Hearns W Charles, M.D.

Artificial ascites and radiofrequency ablation of subdiaphragmatic hepatocellular carcinoma
Aquino T.; Aaltonen E.; Charles H.W.; Kovacs S.; Gross J.; Richard L.; Hillel B.
2011 ;22(3 SUPPL 1):S116-S116, Journal of vascular & interventional radiology
Learning Objectives: Learn to utilize artificial ascites to safely perform radiofrequency ablation of subdiaphragmatic hepatocellular carcinoma. Background: RFA is an effective treatment of HCC. A relative contraindication is subdiaphragmatic tumor location because the diaphragm is at increased risk of thermal injury. Artificial ascites of 5-10 mm thickness creates a protective space between the tumor and diaphragm. 5% dextrose in water (D5W) is used because it provides greater electric isolation than normal saline. The ascites decreases post-procedural pain and recovery time without sacrificing efficacy because there is no significant associated heat sink effect. Clinical Findings/Procedure Details: Ultrasound guidance is used to advance a 20-gauge needle into the peritoneal cavity. If the tumor is in the right hepatic lobe, a subcostal approach along the anterior axillary line is used. If the tumor is in the left hepatic lobe, a subcostal epigastric approach is used. A small amount of D5W (20-50 mL) is injected to create a space for placement of an 8 French pigtail catheter. Placement of the catheter close to the tumor, between the liver and diaphragm is desirable. The catheter is infused with D5W and creation of artificial ascites is monitored under ultrasound or CT. Artificial ascites improves the sonic window for ultrasound guided placement of the RFA probe. If the tumor remains difficult to visualize, CT guidance is used for probe placement. Following completion of ablation, the catheter is drained to gravity. Blood tinged fluid is common following the procedure. The catheter is left in place 12-24 hours to drain residual ascites and prevent hemoperitoneum. Other potential complications include peritonitis, pleuritic chest pain, and pleural effusion. Conclusion and/or Teaching Points: Artificial ascites can effectively decrease risk of thermal injury to the diaphragm, post-procedural pain, and recovery time without sacrificing efficacy of subdiaphragmatic HCC radiofrequency ablation. The infusion catheter should be placed close to the tumor, between the liver and diaphragm, to create 5-10 mm thickness of D5W artificial ascites. The catheter should be drained for 12-24 hours post-procedurally to remove residual ascites and decrease risk of hemoperitoneum
— id: 129332, year: 2011, vol: 22, page: S116, stat: Journal Article,

G2 inferior vena cava filter: retrievability and safety
Charles, Hearns W; Black, Michelle; Kovacs, Sandor; Gohari, Arash; Arampulikan, Joseph; McCann, Jeffrey W; Clark, Timothy W I; Bashar, Mona; Steiger, David
2009 Aug;20(8):1046-1051, Journal of vascular & interventional radiology
PURPOSE: To assess the retrievability of the G2 inferior vena cava (IVC) filter and factors influencing the safety and technical success of retrieval. MATERIALS AND METHODS: From October 2006 through June 2008, G2 IVC filters were placed in 140 consecutive patients who needed prophylaxis against pulmonary embolism (PE). General indications for filter placement included history of thromboembolic disease (n = 98) and high risk for PE (n = 42); specific indications included contraindication to anticoagulation (n = 120), prophylaxis in addition to anticoagulation (n = 16), and failure of anticoagulation (n = 4). Filter dwell time, technical success of filter retrieval, and complications related to placement or retrieval were retrospectively evaluated in patients who underwent filter removal. RESULTS: Twenty-seven attempts at G2 filter removal were made in 26 patients (12 men; age range, 24-88 years; mean age, 55.4 y) after a mean period of 122 days (range, 11-260 d). Data were collected retrospectively with institutional review board approval. Filter removal was successful in all 27 attempts (100%). Tilting of the filter (> or =15 degrees ) occurred in five cases (18.5%), with probable filter incorporation into the right lateral wall of the IVC in one. Other complications of retrieval such as filter thrombosis, significant filter migration, filter fracture, and caval occlusion were not observed. CONCLUSIONS: G2 IVC filter retrieval has a high technical success rate and a low complication rate. Technical success appears to be unaffected by the dwell time within the reported range
— id: 101318, year: 2009, vol: 20, page: 1046, stat: Journal Article,

