Radiotherapy is a highly utilized clinical treatment modality. More than 50% of all cancer patients receive some type of radiation therapy during the course of their illness. In mouse models, radiation treatment has been shown to increase the level of tumor antigen presentation and the variety of peptides available for cross-presentation. Current work in the field focuses on using radiation as a tool to bridge the gap from tumor equilibrium to tumor elimination, which could improve the response rate of immuno-oncology agents. 4T1 is a murine breast cancer model known to have a large percentage of myeloid derived suppressor cells (MDSC) making the model resistant to many immunotherapies and is considered an immunologically cold tumor. We hypothesized that treatment with focal radiation (RT, Xstrahl) would sensitize 4T1 tumors to anti-CTLA-4 treatment. To determine an appropriate dose of RT, mice with 4T1-Lu2 tumors were treated with a single, focal dose of 5, 10 or 20Gy RT. No response was seen at 5Gy, 10Gy resulted in 10 days growth delay, and 20Gy resulted in 16 days growth. In subsequent work, mice were placed into groups and treated with either isotype control (10mg/kg, MPC-11), anti-CTLA-4 (10mg/kg, 9D9), 10Gy RT, or the combination. Mice were monitored over time for changes in primary tumor volume by caliper measurements and for metastatic disease by bioluminescence imaging (BLI) of the thoracic region. Satellite groups were included for immunohistochemistry and the evaluation of changes in tumor infiltrating lymphocytes. Median tumor growth delay with anti-CTLA-4, RT, or the combination, was 2.4, 3.5 and 9.4 days, respectively. Time to progression, to 1,200mm3 tumors, was increased by 25% in the combination group but not significantly in the monotherapy groups. While all mice showed evidence of metastatic disease, mice in the combination group displayed a lower level of BLI signal on day 30 when compared to other groups. To examine the effects on immune cell infiltration, 11 subsets were profiled by flow cytometry. B cells and regulatory T cells were significantly reduced (>95% and 90%, respectively) in the combination group when compared to an untreated group. B cell reductions that exceeded 90% were also observed in some animals within the isotype control group. Examination of the CD8+ T cell phenotype demonstrated that combination therapy, but not monotherapies, increased expression of both CD69 and PD-1 on CD8+ T cells suggesting an enhancement of anti-tumor cytotoxicity in these cells. Interestingly, we found that the combination selectively reduced the levels of phosphorylated STAT3 in MDSC subsets. Collectively, this intimates that anti-CTLA-4 and RT selectively disrupt STAT3 signaling in MDSCs and combine to enhance CD8+ T cell activity, which may play a role in the 4T1 tumor growth delay observed. Citation Format: Maryland Rosenfeld Franklin, David Draper, Sumithra Urs, Scott Wise. Preclinical use of focal radiation and immune checkpoint blockade to improve therapeutic response in an immunologically cold tumor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 535.

Peripheral vascular malformations encompass a wide spectrum of lesions that can present as an incidental finding or produce potentially life- or limb-threatening complications. They can have intra-articular and intraosseous extensions that will result in more diverse symptomology and present greater therapeutic challenges. Developments in classification, imaging and interventional techniques have helped to improve outcome. The onus is now placed on appropriate detailed preliminary imaging, diagnosis and classification to direct management and exclude other more common mimics. Radiologists are thus playing an increasingly important role in the multidisciplinary teams charged with the care of these patients. By fully understanding the imaging characteristics and image-guided procedures available, radiologists will be armed with the tools to meet these responsibilities. This review highlights the recent advances made in imaging and the options available in interventional therapy.

Acute porphyria, though rare, has well-known neurological sequelae. Vasospasm rarely complicates exacerbations of acute intermittent porphyria, but has not been previously reported in hereditary coproporphyria. We describe a porphyric crisis in a woman with previously undiagnosed hereditary coproporphyria (triggered by rifampicin), leading to vasospasm and stroke.

