INTRODUCTIONCone beam computed tomography (CBCT) is a relatively new technological innovation that utilises fl at-panel detector technology to obtain CT-like images. The key strength of a CBCT system is that cross-sectional imaging can be obtained using the angiographic fl at panel unit without having to move the patient, allowing the radiologist to obtain soft tissue imaging during the procedure. This allows treatment planning, guidance, and assessment of outcome to be performed in one interventional suite.

MATERIALS AND METHODSFrom December 2008 to June 2009, 24 CBCT scans were performed during vascular interventional procedures on our department's newly installed multi-axis fl at panel angiographic unit.

RESULTSTen cases were performed for hepatic trans-arterial chemoembolisation, 9 cases for hepatic arterial Yttrium-90 infusion, while 5 cases were for other indications. CBCT was found to be useful in 20 of the 24 cases.

CONCLUSIONOur early experience showed that CBCT was useful in impacting decisions during selected vascular interventional procedures. As CBCT technology improves, we can foresee wider applications of this technology.

Aged ; Angiography ; Cone-Beam Computed Tomography ; standards ; Embolization, Therapeutic ; Female ; Humans ; Male ; Medical Audit ; Middle Aged ; Radiology, Interventional ; methods ; Retrospective Studies

No abstract available.
Hypopituitarism*

Brainstem auditory response abnormalities directly reflect disturbance of neural function rather than the underlying anatomic cause of that disturbance. The test has advantage in detecting lesions that alter electrophysiology but do not produce detectable alterations of radiodensity, displace surrounding structures or change vascular supply and permeability. A sequence of seven low-amplitude potentials that occur in the initial 10 msec following click signals can be recorded from scalp electrodes in 44 patient with focal brain lesions using computer averaging techniques. The potentials, termed auditory brainstem responses, are thought to be the far-field reflection of electrical events originating in the auditory pathway during its course through the brainstem. We have studied auditory brainstem evoked potential responses in a variety of focal brain lesions and found them to be of assistance in evaluating the localization of pontomedullary, pons, midbrain, thalamus, subcortical and functional recovery. 1) Distortion of early components (type I) was occured in the brainstem lesions. 2) Distortion of late components (type II) was developed in the diencephalon or subcortical lesions. 3) Distortion of all components (type III) was developed in the brainstem and diffuse brain contusions. 4) Serial recordings provided information about the evolution of brain stem lesions and good functional recovery marker.
Auditory Pathways ; Brain Injuries ; Brain Stem* ; Brain* ; Diencephalon ; Electrodes ; Electrophysiology ; Evoked Potentials* ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Mesencephalon ; Permeability ; Pons ; Scalp ; Thalamus

Brainstem auditory response abnormalities directly reflect disturbance of neural function rather than the underlying anatomic cause of that disturbance. The test has advantage in detecting lesions that alter electrophysiology but do not produce detectable alterations of radiodensity, displace surrounding structures or change vascular supply and permeability. A sequence of seven low-amplitude potentials that occur in the initial 10 msec following click signals can be recorded from scalp electrodes in 44 patient with focal brain lesions using computer averaging techniques. The potentials, termed auditory brainstem responses, are thought to be the far-field reflection of electrical events originating in the auditory pathway during its course through the brainstem. We have studied auditory brainstem evoked potential responses in a variety of focal brain lesions and found them to be of assistance in evaluating the localization of pontomedullary, pons, midbrain, thalamus, subcortical and functional recovery. 1) Distortion of early components (type I) was occured in the brainstem lesions. 2) Distortion of late components (type II) was developed in the diencephalon or subcortical lesions. 3) Distortion of all components (type III) was developed in the brainstem and diffuse brain contusions. 4) Serial recordings provided information about the evolution of brain stem lesions and good functional recovery marker.
Auditory Pathways ; Brain Injuries ; Brain Stem* ; Brain* ; Diencephalon ; Electrodes ; Electrophysiology ; Evoked Potentials* ; Evoked Potentials, Auditory, Brain Stem ; Humans ; Mesencephalon ; Permeability ; Pons ; Scalp ; Thalamus

