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Sample records for guided percutaneous ethanol

  1. Percutaneous computed tomography-guided ethanol injection in aldosterone-producing adrenocortical adenoma

    International Nuclear Information System (INIS)

    Rossi, R.; Savastano, S.; Tommaselli, A.P.

    1995-01-01

    The feasibility, safety and effectiveness of percutaneous computed tomography-guided ethanol injection (PEI-CT) was investigated in a patient affected by aldosterone-producing adenoma (APA). A 42-year-old male patient with typical features of hyperaldosteronism presented a solitary left adrenal adenoma measuring 2 cm, with a normal contralateral gland, evidenced by both CT scan and adrenal [ 75 Se-19]-nor-cholesterol scintigraphy. After normalization of potassium plasma levels, 4 ml of sterile 95% ethanol with 0.5 ml of 80% iothalamate sodium was injected. The procedure was completed in about 30 min. No severe pain or local complication was noted. Five hour after PEI, a fourfold and a twofold increase in aldosterone and cortisol plasma levels were observed, respectively. After 11 days on a normal sodium and potassium diet, normal potassium plasma levels and reduced aldosterone plasma levels were present, with reappearance of an aldosterone postural response. Plasma renin activity and aldosterone plasma levels normalized 1 month later, with reappearance also of a plasma renin activity postural response and maintenance of normal potassium plasma levels on a high sodium and normal potassium diet. The patient has remained hypertensive, although lower antihypertensive drug dosages have been employed. After 17 months, normal biochemical, hormonal and morphological findings were present. The authors suggested PEI-CT as a further alternative approach to surgery in the management of carefully selected patients with APA. 15 refs., 2 figs., 1 tab

  2. CT-guided percutaneous ethanol injection in the treatment of thyroid adenoma

    International Nuclear Information System (INIS)

    Zheng Jiasheng; Zhao Xia; Cui Xiongwei; Li Hua

    2001-01-01

    Objective: To evaluate the safety and efficacy of CT-guided percutaneous ethanol injection (CT-PEI) in the treatment of thyroid adenoma. Methods: Fifty-four patients with 73 nodules were included in the study. Thyroid adenoma was confirmed by pathology. The serum level T3, T4 and TSH were normal in all cases. CT-PEI (0.3-2.5 ml ethanol/cm 3 nodular tissue) was given for 115 times (mean 1.58 +- 0.78 times/nodule). Results: Complete cure was observed in 37 nodules (50.7%). In 28 nodules (38.3%) volume reduction was greater than 80%. A significant nodule reduction (50%-80%) was observed in 7 nodules. Only 1 (1.4%) nodule volume reduction was 28.9%. Apart from 1 case of transient dysphonia and 2 cases of mild pain and burning sensation, no side effect was observed. Conclusion: CT-PEI is a safe and effective therapeutic procedure with few side effects for thyroid adenoma

  3. The feasibility of CT-guided percutaneous ethanol injection therapy for hepatic tumors

    International Nuclear Information System (INIS)

    Park, Ji Seon; Park, Seong Jin; Lim, Joo Won; Lee, Dong Ho; Kwon, Se Hwan

    2001-01-01

    To describe the technical features of CT-guided percutaneous ethanol injection therapy (PEIT) for hepatic tumors that are undetectable or inaccessible under ultrasound guidance, to analyze its short-term therapeutic results, and to discuss its feasibility and limitations with a review of the related literature. During a 22-month period, 17 patients with 28 hepatic tumors (27 hepatocellular carcinomas and one metastasis) underwent 38 sessions of CT-guided PEIT. Follow-up CT scanning was also performed. All tumors were undetectable or inaccessible under ultrasound guidance. The quantity of ethanol injected depended on their maximum diameter, which was 0.9-5.1 (mean, 2.2) cm. To determine the puncture site and direction of the needle, the graduated grid system was used. A 21 or 22-G PEIT needle was introduced into the tumor stepwise, with intermittent CT monitoring, and if the CT images obtained immediately after initial injection demonstrated incomplete perfusion, an additional dose of ethanol was administered. During the follow-up period of 28-619 (mean, 261) days, three-phase spiral CT scans were obtained. We focused on whether or not a viable portion of ablated tumor was present, and if so, the interval during which the extent of viable portion had changed, as well as the CT findings which suggested a predisposition to incomplete ablation. PEIT was successfully performed in all patients. During each session, 3-30 (mean, 12.1) mL of ethanol was injected for 35-115 (mean, 85) mins, with 1-7 (mean, 3.7) trials to determine the puncture site and needle direction. The follow-up CT results showed that 20 tumors (71.4%) contained no viable portion, that this portion had decreased in four (14.3%), and was unchanged or had increased in four (14.3%). In the eight tumors for which multiple sessions were required, follow-up CT showed that the viable portion was absent or had decreased in size in all except one. In five of the patients with a tumor containing a viable portion

  4. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

    Directory of Open Access Journals (Sweden)

    Nathan Elie Frenk

    Full Text Available OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

  5. Long-term results after CT-guided percutaneous ethanol ablation for the treatment of hyper functioning adrenal disorders

    International Nuclear Information System (INIS)

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho

    2016-01-01

    Objectives: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyper functioning adrenal disorders. Method: We retrospectively evaluated the long-term results of nine patients treated with computed tomography guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macro nodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Results: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macro nodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Conclusion: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyper functioning adrenal disorders and is not without risks. (author)

  6. Long-term results after CT-guided percutaneous ethanol ablation for the treatment of hyper functioning adrenal disorders

    Energy Technology Data Exchange (ETDEWEB)

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina; Menezes, Marcos Roberto de, E-mail: menezesmr@gmail.com [Instituto do Cancer do Estado de Sao Paulo, SP (Brazil)

    2016-10-15

    Objectives: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyper functioning adrenal disorders. Method: We retrospectively evaluated the long-term results of nine patients treated with computed tomography guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macro nodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Results: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macro nodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Conclusion: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyper functioning adrenal disorders and is not without risks. (author)

  7. Non-real-time computed tomography-guided percutaneous ethanol injection therapy for heapocellular carcinoma undetectable by ultrasonography

    International Nuclear Information System (INIS)

    Ueda, Kazushige; Ohkawara, Tohru; Minami, Masahito; Sawa, Yoshihiko; Morinaga, Osamu; Kohli, Yoshihiro; Ohkawara, Yasuo

    1998-01-01

    The purpose of this study was to evaluate the feasibility of non-real-time CT-guided percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC, 37 lesions) untreatable by ultrasonography-guided (US)-PEIT. The HCC lesion was localized on the lipiodol CT image with a graduated grid system. We advanced a 21 G or 22 G needle in a stepwise fashion with intermittent localization scans using a tandem method to position the tip of the needle in the lesion. Ethanol containing contrast medium was injected with monitoring scans obtained after incremental volumes of injection, until perfusion of the lesion was judged to be complete. A total of 44 CT-PEIT procedures were performed. The average number of needle passes from the skin to the liver in each CT-PEIT procedure was 2.3, the average amount of ethanol injected was 14.4 ml, and the average time required was 49.3 minutes. Complete perfusion of the lesion by ethanol on monitoring CT images was achieved in all lesions with only a single or double CT-PEIT procedure without severe complication. Local recurrence was detected only in 5 lesions. At present, it is more time-consuming to perform CT-PEIT than US-PEIT because conventional CT guidance is not real-time imaging. However, it is expected that this limitation of CT-PEIT will be overcome in the near future with the introduction of CT fluoroscopy. In conclusion, CT-PEIT should prove to be a feasible, acceptable treatment for challenging cases of HCC undetectable by US. (author)

  8. Percutaneous ultrasound-guided ablation of BW7756-hepatoma using ethanol or acetic acid in a rat model

    Directory of Open Access Journals (Sweden)

