Thomas A. Demlow

Percutaneous Transluminal Angioplasty versus Endovascular Stent Placement in the Treatment of Venous Stenoses in Patients Undergoing Hemodialysis: Intermediate Results

PURPOSE This report describes intermediate findings from an ongoing prospective randomized trial comparing the results of percutaneous transluminal angioplasty (PTA) with results of endovascular stent placement in patients undergoing hemodialysis. PATIENTS AND METHODS Among 87 consecutive patients with venous stenoses or occlusions, 47 (54%) were treated with PTA alone and 40 (46%) were treated with PTA and stent placement. RESULTS For peripheral sites, the primary patency rates for PTA at 60, 180, and 360 days were 55%, 31%, and 10%, respectively, and for stents were 36%, 27%, and 11%, respectively (P = .6528). The secondary patency rates for PTA at 60, 180, and 360 days were 94%, 80%, and 71%, respectively, and for stents were 73%, 64%, and 64%, respectively (P = .1677). For central sites, the primary patency rates for PTA at 60, 180, and 360 days were 81%, 23%, and 12%, respectively, and for stents were 67%, 11%, and 11%, respectively (P = .4595). The secondary patency rates for PTA were 100% at each interval, and for stents were 100%, 89%, and 78%, respectively (P = .5408). CONCLUSION Intermediate results suggest that, overall, there is no difference in the patency rates for peripheral venous stenoses in dialysis patients treated with PTA or PTA and endovascular stent placement. At this time, the numbers of patients are too small to conclude if certain sites such as larger central veins will respond better to one treatment or the other.

Diagnosis of popliteus injuries with MR imaging

AbstractObjective. Popliteal muscle and tendon injuries are thought to be unusual. This report describes the magnetic resonance (MR) appearances of popliteus muscle and tendon injuries. Design and patients. The study included 24 patients where the diagnoses of popliteal injuries were prospectively made based on MR appearances. The study group was taken from 2412 consecutive knee MRIs. The injuries were characterized as to involving the muscular or tendinous portions of the popliteus apparatus. Results. In 95.8% (23/24) of patients, the tears of the popliteus involved the muscular portion. The injuries were either partial and interstitial or complete. Three patients had tears of both the muscular and tendinous portions or the tendon alone. The anterior and posterior cruciate ligaments were torn in 16.7% (4/24) and 29.2% (7/24) of patients, respectively. There were medial and lateral meniscal tears in 45.8% (11/24) and 25% (6/24) of patients, respectively. There were injuries of the medial and lateral collateral ligaments in 8.3% (2/24) and 4.2% (1/24) of patients, respectively. Bone bruises and/or fractures were seen in 33.3% (8/24) patients. In 8.3% (2/24) of patients, the popliteus injury was an isolated finding. Conclusion. Popliteus muscle and tendon injuries are not uncommon. They usually occur in conjunction with other significant injuries of the knee and can be characterized with MR imaging.

Thyroid Biopsies: Fine-Needle Aspiration Biopsy versus Spring-activated Core Biopsy Needle in 102 Patients

PURPOSE Use of the single-action spring-activated core biopsy needle was compared with the fine needle aspiration biopsy (FNAB) technique in ultrasound (US)-guided thyroid biopsies. PATIENTS AND METHODS Results in 102 patients who underwent sonographically guided thyroid biopsies with both fine needles and core biopsy needles were prospectively evaluated. Results from the 21-gauge FNAB (n = 102) were compared with results from 18-gauge (n = 1), 19-gauge (n = 2), 20-gauge (n = 43), or 21-gauge (n = 56) single-action spring-activated core biopsy needles. RESULTS If the suggestive and diagnostic results were combined, the diagnostic accuracy for the core biopsy needle was 90.2% (92 of 102) and was 80.3% (82 of 102) for FNAB (P = .048). The diagnostic accuracy for the combination of both needles was 97.1% (99 of 102). The complication rate was 0.98% (n = 1). This complication was a minor soft-tissue infection successfully treated with orally administered antibiotics. CONCLUSION In summary, sonographically guided biopsies of the thyroid performed with single-action core biopsy needles are safe and effective. The results with use of these needles are better than the results of FNAB, but the best results are obtained when both needles are used in the same patient.

The role of percutaneous needle biopsies in the original diagnosis of lymphoma: a prospective evaluation.

PURPOSE A prospective evaluation to determine if percutaneous needle biopsy yields enough tissue to establish the diagnosis of lymphoma and initiate therapy. PATIENTS AND METHODS Lymphoma was diagnosed in 43 patients for the first time. Patients underwent either a core needle biopsy (n = 41) or an aspiration-type needle biopsy (n = 2) performed with imaging guidance. Immunochemical studies were performed on specimens from 39 of 43 patients (91%); flow cytometry was performed formed on specimens from 10 patients (23%). Patient progress was followed to see if biopsy results were used as a basis for treatment or if additional material was obtained with an open surgical procedure. RESULTS On the basis of treatment decisions, needle biopsy results were sufficient for a diagnosis to be made in 36 of 43 patients (84%). In seven patients (16%), needle biopsy specimens were considered nondiagnostic, suspicious for lymphoma, or insufficient. None of the 43 patients responded to therapy in a manner that suggested the diagnosis of lymphoma to be incorrect. CONCLUSION Image-guided needle biopsy should be the first procedure performed in the diagnosis of lymphoma, except in easily accessible superficial neck, inguinal, and axillary nodal sites.

Coronal fat suppression fast spin echo images of the knee: Evaluation of 202 patients with arthroscopic correlation

We optimized fat-suppressed fast spin echo (FS-FSE) parameters for coronal imaging of the knee and then evaluated the technique in a clinical setting. Five volunteers and 12 patients were used to evaluate various repetition (TR), echo (TE), and echo train lengths (ETL). Then, 202 patients underwent both knee MR imaging using coronal plane FS-FSE and arthroscopy. The coronal FS-FSE images were compared with radial multiplanar gradient-recalled echo (MPGRE), axial T1-weighted SE, and parasagittal double echo SE images. Proton density images (2,000/19) with an ETL of 2 best depicted the menisci, ligaments, and capsules. The conspicuity of osteochondral abnormalities depicted by the coronal FS-FSE imaging was significantly higher than for axial T1-weighted SE (p < .003) and parasagittal echo SE images (p < .003). The accuracy of the coronal FS-FSE imaging for medial and lateral meniscal tears was 91.6% and 87.6%, respectively. Combined imaging interpretation of the coronal FS-FSE, axial T1-weighted SE, and radial MPGRE imaging improved the accuracy for meniscal tears slightly over any sequence used alone, but the difference was not statistically significant. Fourteen capsular injuries were demonstrated by the coronal FS-FSE imaging. FS-FSE imaging in the coronal plane is a useful complementary sequence in MR examinations of the knee for the evaluation of meniscal tears, capsular injuries, and osteochondral abnormalities.