2304 stereotactic prostate biopsy with pre-interventional mri and live us fusion

Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011 Given the accuracy of this modality, the system can be filled with saline METHODS: A model of the urinary tract was created with a solution without losing the ability to diagnose a fluid leak in the system.
“bladder” (reservoir and pump) designed to move normal saline alongtwo 3mm diameter plastic tubes “ureters” at a rate mimicking urine flow, Source of Funding: None
3–5 mm/sec. In the MRI scanner, the protons of the fluid in the ‘bladder’were excited in a 90 degree axial spin. As the urine moved into theureters a 180 degree pulse was performed along the sagittal plane.
With reflux present (flow up the tubes), the fluid excited by the STEREOTACTIC PROSTATE BIOPSY WITH
90 degree pulse would leave the reservoir, but since it is constrained by PRE-INTERVENTIONAL MRI AND LIVE US FUSION
the tubes it would also be excited by the 180 degree pulse. Only fluids Boris Hadaschik*, Timur Kuru, Corina Tulea, Dogu Teber, Johannes that “see” both RF pulses are visible in the SSFSE sequencing, so only Huber, Valentin Popeneciu, Sascha Pahernik, Heinz-Peter Schlemmer, Markus Hohenfellner, Heidelberg, Germany RESULTS: Performing the described modification of SSFSE MRI, we were able to excite the fluid in the model bladder for approx- INTRODUCTION AND OBJECTIVES: The key challenge for imately 4 seconds, allowing the visualization of fluid reflux up the model focal therapy of prostate cancer is to identify index lesions. In this urinary tract without the use of contrast agents. The temporal resolution context, we describe our initial experience with a new stereotactic prostate biopsy system, which integrates pre-interventional MRI data CONCLUSIONS: Using a modification of a SSFSE, we were with periinterventional ultrasound for perineal prostate biopsies.
able to detect retrograde flow in a model ureter and bladder system METHODS: 33 patients were stereotactically biopsied (mean using MRI. We hope to apply this technology to allow us to detect reflex age of 64yrs., mean PSA level of 8.2ng/ml and mean prostate vol. of in children without contrast, catheterization or ionizing radiation.
40ml). 21 of these 33 patients had already had a negative transrectalUS-guided biopsy. All men underwent multimodal 3 Tesla MRI without Source of Funding: None
endorectal coil including diffusion weighted imaging and dynamic con-trast enhanced sequences as well as MR-spectroscopy. Suspiciouslesions were marked by radiologists with over 10 years experience inreading prostate MRI before the obtained data were transferred to the P40 PROVIDES VALUABLE FUNCTIONAL INFORMATION
Using a custom-made biplane TRUS probe mounted on a BEFORE AND AFTER SURGERY FOR PROBLEMATIC
stepper device, 3D ultrasound data were generated to set the anatomic UPJ OBSTRUCTION PATIENTS WITH A NORMAL
landmarks. Then MRI and TRUS imaging data were fused manually. As PREOPERATIVE T1/2
a result, the suspicious MRI lesions were superimposed onto the TRUS Shelly X Bian*, Judy M Choi, MD, Wesley A Mayer, MD, Alvin Goh, data. Next, 3D biopsy planning was performed including systematic MD, Richard E Link, MD, PhD, Houston, TX biopsies from the peripheral and transitional zones of the prostate.
INTRODUCTION AND OBJECTIVES: Evaluating patients for Perineal biopsies were taken under live US imaging, and the location of UPJ obstruction involves integrating both clinical symptoms and imag- ing findings. Renal scanning can provide important functional informa- RESULTS: 14 out of 33 patients were diagnosed with prostate tion to help identify patients who would benefit from surgical correction.
cancer. These results showed a positive correlation between MRI T1/2 (time from diuretic administration to 50% clearance of tracer) Ͼ 20 findings and histopathology in 22 out of 33 patients. In MRI lesions min is the gold standard for obstruction, and improvement in T1/2 after marked as highly suspicious, the detection rate was 100%. Evaluating pyeloplasty indicates resolution. However, many patients present pre- the biopsies from lesions marked as highly and as questionable sus- operatively with symptoms but a normal T1/2 (Ͻ20min) and many picious together, prostate cancer was detected in 27.95%. In compar- continue to show a delayed T1/2 despite complete resolution of symp- ison, only 8% of the additional systematic biopsies were positive.
toms postoperatively. Our goal was to explore alternative analyses of Target registration error of the first 554 biopsy cores was 1.9 mm. For renal scans that may augment T1/2 in diagnosing clinically significant adverse effects, one patient experienced urinary retention. Postinter- ventional hemorrhage or urinary tract infection did not occur.
METHODS: We retrospectively reviewed records of 96 consec- CONCLUSIONS: Perineal stereotactic prostate biopsies guided utive adult patients undergoing laparoscopic or robotic-assisted pyelo- by the combination of MRI and ultrasound enable effective examination of plasty for UPJ obstruction from 2005 to 2010 by a single surgeon. 95% suspicious MRI lesions. Additionally, each biopsy core taken may be were symptomatic and 5% had unilateral decreased function by imag- documented accurately for its location in 3D. Thus, MRI data may be ing. Pre and postoperative MAG3 lasix-washout renal scan images validated and different treatment options stratified in depth. At the same were available for review in 22 patients with primary unilateral UPJ time the morbidity of the procedure was minimal.
obstruction and two kidneys. We assessed five parameters: differential Source of Funding: None
renal function (DRF), time from diuretic administration to 50% clear-ance (T1/2), time from maximum tracer uptake to 50% clearance(M1/2), percent clearance at 20 minutes (P20) and percent clearance at 40 minutes (P40). The contralateral kidney served as a control and a NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER
paired T-test was used for analysis.
RESULTS: Preoperatively, 10 patients (46%) had a T1/2 Ͼ 20 CONTRAST. . . OH MY!
min, 6 Ͼ 10 min (27%) and 6 Ͻ 10 min (27%). Three measures weresignificantly different between the affected and control kidney: T1/2, Bhavin Patel*, Gordon McLorie, Anthony Atala, Robert Kraft, Steven P20, and P40. In the affected kidney with a preoperative T1/2 Ͼ 20 min, both T1/2 and P40 decreased significantly after surgery. In the prob- INTRODUCTION AND OBJECTIVES: Novel scanning and pro- lematic subset of 12 patients with a “normal” preoperative T1/2 cessing protocols have been developed to augment the diagnostic (Ͻ20min), P40 was still significantly different between the affected and ability of magnetic resonance imaging (MRI). Single Shot Fast Spin control kidney (24% v. 9%, pϭ0.002) and decreased significantly Echo pulse sequencing (SSFSE) is one such technology. It allows one before and after corrective pyeloplasty (24% to 16%, pϭ0.036). DRF to image directional flow independent of contrast. We propose that did not show significant improvement postoperatively (pϾ0.05) and all using this technology, unenhanced urine can be used as an endoge- parameters for the unaffected kidney did not show significant change nous tracer, allowing for the measurement of urine flow back to the before and after pyeloplasty (pϾ0.05) as expected.
kidney. This could allow for the diagnosis of reflux without a catheter, CONCLUSIONS: P40 appears to be a useful alternative renal contrast agent, or ionizing radiation.
scan marker for assessing UPJ obstruction. Even in the problematic

Source: http://www.medcom-online.de/references/publications/pdfs/navigation/2011%20AUA%20hadaschick.pdf


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