Community incorporation of quit and win contests in Bloomington, Minnesota.
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Adolescent↗
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International Sport Nutrition Conference. Bloomington, Minnesota, September 1995. Proceedings.
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Humans↗
Surveillance for certain health behaviors among selected local areas--United States, Behavioral Risk Factor Surveillance System, 2002.
PROBLEM: Monitoring risk behaviors for chronic diseases and participation in preventive practices are important for developing effective health education and intervention programs to prevent morbidity and mortality. Therefore, continual monitoring of these behaviors and practices at the state, city, and county levels can assist public health programs in evaluating and monitoring progress toward improving their community's health. REPORTING PERIOD COVERED: Data collected in 2002 are presented for states, selected metropolitan, and micropolitan statistical areas (MMSA), and their counties. DESCRIPTION OF THE SYSTEM: The Behavioral Risk Factor Surveillance System (BRFSS) is an on-going, state-based, telephone survey of the civilian, noninstitutionalized population aged >18 years. All 50 states, the District of Columbia (DC), Guam, the Virgin Islands, and the Commonwealth of Puerto Rico participated in BRFSS during 2002. Metropolitan and MMSA and their counties with >500 respondents or a minimum sample size of 19 per weighting class were included in the analyses for a total of 98 MMSA and 146 counties. RESULTS: Prevalence of high-risk behaviors for chronic diseases, awareness of certain medical conditions, and use of preventive health-care services varied substantially by state, county, and MMSA. Obesity ranged from 27.6% in West Virginia, 29.4% in Charleston, West Virginia, and 32.0% in Florence County, South Carolina, to 16.5% in Colorado, 12.8% in Bethesda-Frederick-Gaithersburg, Maryland, and 11.8% in Washington County, Rhode Island. No leisuretime physical activity ranged from 33.6% in Tennessee, 36.8% in Miami-Miami Beach-Kendall, Florida, and 36.8% in Miami-Dade County, Florida to 15.0% in Washington, 13.8% in Seattle-Bellevue-Everett Washington, and 11.4% in King County, Washington. Cigarette smoking ranged from 32.6% in Kentucky, 32.8% in Youngstown-Warren- Boardman, Ohio-Pennsylvania, and 31.1% in Jefferson County, Kentucky to 16.4% in California, 13.8% in Ogden- Clearfield, Utah, and 10.9% in Davis County, Utah. Binge drinking ranged from 24.9% in Wisconsin, 26.1% in Fargo, North Dakota-Minnesota, and 25.1% Cass County, North Dakota, to 7.9% in Kentucky, 8.2% in Greensboro- High Point, North Carolina, and 6.6% in Henderson County, North Carolina. At risk for heavy drinking ranged from 8.7% in Arizona, 9.5% in Lebanon, New Hampshire-Vermont, and 11.3% in Richland County, South Carolina, to 2.8% in Utah, 1.9% in Ogden-Clearfield, Utah, and 1.7% in King County, New York. Adults who were told they had diabetes ranged from 10.2% in West Virginia, 11.1% in Charleston, West Virginia, and 11.1% in Richland, South Carolina, to 3.5% in Alaska, 2.7% in Anchorage, Alaska, and 2.4% in Weber County, Utah. Percentage of adults aged>50 years who were ever screened for colorectal cancer ranged from 64.8% in Minnesota, 67.9% in Minneapolis-St. Paul-Bloomington Minnesota-Wisconsin, and 73.6% in Ramsey County, Minnesota, to 39.2% in Hawaii, 30.7% in Kahului-Wailuku, Hawaii, and 30.7% in Maui County, Hawaii. Persons aged >65 years who had received pneumococcal vaccine ranged from 72.5% in North Dakota, 74.8% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 73.1% in Milwaukee County, Wisconsin, to 47.9% in DC, 47.5% in New York-Wayne-White Plains, New York, New Jersey, and 47.9% in DC County, DC. Older adults who had received influenza vaccine ranged from 76.6% in Minnesota, 80.0% in Minneapolis-St. Paul-Bloomington, Minnesota-Wisconsin, and 76.3% in Middlesex County, Massachusetts, to 57.0% in Florida, 55.8% in Houston-Baytown-Sugar Land, Texas, and 56.2% in Cook County, Illinois. INTERPRETATION: BRFSS data indicate substantial variation in high-risk behaviors, participation in preventive healthcare services, and screening among U.S. adults at states and selected local areas, indicating a need for continued efforts to evaluate public health programs or policies designed to reduce morbidity and mortality. PUBLIC HEALTH ACTIONS: Data from BRFSS are useful in developing and guiding public health programs and policies. Therefore, states, selected MMSA, and their counties can use BRFSS data as a tool to prevent premature morbidity and mortality among adult population and to assess progress toward national health objectives. The data indicate a continued need to develop and implement health promotion programs for targeting specific behaviors and practices and serve as a baseline for future surveillance at the local level in the United States.
