Levent Kara

A robotic needle-positioning and guidance system for CT-guided puncture: Ex vivo results

Abstract Purpose: To test the feasibility of a robotic needle-guidance platform during CT-guided puncture ex vivo. Material and methods: Thin copper wires inserted into a torso phantom served as targets. The phantom was placed on a carbon plate and the robot-positioning unit (RPU) of the guidance platform (iSYS Medizintechnik GmbH, Kitzbuehel, Austria) was attached. Following CT imaging and automatic registration a double oblique trajectory was planned and the RPU was remotely moved into appropriate position and angulation. A 17G-puncture needle was then manually inserted until the preplanned depth, permanently guided by the RPU. The CT scan was repeated and the distance between the actual needle tip and the target was evaluated. Results: Automatic registration was successful in ten experiments and the median duration of an experiment was 9.6 (6.4–46.0) minutes. The angulation of the needle path in x-y and z-axis was within 15.6° to 32.6°, and -32.8° to 3.2°, respectively and the needle insertion depth was 92.8 ± 14.4 mm. The Euclidean distance between the actual needle tip and the target was 2.3 ± 0.8 (range, 0.9–3.7) mm. Conclusion: Automatic registration and accurate needle placement close to small targets was demonstrated. Study settings and torso phantom were very close to the clinical reality.

Survival after trepanation-Early cranial surgery from Late Iron Age Switzerland

Trepanation is defined as the intentional perforation of the cranial vault with removal of a piece of skull bone. In Europe, trepanation is known to have been practiced at least since the Neolithic, and it can still be found today in East African native tribes. Two skulls with lesions from the Late Iron Age site Münsingen-Rain (420-240 BC) were investigated. The aim of this study was to analyse the lesions and to determine whether they were caused by surgical interventions. Both individuals were analysed by current morphologic-anthropological methods and radiological examinations were performed with a multislice CT-scanner. Additionally, this work surveys trepanations reported in Switzerland and calculates survival rates. In Switzerland, 34 individuals with trepanations have been published. As a tendency, the survival rate appears to be relatively high from the Neolithic to Late Antiquity but then decreases until Pre-Modern times. The 78% survival rate in Late Iron Age Switzerland indicates that the surgery was often performed successfully. Skull injuries sustained in conflicts could have been a reason for trepanation during the Iron Age.

Rigor mortis at the myocardium investigated by post-mortem magnetic resonance imaging.

INTRODUCTION Post-mortem cardiac MR exams present with different contraction appearances of the left ventricle in cardiac short axis images. It was hypothesized that the grade of post-mortem contraction may be related to the post-mortem interval (PMI) or cause of death and a phenomenon caused by internal rigor mortis that may give further insights in the circumstances of death. METHOD AND MATERIALS The cardiac contraction grade was investigated in 71 post-mortem cardiac MR exams (mean age at death 52 y, range 12-89 y; 48 males, 23 females). In cardiac short axis images the left ventricular lumen volume as well as the left ventricular myocardial volume were assessed by manual segmentation. The quotient of both (LVQ) represents the grade of myocardial contraction. LVQ was correlated to the PMI, sex, age, cardiac weight, body mass and height, cause of death and pericardial tamponade when present. In cardiac causes of death a separate correlation was investigated for acute myocardial infarction cases and arrhythmic deaths. RESULTS LVQ values ranged from 1.99 (maximum dilatation) to 42.91 (maximum contraction) with a mean of 15.13. LVQ decreased slightly with increasing PMI, however without significant correlation. Pericardial tamponade positively correlated with higher LVQ values. Variables such as sex, age, body mass and height, cardiac weight and cause of death did not correlate with LVQ values. There was no difference in LVQ values for myocardial infarction without tamponade and arrhythmic deaths. CONCLUSION Based on the observation in our investigated cases, the phenomenon of post-mortem myocardial contraction cannot be explained by the influence of the investigated variables, except for pericardial tamponade cases. Further research addressing post-mortem myocardial contraction has to focus on other, less obvious factors, which may influence the early post-mortem phase too.

Disastrous Portal Vein Embolization Turned into a Successful Intervention

Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

[A rare complication of pulmonary tuberculosis - Rasmussen aneurysm - radiologic diagnosis and therapy].