Purpose: Radiographer-performed, CT-guided, therapeutic dorsal ganglion block (DGB) for lumbar radiculopathy was prospectively evaluated for firstly, short-term pain outcomes and secondly, complications.Methods: A prospective outcome audit was undertaken for all patients with radiculopathic pain undergoing radiographer-performed CT-guided DGB over a 12 month period. The indicators and standards were derived from published evidence. The complications were analysed by a neuroradiologist retrospectively.Findings: The pain indicator was defined as "the percentage of patients referred for CT-guided DGB experiencing improvement or resolution of pain at two weeks post-procedure". The standard chosen was 64% thus with an outcome of 67% the target was achieved. The complication indicator was defined as "the percentage of all patients referred for CT-guided DGB who were complication-free over two weeks". The standard chosen was 97% thus with an outcome of 81% the target was not achieved. Complications resulted from positioning or inaccurate nerve root selection.Conclusion: Radiographer CT-guided DGB is effective in improving or removing pain at two weeks post-procedure. It is safe and not associated with major complications. However, less patients were complication-free following DGB than would be expected. Pre-procedural review of the patient's MRI by a neuroradiologist is recommended to avoid incorrect nerve root selection. (C) 2011 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Total knee replacement is a well-established treatment for osteoarthritis with increasing numbers performed each year. Recurrent haemarthrosis is a relatively rare complication following TKR being reported in up to 1.6% of patients. While some causes are related to direct trauma to blood vessels, others are more obscure and may be difficult to diagnose. The purpose of this review is to give an overview of this unusual complication and summarise the current methods of management.

Spinal cord ischaemia is a rare, but reported cause of acute deterioration following cervical laminectomies. Various adjuncts have been reported to protect against and treat cord ischaemia, including CSF diversion. We present a case of a patient who experienced an acute neurological deterioration following cervical laminectomies that improved following CSF drainage.

The objective was to evaluate outcomes of a high-risk patient cohort following endovascular abdominal aortic aneurysm repair (EVAR) treatment not entered into the U.K. endovascular stent-graft aortic aneurysm repair trials (EVAR-1 or -2) because of equipoise absence but where EVAR was judged to be the most appropriate intervention option on compassionate grounds. A single-center retrospective analysis was performed involving all patients undergoing compassionate EVAR treatment during the EVAR-1 and -2 trial period. Over an 8-year period, 34 patients underwent compassionate EVAR procedure. The mean (SD) age was 76 (79) years. The mean (SD) preoperative physiology score (P-POSSUM) was 25 (8.3) with a mean (SD) predicted early mortality of 9.9% (16%). The actual early mortality in our study was 2.9% and morbidity was 35%. There were 8 cases of endoleak: type I (n = 2), type II (n = 5), and type IV (n = 1). Aneurysm-related mortality and all-cause mortality after 8 years were 5.8% and 23.5% respectively. Satisfactory outcome with low mortality (2.9%) and morbidity can be achieved in patients with compassionate indications, where clinicians judge EVAR to be an advantage over open abdominal aortic aneurysm repair. Based on our study, the early mortality (2.9%) in our compassionate EVAR group is comparable to EVAR-1 outcomes (1.7%) and better than EVAR-2 mortality results (9%). EVAR should therefore not be denied to a significant number of high-risk abdominal aortic aneurysm patients who fall between the EVAR-1 and EVAR-2 criteria.

OBJECTIVE: This retrospective study aimed to explore the role of Glasgow Aneurysm Score (GAS) and Hardman Index (HI) in predicting outcome after elective endovascular aneurysm repair (EVAR).METHODS: All 71 patients who underwent elective EVAR in a single centre over 9 years were reviewed. Clinical data were used to classify patients into the three standard GAS tertiles and to score patients according to the HI.RESULTS: Fifty-one patients scored >= 77 according to GAS. Actual and predicted mortality in this group were 3.9% and 9.3%. Seventeen patients scored between 69 and 77 with actual and predicted mortality of 0% and 4.1%. Three patients scored less than 69 with actual and predicted mortality of 0% and 2.4%. Ten patients scored >= 3 on the HI with actual and predicted mortality of 10% and 100%, respectively. Twenty-four patients scored 2 with actual and predicted mortality of 4.2% and 55%. Twenty-seven patients scored 1 with actual and predicted mortality of 0% and 28%, respectively. Ten patients scored 0 with actual and predicted mortality of 0% and 16%, respectively. The chi(2) test showed extremely significant p value of 0.0001 in case of HI, and p value of 0.0800 for GAS, slightly less significant, probably due to the small sample size.CONCLUSION: Contrary to their role in ruptured and open aortic aneurysm repair, GAS and HI overestimate both mortality and morbidity following EVAR and are poor predictors of outcome.

Klippel–Trenaunay–Weber syndrome (KTWS) is a congenital disorder characterized by a triad of varicose veins and venous malformation involving one or more extremities, cutaneous haemangioma, and hypertrophy of soft tissue and bone. The syndrome is rare and it usually presents as varicose veins or cutaneous naevi. We report a patient with KTWS who developed superficial thrombophlebitis in her varicose veins and died from a pulmonary embolism. To optimize management it is important to recognize the syndrome, and the patient should ideally be referred for multidisciplinary vascular care and all such patients should be anticoagulated in the long term.