Chest port placement with use of the single-incision insertion technique
Charles, Hearns W; Miguel, Tiago; Kovacs, Sandor; Gohari, Arash; Arampulikan, Joseph; McCann, Jeffrey W
2009 Nov;20(11):1464-1469, Journal of vascular & interventional radiology
PURPOSE: To evaluate the single-incision technique for the placement of subcutaneous chest ports. Advantages, technical success, and complications were assessed. MATERIALS AND METHODS: From March 2007 through May 2008, 161 consecutive chest ports were placed with a modified single-incision technique and sonographic and fluoroscopic guidance via the right internal jugular vein (IJV; n = 130), right external jugular vein (n = 1), right subclavian vein (n = 1), or left IJV (n = 28). The primary indication was for long-term chemotherapy; all patients had malignancy. RESULTS: All single-incision chest port insertions were technically successful. Ports were placed in patients 19 months to 93 years of age (mean, 56.3 y), with a mean follow-up of 203.6 device-days per patient and a total of 32,779 catheter access days. No procedure-related complications, pocket hematomas, venous thromboses, or pneumothoraces were observed. Minor delayed complications occurred in three patients. Premature catheter removal was required for two patients (1.2%; 0.006 per 100 catheter-days). One port was removed less than 30 days after implantation for infection of the pocket (0.61%; 0.003 per 100 catheter-days). Another catheter was removed because of patient dissatisfaction and unconfirmed concerns with arrhythmia (0.61%; 0.003 per 100 catheter-days). One minor superficial wound infection was successfully treated with oral antibiotics, with the port kept in place. CONCLUSIONS: Use of a single-incision technique for chest port implantation in adult and pediatric oncology patients is feasible. This may be the preferred method of subcutaneous port placement, as it has a very low complication rate and a high success rate. Prospective evaluation is needed to compare it versus the conventional two-incision technique
— id: 105177, year: 2009, vol: 20, page: 1464, stat: Journal Article,

Comparison of heparin-coated and conventional split-tip hemodialysis catheters
Clark, Timothy W I; Jacobs, David; Charles, Hearns W; Kovacs, Sandor; Aquino, Theresa; Erinjeri, Joseph; Benstein, Judith A
2009 Jul;32(4):703-706, Cardiovascular & interventional radiology
Catheter coatings have the potential to decrease infection and thrombosis in patients with chronic dialysis catheters. We report our midterm experience with a heparin-coated dialysis catheter. This retrospective, case-control study was approved by our Institutional Review Board. A total of 88 tunneled dialysis catheters were inserted over a 13-month period via the internal jugular vein. Thirty-eight uncoated split-tip catheters and 50 heparin-coated catheters were inserted. Primary catheter patency was compared between the two groups using the log rank test, with infection and/or thrombosis considered as catheter failures. Dialysis parameters during the first and last dialysis sessions, including pump speed, actual blood flow, and arterial port pressures, were compared using unpaired t-tests. Primary patency of the uncoated catheters was 86.0 +/- 6.5% at 30 days and 76.1 +/- 8.9% at 90 days. Primary patency of heparin-coated catheters was 92.0 +/- 6.2% at 30 days and 81.6 +/- 8.0% at 90 days (p = 0.87, log rank test). Infection requiring catheter removal occurred in four patients with uncoated catheters and two patients with heparin-coated catheters (p = 0.23). Catheter thrombosis requiring catheter replacement or thrombolysis occurred in one patient with an uncoated catheter and two patients with heparin-coated catheters (p = 0.9). No differences in catheter function during hemodialysis were seen between the two groups. In conclusion, the heparin-coated catheter did not show a significantly longer patency compared to the uncoated catheter. The flow characteristics of this device were comparable to those of the conventional uncoated catheter. A demonstrable benefit of the heparin-coated catheter in randomized trials is needed before a recommendation for routine implementation can be made
— id: 100609, year: 2009, vol: 32, page: 703, stat: Journal Article,

Treatment of Posttraumatic Aortic Pseudoaneurysms Using Detachable Hydrogel-Coated Coils
Greben, Craig R; Axelrod, David J; Charles, Hearns; Gandras, Eric J; Bank, Matthew; Setton, Avi
2009 Jun;66(6):1735-1738, Journal of trauma
— id: 96448, year: 2009, vol: 66, page: 1735, stat: Journal Article,

Bronchobiliary fistula successfully treated with n-butyl cyanoacrylate via a bronchial approach
Goldman, S Yedida; Greben, Craig R; Setton, Avi; McKinley, Matthew J; Axelrod, David J; Charles, Hearns W; Gandras, Eric J
2007 Jan;18(1 Pt 1):151-155, Journal of vascular & interventional radiology
A bronchobiliary fistula is an abnormal communication between the biliary tree and the airway that can result in debilitating amounts of bilioptysis, or bile-stained sputum. The authors present an approach for the conservative management of a bronchobiliary fistula in a patient who failed traditional conservative therapy and refused surgical intervention
— id: 96449, year: 2007, vol: 18, page: 151, stat: Journal Article,

