BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper lim...BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists.This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding(EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.AIM To analyse the frequency of EVIF identified on computed angiography(CT) of the upper limb.METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs(n = 79)were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A,findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.RESULTS Complete imaging datasets were available in 74/79(93.7%). Patientdemographics included 39(52.7%) females and 35(47.2%) males with a mean age of 59 ± 19.5 years(range 19-93 years). A total of 153 EVIFs were reported in 52 patients(70.3%). Of these, 44 EVIFs(28.7%) were found in the chest, 83(54.2%) in the abdomen, 14(9.2%) in the musculoskeletal system and 9(5.8%) in the head and neck. Thirteen EVIFs(8.4%) identified in 11 patients were noted to be of immediate clinical significance(Category A), 50 EVIFs(32.3%) were identified in20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs(59.5%) identified in 21 patients were determined to be of no clinical significance(Category C). One index case of malignancy(1.3%) and four cases of new disseminated metastatic disease(5.4%) were identified.CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4%for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.展开更多
The accumulation of extravascular lung water （EVLW） after cardiac surgery of congenital heart disease may predicted from the preoperative level of pulmonary blood flow. This accumulation of EVLW may adversely affect...The accumulation of extravascular lung water （EVLW） after cardiac surgery of congenital heart disease may predicted from the preoperative level of pulmonary blood flow. This accumulation of EVLW may adversely affect ventilatory parameters. Lung compliance （LC）, cardiac index （CI）, blood arterial oxygen tension （PaO<sub>2</sub>）, left atrial pressure （LAP）and EVLW were measured serially immediately postoperative in two groups of children after complete repair of congenital heart disease contrasted by their level of pulmonary blood flow: Tetralogy of Fallot （TOF, n=10, 4.6±1.9 years） and ventrvcular septal defect with pulmonary arterial hypertension （VSD+PAH, n=10, 5.4±2.0 years）.Using a double indicator-dilution technique （DIDT） the EVLW peaked at the 16th hour postoperation in TOF group and at the 8 th hour postoperation inthe VSD with PAH group. During the first 24 hours after surgery the EVLW was consistently higher in the VSD with PAH group （P【0.01）. There was a negative correlation between the EVLW and LC, CI and PaO<sub>2</sub> and no correlation between the EVLW and LAP. In three hypoxemic patients of the VSD with PAH group the LC deteriorated while the EVLW was elevated. After treatment with positive end expiratory pressure （PEEP） the hypoxemia corrected as the LC increased and the EVLW decreased, with no change in the CI. Thus, measurement of EVLW provides a sensitive method for explaining changes in LC, that may lead to a more rational adjustment of mechanical ventilator parameters.展开更多
AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively u...AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit(ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the inhospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic(ROC) curve method to analyze the significant variables and the area under the ROC curve(AUC) of the variables, P value and 95%CI were calculated.RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp(the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for inhospital survival rate as variables with EVLWIa(AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW(EVLWI < 10 m L/kg) was better than that of patients with a higher EVLW, whether indexed by actual(HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight(HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method(76% vs 12.5%, respectively).CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict inhospital survival rate among severe sepsis patients in the medical ICU.展开更多
Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (E...Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.展开更多
To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been re...To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been recommended for patients with PNS.[1,4]However,existing surgical means of treatment are not sufficiently safe,effective,or minimally invasive.Here,we present one case of PNS treated with three-dimensional (3D)printed extravascular stent placement using laparoscopy.展开更多
文摘BACKGROUND Computer tomography angiography(CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists.This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding(EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.AIM To analyse the frequency of EVIF identified on computed angiography(CT) of the upper limb.METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs(n = 79)were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A,findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.RESULTS Complete imaging datasets were available in 74/79(93.7%). Patientdemographics included 39(52.7%) females and 35(47.2%) males with a mean age of 59 ± 19.5 years(range 19-93 years). A total of 153 EVIFs were reported in 52 patients(70.3%). Of these, 44 EVIFs(28.7%) were found in the chest, 83(54.2%) in the abdomen, 14(9.2%) in the musculoskeletal system and 9(5.8%) in the head and neck. Thirteen EVIFs(8.4%) identified in 11 patients were noted to be of immediate clinical significance(Category A), 50 EVIFs(32.3%) were identified in20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs(59.5%) identified in 21 patients were determined to be of no clinical significance(Category C). One index case of malignancy(1.3%) and four cases of new disseminated metastatic disease(5.4%) were identified.CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4%for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.