    Galeotti Tommaso

    2007-12-01

    Full Text Available Abstract Background To compare tumor necrosis in hepatoma induced in rats by a single percutaneous injection of ethanol (PEI or acetic acid (PAI. Methods BW7756 hepatomas of 1 mm3 were implanted in the liver of 40 male healthy rats. After 14 days, the 36 surviving rats were treated, in a single session, by ultrasound-guided injection of 300 μl of 95% ethanol (n = 17 or 100 μl of 50% acetic acid (n = 19. They were sacrificed 14 days after treatment and explanted tumoral livers were examined. The same PAI procedure was repeated on 13 additional rats to exclude a suspected occurrence of technical failures during the experiment, due to a surprisingly high rate of deaths within 30 minutes after PAI. Results Four rats died within four days after tumor implantation; after PEI, 1/17 (6% died, whereas after PAI 9/19 (47% died. The remaining 26 rats, after 14 days post-percutaneous ablation, were sacrificed. Gross and microscopic examinations showed that the hepatoma's nodules treated with PEI had 45.3 ± 19.4% tumor necrosis compared to 49 ± 23.3% (P = NS for those treated with PAI. Complete tumor necrosis was not found in any animal. Peritoneal invasion was present in 4/16 (25% and 2/10 (20% rats treated with PEI or PAI, respectively (P = NS. Autopsy was performed in the 5 additional rats that died within 30 minutes after PAI. Conclusion Our results show that there is no significant difference in the percentage of tumor necrosis between two local ablation methods in spite of the different dosages used. However, mortality in the PAI-treated group was greater than in PEI-treated group, presumably due to greater acetic acid systemic diffusion and its metabolic side effects. In human subjects, HCC occurs in the setting of cirrhosis, where the non-tumoral tissue is firmer than the tumor structure, with consequent reduction of drug diffusion. This could be the reason why some human studies have concluded similar or even better safety and efficacy with PAI

  9. Outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules: 27 cases (2008-2011).

    Science.gov (United States)

    Guttin, Talia; Knox, Van W; Diroff, Jeremy S

    2015-10-01

    To describe outcomes for dogs with primary hyperparathyroidism following treatment with percutaneous ultrasound-guided ethanol ablation of presumed functional parathyroid nodules. Retrospective case series. 24 dogs with primary hyperparathyroidism that underwent 27 ultrasound-guided ethanol ablation procedures of presumed functional parathyroid nodules identified by cervical ultrasonography. Dogs were anesthetized for each procedure. For each nodule, 95% ethanol was injected into the center with ultrasound guidance (volume injected calculated on the basis of ultrasonographic measurements). The interval from treatment to resolution of hypercalcemia, complications, and follow-up clinicopathologic data were recorded. 5 procedures involved simultaneous treatment of 2 nodules. Three dogs underwent a second treatment because of initial treatment failure or development of another nodule. Hypercalcemia resolved after 23 of 27 (85%) procedures. In those 23 treatments, 22 (96%) had resolution of hypercalcemia within 72 hours after treatment. Hypocalcemia was detected in 6 different dogs at 2 (1 dog), 7 (3 dogs), 14 (1 dog), and 21 (1 dog) days after treatment; 5 of these dogs had mild transient hypocalcemia and 1 developed clinical signs requiring calcium supplementation. Although there were no periprocedural adverse effects, 2 dogs had delayed adverse effects; the overall rate of complications (including delayed adverse events and clinical hypocalcemia) was 11.1%. Long-term follow-up data indicated sustained normocalcemia in 17 of 19 dogs. Results suggested that percutaneous ultrasound-guided ethanol ablation of functional parathyroid nodules may be an effective treatment for primary hyperparathyroidism of dogs, with short duration of anesthesia, minimal complications, and low risk for hypocalcemia.

  10. Transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma located in the subphrenic region of liver

    International Nuclear Information System (INIS)

    Ueda, Kazushige; Ohkawara, Tohru; Minami, Masahito; Sawa, Yoshihiko; Morinaga, Osamu; Kohli, Yoshihiro; Ohkawara, Yasuo

    2000-01-01

    The purpose of this study is to evaluate the feasibility of transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma (HCC, 15 lesions) located in the subphrenic region and untreatable by ultrasonography-guided PEIT. The HCC was localized on Lipiodol CT image with a graduated grid system. We advanced a PEIT needle in a stepwise fashion, perpendicularly to the major axis of body through the lung with intermittent localization scans to position the tip of the needle in the lesion. Ethanol was injected with monitoring scans obtained after incremental volumes of injection, until perfusion was judged to be complete. A total of 20 CT-PEIT sessions were performed. The average number of needles passed from skin to liver in each CT-PEIT session was 2.7, the average volume of ethanol injected was 11.7 ml, and the average time required was 53.6 minutes. Complete perfusion of the lesion by ethanol was achieved in all lesions with only a single or double CT-PEIT procedure without severe complications. Local recurrence was detected in 3 to 15 followed up lesions for 14 months on average. In conclusion, transpulmonary CT-PEIT should prove to be a feasible, acceptable treatment for challenging cases of HCC located in the subphrenic region. (author)

  11. [Ultrasound guided percutaneous nephrolithotripsy].

    Science.gov (United States)

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

  12. Transcatheter Arterial Embolization with a Mixture of Absolute Ethanol and Iodized Oil for Poorly Visualized Endophytic Renal Masses Prior to CT-Guided Percutaneous Cryoablation

    Energy Technology Data Exchange (ETDEWEB)

    Michimoto, Kenkichi, E-mail: michikoo@jikei.ac.jp; Shimizu, Kanichiro; Kameoka, Yoshihiko; Sadaoka, Shunichi [The Jikei University Scholl of Medicine, Department of Radiology, Kashiwa Hospital (Japan); Miki, Jun; Kishimoto, Koichi [The Jikei University School of Medicine, Department of Urology, Kashiwa Hospital (Japan)

    2016-11-15

    PurposeTo retrospectively evaluate the feasibility of transcatheter arterial embolization (TAE) using a mixture of absolute ethanol and iodized oil to improve localization of endophytic renal masses on unenhanced computed tomography (CT) prior to CT-guided percutaneous cryoablation (PCA).Materials and MethodsOur institutional review board approved this retrospective study. From September 2011 to June 2015, 17 patients (mean age, 66.8 years) with stage T1a endophytic renal masses (mean diameter, 26.5 mm) underwent TAE using a mixture of absolute ethanol and iodized oil to improve visualization of small and endophytic renal masses on unenhanced CT prior to CT-guided PCA. TAE was considered successful that accumulated iodized oil depicted whole of the tumor edge on CT. PCA was considered successful when the iceball covered the entire tumor with over a 5 mm margin. Oncological and renal functional outcomes and complications were also evaluated.ResultsTAE was successfully performed in 16 of 17 endophytic tumors. The 16 tumors were performed under CT-guided PCA with their distinct visualization of localization and safe ablated margin. During the mean follow-up period of 15.4 ± 5.1 months, one patient developed local recurrence. Estimated glomerular filtration rate declined by 8 % with statistical significance (P = 0.01). There was no procedure-related significant complication.ConclusionTAE using a mixture of absolute ethanol and iodized oil to improve visualization of endophytic renal masses facilitated tumor localization on unenhanced CT, permitting depiction of the tumor edge as well as a safe margin for ablation during CT-guided PCA, with an acceptable decline in renal function.

  13. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Brock, Malcolm, E-mail: mabrock@jhmni.edu [Johns Hopkins University, Department of Thoracic Surgery, Center for Sweat Disorders (United States); Chung, Tae Hwan, E-mail: Tchang7@jhmi.edu [Johns Hopkins University, Physical Medicine and Rehabilitation (United States); Gaddam, Sathvika Reddy, E-mail: drsathvikareddy@yahoo.com; Kathait, Anjaneya Singh, E-mail: askathait@gmail.com [Johns Hopkins University, Vascular & Interventional Radiology (United States); Ober, Cecily, E-mail: ceober21@gmail.com [Johns Hopkins University, Department of Thoracic Surgery (United States); Georgiades, Christos, E-mail: cgeorgi@jhmi.edu [Johns Hopkins University, Vascular & Interventional Radiology (United States)

    2016-12-15

    Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.

  14. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis.

    Science.gov (United States)

    Brock, Malcolm; Chung, Tae Hwan; Gaddam, Sathvika Reddy; Kathait, Anjaneya Singh; Ober, Cecily; Georgiades, Christos

    2016-12-01

    Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.

  15. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    2011-06-15

    )-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various ...

  16. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    )-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations ...

  17. Ultrasound Guided Percutaneous Nephrostomy: Experience at ...

    African Journals Online (AJOL)

    2018-01-30

    Jan 30, 2018 ... Background: Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound‑guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, ...

