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Abstract Introduction In 25% of women, symptomatic uterus myomas are diagnosed with clinical and functional impairment ranging from abdominal and pelvic pain to dys- and hypermenorrhea, dyspareunia, pollakiuria and infertility. Women undergoing a treatment increasingly prefer nowadays minimal invasive, uterus preserving therapies like uterine artery embolization (UAE) over surgical hysterectomy, nowadays. To emphasize the efficacy of UAE as a uterus preserving treatment with targeted therapy of myomas only, analysis of tissue perfusion pre and post embolization is required. The purpose of this study was to assess treatment response in UAE in females with symptomatic uterus myomas by quantitative magnetic resonance perfusion imaging. Methods Seven females scheduled for uterus myoma embolization underwent three MRI examinations (pre, post, follow-up) including morphological and dynamic contrast enhanced perfusion imaging at 3 T. To measure tumor volume, regions-of-interest covering the tumor and the uterus were drawn by two readers in consensus. Blood flow, blood volume, and mean transit time were calculated by a pixel-by-pixel deconvolution approach. Kruskal-Wallis/Friedman test was employed to test whether the group medians differ significantly with correction for multiple comparisons using Bonferroni method. Results Change of volume could be observed in all patients after embolization but was significantly different only between pre/post and follow-up time point. Measured differences in all perfusion parameters were significant between pre-intervention and post-intervention/follow-up in the myomas, no significant differences could be detected for the uterus tissue. Conclusions Our results demonstrate devascularization of symptomatic myomas which correlates with cessation of hypermenorrhea in all treated patients without affecting healthy uterus tissue. Supplementing UAE with perfusion imaging to monitor early treatment response is feasible and might provide valuable information for the follow-up of patients and contribute to providing confidence for the patients in treatment success. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures. Methods Absolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot. The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used. Results Median whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand. Conclusions Radiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the clinical efficacy of EverFlex stents (length, 6–20 cm) for the treatment of peripheral artery disease (PAD) in the superficial femoral artery (SFA). Material and Methods: Over a period of 18 months, 56 SFA lesions in 53 patients were treated with an EverFlex stent. The following parameters were documented before the intervention, immediately afterward, and 12 months later: clinical stage, ankle-brachial index, and peak systolic velocity ratio (PSVR). The primary study endpoint was the primary patency rate after 12 months (defined as a PSVR < 2.5). Results: In 18% of the 56 lesions, complete occlusions were present. Mean lesion length was 9.4 cm ± 5.3, and mean stent length was 12.6 cm ± 5.6. Of the 53 patients enrolled in the study, a 12-month follow-up was performed in 46. The primary patency rate after 12 months was 71.7%. In-stent restenosis or occlusion occurred in 13 patients. Compared with the total study group, the mean stent length in these 13 patients was greater (14.0 cm ± 7.3) and the incidence of de novo lesions was lower. In the patient group with stents less than 10 cm in length (n = 24), six patients (25%) required a repeat intervention, compared with seven patients (32%) in the group with stents longer than 12 cm. Conclusions: Although the primary patency rate associated with the EverFlex stent is comparable to those in published data, the present results demonstrate a higher percentage of in-stent stenoses in patients in whom longer SFA stents were implanted. [Copyright &y& Elsevier]

Background: The aims of this study were to assess the value of multislice CT-angiography (MS-CT-A) in percutaneous postinterventional kidney bleeding and to determine the influence of diagnostic outcome on therapeutic patient management. A recommendation for the interdisciplinary patient work-up for the emergency room was offered. Methods: Between April 2003 and January 2006, 12 patients with hematuria and clinically suspected renal bleeding underwent MS-CT-A for emergency diagnostic assessment. The spectrum of kidney injuries on CT was analyzed according to an organ-scaling scheme. The efficacy of MS-CT-A with regard to confirmation of active arterial bleeding was evaluated as well as the therapeutic consequences for patient management. Results: In seven patients (59%) staged grade V renal injury, active renal arterial bleeding was detected on CT-A. Patients immediately underwent therapeutic angiography with confirmation of arterial bleeding and successful embolization. Four patients (33%) were staged grade I renal injury with subcapsular kidney hematoma but no active hemorrhage. Therefore, these patients were not exposed to further therapeutic intervention. One patient (8%) was diagnosed grade II renal injury with superficial cortical renal parenchyma tear and no active bleeding on CT-A. Conclusions: MS-CT-A is a valuable, fast and objective emergency tool for assessment of postinterventional renal hemorrhage. Detection of contrast material extravasation to affirm ongoing arterial bleeding and to localize bleeding site at the level of segmental or interlobar renal artery is a predictor for the need for further treatment and justifies therapeutic radiological or surgical management. [Copyright &y& Elsevier]