Two-station bolus-chase MR angiography with a stationary table: a simple alternative to automated-table techniques
Pandharipande, Pari V; Lee, Vivian S; Reuss, Peter M; Charles, Hearns W; Rosen, Robert J; Krinsky, Glenn A; Weinreb, Jeffrey C; Rofsky, Neil M
2002 Dec;179(6):1583-1589, American journal of roentgenology
OBJECTIVE: Our purpose was to evaluate a simple, two-station, bolus-chase, peripheral MR angiography technique that relies on manual patient translation using a plastic patient-transfer board. SUBJECTS AND METHODS: Twenty patients successfully completed both lower extremity MR angiography and digital subtraction angiography within a 3-month period. For MR angiography, patients were placed on the scanner table on a standard plastic patient-transfer board. We performed unenhanced and contrast-enhanced imaging at the level of the pelvis using a three-dimensional gradient-echo sequence (TR range/TE range, 3.8-4.6/1.3-1.8; flip angle range, 25-40 degrees ). Then patients were quickly pulled 350-400 mm using the transfer-board handles, and two subsequent acquisitions were obtained at the level of the thighs. For each modality, two radiologists who were unaware of correlative imaging results retrospectively scored all vessel segments as either greater than or equal to 50% stenosis or less than 50% stenosis, and interobserver agreement was determined. Using digital subtraction angiography as the standard of reference, we used consensus data to compute MR angiography sensitivity and specificity. RESULTS: In the 261 vessel segments considered, MR angiography had a sensitivity of 75% (12/16) and a specificity of 98% (94/96) for the detection of stenosis greater than or equal to 50% from the aorta through the common femoral arteries. For the superficial and profunda femoral arteries through the popliteal arteries, these values were 97% (31/32) and 94% (34/36), respectively. MR angiography interobserver agreement for detection of stenosis was good (kappa = 0.68) for the aorta through the common femoral arteries and excellent (kappa = 0.88) for the superficial and profunda femoral arteries through the popliteal arteries. These values were comparable to those found for digital subtraction angiography (kappa = 0.67 and kappa = 0.88, respectively). CONCLUSION: Stationary-table MR angiography is a useful, simple strategy for lower extremity angiography in centers without a moving table
— id: 44319, year: 2002, vol: 179, page: 1583, stat: Journal Article,

Salmonella- and Shigella-induced ileitis: CT findings in four patients
Balthazar EJ; Charles HW; Megibow AJ
1996 May-Jun;20(3):375-378, Journal of computer assisted tomography
PURPOSE: The purpose of this study is to describe and illustrate the CT appearance of four cases of acute terminal ileitis induced by nontyphoidal Salmonella and Shigella infection and to review the radiographic and endoscopic findings of these entities. METHOD: The medical records, CT examinations, and small bowel examinations of three patients with Salmonella ileitis and one patient with Shigella ileitis were retrospectively reviewed. CT examinations were done in four patients, colonoscopy in three patients, and small bowel examinations in two patients. Stool cultures established the diagnosis of nontyphoidal Salmonella enteritis in three patients and Shigella enteritis in one patient. The patients' symptoms and clinical findings resolved promptly following supportive therapy and appropriate antibiotic therapy. RESULTS: CT showed slight circumferential and homogeneous thickening of the terminal ileum over a segment of 10-15 cm in patients with Salmonella ileitis. Associated mild thickening of the wall of the colon was present in addition. Small bowel examination performed in one patient revealed a spastic terminal ileum with thickened mucosal folds. Colonoscopy revealed acute colitis involving the colon diffusely in one case, but sparing the distal 50 cm of the colon in one case. CT showed more pronounced thickening of the terminal ileum and a target configuration in the patient with Shigella ileitis. Small bowel examination revealed narrowing, irregular contour, several large nodular defects (thumbprinting), and a severely ulcerated mucosa affecting the terminal ileum. Colonoscopy revealed a normal colon and large ulcerations with fibropurulent exudate in the terminal ileum. CONCLUSION: In patients with severe Salmonella or Shigella infections or persistent and/or confusing clinical presentations, CT can play a complementary but important role in the initial diagnostic evaluation. It avoids clinical mismanagement, circumvents unnecessary invasive procedures, and contributes to the efficient workup and therapy in this group of individuals
— id: 6979, year: 1996, vol: 20, page: 375, stat: Journal Article,