  18. Ultrasound Guided Percutaneous Nephrostomy: Experience at ...

    African Journals Online (AJOL)

    Background: Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound‑guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not ...

  19. Percutaneous Salivary Gland Ablation using Ethanol in a Rat Model

    Directory of Open Access Journals (Sweden)

    Emma Burch

    2017-12-01

    Full Text Available Objectives: Sialorrhea is a common health and psychosocial problem for children with neuromuscular dysfunction secondary to a variety of disorders such as cerebral palsy. Current accepted treatments include the injection of botulinum toxin into the submandibular glands for temporary symptom relief. The purpose of this study is to demonstrate the feasibility of percutaneous ethanol injection for longer lasting salivary gland ablation in an animal model. Material and Methods: Twenty rats were used in this study. In each rat, 98% ethanol was injected into the right submandibular gland under ultrasound guidance. No intervention was performed on the left gland, which served as the control. Ten rats were sacrificed and glands evaluated at three weeks, with the remaining 10 rats sacrificed and evaluated at three months. Unpaired, 1-tailed T-tests were used to analyse the data. Results: Ethanol injections induced a significant and sustained reduction in salivary gland size. Treated glands were 41% smaller by mass than untreated controls in the 10 rats sacrificed at three weeks (P < 0.001. Treated glands were 43% smaller by mass than untreated controls in the 10 rats sacrificed at three months (P < 0.001. Qualitative histologic analysis demonstrated extensive parenchymal damage, inflammation, and fibrosis at both three week and three month time points. Conclusions: Using a rat model, we demonstrated dramatic and sustained submandibular gland damage after percutaneous injection of ethanol.

  20. [CAT-guided percutaneous drainage of abscesses].

    Science.gov (United States)

    Aguilera Manrique, F; Fernández Miranda, E; García Cáceres, E; Franciso Moriana Maldonado, J; Granero Molina, J; Aguilera Manrique, G

    2001-09-01

    Drainage of percutaneous abscesses guided by Computerized Axial Tomography (CAT) is a technique being employed more frequently all the time by Radiodiagnostic Services. Correctly put into practice by trained professionals, this procedure can prevent patients having to undergo another series of treatments which bear greater risks, to have a longer hospital stay, or even, depending on the case, to have to undergo an operation. Nurses in a radiological unit have an overwhelming role in every step of a percutaneous abscess drainage, a role which can not be carried out by any other personnel. To achieve being up to date in this technique and to perform our function as nurses in the use of this technique are the main objectives of this review.

  1. CT guided percutaneous needle biopsy of the chest: initial experience

    African Journals Online (AJOL)

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015.

  2. Possibilities of nontoxic autonomous thyroid nodules treatment by percutaneous ethanol injection

    Directory of Open Access Journals (Sweden)

    Anđelković Zoran

    2011-01-01

    Full Text Available Background/Aim. According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy. Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method. The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume. Methods. In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetium-99m scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied. The procedure was carried out repeatedly once a week until the reduction in nodule size to 50% of the initial size was achieved. Results. An average size of the nodule before curing was 9.68 ± 5.01 mL. An average quantity of the injected ethanol was 9.52 ± 5.08 mL, ie 1.06 ± 0.48 mL/mg of the tissue. The regression of the nodule size in the successfully (Δvol% u = - 57.09 ± 13.75%, p < 0.001 and partly successfully cured (Δvol du = -48.45 ± 14.35%, p < 0.05 was statistically significant compared to the size before the treatment. After ceasing ethanol injection, 18 months later, a further size regression (Δvol% = -79.20 ± 9.89% compared to the initial one (p < 0.001 was noticed. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone (TSH was noticed compared to the initial values (0.18 ± 0.16 vs 0.34 ± 0.31 mU/L, p < 0.01. According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram. The number and frequency of side effects were insignificant. Conclusion. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in

  3. CT-guided percutaneous treatment of solitary pyogenic splenic abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Pombo, F. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Suarez, I. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Marini, M. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Arrojo, L. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Echaniz, A. [Dept. of Internal Medicine, Hospital Juan Canalejo, La Coruna (Spain)

    1991-08-01

    Six patients with solitary pyogenic splenic abscesses treated by CT-guided percutaneous drainage (by catheter or needle), are presented. There were 3 unilocular, purely intrasplenic abscesses and 3 complex lesions with loculations and perisplenic involvement. Percutaneous drainage and intravenous antibiotics were curative in 4 patients. In the other 2, who had multiloculated abscesses, despite initially successful drainage, splenectomy was performed because of intractable left upper quadrant pain in one case and persistent fever and drainage of pus after 30 days in the other. These patients also developed large, sterile left pleural effusions. Solitary pyogenic splenic abscesses - particularly if uniloculated - can be effectively treated by CT-guided percutaneous drainage. (orig.)

  4. [Diagnosis of bone lesions using image guided percutaneous biopsy].

    Science.gov (United States)

    Contreras, Oscar; Burdiles, Alvaro

    2006-10-01

    Percutaneous biopsies have a good sensitivity and specificity for the diagnosis of bone lesions. To report the experience with 270 percutaneous bone lesions biopsies guided with fluoroscopy or computed tomography. Retrospective review of the medical records of 270 patients (mean age 53.4 years, range 4 to 95 years; 134 female) subjected to a percutaneous biopsy of a bone lesion, guided either by computed tomography or fluoroscopy. The final analysis included the tumor type, tumor malignancy, tumor grade and complications of the procedure. One hundred seventy nine lesions were malignant and 91 benign. Of the malignant lesions, 95 were metastatic and 84 were primary. In 3 cases, the initial diagnosis was a false negative (1.1%). Only one patient had a local hematoma after the procedure. Image guided percutaneous biopsy of bone lesions is a safe, effective, fast and economic procedure to obtain a pathological diagnosis of bone lesions.

  5. Small hepatocellular carcinoma treated with percutaneous ethanol injection

    International Nuclear Information System (INIS)

    Sironi, S.; Livraghi, T.; Vanzulli, A.; Delmaschio, A.

    1991-01-01

    This paper assesses the potential role of MR imaging in the evaluation of hepatocellular carcinoma (HCC) lesions treated with percutaneous ethanol injection (PEI). Fifty-seven MR imaging examinations were obtained in 19 patients with 23 HCC lesions less than 3.5 cm in diameter treated with PEI under US guidance. All patients underwent MR imaging at 0.5 T before and after treatment. Seventeen patients were also examined with MR imaging 6 months after the completion of the therapy. After PEI, fine-needle biopsy specimens were obtained in all cases. Before treatment, on SE 500/20 (T1-weighted) images, HCC lesions were hypointense in 13 cases, isointense in 6, and hyperintense in 4, and all 23 tumors were hyperintense on SE 2,000/120 (T2-weighted) images, in comparison with normal liver. After treatment and at 6-month follow-up, all lesions that were negative for malignant cells at fine-needle biopsy (n = 21) had high signal intensity on T1-weighted images and appeared hypointense on T2-weighted images

  6. Ethanol Fuels Reference Guide: A Decision-Makers Guide to Ethanol Fuels

    Energy Technology Data Exchange (ETDEWEB)

    1982-10-01

    This guide is a compendium of information on alcohol fuel production and use. Chapter titles are: facts about ethanol; gasohol-answers to the basic questions; feedstocks and their coproducts; ethanol production processes; and vehicle fuel use and performance. In addition, there are 8 appendices which include fermentation guides for common grains and potatoes, component and enzyme manufacturers, and information on regulations and permits. (DMC)

  7. Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep

    Energy Technology Data Exchange (ETDEWEB)

    Firouznia, Kavous, E-mail: k-firouznia@yahoo.com; Hosseininasab, Sayed jaber, E-mail: dr.hosseininasab@gmail.com [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Amanpour, Saeid, E-mail: saeidamanpour@yahoo.com [Tehran University of Medical Science, Cancer Models Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Haj-Mirzaian, Arya, E-mail: arya.mirzaian@gmail.com [Tehran University of Medical Science, Department of Radiology and Imaging, MIC, Imam Khomeini Hospital (Iran, Islamic Republic of); Miri, Roza, E-mail: rosa.miri@yahoo.com [Tehran University of Medical Science, Department of Pathology, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Muhammadnejad, Ahad, E-mail: mohamadnejad@yahoo.com [Tehran University of Medical Science, Cancer Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Muhammadnejad, Samad, E-mail: s-muhammadnejad@sina.tums.ac.ir [Tehran University of Medical Sciences, Research Center for Molecular and Cellular Imaging (Iran, Islamic Republic of); Jalali, Amir H., E-mail: amirjalali51@yahoo.com [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Ahmadi, Farrokhlagha, E-mail: ahmadi@tums.ac.ir [Tehran University of Medical Sciences, Nephrology Research Center, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Rokni-Yazdi, Hadi, E-mail: rokniyaz@tums.ac.ir [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of)

    2015-08-15

    BackgroundRenal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.AimTo evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.MethodsEthanol (10 ml, 99.6 %) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.ResultsThe right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40 %, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.ConclusionEffective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension.

