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OBJECTIVES: To investigate the change in symptom severity and health-related quality of life among patients treated with uterine artery embolization for leiomyomata. METHODS: Using the Fibroid Registry for Outcomes Data (FIBROID), a multicenter, prospective, voluntary registry of patients undergoing uterine embolization for leiomyomata, we studied changes in symptom status, health-related quality of life, subsequent care, menstrual status, and satisfaction with outcome. Health-related quality-of-life and symptom status were measured using the Uterine Fibroid Symptom and Quality of Life, a leiomyoma-specific questionnaire. Summary statistics were used to describe the data set and multivariate analyses to determine predictors of outcome at 12 months. RESULTS: Of 2,112 eligible patients, follow-up data were obtained on 1,797 (85.1%) at 6 months and 1,701 (80.5%) at 12 months. At 12 months, the mean symptom score had improved from 58.61 to 19.23 (P < .001), whereas 5.47% of patients had no improvement. The mean health-related quality-of-life score improved from 46.95 to 86.68 (P < .001), whereas 5.0% did not improve. In the first year after embolization, hysterectomy was performed in 2.9% of patients, with 3.6% requiring gynecologic interventions by 6 months and an additional 5.9% between 6 and 12 months. Amenorrhea as a result of embolization occurred in 7.3% of patients. Of these, 86% were age 45 or older. Most patients were satisfied with their outcome (82% strongly agree or agree). Predictors of a greater symptom change score include smaller leiomyoma size, submucosal location, and presenting symptom of heavy menstrual bleeding. CONCLUSION: Uterine embolization results in substantial symptom improvement for most patients, with hysterectomy required in only 2.9% of patients in the first 12 months after therapy.

Background. The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. Methods. This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fifty-nine patients completed the donor evaluation process and underwent DSA. Results. Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. Conclusions. We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.

Transjugular intrahepatic portosystemic shunt (TIPS) and surgical distal splenorenal shunt (DSRS) are treatments for complications of portal hypertension. TIPS is widely used because it is relatively easy to place. Because TIPS may malfunction over time, it is unclear whether TIPS is superior to DSRS in patients with Child's class A cirrhosis who enjoy a longer survival. This study compared the cost-effectiveness of TIPS to DSRS for portal hypertension in Child's class A cirrhosis. A decision analysis model was used to evaluate the number of procedures, life expectancy, and costs over the first 2 years in patients with Child's class A cirrhosis who underwent a TIPS or DSRS. Patients who received TIPS survived 1.96 years, required 1.7 procedures, and incurred $41,685 in costs. Patients who underwent a DSRS survived 1.86 years, required 1.0 procedure, and incurred $26,951 in costs. The cost-effectiveness of TIPS compared with DSRS was $147,340 per life-year saved. Adjusting the rate of TIPS dysfunction, 1-year survival, or the number of ultrasounds to detect TIPS dysfunction did not change the results. In patients with Child's class A cirrhosis, DSRS is a more cost-effective treatment than TIPS. Until the results of a randomized controlled trial comparing TIPS with DSRS are available, TIPS should be regarded as experimental and prohibitively expensive in Child's class A cirrhosis.

Medical records and radiologic studies of 238 patients with non-small cell lung cancer who had preoperative evaluation by chest radiography and CT were reviewed. Thirty-six patients were staged as T1N0M0 by chest radiograph. Of this group, 18 (50%) had abnormalities on CT requiring additional evaluation. Confirmation of abnormalities was by tissue sampling or clinical follow-up. Evidence for unresectable spread of disease was obtained in 12 (33%). We conclude that routine preoperative staging of T1N0M0 lung cancer with CT has a positive impact on patient management.

The radiographic demonstration of lymph node involvement in amyloidosis is rare. We report a case of calcified, enlarged perioartic and mediastinal lymph nodes detected by CT.