Complications associated with the use of the Swan-Ganz catheters including coiling and knotting of the catheter in the central venous system or in the chambers of the heart, often with disastrous consequences. We report a case of knotting of a Swan-Ganz catheter in the superior vena cava which necessitated surgical removal via the right internal jugular vein.

A 39-year-old woman presented in July, 1995, with left earache, hearing loss, and diabetes insipidus, and was diagnosed with multisystem Langerhans cell histiocytosis (type-1). The histiocytosis involved the hypothalamus and external auditory meati, and scattered bony disease was most prominent in her skull and right knee. She was initially given cranial external-beam radiotherapy, which induced a complete response in the brain stem and left temporal bone. In May, 1997, she presented with worsening bony pain Treatment with 6 mg/m2 vinblastine once a week for 12 weeks alleviated her symptoms, but the disease progressed in October, 1997, with multiple brain-stem lesions, which were treated with 50 mg/m2 epirubicin on day 1, 200 mg/m2 etoposide and 3 g/m2 ifosfamide on days 1–3, repeated every 3 weeks for four cycles. 1 Proctor SJ Taylor PR Angus B et al. High-dose ifosfamide in combination with etoposide and epirubicin (IVE) in the treatment of relapsed/refractory Hodgkin's disease and non-Hodgkin's lymphoma: a report on toxicity and efficacy. Eur J Haematol. 2001; 64: 28-32 Google Scholar Although she responded initially, she deteriorated over the next 2 years with no response to further chemotherapy with liposomal doxorubicin or lomustine.

Venous thromboembolism (VTE) is the third most frequent vascular disease and the leading cause of preventable intrahospital death. Thrombophilia involves hereditary and acquired factors that increase the risk of VTE. Before 1993, prothrombotic conditions were detected in a small percentage (less than 10%) of VTE patients, but new thrombophilia factors arose during the last decade. The factor V Arg506Gln (factor V Leiden) is found in 12Ð25% of white VTE patients; it increases VTE risk through activated protein C resistance. Moreover, the combination of factor V Leiden and oral contraceptives multiplies the risk of a VTE by a factor of 35, when compared with a patient not taking oral contraceptives and without the mutation. The increased risk associated with prothrombin G20210A mutation, found in 5Ð10% of VTE patients, is attributed to elevated plasma prothrombin level. Hyperhomocysteinaemia, induced by genetic and acquired factors, is a risk factor for both venous and arterial disease. Antiphospholipids are a well recognized thrombophilia factor and are associated with an increased risk of recurrence. Deficiency of antithrombin, protein C and protein S are less frequent. Recent studies also pointed to the risk associated with elevated factor VIII-C and factor IX. Whether thrombophilia will alter the management of VTE patients is still debated. Basically, the initial treatment still relies on the appropriate use of heparin and coumadine derivatives, independently of thrombophilia factors. Testing for prothrombotic conditions is helpful if it can identify patients who bear a higher risk of recurrence and are candidates for long-term anticoagulation. An exaggerated recurrence rate associated with factor V and factor II heterozygous mutation is not definitely recognized. However, it is admitted that patients bearing both heterozygous factor V and factor II mutations or a homozygous factor V or factor II mutation are at higher risk of recurrence and deserve prolonged anticoagulation. Strong evidence also supports prolonged anticoagulation for patients with antiphospholipids, antithrombin deficiency and severe protein C and protein S deficiency. This led to the distinction of severe thrombophilia with VTE occurring early in life and recurring frequently and moderate thrombophilia with more delayed thrombosis and fewer relapses. Apart from defining the duration of anticoagulation, thrombophilia also improves the understanding of disease for both the patient and the physician. In some instances, the discovery of thrombophilia in a recurrent disease may mitigate the fear for an underlying occult malignancy. It may contribute to more appropriate recommendations for secondary prophylaxis during transitory risk and can also benefit the patientÕs family by identifying affected relatives. Thrombophilias are also associated with an increased risk of recurrent late fetal loss. Overall, knowledge of thrombophilia contributes to the understanding of disease and in some instances, it will improve the management of disease by identifying very high risks of recurrence.