  8. CT‑guided percutaneous transthoracic lung biopsy: First experience ...

    African Journals Online (AJOL)

    Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological ...

  9. Amoebic liver abscess: Drained by ultrasound guided percutaneous ...

    African Journals Online (AJOL)

    Summary: Amoebic Liver Abscess in a 20-month-old child: A case of amoebic liver abscess in a Nigerian child is presented. Management consisted of 10days course of Metronidazole and 5days course of Tinidazole without improvement. This was followed by four sessions of ultrasound guided percutaneous needle ...

  10. Double guiding catheters for complex percutaneous coronary intervention.

    Science.gov (United States)

    Chou, Shing-Hsien; Lin, Chia-Pin; Lin, Yen-Chen; Kuo, Chi-Tai; Lin, Ming-Shyan; Chang, Chi-Jen

    2012-01-01

    A large-lumen guiding catheter is often used for complex percutaneous coronary intervention-particularly when a final kissing-balloon or 2-stent technique is required. However, catheter insertion is sometimes restricted by diseased vascular access sites or a tortuous vascular route.We report 2 cases in which a unique double guiding catheter technique was used to create a lumen of sufficient size for complex percutaneous coronary intervention. In each patient, two 6F guiding catheters were used concurrently to engage the ostium of 1 target vessel. In 1 patient, these catheters were used for the delivery of 2 balloons to complete kissing-balloon dilation after single-stent placement. In the other patient, the catheters were used to deliver 2 stents sequentially to their respective target lesions. The stents were then deployed simultaneously as kissing stents, followed by high-pressure kissing-balloon postdilation.

  11. US and RTG guided percutaneous biliary drainage

    International Nuclear Information System (INIS)

    Bukowski, J.

    1994-01-01

    Under combined US and fluoroscopic guidance from anterior approach through left liver lobe a Seldinger technique was used for biliary drainage in 46 patients with nonresectable malignant biliary obstruction. In 9 cases of hilar tumor separating both hepatic ducts a second catheter was inserted through right liver lobe. In 11 cases an internal-external drainage was established. In 3 cases the externally drained bile was recycled by connecting the transhepatic catheter to a percutaneous gastrostomy also performed under US guidance. No severe complications were observed. A described drainage technique provides an effective palliative intervention for advanced biliary malignancies. (author)

  12. Treatment of Recurrent Chordomas by Percutaneous Ethanol Injection Therapy and Radiation Therapy

    International Nuclear Information System (INIS)

    Nakajo, M.; Ohkubo, K.; Fukukura, Y.; Nandate, T.; Nakajo, M.

    2006-01-01

    We report a case of recurrent sacral chordomas that have been successfully controlled by the combination therapy of percutaneous ethanol injection therapy (PEIT) and radiation therapy in a 71-year-old man. PEIT may be one of the adjuvant therapies for recurrent chordomas

  13. CT-Guided Percutaneous Biopsy of Intrathoracic Lesions

    Energy Technology Data Exchange (ETDEWEB)

    Lai, Hira; Neyaz, Zafar; Nath, Alok; Borah, Samudra [Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India)

    2012-03-15

    Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

  14. Ultrasound-guided percutaneous biopsy of digestive tract lesions

    International Nuclear Information System (INIS)

    Gil, S.; Martin, I.; Ballesteros, J. M.; Gomez, C.; Marco, S. F.; Fernandez, P.

    1999-01-01

    To present our experience in ultrasound-guided percutaneous biopsy of lesions located in the digestive tract. We performed ultrasound-guided percutaneous biopsy in 14 patients (10 men and 4 women) ranging in age from 7 to 71 years (mean; 519 years). The lesions were located throughout the digestive tract, from the pyriform sinus to the sigmoid colon. The biopsy was carried out with a 5 MHz convex probe equipped with a device to direct the needle. An 18G automatic needle or a 20G Chiba needle was used to obtain specimens for histological study in every case, and additional samples were collected with a 22G needle for cytological examination in 13 of the patients. The ultrasound images corresponded to pseudokidney in 9 cases and extrinsic masses in 5. The diagnosis was obtained from the histological examination in every case (100%) and from cytology in 6 (44.4%), the latter results were less specific. The only complication corresponded to a case of bilioperitoneum. Ultrasound-guided percutaneous biopsy is a suitable technique for the histological diagnosis of those lesions of the digestive tract that are visible in ultrasound images, but that for some reason can not be examined by endoscopic biopsy. (Author) 20 refs

  15. CT guided percutaneous biopsy of the cervical spine

    International Nuclear Information System (INIS)

    Yuan Huishu; Li Xuan; Liang Kunru

    1997-01-01

    To evaluate the effects of CT guided biopsy of cervical spine in clinical treatment, and discuss the technique involved, ten patients underwent percutaneous biopsy of cervical lesions under CT guidance. Anterior approach with the patient sitting and the needle passing through the mouth was done in one case; latero posterior approach with patient in lateral decubitus position in 5 cases; and lateral approach with 3 patients supine and 1 in lateral decubitus. Nine of ten patients had definitive histological diagnosis, the accuracy of biopsy was 90%, no complications were found. CT guided biopsy of cervical spine is safe and effective, with rare complications, providing important information for clinical treatment

  16. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    International Nuclear Information System (INIS)

    Yegul, I.; Erhan, E.

    2003-01-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures

  17. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Yegul, I. E-mail: iyegul@med.ege.edu.tr; Erhan, E. E-mail: elvanerhan@yahoo.com

    2003-11-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures.

  18. Percutaneous Liver Biopsies Guided with Ultrasonography: A Case Series

    International Nuclear Information System (INIS)

    Cakmakci, Emin; Caliskan, Kosti Can; Tabakci, Omer Naci; Tahtabasi, Mehmet; Karpat, Zeki

    2013-01-01

    Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur. To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease. In our retrospective study, we evaluated ultrasound-assisted needle biopsies that were performed in outpatients from October 2006 to July 2010. The liver biopsies were performed following one-night fasting using the tru-cut biopsy gun (18-20 gauge) after marking the best seen and hypovascular part of the liver, distant enough from the adjacent organs. A total of 1018 patients were referred to our radiology department. Most of the patients had hepatitis B (60.6%). The biopsy specimens were recorded and sent to our pathology department for histopathological examination. According to the results of our series, percutaneous liver biopsy using the tru-cut biopsy gun guided by ultrasonography can be performed safely. We resolve that routine ultrasound of the puncture site is a quick, effective and safe procedure. The complication rate is very low. The US-assisted percutaneous liver biopsy should be used for all cases

  19. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

  20. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    International Nuclear Information System (INIS)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

    2017-01-01

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

  1. Pancreatitis after percutaneous ethanol injection into HCC: a minireview of the literature

    Directory of Open Access Journals (Sweden)

    Perrella Eleonora

    2008-08-01

    Full Text Available Abstract Deaths after percutaneous ethanol injection (PEI into hepatocellular carcinoma (HCC may occur within a few hours to a few days following the procedure because of hemoperitoneum and haemorrhage from oesophageal varices or hepatic insufficiency. Pancreatitis has been recently reported as a rare lethal complication of intra-arterial PEI, another modality for treating HCCs. In this minireview, we analyze the literature concerning the development of acute pancreatitis after PEI. Pathogenesis of pancreatitis from opioids and ethanol is also addressed. Treatment with opioids to reduce the patient's abdominal pain after PEI in combination with the PEI itself may lead to direct toxic effects, thus favouring the development of pancreatitis.

