Purpose To compare lesion primary patency and restenosis rates between drug-eluting balloon (DEB) percutaneous transluminal angioplasty (PTA) and conventional balloon PTA (cPTA) in the treatment of arteriovenous fistula (AVF) and arteriovenous graft (AVG) stenosis. Materials and Methods In this prospective study, 119 participants (mean age, 59.2 years; 79 men, 40 women) with failing AVFs (n = 98) or AVGs (n = 21) were randomly assigned to undergo either DEB PTA (n = 59) or cPTA (n = 60) from January 2012 to May 2013. Primary end points were lesion primary patency and restenosis rates at 6 months; secondary outcomes were anatomic and clinical success after PTA, circuit primary patency at 6 months and 1 year, and lesion primary patency at 1 year. Statistical analysis was performed by using the Kaplan-Meier product limit estimator, and hazard ratio was calculated by using Cox proportional hazards regression. Complication rates were assessed in both groups. Results Estimated lesion primary patency in the DEB PTA and cPTA arms was 0.81 and 0.61, respectively, at 6 months (P = .03) and 0.51 and 0.34, respectively, at 1 year (P = .04). Estimated circuit primary patency in the DEB PTA and cPTA arms was 0.76 and 0.56, respectively, at 6 months (P = .048) and 0.45 and 0.32, respectively, at 1 year (P = .16). Restenosis rate was 34.0% (16 of 47) for DEB PTA and 62.9% (22 of 35) for cPTA at 6 months (P = .01). No major complications were noted. Conclusion Drug-eluting balloon angioplasty was effective in prolonging lesion primary patency of dialysis access stenoses at 6 months and 1 year. © RSNA, 2018.

PurposeTo determine the accuracy of automatic and manual co-registration methods for image fusion of three-dimensional computed tomography (CT) with real-time ultrasonography (US) for image-guided liver interventions.Materials and MethodsCT images of a skills phantom with liver lesions were acquired and co-registered to US using GE Logiq E9 navigation software. Manual co-registration was compared to automatic and semiautomatic co-registration using an active tracker. Also, manual point registration was compared to plane registration with and without an additional translation point. Finally, comparison was made between manual and automatic selection of reference points. In each experiment, accuracy of the co-registration method was determined by measurement of the residual displacement in phantom lesions by two independent observers.ResultsMean displacements for a superficial and deep liver lesion were comparable after manual and semiautomatic co-registration: 2.4 and 2.0 mm versus 2.0 and 2.5 mm, respectively. Both methods were significantly better than automatic co-registration: 5.9 and 5.2 mm residual displacement (p < 0.001; p < 0.01). The accuracy of manual point registration was higher than that of plane registration, the latter being heavily dependent on accurate matching of axial CT and US images by the operator. Automatic reference point selection resulted in significantly lower registration accuracy compared to manual point selection despite lower root-mean-square deviation (RMSD) values.ConclusionThe accuracy of manual and semiautomatic co-registration is better than that of automatic co-registration. For manual co-registration using a plane, choosing the correct plane orientation is an essential first step in the registration process. Automatic reference point selection based on RMSD values is error-prone.

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The APACHE II system has been shown to be a reliable and useful means of evaluating patient outcome from the intensive care unit when applied to a broad spectrum of diagnoses. The major purpose of this study was to determine the use of APACHE II as a means of predicting outcome of ICU oncology patients. Data were retrospectively collected for 451 ICU oncology admissions. A direct relationship between severity of physiologic derangement and patient risk of death was demonstrated. Patients with scores of 30 or greater had hospital mortality rates of 100% for postoperative and 92.6% for nonoperative patients. The APACHE II was a useful means of predicting the outcome of ICU oncology patients. This potentially provides the patient, family, and physician an objective dimension in making decisions whether to transfer the oncology patient.

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Background: Little is known about the epidemiology or mortality associated with trauma in Hong Kong or of its demands on the service of emergency departments. This study describes both the quantity and quality of trauma presenting to an emergency department in Hong Kong. Methods: In a retrospective study conducted from January to June 1997 there were 100,000 new patient attendances at the emergency department of the Prince of Wales Hospital of which 227 trauma patients (0.002%) were triaged to the Resuscitation Room. Patient records were scrutinised for types and mechanisms of injury, times of injury and arrival at the emergency department, role of alcohol, and scored using an injury severity score. Important outcomes were mortality and duration of hospital stay. Results: Data was available on 221 (97%) subjects (male to female ratio 3.7:1) of which there were 203 adults and 18 children. Blunt injury accounted for 199/215 (92.6%) cases and penetrating for 16/215 (7.4%) cases. Motor vehicle crashes accounted for 113/205 (55%) cases, falls for 47/205 (23%) cases and assault for 18/205 (9%) cases. 51/224 (23%) cases presented between the hours of midnight and 8 am. The median injury severity score (ISS) was 9 (mean 11; range 1-59). 32/227 (14%) patients died, the majority resulting from road traffic accidents or falls. Conclusion: Patterns of 'severe' trauma in Hong Kong primarily affect male adults, include a preponderance of motor vehicle crashes and falls, and significant mortality.