فهرست مطالب

  • Volume:7 Issue: 2, 2010
  • تاریخ انتشار: 1389/08/25
  • تعداد عناوین: 9
|
  • S. Etezazian, B. Tavakoli, A. Hekmatnia, N. Omidifar, M. Moradi Page 61
    We evaluated a new ultrasound-guided approach to percutaneous cephalic vein or basilic vein cannulation in patients with difficult intravenous access.Patients who required intravenous access and were candidates for surgical approach, or central venous catheterization were enrolled into the study. They had at least three unsuccessful attempts at establishing a peripheral intravenous line. By using a 7.5-MHz ultrasound probe, the cephalic or basilic vein was identified and then cannulated with a conventional venous cannula. The time from probe placement to cannulation, the number of attempts and complications were recorded. Eighty-eight patients were enrolled; 28 (31.8%) female and 60 (68.2%) male. The intravenous (IV) drug abusers consisted of 29 patients (33%) which were all men (48% of males). The procedure was successful in 94.3% and failed in five cases (5.7%) after three attempts. The mean time of procedure was 175±153 seconds. There was a significant difference between IV drug abusers (231±203) and non IV drug abusers (149±118) regarding access time (p-value=0.012). The procedure was successful after one attempt in 61 patients (73.5%), two attempts in 20 patients (24.1%) and three attempts in two patients (2.4%). The cannula was dislodged in three cases after one hour of follow-up. No other complications happened.Ultrasound-guided cephalic and basilic vein cannulation is safe and time saving, has a high success rate in patients with difficult peripheral intravenous access, and may be used as the first step in these patients before the other more invasive alternatives.
  • A.R. Ghasemi Esfe, S.M. Vaziri Bozorg, F. Ahmadi, Kh. Eslami, M. Ghasemi Esfe, H. Rokni Yazdi Page 67
    Maintenance of the patient’s hemodialysis access is a major issue in chronic dialysis.We report a patient with end stage renal disease who had no alternative for vascular access and failed peritoneal dialysis. A successful vascular access device was inserted using a transhepatic approach.
  • H. Aydin, N. Aydi, N. Oktay, B. Hekimoglu Page 71
    Our aim was to optimize the most effective MR imaging sequence for visualization of the 12th cranial nerve (hypoglossal nerve) through its cisternal course.We applied balanced fast-field echo (B-FFE), 3D-T2 weighted Driven Equilibrium RF Reset Pulse (DRIVE), T2 weighted 2D TSE and post-contrast T1 weighted sequences and tried to find out the best sequence for the perfect visualization of the 12th cranial nerve. One-hundred patients without any hypoglossal nerve paralysis were examined via these sequences. Imaging analysis was graded as follows: certain visualization of nerves (score 2), partially visualized nerves (score 1), non-visualized nerves (score 0).The hypoglossal nerve was visualized exactly in only eight cases and partially depicted in only six cases with the post-contrast T1 series. In B-FFE sequence; 56% of the nerves were properly seen and 8% of the nerves were partially identified, using T2 weighted DRIVE sequences; 30% of the nerves were clearly visualized, the nerves were partially depicted in 15 patients. Regarding the T2 weighted TSE sequence, 15% of the nerves were certainly depicted and in seven patients the nerves were partially depicted.The most diagnostic sequence for the exact visualization of the cisternal course of hypoglossal nerve is B-FFE revealing a 64% visualization rate for the cisternal parts (112 exactly, 16 partially). T2W DRIVE sequence is shown to be more diagnostic than the T2W TSE for vi-sualization of the cisternal part of the hypoglossal nerve.
  • F. Ezoddini Ardakani, M. Zangouie Booshehri, A. Navab Azam, F. Fotoohi Ardakani Page 91
    Extraction of the third lower molar tooth is one of the common surgical procedures that may lead to the damage of the infra-alveolar nerve. This damage could be related to deep impacted third molar teeth and roots close to the mandibular canal. Therefore, the radiography evaluation of the position of this tooth in relation to the inferior dental canal is important before surgery.In this cross-sectional descriptive study, 59 patients who were referred to maxillofacial surgeons for third molar tooth surgery, and had a panoramic radiography were enrolled into the study. The positions of the impacted teeth in the panoramic radiography were determined according to their relation to the mandibular canal and were reported as five different subgroups (A, B, C, D and E). Cases which were not classified in any of these subgroups were considered as F. The surgeon also determined the position of the impacted teeth after surgery based on the mentioned classification. To assess the correlation of the data, Kappa analysis was used.Kappa statistics for agreement between radiography and surgery was 0.85 (p<0.001).According to this study, radiological assessment before third molar tooth surgery can reduce the risk of conceivable damage to the canal and nerve. It is recommended to consider the radiologists opinion before surgery.