  2. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    Energy Technology Data Exchange (ETDEWEB)

    Gevargez, A.; Schirp, S.; Braun, M. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); Groenemeyer, D. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); EFMT Development and Research Center for Microtherapy, Bochum (Germany)

    2002-06-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  3. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    International Nuclear Information System (INIS)

    Gevargez, A.; Schirp, S.; Braun, M.; Groenemeyer, D.

    2002-01-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  4. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Tonino, Pim A L; De Bruyne, Bernard; Pijls, Nico H J

    2009-01-01

    BACKGROUND: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio...... of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. METHODS: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug...

  5. Palmar hyperhidrosis - CT guided chemical percutaneous thoracic sympathectomy

    Energy Technology Data Exchange (ETDEWEB)

    Adler, O.B.; Engel, A.; Rosenberger, A. (Technion-Israel Inst. of Tech., Haifa (Israel). Dept. of Diagnostic Radiology); Dondelinger, R. (Centre Hospitalier, Luxembourg (Luxembourg). Dept. of Diagnostic Radiology)

    1990-10-01

    Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathic chain of the autonomous nervous system. The center of sympathic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathic ganglion. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed. (orig./GDG).

  6. Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients

    International Nuclear Information System (INIS)

    Yang, Z.Q.; Shin, J.H.; Song, H.-Y.; Kwon, J.H.; Kim, J.-W.; Kim, K.R.; Kim, J.-H.

    2007-01-01

    Aim: To assess the feasibility and safety of fluoroscopically guided percutaneous jejunostomy. Material and methods: Between May 1999 and August 2006 percutaneous jejunostomy was attempted in 25 patients. A 5 F vascular catheter (n = 20) or a 7.5 F multifunctional coil catheter (n = 5) was used to insufflate the jejunum. The distended jejunum was punctured using a 17 G needle (n = 19) or a 21 G Chiba needle (n = 6) with the inserted catheter as a target. A 12 or 14 F loop feeding tube was inserted after serial dilations. The technical success, complications, 30-day mortality, and in-dwelling period of the feeding tube placement were evaluated. Results: The technical success rate was 92% (23/25). Technical failures (n = 2) resulted from the inability to insufflate the jejunum secondary to failure to pass the catheter through a malignant stricture at the oesophagojejunostomy site and thus subsequent puncture of the undistended jejunum failed, or failure to introduce the Neff catheter into the jejunum. Pericatheter leakage with pneumoperitoneum was a complication in three patients (12%) and was treated conservatively. The 30-day mortality was 13% (3/23); however, there was no evidence that these deaths were attributed to the procedure. Except for four patients who were lost to follow-up and two failed cases, 15 of the 19 jejunostomy catheters were removed because of patient death (n = 12) or completion of treatment (n = 3), with a mean and median in-dwelling period of 231 and 87 days, respectively. Conclusions: Fluoroscopically guided percutaneous jejunostomy is a feasible procedure with a high technical success and a low complication rate. In addition to a 17 G needle, a 21 G needle can safely be used to puncture the jejunum

  7. Percutaneous computed tomography guided biopsy of spinal lesions

    International Nuclear Information System (INIS)

    Vakhnina-Vassila, O; Flokatoula, M.; Stamatakis, V.; Geroukis, I.; Vlachou, I.; Petinelli, A.; Stathopoulou, S.; Kokkinis, C.

    2012-01-01

    Full text: Introduction: The decision to undertake a spinal biopsy has to be based on a thorough risk benefit analysis. Objectives and tasks: The main purpose of this presentation is to review all the parameters and technical characteristics that must be taken under consideration for a proper planning and implementation of a percutaneous CT-guided biopsy of spinal lesions. Material and methods: The benefit of a CT-guided biopsy is determined by the assessment that the information received will affect the patient's clinical management and therapeutic decisions. Prerequisite in designing and conducting a CT-guided biopsy is the knowledge of : 1) The advantages and disadvantages against an open biopsy; 2) Its indications and counter-indications; 3)The complications that may occur; 4) Imaging tests that must be taken in before the procedure; 5)The exact position of the patient that must be chosen (prone, supine, lateral recumbent); 6)The needle's approach that is chosen (rear/front, through neck, costospinal, lateral); 7) Evaluation of the parameters for targeting the lesion (spin section, section of the vertebral, lesion section); 8)The advantages and limitations of each technique (thin needle biopsy and thick needle biopsy); 9)The limitations of the procedure. Results: CT-guided percutaneous biopsy, a technique of high diagnostic accuracy and low percentage of complications, is the method of choice for the pathoanatomical determination and accurate diagnosis of spinal lesions. Conclusion: Knowledge of the parameters that ensure its proper planning and execution settle the procedure as a valuable and secure tool that raise the diagnostic accuracy

  8. MR guided percutaneous laser lumbar disk hernia ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo; Terao, Tohru; Ishibashi, Toshihiro; Yuhki, Ichiro; Harada, Junta; Tashima, Michiko [Jikei Univ., Chiba (Japan). Kashiwa Hospital; Abe, Toshiaki

    1998-03-01

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  9. MR guided percutaneous laser lumbar disk hernia ablation

    International Nuclear Information System (INIS)

    Hashimoto, Takuo; Terao, Tohru; Ishibashi, Toshihiro; Yuhki, Ichiro; Harada, Junta; Tashima, Michiko; Abe, Toshiaki.

    1998-01-01

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  10. Endoscopic computerized tomography guided percutaneous trans-gastric drainage: A case report on this hybrid approach

    OpenAIRE

    Tsutsui, Nobuhiro; Suzuki, Yutaka; Saito, Nobuhiro; Ohdaira, Hironori; Yamanouchi, Eigoro; Yoshida, Masashi

    2016-01-01

    Percutaneous drainage, percutaneous transgastric drainage, and endoscopic ultrasound (EUS)-guided transgastric drainage are primarily utilized for drainage of fluid collections dorsal to the stomach. Percutaneous transgastric drainage is performed with computed tomography (CT) guidance, but it requires inflation of a balloon in the stomach, and gastric peristalsis makes it difficult to ensure a reliable puncture route via the stomach. Using endoscopy-assisted CT-guidance, we were able to safe...

  11. Ultrasound-Guided Percutaneous Irrigation of Calcific Tendinopathy.

    Science.gov (United States)

    Messina, Carmelo; Sconfienza, Luca Maria

    2016-11-01

    Rotator cuff calcific tendinopathy (RCCT) is a common disease that may cause highly disabling shoulder pain. No treatment is required for asymptomatic calcifications; mild symptoms may be treated conservatively. Among several therapeutic options, ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) is currently accepted as the first-line safe and effective treatment for RCCT, with significant pain improvement and a very low rate of minor complications. Different approaches have been reported to dissolve calcified deposits, all including the use of a fluid (local anesthetic or saline solution) and the use of one or two needles to inject and retrieve the fluid/dissolved calcium. This review describes both one-needle and two-needle US-PICT techniques, providing technical and practical information that can improve daily clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Percutaneous CT-guided treatment of recurrent spinal cyst hydatid.

    Science.gov (United States)

    Ozdemir, Ozgur; Calisaneller, Tarkan; Yildirim, Erkan; Altinors, Nur

    2011-01-01

    The involvement of spinal column in cyst hydatid disease is rare and hard to treat. The gold standard treatment is total removal of the cysts without rupture. However, recurrence after surgery is almost inevitable and reoperations carries technical difficulties and higher morbidity. We present a 69-year-old woman with two cystic masses at the T12 level, which compress the spinal cord causing severe paresis in her left leg. Under local anestesia, the cysts were aspirated and irrigated with 20% hypertonic saline solution via bilateral T12 transpedicular route. We aimed to report that percutaneous CT guided treatment should be considered as an alternative therapeutic option in case of recurrent spinal cyst hydatid.