Adult↗
Mutagenicity of municipal water obtained from an agricultural area.
We have studied the mutagenicity of the water from Lake Bloomington and of the tap water that is made from the lake water. The lake, which is the source of drinking water for Bloomington, Illinois (pop. 44,000), is surrounded by land that is farmed intensively--being mainly in maize and soybeans. Samples were collected monthly from May through October 1979 and concentrated 3,000X with XAD-2 resin. Nearly all of the lake and tap water concentrates were mutagenic in Salmonella typhimurium TA98 and TA100 in the presence of S-9 mix, and the May tap water concentrate was highly mutagenic. In addition, many of the concentrates were toxic to the bacteria in the absence of S-9 mix. Chemical analysis of the highly mutagenic tap water concentrate from May revealed the presence of a number of organic contaminants that were absent from control concentrates prepared from deionized and distilled treated-well water. In addition, unconcentrated lake and tap water were tested in a reverse-mutation test in maize (Zea mays); no mutagenicity was detected. This study indicates that the contamination of drinking water with agricultural and/or industrial chemicals may result in a potential health hazard.
Agriculture↗
Use of four short-term tests to evaluate the mutagenicity of municipal water.
Some ways in which four short-term tests may be used to evaluate the mutagenicity of drinking water were explored by testing raw and treated water from Lake Bloomington, which serves the town of Bloomington, Illinois (population, 44,000). The water was collected from February 1976 to October 1977 and was concentrated by evaporation or by use of XAD-2 resin. The water was tested for the ability to induce reverse mutation in a prokaryote, Salmonella typhimurium; forward mutation in a mold, Neurospora crassa; mitotic gene conversion in a yeast, Saccharomyces cerevisiae; and reverse mutation in maize, Zea mays. Because of the large number of water samples (54) and the limited amounts of the samples, it was not possible to test all samples in all four tests by all the protocols. Thus, the sensitivities of the four tests to potential mutagens in the water samples could not be rigorously compared. However, the results do show that lake and tap water samples collected during 1976 were toxic but not mutagenic in N. crassa and neither toxic nor genotoxic in S. cerevisiae; lake water collected during 1977 was mutagenic in one line of Z. mays and slightly mutagenic in S. typhimurium strain TA1536 in the presence of rat liver S9. The results suggest that tests that detect a variety of genetic end points should be used when testing complex mixtures such as drinking water. The advantages and disadvantages of the tests and protocols are discussed in terms of their applicability to the study of the mutagenicity of drinking water.
Animals↗
Percutaneous tracheostomy: ciaglia blue rhino versus the basic ciaglia technique of percutaneous dilational tracheostomy.
