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Osteoarthritis of the knee is the most common cause of chronic knee pain being more prevalent in middle-aged and elderly patients. Symptomatic patients complain of pain and mobility impairment. Therapeutic armamentarium includes physical therapy, oral pharmacologic therapy, intra-articular injections, nerve ablation or modulation, trans-catheter arterial embolization, minimally invasive arthroscopic treatment and partial or total knee arthroplasty. Interventional radiology therapies for knee osteoarthritis include intra-articular injections, neurotomy and neuromodulation techniques as well as transcatheter intra-arterial therapies. These therapies aim to control pain and inflammation, improve mobility and function whilst the novel cell-based therapies have the potential for bone and cartilage regenerative repair facilitating the delay to surgery. The purpose of this review is to illustrate the technical aspects, the indications and the methodology of local therapies for knee osteoarthritis performed by interventional radiologists and provide current evidence. more...

Purpose The study sought to prospectively evaluate which technique among T2-weighted images, dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted (DW) MRI, or a combination of the 2, is best suited for prostate cancer detection and local staging. Methods Twenty-seven consecutive patients with biopsy-proven adenocarcinoma of the prostate underwent MRI on a 1.5T scanner with a surface phased-array coil prior radical prostatectomy. Combined anatomical and functional imaging was performed with the use of T2-weighted sequences, DCE MRI, and DW MRI. We compared the imaging results with whole mount histopathology. Results For the multiparametric approach, significantly higher sensitivity values, that is, 53% (95% confidence interval [CI]: 41.0-64.1) were obtained as compared with each modality alone or any combination of the 3 modalities ( P < .05). The specificity for this multiparametric approach, being 90.3% (95% CI: 86.3-93.3) was not significantly higher ( P < .05) as compared with the values of the combination of T2+DCE MRI, DW+DCE MRI, or DCE MRI alone. Among the 3 techniques, DCE had the best performance for tumour detection in both the peripheral and the transition zone. High negative predictive value rates (>86%) were obtained for both tumour detection and local staging. Conclusions The combination of T2-weighted sequences, DCE MRI, and DW MRI yields higher diagnostic performance for tumour detection and local staging than can any of these techniques alone or even any combination of them. more...

This study investigates an alternative use of hemp-based materials either in hemp fiber (HF) or shive (HS) form as biosorbents for the removal of Ni(II) from aqueous solutions. The hemp materials were used either in raw form or after chemical modification with sodium hydroxide and citric acid in order to remove any impurities and add extra carboxyl groups (which improve the adsorption), respectively. A series of adsorption experiments was carried out to determine the effect of (i) solution pH on Ni(II) adsorption, (ii) contact time (kinetics fitted to linear pseudo-first, -second order equations and Elovich model), and (iii) initial ion concentration (fitting to Langmuir, Freundlich and Langmuir–Freundlich equations). Furthermore, a complete characterization study (FTIR, XRD, SEM/EDAX, crystallinity, and cellulose content) demonstrated the surface morphology of the prepared hemp-materials along with some possible adsorption interactions between them and ions. The regeneration of materials was confirmed running desorption experiments (effect of solution pH on desorption) finding also the optimum desorption contact time (kinetics fitted to non-linear pseudo-first and -second order equations). Ten sequential reuse cycles (at the optimum conditions found after adsorption and desorption experiments) revealed the reuse potential of the low-cost hemp-based materials. more...

Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5–18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3–2.8 cm). The median time for ablation was 8 min (range 7–10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. more...

The pudendal nerve may be strained either between the sacrospinous and sacrotuberous ligaments at the ischial spine level or within Alcock’s canal. Alcock’s neuralgia is a rare, painful condition caused by compression of the pudendal nerve within Alcock’s canal (pudendal canal) which is an aponeurotic tunnel that cannot be stretched. Patients usually present with intense, unilateral pain involving anatomic areas along the pudendal nerve’s root, genital, anal, and pelvic regions causing mobility impairment. A computed tomography (CT) - guided percutaneous infiltration of the pudendal nerve with a mixture of a local anesthetic and a long-acting corticosteroid is a safe and efficient method that reduces the pain caused by the neuralgia. Corticosteroids and local anesthetics interfere with the neurons, the encoding, and the processing of noxious stimuli; interrupt the pain-spasm cycle; and reduce inflammation. The injected glucocorticosteroid may take 3-5 days to reach its anti-inflammatory effect; therefore, the initial pain relief from the local anesthetic is followed by a baseline pain return and then secondary pain relief at 3-5 days. The procedure is performed under minimal or no anesthesia. In general, at discharge, a responsible person must accompany the patient and ensure a safe return home. Clinical evaluation is performed after 7-10 days. There are 2 types of potential complications that are associated with percutaneous steroid infiltrations: intra-operative (associated with needle placement) and post-operative (infection, bleeding and those associated with the injectate administration). In all cases that steroids were administered within therapeutic doses, no complications were noted. In conclusion, CT-guided percutaneous infiltration with a mixture of long-acting corticosteroid and local anesthetic seems to be a safe and efficient method for the treatment of Alcock’s neuralgia. Key words: Alcock’s canal, neuralgia, corticosteroid, pudendal; nerve, local anesthetic, computed tomography, infiltration, percutaneous, image guided. more...