  13. Animal experiment and clinical preliminary application of percutaneous 70% ethanol injection therapy in multi-drug resistant pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Liu Fuquan; Yue Zhendong; Gao Shunyu; Li YanSheng; Wei Guobin; Guo Weiyi; Chen Xijun; Li Baoyu

    2004-01-01

    Objective: To evaluate the clinical value of percutaneous injection of 70% ethanol in the treatment of multidrug resistant pulmonary tuberculosis. Methods: Percutaneous and transcatheter absolute ethanol, 70% ethanol, and 60% meglucamine diatrizoate(or distilled water) injection into the lung (25 cases) and the bronchi (25 cases) of healthy rabbits were performed, respectively.All specimens were studied with pathology. On the base of animals experiment, thirty-five patients with multi-drug resistant pulmonary tuberculosis were treated with percutaneous 70% ethanol injection. Every patient was treated by the same way for 1-3 times. Results: Pathological findings of the specimens of pulmonary tissue showed nonspecific inflammation, necrosis, and fibrosis. The chief pathological changes with percutaneous or transcatheter 70% ethanol injection were slighter than those with absolute ethanol injection. Pathological findings of the specimens of bronchi showed slight mucosal edema, nonspecific inflammation, and focal cytonecrosis. Recovery of the damaged bronchial mucosa occurred within 14-30 days after the treatment. All patients with multi-drug resistant pulmonary tuberculosis were followed up for 6 to 33 months. The sputum bacterial conversion to negative rate was 100% within 6 months after the treatment. Cavity closing, shrinking, and no changing rate were 47.1% (16/34), 50.0% (17/34), and 2.9% (1/34), respectively. Radiographic improvement rate was 94.3 % (33/35). No severe complications and adverse reactions occurred. Conclusion: Percutaneous 70% ethanol injection is safe, effective, and easy to perform in the treatment of multi-drug resistant pulmonary tuberculosis. (authors)

  14. Radionuclide therapy using nanoparticle of 131I-Lactosome in combination with percutaneous ethanol injection therapy

    Science.gov (United States)

    Hara, Eri; Makino, Akira; Kurihara, Kensuke; Ueda, Motoki; Hara, Isao; Kawabe, Takashi; Yamamoto, Fumihiko; Ozeki, Eiichi; Togashi, Kaori; Kimura, Shunsaku

    2013-12-01

    We present here a radionuclide therapy using nanoparticle of 131I-labeled Lactosome (131I-Lactosome) is effective as a tumor therapy when combined with the local therapy of the percutaneous ethanol injection therapy (PEIT). A mixture of 131I-labeled poly( l-lactic acid)30 and amphiphilic block polymer of poly(sarcosine)64- block-poly( l-lactic acid)30 was dispersed in saline to generate polymeric micelles of 131I-Lactosome (the diameter of 46 nm with PDI of 0.057). Mice were transplanted with murine mammary cancer (4T1) cells, and a relatively small amount of ethanol was injected percutaneously to the tumor region, followed by intravenous administration of 131I-Lactosome (2.0 × 102 MBq/kg). At 16 days after the 131I-Lactosome dosage with PEIT, the relative tumor volume (RTV) was suppressed as low as 5.32 ± 1.06, while the RTV values became significant to be 15.9 ± 5.0 with PEIT alone and 17.4 ± 3.9 with 131I-Lactosome alone. Indeed, 131I-accumulation in the transplanted tumor region at 48 h after 131I-Lactosome dosage became three times higher with PEIT than that without PEIT. The nanoparticle-based radionuclide therapy in combination with PEIT was, therefore, effective in suppression of tumor proliferation.

  15. [Percutaneous ethanol injection in combination with euthyrox suppressive therapy in the treatment of benign nodular goiter].

    Science.gov (United States)

    Meskhi, I A; Sikharulidze, E N; Natmeladze, K V

    2007-05-01

    This study was designed to clarify the efficacy of combination of thyroid hormone (euthyrox) therapy and percutaneous ethanol injection (PEI) in benign nodular thyroid diseases. 55 patients with benign nodular goiter after the first PEI session during the whole study period (from 3 till 12 months after PEI) daily received euthyrox in a dosage - 50 mkg. 48 women and 7 men with thyroid nodules of the various sizes, structures and echogenecity have been included in the study group. The control group consisted of 32 patients: 29 women and 3 men in the same age range as in the study group. In both groups PEI procedure was performed but in the control group no thyroid hormone was added. In patients who were receiving 50 mkg daily after 3 months of PEI progressive reduction of the nodule sizes was registered, the volume of a thyroid gland has decreased and approached to normal parameters (15,79+/-1,21 ml), and in 6-2 months the normal volume of the thyroid gland was registered. Thus, combination of thyroid hormone therapy and percutaneous ethanol injection (PEI) in treatment of patients with benign nodular goiter normalizes the size of a thyroid gland. Euthyrox is the additional factor causing reduction of thyroid nodules and constraining occurrence of new nodules in a thyroid gland.

  16. Percutaneous tracheostomy with the guide wire dilating forceps technique : presentation of 171 consecutive patients

    NARCIS (Netherlands)

    Fikkers, Bernard G; van Heerbeek, Niels; Krabbe, Paul F M; Marres, Henri A M; van den Hoogen, Frank J A

    BACKGROUND: Evaluation of percutaneous tracheostomy (PT) with the guide wire dilating forceps (GWDF) technique. METHODS: Prospective study of perioperative complications, retrospective analysis of early and late complications in an ICU in a teaching university hospital. RESULTS: The success rate of

  17. Percutaneous tracheostomy with the guide wire dilating forceps technique: presentation of 171 consecutive patients.

    NARCIS (Netherlands)

    Fikkers, B.G.; Heerbeek, N. van; Krabbe, P.F.M.; Marres, H.A.M.; Hoogen, F.J.A. van den

    2002-01-01

    BACKGROUND: Evaluation of percutaneous tracheostomy (PT) with the guide wire dilating forceps (GWDF) technique. METHODS: Prospective study of perioperative complications, retrospective analysis of early and late complications in an ICU in a teaching university hospital. RESULTS: The success rate of

  18. Percutaneous Nephrolithotomy Using an Individual 3-Dimensionally Printed Surgical Guide.

    Science.gov (United States)

    Golab, Adam; Smektala, Tomasz; Krolikowski, Marcin; Slojewski, Marcin

    2016-05-13

    Percutaneous nephrolithotomy (PNL) is an endoscopic technique used for treating large stones, multiple stones, and staghorn calculi. Although minimally invasive, complication rate of PNL reaches 25%, and it is partially associated with needle puncture during nephrostomy tract preparation. Continuous improvement of armamentarium and imaging methods and the introduction of three-dimensional (3D) visualizations optimize the procedure; however, the rapid and precise establishment of the nephrostomy tract is still difficult. In the present short communication, we present the PNL procedure assisted by a personalized 3D-printed surgical guide (SG) to ensure fast and precise needle access to the renal collecting system. We also describe the workflow for SG preparation, which consists of CT image acquisition and data segmentation, planning a safe needle insertion path, SG designing, and guide manufacturing. With the growing market of low-cost 3D printers, the presented technique can shorten the PNL procedure time and decrease the complication rate associated with needle puncture in a cost-efficient manner. © 2016 S. Karger AG, Basel.

  19. Therapeutic effectiveness and safety parathyroid adenoma ablation with percutaneous ethanol injection under sonographic guidance in patients with chronic renal failure and secondary hyperparathyroidism refractory to medical treatment

    International Nuclear Information System (INIS)

    De Nubila, Eduardo; Vega, Jose; Garcia Luz; Murillo, Marlyn; Mercado, Jaime

    2010-01-01

    Secondary hyperparathyroidism unresponsive to medical treatment is a common complication in patients with chronic renal failure and prolonged dialysis therapy, which requires surgery of the parathyroid glands, with the risks and costs of surgery. Objective: To evaluate the therapeutic effectiveness and safety of ablation of parathyroid adenomas by percutaneous ethanol injection under ultrasound guidance. Method: After approval by the institutional medical ethics committee, informed written consent was obtained in 15 patients who met the inclusion criteria. Sonographically guided ethanol was injected consecutively into adenomas, with an interval of time less than six months. Results: Size, Doppler vascularity of adenomas, and the levels of parathyroid hormone, calcium and phosphorus were measured before and after ablation as criteria for treatment response in 15 patients. Of all patients, six (40%) had no therapeutic response. Therapeutic response was observed in nine patients (60%). In the latter group, five patients (33.3%) had successful response and symptomatic improvement, in two patients (13.3%), therapeutic response was suboptimal, and in two patients (13.3%), the response was unsatisfactory. The procedure was safe. Local pain, transient dysphonia and cough were considered minor complications and were the most common, with resolution in all cases. There were no major complications. Conclusion: Ablation of parathyroid adenomas with percutaneous ethanol injection and ultrasound guidance, in uremic patients with secondary hyperparathyroidism unresponsive to medical treatment is an effective and safe therapy. Studies involving more patients and longer follow up are needed in order to stablish more conclusive results

  20. Ultrasound-guided percutaneous biopsy in lytic bone lesions

    International Nuclear Information System (INIS)

    Garcia, J.H.; Lazaro, S. de; Gil, S.; Gomez, F.; Gonzalez, M.; Ambit, S.; Piqueras, R.; Bardon, F.