UNLABELLED: Percutaneous dilational tracheostomy (PDT), according to Ciaglia's technique described in 1985, has become the most popular technique for percutaneous tracheostomy and is demonstrably as safe as surgical tracheostomy. In 1999, an extensively modified technique of PDT was introduced, the Ciaglia Blue Rhino (CBR; Cook Critical Care, Bloomington, IL), that consists of one-step dilation by means of a curved dilator with hydrophilic coating. To compare CBR with the basic technique of PDT, we performed a prospective, randomized trial in 50 critically ill adults. Twenty-five of these patients had PDT, and 25 had CBR. Average operating times were <3 min for CBR (range: 50-360 s) and <7 min for PDT (range: 4-20 min; P<0.0001). Tracheostomy was successfully completed in all patients. When CBR was performed, 11 minor, nonlife-threatening complications were noted: nine fractures of tracheal cartilage and two short periods of intraoperative oxygen desaturation. During PDT, seven complications occurred, of which three were potentially life-threatening: two injuries to the posterior tracheal wall, one pneumothorax, two tracheal cartilage fractures (P< 0.05 vs CBR), one case of bleeding, and one short episode of intraoperative oxygen desaturation. Regardless of whether PDT or CBR was performed, oxygenation was not significantly affected, and there was no infection of the tracheostoma. Based on our data, we conclude that new CBR is more practicable than PDT. No life-threatening complications occurred during CBR. IMPLICATIONS: To assess practicability and safety of the Ciaglia Blue Rhino (Cook Critical Care, Bloomington, IL)-an extensively modified technique of percutaneous dilatational tracheostomy-50 critically ill adults on long-term ventilation underwent either new Ciaglia Blue Rhino or percutaneous dilatational tracheostomy in a prospective, randomized clinical trial.
Adult↗
Extravasation rates and complications of intraosseous needles during gravity and pressure infusion.
OBJECTIVE: To compare the extravasation rates and insertion complications under gravity and 300 mm Hg (40 kPa) pressure infusion of threaded (SurFast and Sussmane-Raszynski intraosseous needles, Cook Critical Care, Bloomington, IN); and nonthreaded needles (16-gauge disposable intraosseous needle with 45 degrees trocar Cook Critical Care, Bloomington, IN; Jamshidi bone marrow needle; Baxter Health Care Corp, Valencia, CA). DESIGN: A prospective, randomized study. SETTING: An animal laboratory at a university center. SUBJECTS: Five healthy mix breed piglets, weighing 15 to 15.5 kg. INTERVENTIONS: Piglets were anesthetized and ventilated. Tibial, femoral, and humeral osseous sites were exposed by dissection of overlying tissue. All bleeding points were cauterized and oozing was prevented by sealing with cyanoacrylate. Intraosseous access devices then were inserted one at a time in random order and rated for difficulty of insertion. Normal saline solution was infused under gravity or 300 mm Hg (40 kPa) pressure. Extravasation rates then were calculated from the increase in weight of a gauze sponge wrapped tightly at the base of the needle during infusion. MEASUREMENTS AND MAIN RESULTS: No significant (p > .05) differences in extravasation rates were noted among the different types of needles, either under gravity or pressure infusions. The Sussmane-Raszynski needle was significantly more difficult to insert than the others (rated difficult to insert and control in 16 of 34 attempts). Inadvertent penetration of both cortices occurred with nonthreaded needles only (three of 66 attempts). The SurFast needle provided greatest penetration control and was most resistant to accidental dislodgement. CONCLUSIONS: Under ideal conditions, needle type does not influence extravasation rates. However, difficulty with insertion and penetration of both cortices occur commonly and may lead to extravasation during stressful emergency situations or when performed by unskilled personnel.
Animals↗
Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases.
