study. Cardiovascular Interventional Radiology 1990; 13:200-207.
P L A C E M E N T OF A N T E G R A D E J J S T E N T S C. T. K U N N E N K E R I L , I. B. N O C K L E R and H. N. W H 1 T F I E L D
Departments of Radiology and Urology, St Bartholomew's Hospital, London The placement of antegrade JJ stents is a realistic alternative to retrograde stent insertion which almost always requires a general anaesthetic and m a y be disadvantageous in patients with impaired renal function. We have adopted a policy of elective antegrade insertion of stents over the past year in those patients who do not require cytoscopic and/or ureteroscopic manoeuvres simultaneously. Twenty-five stents in 21 patients were attempted for a variety of pathologies. Ureteric obstruction or fistula (l 3), stone management pre or post ESWL (7), ureteric obstruction after renal transplantation (4) and ureteral stenosis (1). A description of the materials and methods adopted is presented. JJ stent placement was not successful in four cases. The reasons for failure and pitfalls are presented. Antegrade JJ stent placement as an alternative to percutaneous nephrostomy avoid external drainage and tube dislodgement. This is of particular value in patients with malignant disease where effective palliation with m i n i m u m morbidity is achieved. The advantage over retrograde placement of stents is that it does n o t require a general anaesthetic and has also reduced cost and length of hospitalization.
O R O G A S T R I C M A G N E T R E M O V A L OF I N G E S T E D DISC BATTERIES V. G. M c D E R M O T T , T. T A Y L O R , S. M a c K E N Z I E and G. M. A. H E N D R Y
Between 1987 and 1991, 21 children presented to the Royal Hospital for Sick Children with a history of disc battery ingestion. Abdominal Xray was performed to show the position of the battery. If the battery was in the stomach a 5 m m cylindrical magnet attached to an 18 inch, 8 F orogastric tube was swallowed by the patient and manipulated close to the battery under fluoroscopy. W h e n the magnet gripped the battery it was withdrawn. Following successful removal the patient was discharged. The 21 children had swallowed 23 batteries. In three cases the abdominal X-ray showed the battery to be in small bowel. In two cases the patient refused to swallow the magnet. In one of these cases the battery, was removed by magnet under general anaesthesia; in the other it passed spontaneously into small bowel. Eighteen batteries were removed by magnet without anaesthesia. In one case the battery fragmented in the oesophagus during removal. The fragments were extracted successfully using a Foley catheter but the serum mercury level was 65 nmol/l (Normal < 35 nmol/1). Orogastric magnet removal is a minimally invasive, welt tolerated method of removing ingested disc batteries. T H E EFFECT OF C O N T R A S T M E D I A O N W H I T E C E L L C H E M O T A X I S IN VITRO: A N E W L Y R E C O G N I Z E D ADVERSE EFFECT C. A. R O O B O T T O M , R. F A R R O W and I. P. W E L L S
Department of Radiodiagnosis, DerriJord General Hospial, Plymouth The adverse effects of radiographic contrast media (RCM) are diverse. Their effects, however, on white cell function have been little studied, especially in vivo. Using an under agarose technique we examined the effect of R C M on white cell chemotaxis in patients undergoing angiography. Fifteen patients were given 100 ml of Iohexol 300 arterially during angiography. Heparinized venous blood samples were obtained both pre and post injection of the RCM. After an incubation of 4 h the under agarose motility of the granulocytes was assessed via light microscopy. Migration was assessed for each cell and from this an overall motility score was obtained. A comparison of the motility score pre and post R C M administration was made.Results show a statistically significant reduction in white cell motility (P < 0.05) fo'llowing RCM. Whilst R C M have been shown to reduce chemotaxis in vitro this is the first time the effects in vivo have been studied. These results suggest that the use of R C M in patients with concurrent infection or immunosuppression may be hazardous. THE PLAIN CHEST RADIOGRAPHIC CHANGES OF THE ABSENT P U L M O N A R Y VALVE S Y N D R O M E C. M. OWENS, P. DEES and D. S H A W
Departments of Radiology and Cardiology, The Hospital for Sick Children, Great Ormond Street, London The absent pulmonary valve syndrome is a relatively rare condition, representing approximately 3% of cases of the Tetralogy of Fallot in autopsy series and clinical reviews. The syndrome is characterized by a ring-like, and usually stenotic malformation of the pulmonary valve, with failure of development of the valve cusps rather than true absence. We have analysed the plain chest radiographs in 40 patients with this syndrome, who underwent corrective surgery in our hospital. We found the conventional posteroanterior projection to show characteristic changes of massively dilated central pulmonary arteries, with normal peripheral vascular markings in all of the infant group, with hyperinflation of the upper and middle lobes in the majority. All of the patients had the intracardiac features of the Tetralogy of Fallot. The plain chest radiograph provided both valuable diagnostic information and aided in the post-operative assessment of these patients who are prone to obstructive emphysema.
F O U R Q U A D R A N T T R A N S R E C T A L U L T R A S O U N D (TRUS) BIOPSY O F T H E P R O S T A T E : I M P L I C A T I O N S F O R DIAGNOSIS AND S T A G I N G OF C A N C E R J. SPENCER, A. A L E X A N D E R , T. M A T T E U C C I and B. G O L D B E R G
Department of Diagnostic Radiology, Royal Hospital for Sick Children, Edinburgh
Division of Diagnostic Ultrasound, Thomas Jefferson University Hospital, Philadelphia. PA 19107, USA
Purpose: To evaluate orogastric magnet removal in the management of ingested disc batteries.
Purpose: To investigate the efficacy of ultrasound guided four quadrant biopsy (4QB) of the prostate for the diagnosis and staging of prostate