This experiment was performed to define the paricipation of a discrete hypothalamic neural structure in the genesis of pulmonary edema and the effect of alpha adrenergic blockade. Fifty adult cats weighing 2.5 to 4.0 Kg, were used in this study. The components of the pathophysiological systemic changes, lung weight, and histopathological changes of lung and hypothalamus were studied in groups of animals when intracranial pressure(ICP) was raised to 200 mmH2O of 300 mmH2O for 2 hours by intraventricular infusion with normal saline. The animals were divided into 5 groups : The normal control group was comprised in 10 normal cats. Control and phentolamine treated animal groups which had an elevated ICP of up 200 mmH2O consisted of 10 cats each. Control and phentolamine treated animal groups which had an elevated ICP of up to 300 mmH2O consisted of 10 cats each. The results obtained were as follows : 1) In the animal groups of elevated ICP to 200 mmH2O or 300 mmH2O, there were hemodynamic systemic changes which were neurogenically mediated and caused an immediate elevation in blood pressure of 30 mmHg to 60 mmHg. The hemodynamic data of the animals that had an elevated ICP of up to 300 mmH2O were significantly more deviated from normal control values than the 200 mmH2O ICP groups. The hemodynamic responses of the phentolamine treated animal with elevated ICP of up to 200 and 300 mmH2O were less deviated from normal control values. 2) The lung weights of the animals with an elevated ICP of up to 200 and 300 mmH2O were significantly heavier than the normal control value(p<0.05) and the lung weights of the animals with an elevated ICP of 300 mmH2O were significantly heavier than those with an ICP of 200 mmH2O(p<0.01). The lung weights of the phentolamine treated animal groups were significantly lighter than the control group but showed little increase in the lung weight when compared to the normal value. 3) By controlling the elevated ICP above 200 mmH2O in the experimental animals we have confirmed gross and microscopic appearances of hemorrhagic pulmonary edema. Histopathological changes of the phentolamine treated animals were significantly less sever than in the control groups. 4) By elevating ICP above 200 mmH2O in the experimental animals, we have confirmed discrete bilateral hemorrhagic spots of the anterior hypothalamus, preoptic region induced by increased intracranial pressure. Histopathological changes of the phentolamine treated animals with the elevated ICP were significantly less severe than of the control groups. 5) This experimental model may define the specific particification of the hypothalamus in the pathophysiological pathogenesis of neurogenic pulmonary edema. These results suggest that the lungs are directly affected by the intense sympathetic discharge evoked by release phenomenon from the sympathoinhibitory influence of the hypothalamus, and pulmonary edema was effectively eliminated by alpha adrenergic blockade.
Adult ; Animals ; Blood Pressure ; Cats* ; Edema* ; Hemodynamics ; Humans ; Hypothalamus ; Hypothalamus, Anterior ; Infusions, Intraventricular ; Intracranial Pressure ; Lung* ; Models, Theoretical ; Phentolamine* ; Pulmonary Edema ; Reference Values ; Weights and Measures