OBJECTIVES/HYPOTHESIS: An evaluation of 500 adult, intubated, intensive care unit patients undergoing endoscopic percutaneous tracheotomy using the multiple and single dilator techniques was conducted to assess the feasibility and safety of the procedure as it compares with surgical tracheotomy. Endoscopy was used in all cases and evaluated as an added safety measure in reducing complications. STUDY DESIGN: A prospective evaluation of endoscopic percutaneous dilatational tracheotomy in 500 consecutive adult, intubated intensive care unit patients. METHODS: Between 1990 and 2003, endoscopically guided percutaneous dilatational tracheotomy (PDT) was performed in 500 consecutive adult, intubated patients in the intensive care units (ICU) of three tertiary care adult hospitals. The first 191 patients underwent PDT using the Ciaglia Percutaneous Tracheostomy Introducer Kit (Cook Critical Care Inc., Bloomington, Indiana) and in the remaining 309 patients the Ciaglia Blue Rhino Single Dilator Kit (Cook Critical Care Inc., Bloomington, Indiana) was used. The procedure was contraindicated in the following situations: 1) children, 2) unprotected airway, 3) emergencies, 4) presence of a midline neck mass, 5) inability to palpate the cricoid cartilage, and 6) uncorrectable coagulopathy. The following parameters were recorded preoperatively: age, sex, diagnosis, American Society of Anesthesia (ASA) class, body mass index (BMI), and number of days intubated. Recorded hematologic parameters included hemoglobin (Hgb), platelets, prothrombin time (PT), partial thromboplastin time (PTT), and the international normalized ratio (INR) since it became available in 1998. All patients were ventilated on 100% oxygen and vital signs were continuously monitored. Tracheotomy was carried out under continuous endoscopic guidance using a series of graduated dilators in the first 191 cases, and a single, tapered dilator in the remaining 309 patients. The preoperative data on each patient, along with the type of dilator used, the size of the tube, the intraoperative and postoperative complications, and blood loss information were recorded prospectively and maintained in a computer spreadsheet. Univariate analyses were used in each group separately for each type of dilator to assess the risks of a complication within subgroups defined by each parameter/characteristic, and the statistical significance assessed with a chi test, or Fisher exact test. RESULTS: The total complication rate was 9.2% (13.6% in the multiple dilator group, and 6.5% in the single dilator group), with more than half of these considered minor. Overall, the two most common complications were oxygen desaturation in 14 cases and bleeding in 12 cases. The absence of serious complications such as pneumothorax and pneumomediastinum are attributable to the use of bronchoscopy. There was no significant association between the rate of complications and age, gender, ASA, weeks intubated, tracheostomy tube size, Hgb levels, platelets, PT, PTT, or INR. There was a statistically significant relationship between experience and the likelihood of complications in the multiple dilator group (P < .0001), with a higher rate of complications in the first 30 patients (40%) compared with 8.7% in the remaining 161 patients. This relationship did not exist for the first 30 patients in the single dilator group. Patients with a BMI of 30 or higher experienced a significantly greater (P < .05) number of complications (15%), compared with an 8% complication rate in patients with a BMI of less than 30. This risk was even more significant for patients with a BMI of 30 or greater who were also in ASA class 4 (11/56 or 20%) (P < .02). CONCLUSIONS: Endoscopic PDT is associated with a low complication rate and is at least as safe as surgical tracheotomy in the ICU setting. Bronchoscopy significantly decreases the incidence of complications and should be used routinely. While embraced by critical care physicians, endoscopic PDT has been infrequently performed by otolaryngologists. As the airway experts, otolaryngologists are in the best position to learn and teach the procedure as it should be done.
Adult↗
Molecular typing of nosocomial isolates of Legionella pneumophila serogroup 3.
In Paris, France, an outbreak of pneumonia due to Legionella pneumophila serogroup 3 was observed in Necker (four cases) and Pitié (six cases) hospitals. Neither the 10 clinical isolates nor 5 tap water isolates from Necker Hospital harbored plasmids. Clinical and environmental serogroup 3 isolates and serogroup 3 reference strain Bloomington 2 were analyzed by chromosomal probe fingerprinting. rRNA, 16S and 23S from Escherichia coli and a randomly cloned 15-kilobase-pair nucleotide sequence from L. pneumophila serogroup 3 were used as probes. All strains tested showed a single pattern after HindIII digestion of DNA and hybridization with the 32P-end-labeled rRNA probe, whereas three patterns were obtained after hybridization with the 32P-labeled 15-kilobase-pair DNA probe. One pattern was given by all clinical and tap water isolates from Necker Hospital, another one was given by all clinical isolates from Pitié Hospital, and a last one was given by reference strain Bloomington 2. Thus, molecular analysis showed that the two hospital outbreaks of legionellosis were unrelated and could link the outbreak in Necker Hospital to contaminated tap water.
