A Randomized Trial of Endovascular Embolization Treatment in Pelvic Congestion Syndrome: Fibered Platinum Coils versus Vascular Plugs with 1-Year Clinical Outcomes

Purpose: To compare safety and efficacy of vascular plugs (VPs) and fibered platinum coils (FPCs) for embolization in pelvic congestion syndrome (PCS). Materials and Methods A randomized, prospective, single-center study enrolled 100 women with PCS from January 2014 to January 2015. Patients were randomly assigned to 2 groups, and embolization was performed with FPCs (n = 50) or VPs (n = 50). Mean age of patients was 42.7 years ± 7.60, and mean visual analog scale (VAS) score for pelvic pain before treatment was 7.4 ± 7.60. Primary outcome (clinical success at 1 y using a VAS), number of devices, procedure and fluoroscopy times, radiation doses, costs, and complications were compared, and participants were followed at 1, 3, 6, and 12 months. Results: Clinical success and subjective improvement were not significantly different at 1-year follow-up (89.7% for FPCs vs 90.6% for VPs; P = .760). Mean number of devices per case was 18.2 ± 1.33 for FPCs and 4.1 ± 0.31 for VPs (P < .001). Three FPCs and 1 VP migrated to pulmonary vasculature approximately 3–6 months after the embolization procedure; all were retrieved without complications. The FPC group had a significantly longer fluoroscopy time (33.4 min ± 4.68 vs 19.5 min ± 6.14) and larger radiation dose (air kerma 948.0 mGy ± 248.45 vs 320.7 mGy ± 134.33) (all P < .001). Conclusions: Embolization for PCS resulted in pain relief in 90% of patients; clinical success was not affected by embolic device. VPs were associated with decreased fluoroscopy time and radiation dose

Complicaciones en cadena del TEP. De lo poco probable a la realidad

El tromboembolismo pulmonar (TEP) agudo es una forma de tromboembolismo venoso y representa una emergencia frecuente y en ocasiones fatal. El pilar fundamental del tratamiento del TEP agudo confirmado es la anticoagulación. No obstante, existe riesgo hemorrágico en el paciente anticoagulado, que será mayor dependiendo de algunos factores. Cuando este riesgo es inasumible, la anticoagulación está contraindicada y otras medidas deben de ser tomadas como implantar un filtro de VCI o realizar terapias asistidas por catéter en pacientes hemodinámicamente inestables. La principal complicación del tratamiento anticoagulante es el sangrado agudo y cuando esta se produce se debe actuar con rapidez. Exponemos un caso de una paciente con TEP agudo de riesgo intermedio que fue tratada con anticoagulación. Como complicación sufrió un sangrado agudo tratado con embolización endovascular, implantándose un filtro de VCI al tener que retirar la anticoagulación. Posteriormente el hematoma se complicó con infección y fístula a vía urinaria

Radiólogas intervencionistas embarazadas, ¿y ahora cómo lo hago yo?

En octubre de 2019, el 26,6 % (n/n) de los miembros de la Sociedad Española de Radiología Vascular e Intervencionista son mujeres, sin tener en cuenta las que hay en otros ámbitos como cardiología o cirugía vascular. Es una obligación de la trabajadora comunicar su embarazo para que las condiciones laborales resulten improbables que alcancen una dosis equivalente al feto de 1mSv. En nuestro país son muy pocas o ninguna las radiólogas intervencionistas que continúan ejerciendo como tales después de comunicar su embarazo, pasando a ocupar puestos en radiología general. A esto se le suma la falta de apoyo por parte de su entorno, con formación en radioprotección insuficiente que transmite su angustia a la trabajadora gestante. Por todo ello y para tomar una correcta decisión es muy importante conocer los efectos y las dosis de radiación en cada etapa del embarazo y las correctas medidas de radioprotección

