Hungarian Radiology

[The possibilities of invasive radiological therapy of deep venous thrombosis and in vitro experimental examination of therapeutic factors affecting the treatment]

HARMAT Zoltán, JÁRAY Ákos, BATTYÁNY István

JUNE 10, 2005

Hungarian Radiology - 2005;79(03)

[INTRODUCTION - The first part of this paper is an overview on the possibilities of invasive radiology treatment of deep venous thrombosis. In the next part an in vitro experiment is described demonstrating the basics of mechanical and pharmaco-mechanical catheters applied in deep venous thrombosis. MATERIALS AND METHODS - The in vitro haemodinamic model of the iliocaval veins contained a thermostat and an engine responsable for pulsing circulation according to the venous system. We tested the chance of driftage of thrombus in different age according to the state of the collateral system. Thrombectomy was made by mechanical (Simpson-catheter) and pharmaco-mechanical (Pulsespray catheter) ways. The weight of the non-drifted thrombi was measured. RESULTS - All the 16 thrombus were flown while collateral system was closed and none of them were flown while the collateral system was open but the rate of their solubility was different. The efficacy of the thrombus-removal by Simpson catheter was better than by Pulse-spray catheter and fresh thrombus-fragments were more soluble than older ones. CONCLUSION - By this in vitro experiment we opened the way for using mechanical and pharmaco-mechanical catheters in deep venous thrombosis.]

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[INTRODUCTION - The frequency of the pulmonary embolism is high and the underdiagnosis or delayed recognition of the disease occurs. Recently the helical CT is used to detect pulmonary embolism. The authors compare the results of single-slice spiral thoracic CT and lung scan. PATIENTS AND METHODS - During one year period chest CT examination was performed in 49 patients due to the suspicion of pulmonary embolism, in 30 of them lung scan was also performed. RESULTS - The results of the two diagnostic methods were the same in 21 cases out 30 (in 13/21 cases both methods demonstrated embolism and 8/21 cases the findings were normal). In the remaining nine cases the findings were different. CONCLUSIONS - The lung CT examination is a rapid, non-invasive method to depict the central pulmonary embolism and small infarcts in non fresh cases. The negative result of perfusion lung scan can exclude the pulmonary embolism. If the lung scan demonstrates perfusion defect(s), it is necessary to perform another diagnostic tests (e.g. chest X-ray, ventillation scan). While the lung scan is a cheap, simple method with low radiation dose, it can play important role in the screening.]

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[INTRODUCTION - In palliative treatment of malignant bile duct obstruction the endoscopic and the percutaneous methods are the possible options. In multiple lesions the percutaneous method must be preferable. Decrease of the bilirubin level to normal gives an opportunity for further treatment of the oncology patients. CASE REPORT - Authors report three patients’ case history, when following an unsuccessful endoscopic retrograde cholangiopancreatography, percutaneous cholangiography revealed multiple biliary stenoses. In all cases successful stent implantations were performed (three stents in one patient, two stents in two patients). The bilirubin levels decreased rapidly and the quality of life improved in all cases. Following the stent implantation selective cytostatic treatment (one patient) and systemic cytostatic treatment (one patient) were performed. The mean survival time was 300 days. CONCLUSION - In the case of multiple biliary stenoses the percutaneous stent implantation is an acceptable palliative method, which permit the possibilities of further interventional radiological or oncological treatments.]

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