Determination of the urinary or plasma clearance of exogenous renal markers, such as inulin or iohexol, is considered to be the gold standard for glomerular filtration rate (GFR) measurement. Here, we describe a technique allowing determination of renal function based on transcutaneously measured elimination kinetics of fluorescein isothiocyanate (FITC)-sinistrin, the FITC-labeled active pharmaceutical ingredient of a commercially available marker of GFR. A low cost device transcutaneously excites FITC-sinistrin at 480 nm and detects the emitted light through the skin at 520 nm. A radio-frequency transmission allows remote monitoring and real-time analysis of FITC-sinistrin excretion as a marker of renal function. Due to miniaturization, the whole device fits on the back of freely moving rats, and requires neither blood sampling nor laboratory assays. As proof of principle, comparative measurements of transcutaneous and plasma elimination kinetics of FITC-sinistrin were compared in freely moving healthy rats, rats showing reduced kidney function due to unilateral nephrectomy and PKD/Mhm rats with cystic kidney disease. Results show highly comparable elimination half-lives and GFR values in all animal groups. Bland-Altman analysis of enzymatically compared with transcutaneously measured GFR found a mean difference (bias) of 0.01 and a −0.30 to 0.33 ml/min per 100 g body weight with 95% limit of agreement. Thus, with this device, renal function can be reliably measured in freely moving rats eliminating the need for and influence of anesthesia on renal function. [ABSTRACT FROM AUTHOR]

Abstract: There is an obvious and growing medical need for an accurate and easy to handle determination of glomerular filtration rate (GFR) for a broad spectrum of indications. Newly synthesized fluorescein-isothiocyanate (FITC)-sinistrin (FS) with various degrees of labeling was selected by its physicochemical properties and good tolerability out of a number of dye-labeled compounds intended for use as GFR markers for characterization of its pharmacological profile. With respect to solubility FS is more convenient in handling compared to FITC-inulin (FI). Up to 100 mg ml–1 of FS can be dissolved in aqueous solvents at room temperature, whereas FI can only be solubilized after warming up to 55 °C. This reveals a considerable advantage of FS over FI in preparation of galenical formulations for intended i.v. application. A fluorometric method was established to determine FS concentration in blood serum with a comparable accuracy to the established enzymatic method for polyfructosanes. Similar concentration time curves in blood serum of FS measured fluorometrically and enzymatically suggest no relevant change of pharmacokinetic behavior by dye labeling. This notion is supported by the rapid renal and missing of biliary excretion. On the basis of these results, FS is superior in handling to the available GFR markers and makes it highly interesting as a novel diagnostic drug. [Copyright &y& Elsevier]

Background: The aim of this study was to evaluate by light and electron microscopy the effect of topical estriol on the nasal mucosa in patients with hereditary hemorrhagic telangiectasia (HHT). Methods: Twelve patients were instructed to apply twice daily 0.1% estriol as a nose ointment over a period of 12 months. Written consent was obtained from each patient, allowing biopsy specimens of the nasal mucosa to be taken prior to and 3, 6 and 12 months after estriol application. Results: Metaplastic change of the nasal mucosa was observed 6 months after topical estriol application. The former ciliated columnar epithelium changed into a keratinizing squamous epithelium. The effect was reversible after discontinuation of estriol application. Conclusions: For the first time, we could outline the effect of topical estriol on the nasal mucosa. These histomorphological findings, and the fact that estriol is a low-potency metabolite of estradiol, make estriol a valuable agent in the treatment of HHT patients. [Copyright &y& Elsevier]