Obwohl die Inzidenz der Tuberkulose (TBC) in der westlichen Welt sehr niedrig ist und in den letzten Jahren eine weiter fallende Tendenz aufweist, gilt sie mit einer weltweiten Mortalität von über 1,3 Millionen (WHO-Statistik 2012) als eine häufige und lebensbedrohliche Erkrankung. Die 30Mitgliedstaaten der europäischen Union (EU) sowie die Mitgliedsstaaten der europäischen Freihandelsassoziation (EFTA) zeigen bezüglich TBC-Epidemiologie eine heterogene Verteilung, mit Ländern niedriger, moderater und hoher Inzidenz. Die mittlere Inzidenzrate für das Jahr 2010 betrug 14,6 Fälle pro 100.000; in 22 europäischen Ländern wurde die TBC als eliminiert angesehen, was per definitionem einer Inzidenz von unter 20 Fällen auf 100.000 entspricht (Sandgren A et al. Eur J Microbiol Immunol 2012; 2: 292–296). 2007 waren 21% (range: 0–78% für alle EU Länder) der neuaufgetretenen TBC-Fälle nicht europäischen Ursprungs (Hollo V et al. Euro Surveill. 2009; 14 (11): pii = 19151). In Abhängigkeit von der Keimvirulenz sowie dem Immunstatus eines Individuums kann eine TBC-Infektion latent bleiben, zu einer primären Tuberkulose oder im ungünstigen Fall zu einer disseminierten Erkrankung führen, was als Miliartuberkulose bezeichnet wird. Zu den bekannten Folgen und Komplikationen einer Lungen-TBC zählen die folgenden: Granulom/Tuberkulom, Aspergillom, Zysten, Bronchiektasen, Empyem, mediastinale Lymphknoten mit möglicher Verkalkung, oesophagomediastinale oder oesophagobronchiale Fistel, Dilatation/Thrombose von Pulmonaloder Bronchialarterien (Kin HY et al. Radiographics 2001; 21: 839–58).

Seltene Komplikation einer pulmonalen Tuberkulose - Rasmussen-Aneurysma - radiologische Diagnose und Therapie

Obwohl die Inzidenz der Tuberkulose (TBC) in der westlichen Welt sehr niedrig ist und in den letzten Jahren eine weiter fallende Tendenz aufweist, gilt sie mit einer weltweiten Mortalität von über 1,3 Millionen (WHO-Statistik 2012) als eine häufige und lebensbedrohliche Erkrankung. Die 30Mitgliedstaaten der europäischen Union (EU) sowie die Mitgliedsstaaten der europäischen Freihandelsassoziation (EFTA) zeigen bezüglich TBC-Epidemiologie eine heterogene Verteilung, mit Ländern niedriger, moderater und hoher Inzidenz. Die mittlere Inzidenzrate für das Jahr 2010 betrug 14,6 Fälle pro 100.000; in 22 europäischen Ländern wurde die TBC als eliminiert angesehen, was per definitionem einer Inzidenz von unter 20 Fällen auf 100.000 entspricht (Sandgren A et al. Eur J Microbiol Immunol 2012; 2: 292–296). 2007 waren 21% (range: 0–78% für alle EU Länder) der neuaufgetretenen TBC-Fälle nicht europäischen Ursprungs (Hollo V et al. Euro Surveill. 2009; 14 (11): pii = 19151). In Abhängigkeit von der Keimvirulenz sowie dem Immunstatus eines Individuums kann eine TBC-Infektion latent bleiben, zu einer primären Tuberkulose oder im ungünstigen Fall zu einer disseminierten Erkrankung führen, was als Miliartuberkulose bezeichnet wird. Zu den bekannten Folgen und Komplikationen einer Lungen-TBC zählen die folgenden: Granulom/Tuberkulom, Aspergillom, Zysten, Bronchiektasen, Empyem, mediastinale Lymphknoten mit möglicher Verkalkung, oesophagomediastinale oder oesophagobronchiale Fistel, Dilatation/Thrombose von Pulmonaloder Bronchialarterien (Kin HY et al. Radiographics 2001; 21: 839–58).