We describe 10 children who developed lung cavitation during the treatment of bacteremic pneumococcal lobar pneumonia. Chest CT scan showed extensive consolidation with several small lucencies and air-filled cavities. Invasive procedures like aggressive pleural intervention were not needed and the children recovered attaining normal lung function on long-term follow-up. more...

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. more...

Background: Community-acquired pneumonia in children is rarely depicted as round opacity. The aim of the present study was therefore to describe the clinical and laboratory characteristics of round pneumonia in children. Methods: The clinical series consisted of 30 children aged 1-7 years (mean age, 3.4 1 1.8 years) who were compared to an equal number of children with segmental or lobar pneumonia aged 3-11 years (mean age, 5.5 1 2.7 years). Results: Round pneumonia was localized more often in the lower lobe (17/30), and the right side was more commonly affected (20/30). The same, however, was the case for the control group. The two groups were not different regarding the severity of the disease but cough was much more common in the control patients. The white blood cells were considerably higher in round pneumonia, whereas the other inflammatory indices were not significantly different. All round consolidations responded promptly to antibiotics and resolved radiographically in 8 weeks. Conclusion: Round consolidations in febrile children associated with elevated inflammatory indices seem to be attrib- uted to round pneumonia, which responds promptly to antibiotics without complications. more...

The pudendal nerve may be strained either between the sacrospinous and sacrotuberous ligaments at the ischial spine level or within Alcock's canal. Alcock's neuralgia is a rare, painful condition caused by compression of the pudendal nerve within Alcock's canal (pudendal canal) which is an aponeurotic tunnel that cannot be stretched. Patients usually present with intense, unilateral pain involving anatomic areas along the pudendal nerve's root, genital, anal, and pelvic regions causing mobility impairment. A computed tomography (CT)--guided percutaneous infiltration of the pudendal nerve with a mixture of a local anesthetic and a long-acting corticosteroid is a safe and efficient method that reduces the pain caused by the neuralgia. Corticosteroids and local anesthetics interfere with the neurons, the encoding, and the processing of noxious stimuli; interrupt the pain-spasm cycle; and reduce inflammation. The injected glucocorticosteroid may take 3-5 days to reach its anti-inflammatory effect; therefore, the initial pain relief from the local anesthetic is followed by a baseline pain return and then secondary pain relief at 3-5 days. The procedure is performed under minimal or no anesthesia. In general, at discharge, a responsible person must accompany the patient and ensure a safe return home. Clinical evaluation is performed after 7-10 days. There are 2 types of potential complications that are associated with percutaneous steroid infiltrations: intra-operative (associated with needle placement) and post-operative (infection, bleeding and those associated with the injectate administration). In all cases that steroids were administered within therapeutic doses, no complications were noted. In conclusion, CT-guided percutaneous infiltration with a mixture of long-acting corticosteroid and local anesthetic seems to be a safe and efficient method for the treatment of Alcock's neuralgia. more...

Percutaneous portal vein embolization (PPVE) induces hypertrophy of the future liver remnant before hepatic resection. The ideal embolic material has not yet been determined. We compared N-butyl-2-cyanocrylate (NBCA) with sodium acrylate–vinyl alcohol copolymer particles using a swine model. Twelve pigs underwent PPVE. Six pigs (group A) were embolized with NBCA, and 6 pigs (group B) were embolized with sodium acrylate–vinyl alcohol copolymer particles. Computed tomographic volumetry of the embolized lobe (EL) and the nonembolized lobe (NEL), along with liver function tests, was performed before and at 14 and 28 days after embolization. Tissue samples from both lobes were taken 14 and 28 days after PPVE. NEL-volume and NEL-ratio increases were significantly higher in group A at 14 and 28 days after PPVE (78 and 52% and 91 and 66%, respectively) than in group B (32 and 12% and 28 and 10%, respectively) (p more...