Bacterial Typing Techniques↗
Experimental infections of horses with Legionella pneumophila.
Attempts to infect horses with Legionella pneumophila were undertaken to determine pathogenicity and to evaluate the possibility that horses serve as a reservoir for the organism. A previous study showed that the prevalence of antibodies to L pneumophila in the equine population exceeded 30% of over 600 sera examined. Horses were infected experimentally with the Philadelphia 1 or Bloomington 2 strain of L pneumophila IV or by aerosolization. Signs of clinical illness were restricted to a transient febrile response. A transient decrease in circulating lymphocytes occurred 2 days after inoculation. At necropsy, only moderate generalized lymphadenopathy was noted. Histologically, the lungs contained evidence of a low-grade inflammatory response characterized by focal proliferation of alveolar lining cells, with few neutrophils and eosinophils. Lymph nodes had evidence of reactive hyperplasia. The tissue response to Bloomington 2 strain was slightly more pronounced than that to Philadelphia 1. Attempts to reisolate L pneumophila from blood and nasal or pharyngeal swabs were unsuccessful. The organism was not isolated by culturing tissues obtained at necropsy, nor was it demonstrated by tissue-staining techniques. However, all horses exhibited a marked increase in agglutinating antibodies to L pneumophila serogroups (SG) 1 and 3 as early as 4 days after inoculation. The serologic response was confirmed by indirect immunofluorescence and was shown to consist predominantly of immunoglobulin M by 2-mercaptoethanol treatment. Agglutinating antibodies persisted at least 4 months after infection. On the basis of these studies, the pathogenicity of L pneumophila SG 1 and 3 for the horse appears to be low. There is no evidence to support a role for the horse in the maintenance of these organisms in nature. Horses may be exposed in the environment and maintain a relatively long-lived serologic response to L pneumophila. However, it is also possible that they become infected with other strains of L pneumophila or Legionella-like organisms more pathogenic for horses, or other non-Legionella bacteria, which elicit a cross-reacting serologic response to L pneumophila SG 1 to 4.
Animals↗
Fine-needle core and aspiration biopsy. A new method for diagnosis of prostatic carcinoma.
Fine-needle aspiration of the prostate has failed to gain widespread acceptance among pathologists more familiar with histologic sections. The authors aspirated 27 freshly excised radical prostatectomy specimens with needles of varying caliber and type and found a 22-gauge Turner needle (Cook Incorporated, Bloomington, IN) which obtained large tissue fragments suitable for cell block preparation as well as high quality cytologic specimens. Thirty men with prostate nodules each had 14-gauge transperineal core biopsy and fine-needle aspiration. In 20 cases, cytologic smears and cell blocks and core biopsies agreed on a diagnosis: 12 benign and eight carcinoma. Of seven cases that were atypical by cytologic smears, five were benign on cell block and core; one was benign on cell block and carcinoma on core; and one was carcinoma on cell block and core. Three cases with scant specimens and diagnoses of carcinoma by cytologic smears were benign on cell blocks and cores: one contained seminal vesicle on review; one had repeat benign biopsies; and one had three microscopic foci of low-grade carcinoma in his radical prostatectomy specimen. This fine-needle aspiration technique provides histologic sections which are especially useful to those gaining experience with cytologic specimens of the prostate. Cases with discordant diagnoses on cell block and cytologic preparations warrant further evaluation.
Biopsy, Needle↗
A new technique for endomyocardial biopsy in infants and small children.
