The aim of this study was to assess costs and safety of immediate femoral sheath removal and closure with a suture-mediated closure device (Perclose, Menlo Park, CA) in patients undergoing elective (PCI). A total of 193 patients was prospectively randomized to immediate arterial sheath removal and access site closure with a suture-mediated closure device (SMC; n = 96) or sheath removal 4 hr after PCI followed by manual compression (MC; n = 97). In the SMC group, patients were ambulated 4 hr after elective PCI if hemostasis was achieved. In the MC group, patients were ambulated the day after the procedure. In addition to safety, total direct costs including physician and nursing time, infrastructure, and the device were assessed in both groups. Total direct costs were significantly (all P < 0.001) lower in the SMC group. Successful hemostasis without major complication was achieved in all patients. The time to achieve hemostasis was significantly shorter in the SMC group (7.1 +/- 3.4 vs. 22.9 +/- 14.0 min; P < 0.01) and 85% of SMC patients were ambulated on the day of intervention. Suture-mediated closure allows a reduction in hospitalization time, leading to significant cost savings due to decreased personnel and infrastructural demands. In addition, the use of SMC is safe and convenient to the patients.
BACKGROUND:The purpose of this study was to propose a new method for imaging the uterine cavity and Fallopian tube patency by three-dimensional dynamic magnetic resonance hysterosalpingography (3D dMR-HSG) and to analyse if, by using a higher viscosity contrast solution, direct visualization of the Fallopian tubes may be achieved by this new technique. METHODS: 10 consecutive infertile women underwent 3D dMR-HSG and conventional HSG as gold standard. 3D dMR-HSG consisted of injection of 20 ml of a gadolinium-polyvidone solution into the uterine cavity while acquiring five consecutive three-dimensional (3D) T1-weighted MR-sequences. RESULTS: In three patients the catheter became dislodged during 3D dMR-HSG. However, in one of these patients the examination was still partially diagnostic. Imaging findings of 3D dMR-HSG showed good correlation with conventional hysterosalpingography and allowed 3D imaging of the uterine cavity and of Fallopian tube patency in 8/10 patients and direct visualization of the Fallopian tubes in 5/7 patients. CONCLUSION: 3D dMR-HSG represents a new and promising imaging approach to female infertility causing less pain and avoiding exposure of the ovaries to ionizing radiation. By using a higher viscosity MR-contrast agent it allows not only visualization of uterine cavity and Fallopian tube patency but also direct visualization of Fallopian tubes.
VCE can readily depict and characterize subtle mucosal lesions missed at MRE, whereas MRE yields additional mural, perienteric, and extraenteric information. Thus, VCE and MRE appear to be complementary methods which, when used in conjunction, may better characterize suspected small bowel disease.
Ultrafast MR imaging using the T2-weighted single-shot fast spin-echo sequence allows dynamic evaluation of the pelvic compartments at maximal strain with no need for contrast medium. Pelvic floor laxity and supporting fascia abnormalities were most common in patients with stress incontinence followed by continent women with a history of vaginal delivery. The results are therefore compatible with the hypothesis of vaginal delivery as a contributory factor to stress incontinence in older parous women.
3D dMR-HSG represents a new and promising imaging approach to female infertility causing less pain and avoiding exposure of the ovaries to ionizing radiation. By using a higher viscosity MR-contrast agent it allows not only visualization of uterine cavity and Fallopian tube patency but also direct visualization of Fallopian tubes.
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