Community-acquired pneumonia in children is rarely depicted as round opacity. The aim of the present study was therefore to describe the clinical and laboratory characteristics of round pneumonia in children.The clinical series consisted of 30 children aged 1-7 years (mean age, 3.4 +/- 1.8 years) who were compared to an equal number of children with segmental or lobar pneumonia aged 3-11 years (mean age, 5.5 +/- 2.7 years).Round pneumonia was localized more often in the lower lobe (17/30), and the right side was more commonly affected (20/30). The same, however, was the case for the control group. The two groups were not different regarding the severity of the disease but cough was much more common in the control patients. The white blood cells were considerably higher in round pneumonia, whereas the other inflammatory indices were not significantly different. All round consolidations responded promptly to antibiotics and resolved radiographically in 8 weeks.Round consolidations in febrile children associated with elevated inflammatory indices seem to be attributed to round pneumonia, which responds promptly to antibiotics without complications. more...

We here present a 6-month-old girl with cystic hepatic mesenchymal hamartoma and elevated a-fetoprotein (aFP). Following hepatectomy of the left lobe and partial right lobectomy, decline of the serum aFP was observed. The child has been well for 20 years and it is one among a few cases with such a long observational period. more...

To examine the results of segmental transcatheter arterial chemoembolization with doxorubicin-loaded DC Bead in the treatment of hepatocellular carcinoma (HCC) in non-surgical candidates. Seventy-one patients (60% men; 11% women; mean age 63; range 46–71 years) with documented HCC of 3–10 cm in diameter (mean 6.2) were enrolled prospectively in the study. All patients had cirrhosis-related HCC that was developed on an underlying controlled hepatitis infection. Only patients with compensated cirrhosis—Child A or B—were included in this study. Overall complete response (CR) according to EASL on an intention to treat basis was seen in 11 patients who developed complete necrosis (15.5%). Objective response (OR) ranged from 66.2% to 85.5% across the four treatments. Survival at 12 months was 97.05%. Sustained CR was observed in 11 (16.1%), and OR in 49 (72%). Sustained partial response was seen in 49 patients (72.05%). Survival at 18 months was 94.1%. At 24 months follow-up survival was 91.1%. Sustained OR was seen in 45 patients (66.2%) while sustained CR was 16.1% (11/68). At 30 months survival was 88.2%. One patient with CR developed multifocal HCC in areas that most likely were not embolized during the previous embolization sessions. In this patient recurrence-free survival was 28 months. Alpha Fetroprotein levels decreased significantly in measurements 1 month post each procedure (p more...

Purpose of the study is to determine the appropriate iterative reconstruction (IR) algorithm level that combines image quality and diagnostic confidence, for pediatric patients undergoing high-resolution computed tomography (HRCT). During the last 2 years, a total number of 20 children up to 10 years old with a clinical presentation of chronic bronchitis underwent HRCT in our department's 64-detector row CT scanner using the iDose IR algorithm, with almost similar image settings (80kVp, 40-50 mAs). CT images were reconstructed with all iDose levels (level 1 to 7) as well as with filtered-back projection (FBP) algorithm. Subjective image quality was evaluated by 2 experienced radiologists in terms of image noise, sharpness, contrast and diagnostic acceptability using a 5-point scale (1=excellent image, 5=non-acceptable image). Artifacts existance was also pointed out. All mean scores from both radiologists corresponded to satisfactory image quality (score ≤3), even with the FBP algorithm use. Almost excellent (score more...

1. The magnetic resonance (MR) study shows a wedgeshaped area in the right kidney (black arrows), which had homogeneous early arterial enhancement, similar to that of the renal cortex (black arrows). The appearance is consistent with a hypertrophied column of Bertin. Magnetic resonance is helpful in differentiating renal masses that have been found by ultrasound to be suggestive of malignancy. 2. The renal scan shows normal size, shape and contour of both kidneys, with normal homogeneous uptake of the isotope and no photopenic areas. 3. The renal mass represents columns of Bertin, as the wedge-shaped area in the MR study showed arterial enhancement similar to that of the cortex and the renal scan was normal. Commentary more...

A 6-year-old girl was admitted because of a low-grade fever of 5 days’ duration. She had an isolated, bulging, block of tender, firm, cervical lymph nodes, without erythema or increased temperature of the overlying skin. A full blood count showed white blood cells of 5.7×10/μl, with neutrophils 39%, lymphocytes 51%, monocytes 6%, and eosinophils 4%; hemoglobin level 12.7 g/dl; hematocrit 37.4%; platelets 340×10/μl. The findings of urine analysis were normal. The child was given clindamycin intravenously for 10 days, and the block of lymph nodes gradually resolved. Looking for abdominal masses or para-aortic lymph nodes, we found a discrete mass in the middle right kidney, incidentally identified by ultrasonography (Fig. 1a). We further explored this finding with color Doppler ultrasonography (Fig. 1b), technetium-99m dimercapto-succinic acid (Tc-DMSA) scan, and magnetic resonance (MR) imaging. Pediatr Nephrol (2010) 25:441–442 DOI 10.1007/s00467-009-1216-8 more...