New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model

Background Canine tracheal collapse is a complex airway pathology without promising treatment results. Currently nitinol stents are the best surgical option; however, some professionals are doubting if stent placement is the best option due to the associated complications. Objective Determine the technical feasibility, safety, and long-term follow-up after the implantation of a new tracheal stent designed for canine tracheal collapse. Methods Thirteen healthy, adult female New Zealander rabbits were involved in this pilot study.A new intra-tracheal device (Reference number 902711 patent registered as CasMin-Twine) was implanted in ten animals. Deployment was performed under general anesthesia, making a puncture incision via a 21 Gauge needle in the intra-tracheal space where the stent was introduced with a screwing process. The device was fixed to the tracheal wall with a non-absorbable suture. Computerized Tomography (CT) and an endoscopy to study structural abnormalities were performed after 30, 90 and 365 days after stent placement. Results Technical and clinical success was 100%. There was no significant change in behavior or respiratory disorders. CT studies showed no significant alterations. After the 30 days, 60% of the animals showed partial endothelization in the endoscopy study, and only one animal still presented partial endothelization after 12 months. Mucus accumulation was only present in 40% of cases and classified as low, without respiratory consequences. Only one animal presented a single granuloma at caudal stent tip. Conclusions This new tracheal stent (CasMin-Twine) is an effective and safe procedure with promising results, and also shows the possibility of removing the device after endothelization has been produced. New studies should be carried out to evaluate the effectiveness in patients with tracheomalacia. Clinical Significance/Impact This new product can give veterinarians a new option of treatment for this complicated pathology. Minimizing specific equipment for its deployment, CasMin-Twine will be more accessible for all professionals

A new airway spiral stent designed to maintain airway architecture with an atraumatic removal after full epithelization - Research of feasibility and viability in canine patients with tracheomalacia

Objective: Surgical management of tracheomalacia is a challenge, with current treatments still presenting numerous complications. In the field of veterinary medicine, this same pathology is present in a significant number of dogs. For this reason, we present an experimental clinical trial performed on canines with tracheobronchomalacia, using a new atraumatic removable tracheal spiral stent (SS). Both implantation procedure and clinical improvement have been analyzed in this study.Methods: In this study, four small dogs, a mean weight of 4.89 kg and body condition scores IV‐V, were included. SS was implanted by two different surgical approaches. Image and clinical follow‐up have been performed during 90 days. Symptoms were evaluated from 1 to 10 every week. Results: This study achieved 100% technical and clinical success. Median tracheal diameters were as follows: cervical 10.85 (3.3), inlet 7.75 (2.1), and carina 7.75 (1.9) mm, and length was 77.5 (26) mm. A 12 × 10 × 100‐mm SS was implanted in all cases. Goose honk cough punctuation improved from 8 to 1; also, there were important changes in exercise intolerance, a mean weight loss of 8.76%. The values of modified Karnofsky scale varied from 50 (20) before surgery to 90 (10) after 30 days of surgery. Neither granuloma tissue nor fractures of the prosthesis was observed.Conclusion: The results in dogs are promising, and a new therapeutic alternative seems to be available for veterinarian field. The similarity of this disease between dogs and newborns suggests that this SS design can also be useful for human trials

IAA : Información y actualidad astronómica (30)

Sumario : Habitabilidad en el Universo.-- El imán de la Vía Láctea.-- El estudio del Universo frío.-- DECONSTRUCCIÓN Y otros ENSAYOS. Johannes Kepler.-- EL “MOBY DICK” DE... Matilde Fernández (IAA-CSIC).-- HISTORIAS DE ASTRONOMÍA. La noche de Noli.-- ACTUALIDAD.-- ENTRE BASTIDORES.-- CIENCIA: PILARES E INCERTIDUMBRES : Núcleos activos de galaxias.-- ACTIVIDADES IAA.N

Spanish multicenter real – life registry of retrievable vena cava filters (REFiVeC)

Background The treatment of venous thromboembolic disease the treatment of choice is systemic anticoagulation. However, the interruption of the inferior vena cava with filters has been recommended when anticoagulation fails or there is a contraindication. Due to the rising inferior vena cava filter (IVCF) complications, physicians are encouraged to retrieve them when there is no longer recommended. In daily practice, it may be a difficult close follow-up of these patients. In this study, the primary objective was to evaluate the IVCF retrieval rate of all implanted filters in a Spanish registry. Secondary objectives were to analyze the causes of failed retrieval, procedure-related complications, and outcomes at a 12-month follow-up. Results Three hundred fifty-six vena cava filters were implanted in 355 patients. The types of filter were: Gunther Tulip (Cook Medical) 160 (44.9%), Optease (Cordis) 77 (21.6%), Celect (Cook Medical) 49 (13, 7%), Aegisy (Lifetech Scientific) 33 (9.2%), Option ELITE (Argon Medical devices) 16 (4.4%), Denali filter (BD Bard) 11 (3.08%), ALN filter (ALN) 10 (2.8%). Removal was achieved in 274/356 (76,9%). eighty-two (23,1%) IVCF were not retrieved due to the following: 41 (11,5%) patients required ongoing filtration, 24 IVCF (6,7%) patients died before retrieval, and 17 (4,7%) impossibility of retrieval because of a tilted and embedded filter apex. There were no major complications observed. Conclusions The global retrieval rate of IVCF was achieved in 76.9%, and the adjusted retrieval rate was of 94.15% with no major complications. IVCF tilting was associated with failure of filter removal in less than 5% of cases. This study demonstrates that the retrieval procedure of IVCF is controlled by the clinician and not by the interventional radiologist