    1996-01-01

    Percutaneous biopsy (PB) of bone lesions is a widely used diagnostic technique that involves fluoroscopic or computerized tomography guidance. Among the bone lesions that can be studied by biopsy, the most common types in practice are lytic lesions composed to some degree of soft tissue. The objective of this report is to propose the use of ultrasonography (US) inthe guidance of PB in this type of lesions. We employed US to guide PB of lytic bone lesions in 62 patients. The lesions were located as follows; rib (n=3D23), dorsal vertebra (n=3D10), lumbarvertebra (n=3D5), sacrum (n=3D2), ilium (n=3D7), sternum (n=3D5), humerus (n=3D3),femur (n=3D3), ischium (n=3D2), sternoclavicular joint (n=3D1) and clacaneus (n=3D1). The definitive diagnosis was metastasis of diverse origin in 36 cases, lung carcinoma in 7, plasmacytoma in 6, myeloma in 1, Ewing's tumor in 2. non-Hodgkin's lymphoma in 2, neuro fibrosarcoma in 1, sarcoma in 1, osteoblastoma in 1, desmoplastic fibroma in 1, nonspecific osteomyelitis in3 and inflammatory arthritis in 1. The correct histological diagnosis was obtained in 93.5% of cases. The only complication was a case of minor pneumothorax that did not require drainage. US is a highly safe method of guidance in PB of lytic bone lesions that clearly identifies changes in the cortical tissue and the associated soft tissue component. (Author)

  1. Percutaneous MR-guided cryoablation of prostate cancer: initial experience

    International Nuclear Information System (INIS)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier; Mathelin, Michel de; Jacqmin, Didier; Lang, Herve

    2012-01-01

    We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. (orig.)

  2. Percutaneous MR-guided cryoablation of prostate cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier [University Hospital of Strasbourg, Department of Interventional Radiology, Strasbourg (France); Mathelin, Michel de [University of Strasbourg, Lsiit, Strasbourg (France); Jacqmin, Didier; Lang, Herve [University Hospital of Strasbourg, Department of Urology, Strasbourg (France)

    2012-08-15

    We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. (orig.)

  3. A Swine Model of Percutaneous Intracoronary Ethanol Induced Acute Myocardial Infarction and Ischemic Mitral Regurgitation.

    Science.gov (United States)

    Shi, Weiwei; McIver, Bryant V; Kalra, Kanika; Sarin, Eric L; Schmarkey, Susan; Duggan, Michael; Thourani, Vinod H; Guyton, Robert A; Padala, Muralidhar

    2017-08-01

    Ischemic mitral regurgitation (IMR) is a frequent complication after a myocardial infarction (MI), which doubles mortality. Transcatheter mitral repairs are emerging as alternative treatment options to open heart surgery for IMR, but animal models to test them are lacking. We report a percutaneous swine model of IMR. Seventeen swine were randomized to (group 1, n = 12) MI causing IMR, and (group 2, n = 5) controls. In group 1, MI was induced via percutaneous ethanol injection into the obtuse marginal branches of the left circumflex artery, resulting in ST elevating myocardial infarction. Nine animals were survived to 8-10 weeks with weekly echocardiograms and three swine were survived to 16-20 weeks with MRI at termination. In group 1 animals, average IMR fraction at termination was 26.6 ± 2.3% in the echo group, and 24.51 ± 0.41% in the MRI group. None of the animals in group 2 had IMR. Left ventricular dysfunction and significant dilatation were evident in group 1 animals, compared to the controls. In conclusion, a reproducible model of IMR is reported for use in pre-clinical testing of new mitral technologies.

  4. In vitro percutaneous absorption enhancement of propranolol hydrochloride through porcine epidermis by terpenes/ethanol.

    Science.gov (United States)

    Zhao, K; Singh, J

    1999-12-06

    The purpose of this study was to investigate the mechanism(s) of percutaneous absorption enhancement of propranolol hydrochloride (PHCL) across porcine epidermis by terpenes (e.g. menthone and limonene) in combination with ethanol. The in vitro percutaneous absorption experiments were performed using Franz diffusion cells. The solubility of PHCL in control and enhancer solutions was determined through high-performance liquid chromatography. Partitioning of PHCL to powdered SC from control or enhancer solutions was also determined in order to investigate the binding of PHCL to the SC from the SC/enhancer system. Fourier transform infrared spectroscopy (FT-IR) was employed to study the biophysical changes in stratum corneum (SC) lipids. The in vitro macroscopic barrier properties were investigated by measuring transepidermal water loss (TEWL) using Tewameter. Five percent menthone or limonene in combination with ethanol (EtOH) (menthone/EtOH or limonene/EtOH) significantly increased (P<0.05) the flux of PHCL through porcine epidermis in comparison to the control (EtOH). The partitioning of PHCL to the SC from the SC/enhancer system was also significantly greater than the SC/control system. The above enhancers showed a decrease in the peak heights and areas for both asymmetric and symmetric C-H stretching absorbances in comparison with the untreated SC, indicating the SC lipids extraction. Menthone/EtOH and limonene/EtOH enhanced (P<0.05) the in vitro TEWL through the epidermis in comparison to the control. Thus, an enhancement in the flux of PHCL by menthone/EtOH and limonene/EtOH is due to SC lipid extraction, macroscopic barrier perturbation, and improvement in the partitioning of the drug to the SC.

  5. Cohort study of lumbar percutaneous chemonucleolysis using ethanol gel in sciatica refractory to conservative treatment.

    Science.gov (United States)

    Touraine, Sébastien; Damiano, Joël; Tran, Olivia; Laredo, Jean-Denis

    2015-11-01

    To investigate the efficacy of percutaneous chemonucleolysis using ethanol gel (PCEG) in alleviating radicular pain due to disc herniation after failure of conservative treatment. After failure of conservative treatment, PCEG was performed under fluoroscopic guidance in 42 patients with sciatica >4/10 on a Visual Analog Scale (VAS) for at least 6 weeks and consistent disc herniation on MRI or CT <3 months. The VAS pain score was determined at baseline, then after 1 and 3 months. We assessed the influence of patient-related factors (age, gender, pain duration) and disc herniation-related factors (level, migration pattern, disc herniation-related spinal stenosis) on outcome of PCEG. Mean pain duration was 6.7 months. Pain intensity decreased by 44% and 62.6% after 1 and 3 months, respectively, versus baseline (P = 0.007). A mild improvement was noted by the rheumatologist in 30/42 (71.4%) and 36/42 (85.7%) patients after 1 and 3 months, respectively, and in 31/42 (73.8%) and 33/42 (78.6%) patients by self-evaluation. Patients who failed PCEG were significantly older (49.8 vs. 37.3 years, P = 0.03). None of the other variables studied were significantly associated with pain relief. PCEG may significantly improve disc-related radicular pain refractory to conservative treatment. • Percutaneous chemonucleolysis using ethanol gel (PCEG) is feasible on an outpatient basis. • PCEG improves disc-related radicular pain refractory to conservative treatment. • PCEG is feasible on an outpatient basis. • Failure of PCEG does not interfere with subsequent spinal surgery.