  • M. Apaydin, M. Varer, O. Oztekin Page 97
    Endolymphatic sac tumors are aggressive papillary tumors of the temporal bone that could be associated with von Hippel-Lindau disease (VHL). We present imaging findings of a VHL family with two cases of endolymphatic sac tumors. These tumors spread to the cerebellum and the cerebellopontine cistern and may mimic more frequent tumors of this region. They show predominantly high signals on T1- and T2-weighted images and enhance heterogeneously. There are some difficulties in its differential diagnosis from other vascular and non-vascular tumors of the temporal bone. Increased signal intensity at unenhanced T1-weighted MR imaging is common and may help distinguish these lesions from more common aggressive temporal bone tumors.
  • R. Monzavi Sani, F. Savadkuhi, Z. Rohani Page 101
    Early diagnosis of thalassemia with chorionic villus sampling has an important role in fetal evaluation. Because of the increasing risk of fetal loss and other probable risks, it seems there are some considerations about the safety of this method. Since different studies have mentioned variable complications of this method for the mother and her fetus and also the fact that this information is limited in most areas of our country, this study was performed to com-pare the complications of this procedure with other reports.This prospective case series study was performed in the chorionic villus sampling (CVS) center of Zahedan University of Medical Sciences from October 2003 till July 2006. One-hundred thirty seven patients who were referred to this center were sampled and examined by sonography regarding early complications of CVS in mothers and fetuses and deformities in their neonates. The most common early complication of CVS was subchorionic hematoma (6.5%), of which one case finally resulted in placenta abruption and abortion. The fetal loss rate after CVS was the same as the abortion rate following subchorionic hematoma. In this study, we did not find any chorioamnionitis, oligohydramnios and fetal loss during the sampling. Furthermore, in the follow up control of their neonates, there were neither limb deficiency and oromandibular defects nor cutaneous hemangioma.Results show that minor complications of CVS such as subchorionic hematoma can be dangerous and may increase the risk of fetal loss. In addition, this study agrees that sampling after 10 weeks of pregnancy on the hands of an expert is a safe procedure.
  • W.J. Liang, X.Y. Zhou, S.L. Xu Page 105
    A 33-year-old man was admitted with fever, chest pain and multiple nodules. Infection was the first diagnosis and antibiotic therapy was considered for the patient. After two weeks of no improvement, infection was ruled out and based on the CT findings, metastatic tumor of the lung was strongly considered. The CT imaging of the patient also demonstrated air bronchogram in a mass-like lesion and one nodular lesion. Eventually, the patient underwent CT-guided transthoracic needle biopsy of the mass-like lesion in the right upper lung. The sample confirmed a primary pulmonary T-cell lymphoma. The patient entered complete remission after one course of CHOP (cyclophosphamide, adriamycin, vincristine and prednisone) combination chemotherapy. During the second course of combination chemotherapy, the patient died of an uncontrollable secondary pulmonary infection.
  • S. Izadyar, H.R. Abtahi, S. Saber, M. Abbasi Page 109
    Quantitative pulmonary perfusion scintigraphy (QPPS) has few indications for evaluation of pre- and post-lung transplantation. QPPS is useful for preoperative regional assessment of pulmonary function. Post-transplantation lung scintigraphy has a prognostic value in detecting chronic rejection. Here we report the clinical implication of QPPS in a 36-year-old man with post-alveolar microlithiasis complicated lung-transplantation. The pulmonary function tests and repeat thoracotomy excluded corresponding ventilatory problems and surgical complications. Doppler echocardiography suggested elevated pulmonary artery (PA) pressure. QPPS revealed decreased perfusion of transplanted lung (geometric mean: 46.8%) compared to contra-lateral lung affected by severe alveolar microlithiasis indicating post-transplant pulmonary artery stenosis; the diagnosis was confirmed by pulmonary CT-angiography. The patient underwent a successful balloon angioplasty. Post-revascularization perfusion scintigraphy documented increasing graft blood flow (geometric mean; 51%). We conclude that QPPS may play a significant role in the assessment and follow-up of patients with complicated lung transplantation, including pulmonary artery stenosis.