Fibromuscular dysplasia (FMD) is a disease of unknown aetiology, first typically presenting in the medium and large arteries of young to middle-aged women. It was first described by Leadbetter and Burkland in 1938 and is most commonly noted to involve the renal vessels. The management of FMD with severely stenotic and symptomatic lesions has historically been surgical.

CommentaryThe role of anaesthesia in interventional radiologyA F Watkinson, I S Francis, P Torrie and A D PlattsA F WatkinsonDepartment of Radiology, Royal Free Hospital, Pond Street NW3 2QG, London and Department of Radiology, Royal Berkshire Hospital, Reading, UKSearch for more papers by this author, I S FrancisDepartment of Radiology, Royal Free Hospital, Pond Street NW3 2QG, London and Department of Radiology, Royal Berkshire Hospital, Reading, UKSearch for more papers by this author, P TorrieDepartment of Radiology, Royal Free Hospital, Pond Street NW3 2QG, London and Department of Radiology, Royal Berkshire Hospital, Reading, UKSearch for more papers by this author and A D PlattsDepartment of Radiology, Royal Free Hospital, Pond Street NW3 2QG, London and Department of Radiology, Royal Berkshire Hospital, Reading, UKSearch for more papers by this authorPublished Online:5 Mar 2014https://doi.org/10.1259/bjr.75.890.750105SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About"The role of anaesthesia in interventional radiology." The British Journal of Radiology, 75(890), pp. 105–106 References 1 Royal College of Anaesthetists and Royal College of Radiologists. Sedation and anaesthesia in radiology, Report of a Joint Working Party. London: RCR/RCA, 1992. Google Scholar2 Morello FP, Donaldson JS, Saker MC, Norman JT. Air embolism during tunneled central catheter placement procedures without general anaesthesia in children: a potentially serious complication. J Vasc Interv Radiol 1999;10:781–4. [Comment. J Vasc Interv Radiol 1999;10:1416.] Crossref Medline ISI, Google Scholar3 Sury MR, Hatch DJ, Deeley T, Dicks-Mireaux C, Chong WK. Development of a nurse-led sedation service for paediatric magnetic resonance imaging. Lancet 1999;353:1667–71. Crossref Medline ISI, Google Scholar4 Trotteur G, Stockx L, Dondelinger RF. Sedation, analgesia and anaesthesia for interventional radiological procedures in adults. Part I. Survey of interventional radiological practice in Belgium. JBR-BTR 2000;83:111–5. Medline, Google Scholar Next article FiguresReferencesRelatedDetailsCited byHepatic Hilar Nerve Block for Hepatic Interventions: Anatomy, Technique, and Initial Clinical Experience in Thermal Ablation of Liver TumorsRadiology, Vol. 301, No. 1Conscious Sedation and Anesthesia Care21 January 2021Pharmacologic Agents Used in Image-Guided InterventionsAmbulatory Anesthesia in Remote Locations1 December 2016 | Current Anesthesiology Reports, Vol. 6, No. 4Conscious Sedation and Anesthesia Care5 September 2014Anesthesia and sedation outside of the operating roomKorean Journal of Anesthesiology, Vol. 68, No. 4Right thoracic paravertebral anaesthesia for percutaneous radiofrequency ablation of liver tumoursM Cheung Ning and M K Karmakar5 March 2014 | The British Journal of Radiology, Vol. 84, No. 1005Practical Application of Local AnestheticsJournal of Vascular and Interventional Radiology, Vol. 22, No. 2The use of sedation in the radiology departmentClinical Radiology, Vol. 64, No. 7Radiologists and AnesthesiologistsAnesthesiology Clinics, Vol. 27, No. 1Thoracic paravertebral block for analgesia following liver mass radiofrequency ablationW C Culp, M N Payne and M L Montgomery28 January 2014 | The British Journal of Radiology, Vol. 81, No. 961Closed claims review of anesthesia for procedures outside the operating roomCurrent Opinion in Anaesthesiology, Vol. 19, No. 4Anaesthetists and Sedation in the Radiology Department: Involved or left behind?9 April 2005 | Anaesthesia, Vol. 60, No. 5Current Opinion in Anaesthesiology, Vol. 16, No. 4Interventional neuroradiologyCurrent Opinion in Anaesthesiology, Vol. 16, No. 4 Volume 75, Issue 890February 2002Pages: 105-197 © The British Institute of Radiology History RevisedOctober 24,2001ReceivedJuly 03,2001AcceptedNovember 06,2001Published onlineMarch 05,2014 Metrics Download PDF