OBJECTIVE:To investigate the safety profile of percutaneous cryoablation of renal tumours < 7 cm, utilising data extracted from an international multicentre registry. MATERIALS AND METHODS:A retrospective review of all immediate and delayed complications from a multicentre database was performed and was categorised according to the Clavien-Dindo classification. Statistical analysis was performed for both overall complications (all Clavien-Dindo) and major complications (Clavien-Dindo 3 to 5). The following criteria were identified as potential predictive factors for complications: centre number, modality of image guidance, tumour size (≤ 4 cm vs. > 4 cm), number of tumours treated in the same session (1 vs. > 1) and tumour histology. RESULTS:A total of 713 renal tumours underwent ablation in 647 individual sessions. In 596 of the cases, one tumour was treated; in the remaining 51 cases, several tumours were treated per session. Mean lesion size was 2.8 cm. Fifty-four complications (Clavien-Dindo 1 to 5) occurred as a result of the 647 procedures, corresponding to an overall complication rate of 8.3%. The most frequent complication was bleeding (3.2%), with 9 cases (1.4%) requiring subsequent treatment. The rate of major complication was 3.4%. The only statistically significant prognostic factor for a major complication was a tumour size > 4 cm. CONCLUSION:Percutaneous renal cryoablation is associated with a low rate of complications. Tumours measuring more than 4 cm are associated with a higher risk of major complications. KEY POINTS:• Percutaneous kidney cryoablation has a low rate of complications. • Bleeding is the most frequent complication. • A tumour size superior to 4 cm is a predictive factor of major complication.

With the routine use of diagnostic imaging smaller cancers are being detected at an earlier stage. Cancer is now increasingly a “subclinical” disease process often detected incidentally on investigation of alternative symptomatology or on radiological screening of at-risk patient cohorts. For some years now, there have been attempts to reduce the morbidity of traditional resection through laparoscopic and “organ-sparing” approaches. Similarly radiation oncologists have sought more tailored, tissue-lethal treatments so as to improve treatment efficacy and reduce collateral, non-target injury with increasingly stereotactic techniques. Conceptually the same applies to medical oncology where targeting molecular processes (proliferation, apoptosis, tumour metabolism, and angiogenesis) at the cellular level is helping to deliver a more individual cancer-specific approach. Diagnostic imaging has become an essential part of the management pathway of modern cancer care. This introduces the question that if the disease is best appreciated and characterised by diagnostic radiology, including molecular imaging, then perhaps “image-guided” interventional radiology may also be the best way to deliver the required treatment?

Hypertension is a common clinical problem, which if effectively controlled is associated with a reduced incidence of cardiovascular and renal disease. Hyperaldosteronism causes adverse effects on the cardiovascular and renal systems that are independent of hypertensive end-organ damage. 1 McKenzie T.J. Lillegard J.B. Young W.F. et al. Aldosteronomas—state of the art. Surg Clin N Am. 2009; 89: 1241-1253 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar The effect of hyperaldosteronism on the cardiovascular system has been proven to be reversible following adrenalectomy, highlighting that the benefit of intervention is not limited to blood pressure and serum potassium control. 1 McKenzie T.J. Lillegard J.B. Young W.F. et al. Aldosteronomas—state of the art. Surg Clin N Am. 2009; 89: 1241-1253 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar , 2 Pang T.C. Bambach C. Monaghan J.C. et al. Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg. 2007; 77: 768-773 Crossref PubMed Scopus (63) Google Scholar

The incidence of renal cell carcinoma is increasing and image-guided radiofrequency ablation (RFA) is emerging as a safe and effective primary treatment. Therefore, it is essential for radiologists to appreciate the varied computed tomography (CT) imaging features following RFA. Prompt recognition of residual or recurrent tumour is crucial in facilitating timely re-treatment where necessary. Conversely, involuting, completely ablated lesions may be mistaken for residual disease. Using examples from experience of treating 105 renal tumours over a 5-year period, the spectrum of post-RFA CT appearances will be illustrated.

Aspergillus infection originating in the nasal cavity or paranasal sinuses is a rare cause of benign, locally invasive disease affecting the skull base. We describe a case in which extensive disease led to bilateral proptosis and invasion of the anterior cranial fossa.

The abdomen remains a challenging environment in which to image or intervene. Imaging is plagued by respiratory and peristaltic artefact, variable anatomy and, not least, soft-tissue disease processes which are inconspicuous against the substrate organs in which they arise. Likewise with abdominal intervention, whereas luminal gut stenting and gastrointestinal embolization have evolved considerably in recent years, the goal of targeted, minimally invasive therapies in some of the commonest tumours and disease processes remains elusive. It is against this background that a number of key subjects have arisen recently in abdominal radiology. These include: (1) computed tomography colonography (CTC), (2) double contrast liver magnetic resonance (DCMR) and (3) radiofrequency ablation (RFA).

Visceral artery pseudoaneurysms are often treated surgically or by transcatheter embolisation. We report a case of a pseudoaneurysm in a patient with chronic pancreatitis, which was successfully occluded by percutaneous injection of thrombin into the pseudoaneurysmal sac as a first-line management.

