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Background: Recent advancements in the context of shock pathophysiology, support ultrasound assessment of organ perfusion. Renal resistive index (RRI) has been used to evaluate renal blood flow. Our aim was to investigate the relation between RRI, and global tissue hypoperfusion indices, in mechanically ventilated critically ill patients and their association with clinical outcome.Methods: In this prospective observational study, RRI was measured within 24 hours of intensive care unit (ICU) admission. Clinical and laboratory data, routine hemodynamic variables and gas exchange at the time of RRI assessment were recorded. The ratio of central venous-to-arterial carbon dioxide partial pressure difference by arterial-to-central venous oxygen content difference (P(cv-a)CO2/C(a-cv)O2) and lactate were used as global tissue hypoperfusion indices. Results A total of 126 mechanically ventilated patients were included [median age 61 (IQR 28) years, 74% males]. Seventy-seven patients had RRI values >0.7. P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate, were significantly higher in patients with RRI > 0.7 compared to those with RRI ≤0.7 [2.4 (2.2) versus 1.2 (0.6) and 2.88 (3.39) versus 0.62 (0.57) mmol/l respectively, both p(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate for the whole patient population (rho=0.64, both p2 / C(a-cv)O2 ratio [3.67 (3.8) versus 0.91 (1.4)] and lactate levels [2.80 (2.00) versus 1.50 (1.20)], both p (cv-a)CO2/C(a-cv)O2 ratio with clinical outcome. RRI showed good ability to predict ICU mortality (AUC 74.9% (95% CI 61% - 88.8%). The combination of RRI with P(cv-a)CO2)/(C(a-cv)O2 ratio and lactate better predicted mortality than RRI alone [AUC 84.8% (95% CI 5.1% - 94.4%)] versus 0.74.9%, respectively, pConclusions: In mechanically ventilated patients, renal blood flow impairment, assessed by the RRI on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation is more valuable in predicting clinical outcome than RRI alone.

This is a prospective study with the purpose of assessing patient radiation dose and stochastic risk (risk for fatal cancer) in a patient population undergoing interventional radiological (IR) procedures. Measurements were performed on 36 consecutive patients undergoing percutaneous transluminal angioplasty (PTA, n=18), transjugular intrahepatic portosystemic shunt (TIPS, n=3), diagnostic angiography (DA, n=6), arterial embolization (AE, n=3), and hepatic neoplasm chemoembolization (HCE, n=6). Kerma area product (KAP) was used as a measure of x-ray exposure to the patient. Mean KAP value per procedure was 79+/-50 Gy cm for PTA, 139+/-55 Gy cm for TIPS, 110+/-44 Gy cm for DA, 325+/-145 Gy cm for AE, and 150+/-76 Gy cm for HCE. Forty-six percent of total KAP value was attributed to fluoroscopy. In conclusion, we showed that a linear correlation between effective dose and KAP was found (r=0.84), which could be used for estimating patient effective dose using KAP measurements. Small changes to the number of digital frames acquired result in substantial change of the total KAP in interventional radiological procedures. Stochastic risk from IR procedures is quite low for the patient. Measuring KAP is a simple and accurate method, which provides the interventional radiologist with a good estimation of the patient's relative risk for stochastic effects.

Priapism is defined as the state of prolonged engorgement or erection of the penis not related to sexual desire or stimulation.1 Priapism is classified into 2 categories based on the underlying pathophysiological mechanism—low flow or ischemic, and high flow or nonischemic.1 High flow priapism is an uncommon clinical entity. The vast majority of cases are caused by perineal or penile trauma, which can result in penile artery laceration and the formation of an arteriocavernous fistula.2 Iatrogenic high flow priapism has been described during treatment of erectile dysfunction with intracorporeal injections.2 We report a case of iatrogenic high flow priapism secondary to transurethral surgery. The patient was successfully treated with selective embolization.

We report a patient with symptomatic liver metastases as the sole site of recurrence of a previously resected malignant fibrous histiocytoma of the trunk. We treated the patient with two sessions of transcatheter chemoembolization. Tumor regression was achieved, and the patient remained free of symptoms 23 months after the diagnosis of liver involvement, when he died of acute myocardial infarction. To our knowledge, this is the only case of transcatheter chemoembolization of liver metastases from soft-tissue sarcoma reported in the literature. Although it is a single case, it shows that this method may be a promising therapy for this grave disease.