文摘The accumulation of extravascular lung water （EVLW） after cardiac surgery of congenital heart disease may predicted from the preoperative level of pulmonary blood flow. This accumulation of EVLW may adversely affect ventilatory parameters. Lung compliance （LC）, cardiac index （CI）, blood arterial oxygen tension （PaO<sub>2</sub>）, left atrial pressure （LAP）and EVLW were measured serially immediately postoperative in two groups of children after complete repair of congenital heart disease contrasted by their level of pulmonary blood flow: Tetralogy of Fallot （TOF, n=10, 4.6±1.9 years） and ventrvcular septal defect with pulmonary arterial hypertension （VSD+PAH, n=10, 5.4±2.0 years）.Using a double indicator-dilution technique （DIDT） the EVLW peaked at the 16th hour postoperation in TOF group and at the 8 th hour postoperation inthe VSD with PAH group. During the first 24 hours after surgery the EVLW was consistently higher in the VSD with PAH group （P【0.01）. There was a negative correlation between the EVLW and LC, CI and PaO<sub>2</sub> and no correlation between the EVLW and LAP. In three hypoxemic patients of the VSD with PAH group the LC deteriorated while the EVLW was elevated. After treatment with positive end expiratory pressure （PEEP） the hypoxemia corrected as the LC increased and the EVLW decreased, with no change in the CI. Thus, measurement of EVLW provides a sensitive method for explaining changes in LC, that may lead to a more rational adjustment of mechanical ventilator parameters.
基金Supported by Grants from Taiwan National Science Council,No.NSC-100-2314-B-182A-054Chang Gung Memorial Hospital,Nos.CMRPG3B0831,CMRPG3B0832 and CMRPG3A0562
文摘AIM: To investigate extravascular lung water indexed to predicted body weight(EVLWIp) and actual body weight(EVLWIa) on outcome of patients with severe sepsis.METHODS: Transpulmonary thermodilution was prospectively used to measure cardiovascular hemodynamics, EVLWIp and EVLWIa via an arterial catheter placed in each patient within 48 h of meeting the criteria for severe sepsis from a medical intensive care unit(ICU) at a university affiliated hospital. Survival was the single dependent variable. In order to examine and compare the predictive power of EVLWIp, EVLWIa and other clinically significant factors in predicting the inhospital survival status of severe sepsis patients in the medical ICU, a receiver operating characteristic(ROC) curve method to analyze the significant variables and the area under the ROC curve(AUC) of the variables, P value and 95%CI were calculated.RESULTS: In total, 33 patients were studied. In the ROC curve method analyses, EVLWIp(the AUC: 0.849; P = 0.001, 95%CI: 0.72-0.98) was as predictive for inhospital survival rate as variables with EVLWIa(AUC, 0.829; P = 0.001, 95%CI: 0.68-0.98). The proportion of patients surviving with a low EVLW(EVLWI < 10 m L/kg) was better than that of patients with a higher EVLW, whether indexed by actual(HR = 0.2; P = 0.0002, 95%CI: 0.06-0.42) or predicted body weight(HR = 0.13; P < 0.0001, 95%CI: 0.05-0.35) during their hospital stay with the Kaplan-Meier method(76% vs 12.5%, respectively).CONCLUSION: This investigation proposed that EVLWIp is as good a predictor as EVLWIa to predict inhospital survival rate among severe sepsis patients in the medical ICU.
文摘Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS.
文摘To the Editor:Posterior nutcracker syndrome (PNS)is a condition caused by compression of the left renal vein (LRV)between the vertebral column and the aorta (AO).Open surgery with LRV transposition has usually been recommended for patients with PNS.[1,4]However,existing surgical means of treatment are not sufficiently safe,effective,or minimally invasive.Here,we present one case of PNS treated with three-dimensional (3D)printed extravascular stent placement using laparoscopy.
