The ‘radical combined approach’ in cerebral arteriovenous malformation treatment: Technical note

AVMs are vessel anomalies where a connection between arterial and venous systems is present and the capillary bed is absent between the two. AVMs tend to present with seizures, headaches, focal neurological deficits and hemorrhage. Hemorrhage is the most common form of presentation. AVM's have a 2–4% annual risk of hemorrhage. Certain studies report this rate as 1%. The greatest discussion in AVM treatment is whether to use interventional treatment or monitor with medical treatment. There are 3 modalities that can be used for interventional treatment; microsurgical resection, endovascular embolization and stereotactic radiosurgery. Combined techniques are also possible. We defined the ‘radical combined approach’ combines embolization and microsurgery. We will discuss this procedure in this article as we believe it has several advantages

Treatment with ultrasound guided percutaneous cholecystostomy in acute cholecystitis: 10-year a single-center experience

Purpose: Evaluating the technical success, clinical outcomes and safety of ultrasound-guided percutaneous cholecystostomy (PC) in patients with acute cholecystitis. Material and Methods: Medical records of patients diagnosed as acute cholecystitis and treated with PC from year 2000 to 2011 were retrospectively examined. ASA scores, leukocyte counts, gall stone presence, bile cultures, additional interventions, interval surgery, procedure-related complications and mortality were reviewed. Results: PC catheters were placed in 127 patients (72 male, 55 female) aged from 31 to 100 years. Technical success of the procedure was 100%. Clinical success was obtained in 86% of the patients. No procedure related mortality or early major complications were observed. Minor complication rate was 7% (9/127) and late major complication rate was 3% (4/127). Thirty day in-hospital mortality rate was 8% (10/127). Six patients died after interval cholecystectomy and 4 patients died before the operation. PC served as a definitive treatment in 74% (17/23) of the patients with acalculous cholecystitis. Fifty-eight percent (31/53) of the patients with acute calculous cholecystitis were treated only with percutaneous cholecystostomy and only 10% (3/31) had recurrent cholecystitis in follow up. Conclusion: PC can be preferred over primary cholecystectomy in acute cholecystitis patients. The procedure has high technical success, high clinical response and low complication rates. It can also serve as a definitive treatment option in patients with high surgical risk

Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone

Purpose: In some patients with a ureteral stone without uretero-hydronephrosis, it is difficult to determine the location of the stone. The objective of the present study was to investigate the changes in renal papillae using unenhanced computerized tomography (uCT) and determine the side of calculi using the renal papillary findings in patients with a ureteral stone. Methods: uCT data from 81 patients were retrospectively reviewed for this study. The inclusion criteria were unilateral ureteral calculi, no renal calculi and no hydronephrosis. For each patient, three measurements of CT attenuation of 0.05 cm2 area were made in the tip of the interested renal papillae, both stone side and non-stone side. Student’s t test was used for statistical analysis. Results: Forty-one right-sided and 40 left- sided isolated unilateral ureteral calculi patients were evaluated by uCT exam. The average attenuations of the tip of the papillae in stone side and non-stone side were 34.1 Hounsfield units (HU) and 30.6 HU, respectively. There was a statistically significant difference between stone and non-stone sides (p< 0.05). Conclusion: During routine practical uCT applications, it can be difficult to distinguish phleboliths, ureteral stone or the existence of non-opaque ureteral stone, so papillae density measurements can be a practical method to identify the existence of ureter stone and its location (side)

The role of kidney diffusion tensor magnetic resonance imaging in children

Background: Diffusion tensor imaging (DTI) in magnetic resonance imaging (MRI) provides information about the microstructure of renal tissue and is becoming increasingly useful in the evaluation of relationship between renal structure and function. Objectives: To investigate, whether DTI allows assessment of renal impairment and pathology in pediatric patients with decreased renal functions. Materials and methods: Thirty-two pediatric patients and seventeen healthy children were included in this prospective study. For DTI, a respiratory-triggered coronal echo planar imaging (EPI) sequence was performed. Cortical and medullary mean axial and radial diffusivity and fractional anisotropy (FA) were analyzed. Results: In healthy subjects, the cortical FA values were significantly lower than the medullary FA values (p < 0.001). Cortical and medullary ADC values showed positive correlations (r = 0.499, p = 0.041) and a negative correlation with cortical FA values(r = −0.533, p = 0.028). The eGFR values were negatively correlated with the medullary ADC values (r = −0.484, p = 0.049) in healthy subjects and positively correlated with the λ medullary values (r = 0.385, p = 0.027). Additionally in the patient group, the age was positively correlated with FA cortex values (r = 0.411, p = 0.018) and with the medullary ADC values (r = 0.461, p = 0.007). However, the medullary FA values were negatively correlated with the medullary ADC values (r = −0.363, p = 0.038). Tractography of healthy volunteers showed a radial arrangement which converged into the pyramids, whereas renal insufficiency patients had irregular arrangement patterns and architectural distortions in the observed areas. Conclusions: Renal DTI is a promising diagnostic tool in the assessment of microstructural renal changes and correlates with the eGFR. Therefore, it is possible to estimate the arrangement of the tracks which emanate from the renal medulla. Furthermore, diffusion of the water molecules could be carried out. This study demonstrates the usage of DTI in renal pediatric kidneys. Validations in larger cohort groups with histopathological biopsies are needed