Resistant hypertension (RHTN) is commonly defined as the presence of uncontrolled blood pressure (BP) (systolic BP > 140 mm Hg or diastolic BP > 90 mm Hg) despite appropriate lifestyle measures and adherence to adequate or maximal tolerated doses of at least three antihypertensive medications from different classes, including a diuretic.1-3 Neither national nor international guidelines specify what the optimal or adequate doses are, but a pragmatic approach may be to consider prescribing half (or above) the maximal licensed dose for hypertension. By definition, this group also includes patients whose BP is controlled on four or more medications.
OBJECTIVE. Dual-energy CT (DECT) is an innovative imaging technique that operates on the basic principle of application of two distinct energy settings that make the transition from CT attenuation–based imaging to material-specific or spectral imaging. The purpose of this review is to describe the use of DECT in oncology.
Purpose: To assess downstaging rates in patients with United Network for Organ Sharing stage T3N0M0 hepatocellular carcinoma (HCC) treated with doxorubicin-eluting bead transarterial chemoembolization to meet Milan criteria for transplantation.
AIM: To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.
Context: Recent reports suggest that rheumatoid arthritis (RA) may be a risk factor for venous thromboembolism (VTE), particularly in conjunction with hospitalization. Using hospitalization data to identify RA and VTE may identify patients when they are at elevated risk for other reasons, obscuring the incompletely understood underlying association between RA and VTE and leading to inappropriate institution or timing of interventions.
Resistant hypertension has been defined as a failure to reach blood pressure targets despite a combination of three to four antihypertensive drugs from different drug classes (including a diuretic) at optimal dosages.1 The goal blood pressure is defined as < 140/90 mm Hg for the general population and < 130/80 mm Hg for those with diabetes mellitus or chronic kidney disease. Resistant hypertension is not the same as uncontrolled hypertension (ie, hypertension due to inadequate treatment regimen or poor adherence, or secondary hypertension).
Introduction: Many of the anticancer agents investigated in the past few years for hepatocellular carcinoma (HCC) act against the tumor vasculature (1,2); one of these (sorafenib) received U.S. Food and Drug Administration and European Committee for Medicinal Products for Human Use approvals in 2007 and is now approved in over 80 countries for use in unresectable HCC (3–6). The Response Evaluation Criteria in Solid Tumors, or RECIST, guidelines based on tumor size, as measured on conventional computed tomographic (CT) or magnetic resonance (MR) images, are inadequate for effective early monitoring of such therapies (7), because cell death and so reduction in tumor size are not direct effects of these cytostatic treatments.
OBJECTIVE. Dual-energy CT permits a variety of image reconstructions for the depiction and characterization of vascular disease. Techniques include visualization of low– and high–peak-kilovoltage spectra image datasets and also material-specific reconstructions combining both low– and high–peak-kilovoltage data.
Preamble: In recent years, the Society of Interventional Radiology (SIR) has become aware of a growing heterogeneity in the learning experiences of radiology trainees (residents and fellows) as it pertains to the subject of interventional radiology (IR). Unfortunately, the Accreditation Council for Graduate Medical Education (ACGME) program requirements are somewhat vague as to what constitutes adequate training in this field. Therefore, a task force was created to create guidelines for training in the field of IR. Task force members included physicians who practice in academic and private-practice settings. Also, the task force contained a cross-section of thought leaders in the various clinical realms of IR (peripheral arterial disease, interventional oncology, venous disease, interventional neuroradiology, and renal insufficiency). Many members are current or past program directors of diagnostic radiology (DR) residencies or IR fellowships.
AIM: To explore the physiopathology and magnetic resonance imaging (MRI) findings in an animal model of acute arterial mesenteric ischemia (AAMI) with and without reperfusion. METHODS: In this study, 8 adult Sprague-Dawley rats underwent superior mesenteric artery (SMA) ligation and were then randomly divided in two groups of 4. In group I, the ischemia was maintained for 8 h. In group II, 1-h after SMA occlusion, the ligation was removed by cutting the thread fixed on the back of the animal, and reperfusion was monitored for 8 h. MRI was performed using a 7-T system.
Introduction: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that develops in patients with severe liver disease and/or portal-systemic shunting, which is characterized by a wide spectrum of clinical manifestations, ranging from alterations of psychometric performance to stupor and coma. This disorder has been considered as a continuum of neurocognitive dysfunction, from minimal HE to overt HE (1). Minimal HE has drawn attention in recent years because of its high prevalence, its relevant to cause falls, and concerns that patients will drive while impaired (2–4). Although many behavioral study results have indicated that patients with minimal HE have cognitive dysfunction in attention and response inhibition (1,5,6), authors of a few studies have focused on the neural mechanism of this cognitive dysfunction. (7–9). Schiff et al (7) found that top-down processes were altered and bottom-up processes are preserved in the extrastriate cortex of patients with minimal HE with event-related relevants. Zafiris et al (8) found an early impaired and compensatory neural mechanism during visual judgment in patients with minimal HE by using blood oxygen level–dependent functional MR imaging with critical flicker frequency as the target task. Authors of some other studies also found impaired attention and default mode network, which can partially explain cognitive dysfunctions in cirrhotic patients (9–12).
OBJECTIVE. The purpose of this perspective is to document an experience with the adoption of dual-energy CT (DECT) for routine clinical imaging.
PURPOSE: e aimed to describe the long-term outcome of endovascular treatment of iliofemoral deep vein thrombosis in the postpartum period.
The Physician Patient Sunshine Act of 2010 mandates new disclosure and publication requirements for certain financial relationships between physicians and industry. Sponsored by Senators Charles Grassley (Republican, Iowa) and Herb Kohl (Democrat, Wisconsin), the Physician Patient Sunshine Act is premised on the belief that providing transparency to these relationships will deter quid pro quo dealings between physicians and industry that may contribute to inappropriate use of health care resources and increasing health care costs (1). The tracking and reporting requirements under the law are expected to take effect August 1, 2013, and all physicians, including interventional radiologists, are likely to be affected to some extent. The purpose of this commentary is to provide historical context to this issue, clarify the reporting requirements of the Physician Payment Sunshine Act, and discuss its potential impact on the interventional radiology community and steps that interventional radiologists can take to manage their own public profile vis-à-vis physician-industry relationships and this new law.
Abstract: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related death in the world. With advances in imaging diagnostics, accompanied by better understanding of high-risk patients, HCC is now frequently detected at an early stage; however, the prognosis remains poor. The recurrence rate after treatment of HCC is higher than that associated with cancers of other organs. This may be because of the high incidence of intrahepatic distant recurrence and multicentric recurrence, especially with hepatitis C virus (HCV)-related hepatocellular carcinoma. The Barcelona Clinic Liver Cancer (BCLC) classification has recently emerged as the standard classification system for the clinical management of patients with HCC. According to the BCLC staging system, curative therapies (resection, transplantation, transcatheter arterial chemoembolization, percutaneous ethanol injection therapy, percutaneous microwave coagulation therapy and percutaneous radiofrequency ablation) can improve survival in HCC patients diagnosed at an early stage and offer a potential long-term cure. However, treatment strategies for recurrent disease are not mentioned in the BCLC classsification. The strategy for recurrence may differ according to the recurrence pattern, i.e., intrahepatic distant recurrence vs multicentric recurrence. In this article, we review recurrent HCC and the therapeutic strategies for reducing recurrent HCC, especially HCV-related HCC.
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