RF tumor ablation with internally cooled electrodes and saline infusion: what is the optimal location of the saline infusion?

<p>Abstract</p> <p>Background</p> <p>Radiofrequency ablation (RFA) of tumors by means of internally cooled electrodes (ICE) combined with interstitial infusion of saline may improve clinical results. To date, infusion has been conducted through outlets placed on the surface of the cooled electrode. However, the effect of infusion at a distance from the electrode surface is unknown. Our aim was to assess the effect of perfusion distance (PD) on the coagulation geometry and deposited power during RFA using ICE.</p> <p>Methods</p> <p>Experiments were performed on excised bovine livers. Perfusion distance (PD) was defined as the shortest distance between the infusion outlet and the surface of the ICE. We considered three values of PD: 0, 2 and 4 mm. Two sets of experiments were considered: 1) 15 ablations of 10 minutes (n ≥ 4 for each PD), in order to evaluate the effect of PD on volume and diameters of coagulation; and 2) 20 additional ablations of 20 minutes. The effect of PD on deposited power and relative frequency of uncontrolled impedance rises (roll-off) was evaluated using the results from the two sets of experiments (n ≥ 7 for each PD). Comparisons between PD were performed by analysis of variance or Kruskal-Wallis test. Additionally, non-linear regression models were performed to elucidate the best PD in terms of coagulation volume and diameter, and the occurrence of uncontrolled impedance rises.</p> <p>Results</p> <p>The best-fit least square functions were always obtained with quadratic curves where volume and diameters of coagulation were maximum for a PD of 2 mm. A thirty per cent increase in volume coagulation was observed for this PD value compared to other values (<it>P </it>< 0.05). Likewise, the short coagulation diameter was nearly twenty five per cent larger for a 2 mm PD than for 0 mm. Regarding deposited power, the best-fit least square function was obtained by a quadratic curve with a 2 mm PD peak. This matched well with the higher relative frequency of uncontrolled impedance rises for PD of 0 and 4 mm.</p> <p>Conclusion</p> <p>Saline perfusion at around 2 mm from the electrode surface while using an ICE in RFA improves deposition of energy and enlarges coagulation volume.</p

Desórdenes venosos pélvicos en la mujer debidos a varices pélvicas. Tratamiento mediante embolización. Breve revisión

El síndrome de congestión pélvica (SCP), actualmente englobado en los “desordenes venosos pélvicos en la mujer (DVPm) debidos a varices pélvicas”1 es una condición patológica que sufre un importante porcentaje de mujeres, y generalmente, se caracteriza por dolor abdominal que dura al menos 6 meses. Existen diferentes tipos de tratamientos, pero el más extendido es la embolización de las venas varicosas pélvicas. Presentamos una pequeña revisión del tema y aportamos nuestra experiencia de casi 20 años con más de 500 pacientes. La embolización de las varices pélvicas parece ser un tratamiento seguro y relativamente efectivo en la gran mayoría de las mujeres

Проектирование автоматизированной системы дожимной насосной станции

Целью данной выпускной квалификационной работы является разработка автоматизированной системы управления ДНС с использованием современного оборудования для увеличения производительности и надежности станции, а также снижения затрат на обслуживание. В ходе работы будет выполнено исследование и проектирование автоматизированной системы дожимной насосной станции.The purpose of this final qualifying work is the development of an automated control system for CSN using modern equipment to increase plant performance and reliability, as well as reduce maintenance costs. In the course of work, research and design of an automated system of a booster pumping station will be performed