PURPOSE: The aim of this study was to assess the safety of TME with pelvic autonomic nerve preservation in male rectal cancer patients in terms of voiding and sexual function. METHODS: We performed uroflowmetry using Urodyn (Dantec, Denmark) and a standard questionnaire employing the IIEF (International Index of Erectile Function) and the IPSS (International Prostate Symptom Score) pre- and postoperatively in 68 male rectal cancer patients. RESULTS: There were significant differences of mean maximal flow rate and voided volume before and after surgery (18.9+/-5.7 vs 13.7+/-7.0, 240+/-91.9 vs 143+/-78, P<0.05, P<0.05), respectively. But, there was no difference of residual volume before and after surgery (4.4 2.6 vs 8.1 4.4, P>0.05). The total IPSS (International Prostate Symptom Score) was increased after surgery from 6.2+/-5.8 to 9.8+/-5.9 (P<0.05). There were no changes of score for one of each seven IPSS items in from 49 patients (73.5 percent) to 61 patients (89.7 percent). Five IIEF (International Index of Erectile Function) domain score (erectile function, intercourse satisfaction, orgasmic function, sexual desire and overall satisfaction) was statistically decreased after surgery (18.2+/-9.3 vs 13.5+/-9.0, 8.4+/-4.2 vs. 4.4+/-2.9, 5.8+/-2.9, vs. 4.4+/-2.9, 6.1+/-2.4 vs. 4.8+/-2.0, 6.1+/-2.2 vs. 4.5+/-2.3, P<0.05, respectively. Erection was possible in 55 patients (80.9 percent), but penetration ability was possible in 51 patients (75 percent). Complete inability for erection and intercourse was observed in 3 patients (5.5 percent). Retrograde ejaculation was noted in 9 patients (13.2 percent). IIEF domains such as sexual desire and overall satisfaction were markedly decreased in 39 patients (57.4 percent), 43 patients (63.2 percent), respectively. Multiple regression analysis of factors affecting postoperative sexual dysfunction showed that over 60 years (sexual desire: P=0.019), within 6 months (erectile function: P=0.04, intercourse satisfaction: P=0.011, orgasmic function: P=0.03), lower rectal cancer (erectile function: P=0.02, intercourse satisfaction: P=0.036, orgasmic function: P=0.027) were significant factors. CONCLUSIONS: TME with pelvic autonomic nerve preservation technique showed a safety and comparable data in preserving sexual and voiding function. The IPSS and IIEF questionnaire were useful and more investigative in assessing urinary and sexual function.
Autonomic Pathways* ; Ejaculation ; Humans ; Male* ; Orgasm ; Prostate ; Surveys and Questionnaires ; Rectal Neoplasms* ; Residual Volume

PURPOSE: Despite recent advances in laparoscopic pancreatic surgery, few studies have compared laparoscopic central pancreatectomy (LCP) with open central pancreatectomy (OCP). The aim of this study was to compare clinical outcomes between LCP and OCP as a single institutional study. METHODS: During the study period (From January, 1998 to December, 2010), we performed central pancreatectomy in 95 cases. Among them, 26 cases of totally LCP and 55 cases of OCP were compared retrospectively. RESULTS: Benign pancreatic neoplasm was the main indication. The mean operation time for the LCP group (350.2 min) was longer than that for the OCP group (283.4 min). And there was no significant difference in mean actual blood loss (477 ml versus 714 ml, p=0.083) between the LCP and OCP groups. Return to a normal bowel movement and resumption of a liquid diet were achieved 5.5+/-2.6 days after the operation in the LCP group and 6.6+/-2.0 days after the operation in the OCP group (p=0.039). The mean duration of postoperative hospital stay was 13.8 days for the LCP group, which was significantly shorter than the 22.5 days for the OCP group (p=0.015). The overall complication rate was 42.3% (11 cases) in the LCP group and 45.5% (25 cases) in the OCP group (p=0.790). CONCLUSION: Use of LCP for benign or low grade malignant lesions of the pancreatic neck portion is feasible and safe. Compared to the open method, the laparoscopic approach to central pancreatectomy appears to provide advantages of early resumption of a normal diet and reduction of postoperative hospital stay without further complications.
Diet ; Laparoscopy ; Length of Stay ; Neck ; Pancreatectomy ; Pancreatic Fistula ; Pancreatic Neoplasms

Appendiceal neoplasms are rare and often only discovered incidentally during surgery performed for acute appendicitis. Computed tomography (CT) has been demonstrated to be a reliable technique for accurately establishing the preoperative diagnosis of appendiceal neoplasms that manifest as acute appendicitis through the presence of certain imaging findings. Other manifestations of appendiceal neoplasms include appendiceal mass, mucocoele, localised abscess formation, ileus, increasing abdominal girth from pseudomyxoma peritonei, and intussusception. This pictorial essay illustrates varied CT findings of neoplasms of the appendix, with emphasis on the more commonly encountered manifestations of these tumours.