Objective: To determine the diagnostic accuracy of helical computed tomography (CT) in the detection of blunt bowel and mesenteric injury in a clinical setting.Materials and Methods: We evaluated the helical CT and surgical findings in 31 patients with blunt abdominal trauma. Nineteen patients had surgically proven bowel and/or mesenteric injury, and 12 patients had no bowel or mesenteric injury at laparotomy, The CT scans were assessed by three observers in consensus and were graded as showing no injury, minor bowel or mesenteric injury (not requiring urgent surgery), or major bowel or mesenteric injury (requiring immediate surgery). The CT diagnoses were compared with the surgical findings.Results: In the 19 cases of surgically proven bowel injury, CT had an accuracy of 84% (26/31), specificity 84% (16/19), and negative predictive value 89% (16/18) for diagnosis of bowel injury. CT correctly differentiated minor from major bowel injuries in eight of 12 cases (75%). For the 13 cases of mesenteric injury, the accuracy of CT diagnosis was 77% (24/31), specificity 67% (12/18), and negative predictive value 93% (12/13) for diagnosis of mesenteric injury. The CT findings allowed correct differentiation of minor from major mesenteric injuries in seven of 13 cases (54%).Conclusion: Helical CT is moderately accurate and has a high negative predictive value in detecting bowel and mesenteric injuries after blunt trauma. Helical CT is not highly accurate in predicting the severity of injury or need for urgent surgery.

PURPOSE:Our goal was to determine the sensitivity and specificity of various CT signs of blunt bowel and mesenteric injury. METHOD:The CT findings of 31 patients with blunt abdominal trauma were retrospectively assessed by three observers in consensus. All patients had laparotomy within 24 h of CT. The study group consisted of 19 patients with surgically proven bowel and/or mesenteric injury. The control group consisted of 12 traumatized patients who had no bowel or mesenteric injury. The CT signs assessed were presence, location, and extent of intraperitoneal fluid, extraluminal air, bowel wall thickening, bowel wall discontinuity, mesenteric streaking, and mesenteric hematoma. RESULTS:In the 12 cases of bowel injury (9 transmural injury, 3 partial thickness injury), the CT sign of bowel wall thickening had sensitivity of 50% and specificity of 84% and the CT sign of bowel wall discontinuity had sensitivity of 58% and specificity of 95%. Extraluminal air was a specific but relatively insensitive sign of transmural bowel injury (sensitivity 44%, specificity 100%). In the 13 patients with mesenteric injuries, the CT sign of mesenteric hematoma had sensitivity of 54% and specificity of 94%. Isolated mesenteric streaking was a less specific sign of mesenteric injury (sensitivity 77%, specificity 44%). The finding of peritoneal fluid with no visible solid organ injury was a useful sign of bowel or mesenteric injury, occurring in 11 of 19 (58%) study patients and none of the controls (p < 0.001). CONCLUSION:Bowel wall thickening, bowel wall discontinuity, extraluminal air, and mesenteric hematoma are reasonably specific CT signs of bowel and mesenteric injury following blunt abdominal trauma. The presence of a moderate to large volume of intraperitoneal fluid without visible solid organ injury is an important sign of bowel or mesenteric injury.

Percutaneous fluoroscopically-guided retrieval of seven dysfunctional ureteric stents was performed in five patients (four male, one female) over an 18 month period. The technical aspects of the procedure are discussed and the preferred method using rigid forceps is described.

Administration of acetylsalicylic acid (aspirin) in the dog may cause gazstric mucosal damage. Enteric-coated tablets protect the canine stomach during oral aspirin medication. A therapeutic plasma salicylate concentration can be attained using enteric-coated aspirin tablets at a dosage of 25 mg/kg TID. In a series 4 of experiments using adult beagle and large mixed breed dogs and two types enteric-coated tablets, the influence of food intake on the plasma salicylate concentration was studied. Tablets were administered with 8h intervals and food intake was either once daily or three time daily with 8h intervals. Plasma salicylate concentrations were also studied during fasting. It is concluded that, when using enteric-coated tablets, the plasma salicylate concentration in the dog after oral medication is strongly influenced by the aspirin dosage, the tablet type and the feeding pattern. Large enteric-coated tablets may accumulate in the stomach over several days and are not suitable for use in the dog. The gastric accumulation is caused by the enteric-coating of the large tablets and not by the aspirin medication.

Titanium alloy, in its Ti-318 (Ti-A16-V4) format, is a widely used material for orthopaedic implants. However, it has frequently been reported as causing black staining of the periprosthetic tissues as a result of debris from metallic wear. This process of metallosis has been implicated in implant failure. We report three cases in which titanium alloy prostheses for primary bone tumours at the knee have caused the formation of fluid-filled cysts containing metallic debris. The cysts result in radiological appearances which may mimic soft tissue tumour recurrence and also contribute to post-operative failure of the extensor mechanism of the knee.

Administration of acetylsalicylic acid (aspirin) in the dog may cause gastric mucosal damage. Enteric-coated tablets protect the canine stomach during oral aspirin medication. A therapeutic plasma salicylate concentration can be attained using enteric-coated aspirin tablets at a dosage of 25 mg/kg TID. In a series 4 of experiments using adult beagle and large mixed breed dogs and two types enteric-coated tablets, the influence of food intake on the plasma salicylate concentration was studied. Tablets were administered with 8h intervals and food intake was either once daily or three time daily with 8h intervals. Plasma salicylate concentrations were also studied during fasting. It is concluded that, when using enteric-coated tablets, the plasma salicylate concentration in the dog after oral medication is strongly influenced by the aspirin dosage, the tablet type and the feeding pattern. Large enteric-coated tablets may accumulate in the stomach over several days and are not suitable for use in the dog. The gastric accumulation is caused by the enteric-coating of the large tablets and not by the aspirin medication.