Endomyocardial biopsy (EMB) is usually performed from the femoral veins in infants and small children. This requires the use of a long vascular sheath to direct a bioptome to the ventricular septum. We describe a technique of EMB in this population that obviates the need for the use of a long vascular sheath. A 5 Fr 0.038" internal diameter, no-sideholes Cobra catheter (Cook, Bloomington, IN) introduced via a 5 Fr short sheath was used to direct a 3 Fr, 60-cm-length Cook bioptome to the ventricular septum. From January 1998 to August 1999, this technique was used 22 times in seven patients for EMB (median, age 13 months; range, 1-72 months). Indications for EMB in this group were posttransplantation surveillance (21 times) and evaluation for cardiomyopathy/myocarditis (1). Median number of EMB specimens obtained per procedure was 6 (range, 5-9). There was one pneumopericardium seen post-EMB with this technique without hemodynamic embarrassment. EMB in infants and small children can be performed successfully, safely, and repeatedly from the femoral veins without the need for a long sheath.
Biopsy↗
Transcatheter embolization coil closure of patent ductus arteriosus--modified delivery for enhanced control during coil positioning.
The use of Gianturco coils (Cook, Inc., Bloomington, IN) has been recently described as a method of occluding restrictive patent ductus arteriosus (PDA). Precise control of the coil during positioning or withdrawal is difficult. We designed an inexpensive and readily available system to control the coil during delivery and repositioning. A 5 French Mallincrodt vertebral catheter was heat tapered to allow slight, but definite resistance of a 0.035" guide wire when it was passed through the catheter. The delivery system has been used to successfully coil occlude restrictive PDAs in seven patients. The system has added no additional costs to the procedure and has provided improved control of the coil position prior to release of the coil.
Cardiac Catheterization↗
Percutaneous MR-guided discography in a low-field system using optical instrument tracking: a feasibility study.
PURPOSE: To evaluate the feasibility of MRI-guided discography with optical tracking. MATERIAL AND METHODS: 12 consecutive patients who had a clinical suspicion of lumbar discogenic pain and/or suggestive finding of disc degeneration in imaging studies (MRI, CT, plain radiography) underwent MRI-guided discography in order to determine possible pain provocation during puncture and contrast injection. An 0.23 T open configuration MRI device with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used in procedural imaging and instrument guidance. An optical guidance tool was attached to the MRI compatible needle (Chiba-type MReye, Cook, Bloomington, IN). After initial disc puncture, 1-2 mL of gadolinium contrast (Magnevist, 469 mg/mL, Schering AG, Germany) saline mixture (1:8) was injected into the disc. Immediately after injection, sagittal FE T1 weighted images were obtained to verify the final position of the needle and formation of the MRI discogram. On nine patients, additional noncontrast sagittal fast spin echo (FSE) T1, FSE T2, and axial 3D T1 gradient echo imaging was performed before and after contrast media injection to obtain MRI discograms. RESULTS: Overall, 35 disc punctures were initialized and 34 MRI discograms were obtained. In all punctures, a positive or negative pain response was obtained. The average time for performing a procedure for three discs was 1 hour 25 minutes (minimum 45 minutes, maximum 2 hours, 15 minutes), and the average number of imaging sequences used for a puncturing one disc was 12. On one disc, the puncture failed and a discogram was not acquired. There was one complication (disc collapse) reported during follow-up. CONCLUSION: Our results show that MRI guidance in performing discography is accurate and relatively safe. It is a technically comparable method to CT-guidance or fluoroscopy.
Adult↗
Endoscopic carpal tunnel release surgery: retrospective study of 390 consecutive cases.
Endoscopic carpal tunnel release (ECTR) surgery was developed by Okutsu and Chow in 1989. Many reports indicated that the endoscopic technique reduces postoperative morbidity with minimal incision, minimal pain and scarring, a shortened recovery period and high level of patient satisfaction. To evaluate these reports, a retrospective study was conducted with 390 procedures of two-portal Chow technique for idiopathic carpal tunnel syndrome. Follow-up was performed at 1, 3 and 6 months and overall results were backed up by telephone questionnaire (Health Outcomes Carpal Tunnel Questionnaire, Health Outcomes, Bloomington, MN, USA). Results were favourable in 98% and 2% unfavorable for persistent pain. Rate of satisfaction of the patients was 90%. Average time of patient's return to work was 20 days. Eleven procedures (2.8%) were converted to open release. There was one case (0.2%) of incompleted section of the perineurium due to failure of endoscopic visualization of the ligament. In this case the procedure was converted to open and was completed with perineurium sutura. In six cases (1.5%) there were injury to superficial palmar arch. During the follow-up period there were no recurrences and no re-exploration. The mean preoperatively obtainable distal motor latency (DML) and sensory conduction velocity (SCV) values were 6.7 m/s and 29.2 m/s, respectively. The mean DML and SVC values at final follow-up were 3.8 msec and 42.3 m/s, respectively. In conclusion, ECTR can be used in the carpal tunnel syndrome and is a reliable alternative to the open procedure with excellent self-report of patient satisfaction. Reduced recovery period with minimal tissue violation and incisional pain can be expected.
