Abstract:

Over the last two decades, interventional neuroradiologists have developed powerful techniques for the treatment of cerebrovascular disorders and brain tumors. Current interventional neuroradiological procedures are performed under X-ray fluoroscopy, which has allowed for high temporal and spatial resolution. However, these imaging techniques do not provide the treating physician with vital anatomic and functional information regarding vessel walls and the surrounding brain tissue. Better visualization of vessel structures and real-time information about the state of perfusion and metabolism of the surrounding brain tissue (real-time magnetic resonance arteriography, diffusion and perfusion-weighted imaging, apparent diffusion coefficient maps) would enhance safety and efficacy of neuroendovascular procedures available currently. Recent advances in magnetic resonance hardware and software have permitted significant enhancements in temporal and spatial resolution, which have resulted in the capability of visualizing anatomic structures with real-time fluoroscopy and angiography. This review outlines how real-time magnetic resonance procedures may replace conventional X-ray fluoroscopy in diagnostic and interventional neuroradiology during the next decade.

Authors:

H. Christian Schumacher, M.D. ,Charles L. Dumoulin, Ph.D., Lei Feng, M.D., Ph.D., Sundeep Mangla, M.D., Philip M. Meyers, M.D., Joy Hirsch, Ph.D., J.P. Mohr, M.D., M.S., Robert L. DeLaPaz, M.D., John Pile-Spellman, M.D.

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Abstract:

Atrial fibrillation (AF) is the most common dysrhythmia following open heart surgery with or without cardiopulmonary bypass. In previous studies, the AF incidence varied between 25.0% and 60.0% of all patients. The conventional treatment of postoperative AF periods consists of antiarrhythmic medication, most frequently calcium channel antagonists, β-adrenergic blockers, or amiodarone. If the pharmacological treatment is ineffective or leads to further impairment of hemodynamics, external electrical cardioversion under general anesthesia and simultaneous transesophageal echocardiography is performed. Systemic heparinization is recommended to prevent neurological events related to AF. In 1995, a new method for internal electrical cardioversion using epicardial wire electrodes with low shock energies was developed in a canine model. Since June 1997, this device for internal cardioversion that consisted of two multifilament epicardial wires has been available clinically (TADPole® followed by SYNCRUS™ heart wires, Guidant Corporation, Santa Clara, California, USA). The safety and efficacy of this innovative strategy for treatment of postoperative AF has been investigated in two clinical studies in Europe. These studies demonstrated a success rate of internal cardioversion up to 92.9% with optimized pre-shock treatment that leads to a significant shortening of AF periods, with the expectation of reduction in length of hospital stay.

Authors:

Dr. med. Peter Kleine M.D., Dr. med. Omer Dzemali M.D., Professor Dr. med. Anton Moritz M.D.

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Abstract:

Before introduction of endoscopic subfascial dissection, surgical treatment of the perforating veins was a neglected topic. High error rates in the preoperatively marked perforating veins, wound-healing problems due to the incision in trophically disturbed areas, and leg ulcers prevented correct surgical treatment. Endoscopic subfascial dissection allows the accurate elimination of all clinically relevant, insufficient perforating veins in the lower leg. Therefore, it has become an accepted, improved treatment concept in the surgical therapy of primary varicosis in all three stages of chronic venous insufficiency. This experience is demonstrated based on a prospective study of the patients treated in the year 2000.

Authors:

Michael Jugenheimer, M.D., Wolfgang Mayer, M.D., Matthias Uckele, M.D.

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Abstract:

Magnetic resonance angiography (MRA) is a method of non-invasive vascular imaging that has evolved and improved significantly since first described. In this article, the basic principles of MRA are reviewed and MRA compared with the more conventional imaging techniques of Doppler ultrasound and angiography. The ways in which MRA can be used in conjunction with more conventional vascular imaging techniques in investigation and management of carotid disease, aortic disease, and peripheral vascular disease are discussed in this article.

Authors:

Shirley Y.Y. Chan, F.R.C.S. , Tom Johnson-Smith, F.R.C.R., Sam Andrews, M.S., F.R.C.S.

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