The Fibroid Registry for Outcomes Data (FIBROID) was founded in 1999 to serve as a prospective multicenter database of women undergoing uterine embolization for leiomyomata. This paper presents an analysis of the short-term outcomes of patients enrolled at 72 participating sites. Of a total 3005 patients, 2729 had a 30-day follow-up interview, which provided information on any further medical care, adverse events, time to return to work, and time to return to normal activities. The Registry defined an adverse event as an unexpected problem that required an unanticipated clinic visit or unanticipated therapy. Seventy-four percent of all patients received preprocedure antibiotics and one fourth was also given antibiotics postprocedure. Uterine embolizations were generally carried out under intravenous conscious sedation and supplemented with narcotics, two thirds of which were patient-controlled. In one participating center, regional analgesia was used in 12% of cases. Overall, 5% of patients had postprocedure deep vein thrombosis (DVT) prophylaxis with automated intermittent compression boots. Seventy-four percent of procedures were technically successful. Technical failures occurred when only one uterine artery could be identified for embolization or when bilateral uterine artery catheterization was unsuccessful. The average hospital stay was 1.68 days. During hospitalization, 90 patients experienced 94 adverse events, of which 20 were major. Eleven of these prolonged the hospital stay. Pain and nausea were the most common conditions, but one patient had a femoral nerve injury, which resulted in permanent leg pain. Other problems included drug reaction, urinary retention, and contrast reaction. Of 74 minor complications, groin hematomas were the most common (n = 22). Other minor complications included less severe nausea, pain, vessel injury, drug reaction, urinary retention, and contrast reaction, as well as device-related problems and nontarget embolization. Patients generally resumed normal activities after 2 weeks. Major and minor adverse events were combined for univariate analysis. Possible predictors for perioperative complications, including patient demographic variables, medical history variables, presenting signs and symptoms, medications used, procedure-related variables, and site-related variables, were included. Only length of procedure, site status (ie, core registry sites vs participating sites), and size of leiomyomata were found to have predictive value for operative complications (odds ratio [OR], 1.012; 95% confidence interval [CI], 1.005-1.019; OR, 0.334; 95% CI, 0.15-0.76; OR, 1.0173; 95% Cl, 1.0131-0138; respectively). After multivariate analysis, site status was no longer predictive of perioperative adverse advents. By the 1-month postprocedure evaluation, 710 patients had reported adverse events. Major complications (n = 111; 4%) were persistent bleeding in 7 patients, infection or possible infection in 17, new hot flashes in 2, thromboembolism in 4, recurrent pain in 65, sloughing or passing leiomyomata in 19, and spinal headache in one patient. Twenty additional patients had unspecified adverse events. Six hundred ten women had minor postprocedure complications, which included less severe experiences of these symptoms. Pain, new hot flushes, and sloughing were the most common (n = 264, 156, and 123, respectively). One patient had a repeat uterine embolization after an initial failure. Another 31 patients required surgical intervention, including 3 hysterectomies, for resolution of postprocedure complications. Dilatation and curettage and hysteroscopy were the most common procedures for sloughing leiomyomata or passing leiomyomata tissue. History of therapy for leiomyomata, race listed as black, history of current or recent smoking, and comorbidity were predictive of complications in the 30 days postprocedure on univariate analysis.

Increased hepatic density on CT has been described in several clinical entities. We present a case of arsenic poisoning demonstrating both increased hepatic and splenic attenuation.

A case of wandering spleen with torsion of the splenic vascular pedicle and pancreatic tail is presented. The entity was diagnosed and evaluated preoperatively with various imaging modalities (ultrasound, nuclear medicine, and CT) as well as visceral angiography.

Three hemophiliac patients are presented who had gas within their pelvic pseudotumors demonstrated by computed tomography. Etiologies of the gas included iatrogenically introduced gas from infection, failed tube drainage of the pseudotumor, and a communication between the pseudotumor and the bladder containing a Foley catheter.

The surgical approach to bleeding visceral artery aneurysms has a mortality rate of 16-50% that is dependent primarily on anatomic location and underlying cause. Nineteen patients were studied over a 10-year period who were definitively treated by embolization. There was a 79% success rate and no mortality. The cause of the aneurysms was pancreatitis in 13 patients, trauma in four patients, subacute bacterial endocarditis in one patient, and secondary to biliary tract surgery in one patient.

Extramedullary hematopoiesis occurring in the thorax is a well-known complication of a number of various blood dyscrasias, and its appearance with planar Tc-99m sulfur colloid marrow scintigraphy and transmission computed tomography (CT) has been described previously. The authors present a case of thoracic extramedullary hematopoiesis evaluated by CT and emission computed tomography (ECT).