Canalis Gc

A second hysterosalpingography reduces the use of selective technique for treatment of a proximal tubal obstruction

OBJECTIVE To assess whether a second hysterosalpingography (HSG) can permit tubal patency, reducing the use of selective salpingography in patients with proximal tubal obstruction. DESIGN Prospective study. SETTING University hospital. PATIENT(S) The study population consisted of 360 infertile women. INTERVENTION(S) In patients with unilateral or bilateral proximal tubal obstruction, a second HSG was performed after about 1 month. In those cases with persistent obstruction, an immediate selective salpingography and tubal catheterization were performed. MAIN OUTCOME MEASURE(S) Tubal opacification. RESULT(S) Forty patients underwent a second HSG procedure for proximal tubal occlusion. Among these, 24 achieved bilateral tubal patency. Thus, repetition of a conventional HSG after 1 month avoided unnecessary salpingography in 60% of patients. CONCLUSION(S) In infertile women with proximal tubal obstruction, we believe it is best to perform a second HSG. HSG is easy to carry out and subjects patients to a lower dosage of radiation and fewer risks than selective salpingography. The latter technique should be reserved for unsuccessful cases.

Combined Biliary and Duodenal Stenting for Palliation of Pancreatic Cancer

The aim of this case report was to evaluate the usefulness of combined biliary and duodenal stenting in the palliation of pancreatic cancer. We report a series of 4 consecutive patients (2 men and 2 women, mean age 58.5 years, range 38–77 years) who underwent combined biliary and duodenal stenting in our department between March 2000 and April 2001. All patients had cancer of the head of the pancreas causing stricture of the common bile duct and second portion of the duodenum. Biliary and duodenal stents were successfully positioned, with relief of symptoms in all cases. No early complications were observed, except for a transient increase in serum lipase and amylase in one case. Mean follow‐up was 7.5 months (range 5–14 months). One patient presenting recurrence of vomiting after 4 months because of tumour overgrowth at the distal edge of the prosthesis was successfully treated by insertion of a partially overlapping second coaxial stent. Combined biliary and duodenal stenting for the palliation of pancreatic cancer was performed safely and successfully. Stents allowed effective re‐canalization of the biliary tract and duodenum, relieving both jaundice and vomiting. This procedure should be considered as an alternative to palliative surgery, especially in critically ill patients.

Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature

PurposeThis article discusses the possible pathophysiological conditions responsible for magnetic resonance imaging (MRI) finding of transient focal lesions in the splenium of the corpus callosum on the basis of our experience and a review of the literature.Materials and methodsIn six patients undergoing computed tomography (CT) and MRI examinations, focal nonhemorrhagic lesions of the splenium of the corpus callosum were incidentally discovered. Patients had been referred for suspected encephalitis (n=2), dural sinus thrombosis (n=1) and multiple sclerosis (n=3). MRI examinations were repeated after 4, 8 and 12 weeks and in two cases also after 6 and 9 months. MRI and medical records were retrospectively reviewed with respect to patients’ clinical history, medication and laboratory findings to define lesion aetiology.ResultsIn all patients, the lesions were isolated, reversible and with no contrast enhancement. In four patients, the lesion disappeared after complete remission of the underlying disease, whereas in two patients, they persisted for 6 and 9 months, respectively.ConclusionsTo our knowledge and according to previous reports, the fact that these lesions are detected in a relatively large number of conditions with heterogeneous etiopathogenetic factors leads to the hypothesis that a common underlying pathophysiological mechanism that, considering signal characteristic, reversibility and white matter location, could be represented by vasogenic oedema.RiassuntoObiettiviFormulare delle ipotesi fisio-patogenetiche responsabili della comparsa all’imaging RM di lesioni focali transitorie nello splenio del corpo calloso, oltre che identificarne il significato e le eventuali correlazioni cliniche in base alla nostra esperienza e ai dati riportati finora in letteratura.Materiali e metodiIn 6 pazienti sottoposti a indagini TC e RM sono state riscontrate incidentalmente lesioni focali non emorragiche, isolate, nel contesto dello splenio del corpo calloso. I pazienti giungevano alla nostra osservazione con sospetto clinico di patologia infettiva (2), trombotica (1), demielinizzante (3) dell’encefalo. In tutti i casi sono stati effettuati controlli RM seriati nel tempo a distanza di 4–8–12 settimane e in 2 pazienti anche dopo 6 e 9 mesi. Le immagini RM unitamente ai dati clinico-laboratoristici sono state analizzate retrospettivamente al fine di definire l’eziologia di tali lesioni.RisultatiIn tutti i pazienti le lesioni si sono rivelate focali, prive di enhancement dopo mezzo di contrasto (MdC) e reversibili. In 4 pazienti le lesioni sono scomparse dopo la remissione completa della patologia di base mentre in 2 le alterazioni sono persistite rispettivamente sino a 6 e 9 mesi.ConclusioniLa spiegazione definitiva di tale reperto appare ancora controversa. Secondo la nostra esperienza e quella di altri autori, essendo il riscontro di tali lesioni comune a un ampio spettro di condizioni patologiche con fattori eziopatogenetici eterogenei, è ipotizzabile che attraverso un comune, complesso meccanismo fisiopatologico tali fattori possano creare squilibri responsabili della comparsa di edema vasogenico che si esprime in un’alterazione del segnale RM nello splenio del corpo calloso.

Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia

PurposeTo assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures.MethodsWe report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec.ResultsWe obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration.ConclusionsTracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.

Radial scar of the breast: mammographic enigma in pre- and postmenopausal women

OBJECTIVE The aim of the study was to investigate the incidence and the mammographic features of the lesions suggestive of radial scar (RS). METHODS We reviewed 31883 mammograms of women in pre and postmenopause and we found 23 (0.072%) images suggestive of RS. Twelve out of 23 (52%) women were in premenopause and 11 out of 23 (48%) in postmenopause, respectively. Histologic diagnosis was made on the surgical biopsy specimen. RESULTS We described mammographic features of these lesions. On 23 biopsy specimens of mammograms suggestive of RS, histology pointed out 11 (48%) radial scars, 3 (13%) sclerosing adenosis and 9 (39%) carcinomas. CONCLUSIONS In our case histories we found 11 (0.034%) radial scars among 31883 performed mammographies. Mammographic findings suggestive of RS provide remarkable diagnostic problems because numerous aspects at mammography suggestive of this lesion can be found also both in case of sclerosing adenosis and carcinomas making differential diagnosis impossible. The finding of mammographic features suggestive of RS imposes performance of targeted surgical biopsy for the correct diagnosis.

A double-blind comparative study of the safety and efficacy of iomeprol in renal intra-arterial digital subtraction angiography.

This randomised, double-blind, parallel group study was to compare the safety, tolerance and diagnostic efficacy of iomeprol and iopamidol, both at an iodine concentration of 150 mgI/ml, in 40 patients with arterial hypertension who required renal intra-arterial digital subtraction angiography (IA-DSA) for suspected renovascular stenosis. All patients underwent extensive pre- and post-contrast clinical, instrumental and laboratory controls for safety assessments. The tolerance to the test contrast media was evaluated in terms of discomfort associated with the injection of the test compounds. Image quality was prospectively graded by two independent readers according to a five-point scale as follows: 1, insufficient; 2, sufficient; 3, good; 4, excellent; E, excessive. The quality of vascular opacification in the region of interest was rated as diagnostic in 87.8% of radiographs obtained in the iomeprol group and in 84.5% in the iopamidol group, without significant differences between the two study groups. The results of angiography were always useful for subsequent patient management. The procedure was always well tolerated. There were no clinically significant changes in vital signs, ECG and laboratory parameters during the study in both groups. The results of our study show that iomeprol 150 mgI/ml, and iopamidol 150 mgI/ml are equally effective, well tolerated and safe contrast agents when used for IA-DSA.

Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical–physiological explanation and review of the literature

Purpose This article discusses the possible pathophysiological conditions responsible for magnetic resonance imaging (MRI) finding of transient focal lesions in the splenium of the corpus callosum on the basis of our experience and a review of the literature.

Digital angiography in evaluation of orthopedic tumors

Preoperative evaluation of orthopedic tumors using digital subtraction angiography (DSA) proved useful to ascertain the nature of the lesion, its extension to soft tissues and joints, and the presence of arteriovenous (AV) shunts. We report that overall accuracy varied from 89% to 92%, depending on the feature evaluated. The importance of angiographic examination of this entity is discussed as well as the advantages of DSA over conventional angiography.