Adult↗
Catheter-aided extraction of a steel coil accidentally lodged in the right ventricle.
In one case a steel coil similar to the Gianturco coil accidentally lodged in the outflow tract of the right ventricle during the embolization of a pulmonary arteriovenous fistula. Extraction of the coil with an intravascular foreign body retrieval set (Cook Inc., Bloomington Ind.) was unsuccessful because the extraction wire broke. An improvised device was then employed, using a Cordis 8 French multipurpose catheter and a single stainless steel wire designed for surgical osteosynthesis. The steel coil was successfully caught by the device and pulled out via the femoral vein.
Adult↗
MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking.
The purpose of this study was to evaluate the feasibility of the MRI-guided periradicular nerve root infiltration therapy. Sixty-seven nerve root infiltrations under MRI guidance were done for 61 patients suffering from lumbosacral radicular pain. Informed consent was acquired from all patients. A 0.23-T open-MRI scanner with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used. A surface coil was used in all cases. Nerve root infiltration was performed with MRI-compatible 20-G needle (Chiba type MReye, Cook, Bloomington, Ind.; or Manan type, MD Tech, Florida). The evaluation of clinical outcome was achieved with 6 months of clinical follow-up and questionnaire. The effect of nerve root infiltration to the radicular pain was graded: 1=good to excellent, i.e., no pain or not disturbing pain allowing normal physical activity at 3 months from the procedure; 2=temporary, i.e., temporary relief of pain; 3=no relief of pain; and 4=worsening of pain. As an adjunct to MRI-guided positioning of the needle the correct needle localization by the nerve root was confirmed with saline injection to nerve root channel and single-shot fast spin echo (SSFSE) imaging. The MRI guidance allowed adequate needle positioning in all but 1 case (98.5%). This failure was caused by degeneration-induced changes in anatomy. Of patients, 51.5% had good to excellent effect with regard to radicular pain from the procedure, 22.7% had temporary relief, 21.2% had no effect, and in 4.5% the pain worsened. Our results show that MRI guidance is accurate and safe in performing nerve root infiltration at lumbosacral area. The results of radicular pain relief from nerve root infiltration are comparable to CT or fluoroscopy studies on the subject.
Adult↗
MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking.
The purpose of this study was to evaluate the feasibility of MRI-guided bone biopsy with optical instrument tracking and evaluate advantage of combined fine-needle aspiration (FNA) with trephine biopsy. Twenty trephine bone biopsies and 13 FNAs were performed under MRI and CT guidance in 14 patients. Informed consent was obtained from all patients. The evaluation of diagnostic accuracy was achieved by comparing the histopathological and cytological diagnosis with current or final diagnosis made during 6-month clinical follow-up. A 0.23-T open MRI scanner with interventional tools (Outlook Proview, Marconi Medical Systems, Cleveland, Ohio) was used. A surface coil was used. For trephine biopsy MRI-compatible bone biopsy set (Daum medical, Schwerin, Germany) was used. The FNA was performed with MRI compatible 20-G needle (Cook, Bloomington, Ind.). The diagnostic accuracy of MRI-guided trephine biopsy was 95%. The FNA sample diagnosis concurred with the histological in 54%. Our results show that MRI guidance in bone biopsies is accurate and safe. It is comparable to CT-guided or open biopsy. The role of combined FNA with bone biopsies remains controversial.
Biopsy↗