  6. Image-guided Percutaneous Transhepatic Removal of Fish Bone from Liver Abscess.

    Science.gov (United States)

    Lau, Chin Wah; Wong, Kang Min; Gogna, Apoorva

    2017-02-01

    We present a case of a woman who was diagnosed with a hepatic abscess secondary to a migrated fish bone. As the patient did not improve after percutaneous drainage of the abscess, image-guided percutaneous transhepatic removal of the fish bone was performed. Fish bones in hepatic abscesses are typically removed surgically, with the fish bone left in situ in a number of cases. There has been only another reported case of percutaneous transhepatic fish bone removal. We conclude that in the rare case of a hepatic abscess complicating fish bone migration, image-guided percutaneous transhepatic removal of the offending foreign body is a feasible alternative to surgery, especially in high surgical risk patients.

  7. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    Science.gov (United States)

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms. Copyright 2015, SLACK Incorporated.

  8. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    José L. Arias-Buría

    2015-01-01

    Full Text Available Objective. To compare effects of ultrasound- (US- guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n=17 group or exercise (n=19 group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions. Shoulder pain (NPRS and disability (DASH were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P<0.01: individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  9. Outpatient percutaneous treatment of deep venous malformations using pure ethanol at low doses under local anesthesia

    Directory of Open Access Journals (Sweden)

    José Luiz Orlando

    2010-01-01

    Full Text Available INTRODUCTION: Venous malformations are the most frequent vascular malformation. Deep venous malformations are located in subcutaneous tissue or in the muscles. Percutaneous sclerotherapy is the treatment of choice, and the use of ethanol at low doses has not yet been described. OBJECTIVE: To analyze the results of treating Deep venous malformations patients with low doses of ethanol. METHODS: Thirty-nine patients treated between July 1995 and June 2007 were followed up prospectively over a median period of 18 months. Twenty-nine were female (74.4% and 10 were male (25.6%, with ages ranging from 11 to 59 years (median of 24 years. All of the lesions affected limbs, and the main symptom reported was pain (97.4%. Each patient underwent fortnightly alcohol application sessions under local anesthesia on an outpatient basis. The lesions were classified into three groups according to size using nuclear magnetic resonance imaging: small, up to 3 cm (4 patients; medium, between 3 and 15 cm (27 patients; and large, greater than 15 cm (8 patients. RESULTS: The symptoms completely disappeared in 14 patients (35.9% and improved in 24 (61.5%. The lesion size reduced to zero in 6 patients (15.4% and decreased in 32 (82%. The median number of sessions was 7. There were no complications in 32 patients (82%, while 3 presented local paresthesia (7.7%, 2 superficial trombophlebites (5.1%, 1 skin ulcer (2.6%, and 1 case of hyperpigmentation (2.6%. CONCLUSION: Outpatient treatment for Deep venous malformations patients using ethanol at low doses was effective, with a low complication rate.

  10. Determining the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position

    OpenAIRE

    Sharma, Gyanendra; Sharma, Anshu

    2015-01-01

    Introduction: Optimal renal access is necessary for ensuring a successful and complication-free percutaneous nephrolithotomy. We describe a technique to determine the angle and depth of puncture for fluoroscopy-guided percutaneous renal access in the prone position. Materials and Methods: Forty-two consecutive patients undergoing percutaneous nephrolithotomy from January 2014 had a fluoroscopy-guided access in the prone position. Using the bull′s eye technique, the site of skin puncture ...

  11. Feasibility and effectiveness of image-guided percutaneous biopsy of the urinary bladder.

    Science.gov (United States)

    Butros, Selim Reha; McCarthy, Colin James; Karaosmanoğlu, Ali Devrim; Shenoy-Bhangle, Anuradha S; Arellano, Ronald S

    2015-08-01

    To evaluate the indications, technique, results, and complications of image-guided percutaneous biopsy of the urinary bladder. This retrospective study included 15 patients (10 male, 5 female) who underwent image-guided percutaneous biopsy of the urinary bladder between January 1999 and December 2013. The medical records, imaging studies, procedural details, and long-term follow-up of each patient were reviewed in detail to assess the feasibility of percutaneous bladder biopsy. Ten patients had focal bladder masses and 5 patients had asymmetric or diffuse bladder wall thickening. Eleven patients had either negative or unsatisfactory cystoscopies prior to the biopsy. Percutaneous biopsies were performed under computed tomography guidance in 12 patients and ultrasound in 3 patients. All procedures were technically successful and there were no procedural complications. Malignancy was confirmed in 8 patients, among whom 6 had transitional cell carcinoma, 1 cervical cancer, and 1 prostate cancer metastasis. Seven patients had a benign diagnosis, including 3 that were later confirmed by pathology following surgery and 2 patients with a false-negative result. The overall sensitivity was 80% and accuracy was 87%. Image-guided percutaneous biopsy of the urinary bladder is a safe and technically feasible procedure with a high sensitivity and accuracy rate. Although image-guided bladder biopsy is an uncommon procedure, it should be considered in selected cases when more traditional methods of tissue sampling are either not possible or fail to identify abnormalities detected by cross-sectional imaging.

  12. Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy.

    Science.gov (United States)

    Sconfienza, Luca Maria; Randelli, Filippo; Sdao, Silvana; Sardanelli, Francesco; Randelli, Pietro

    2014-08-01

    Calcific tendinopathy of the rotator cuff is a common condition. Ultrasound-guided percutaneous aspiration is one of several options to treat this condition. The main advantages of this procedure are short duration, good outcome, and low cost. Furthermore, only minor complications have been reported in the literature, namely, vagal reactions during the procedure and mild postprocedural pain. We report the first case of septic bursitis after ultrasound-guided percutaneous treatment of calcific tendinopathy. Although this is generally considered a very safe procedure, a risk of infection should be taken into account. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  13. Absolute Ethanol Embolisation of Mandibular Arteriovenous Malformations Following Direct Percutaneous Puncture and Release of Coils via a Microcatheter.

    Science.gov (United States)

    Wang, D; Su, L; Han, Y; Wang, Z; Zheng, L; Fan, X

    2017-06-01

    To evaluate the safety, efficacy, and medium-term outcome of a modified technique of ethanol embolisation of mandibular arteriovenous malformations (AVMs) following a direct percutaneous transvenous approach to the release of coils via a microcatheter. From January 2012 to July 2014, 18 consecutive patients (mean age 20.9 years [range 10-35 years]) with symptomatic AVMs of the mandible were enrolled. A microcatheter was inserted into the lesion via a direct percutaneous puncture needle. Electrolytically detachable coils and 0.018 mm coils were super-selectively placed to decrease the flow and volume of the arteriovenous fistulas via a microcatheter. Absolute ethanol was injected to obliterate the fistulas. Clinical follow-up was performed in all patients. Therapeutic outcomes were determined by evaluating the degree of devascularisation at follow-up angiography and symptoms and signs. Transvenous release of coils combined with absolute ethanol embolisation were used in all cases. The amount of ethanol used ranged from 5 to 50 mL (mean 25.7 mL) in a single session. Sixteen of 18 patients were cured, and two had partial remission. Follow-up times ranged from 8 to 26 months (medium 15.7 months), and there was no angiographic recurrence of the lesions. Minor complication occurred in five of the 18 patients. There were no major complications. Absolute ethanol embolisation following a direct percutaneous transvenous approach to release coils via a microcatheter is a feasible, safe, and highly effective method for the management of mandibular AVMs. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  14. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

    Directory of Open Access Journals (Sweden)

    Chiang Jeng Tyng

    2013-06-01

    Full Text Available Objective To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and Methods In the period from June 2011 to May 2012, seven computed tomography-guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results In all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible.

  15. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

    International Nuclear Information System (INIS)

    Tyng, Chiang Jeng; Bitencourt, Almir Galvao Vieira; Almeida, Maria Fernanda Arruda; Barbosa, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Junior, Joao Paulo Kawaoka Matushita; Chojniak, Rubens; Coimbra, Felipe Jose Fernandez

    2013-01-01

    Objective: to describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and methods: in the period from June 2011 to May 2012, seven computed tomography guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results: in all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion: Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible. (author)

  16. Cohort study of lumbar percutaneous chemonucleolysis using ethanol gel in sciatica refractory to conservative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Touraine, Sebastien; Tran, Olivia; Laredo, Jean-Denis [Hopital Lariboisiere, AP-HP, Radiologie Osteo-Articulaire, Paris Cedex 10 (France); Damiano, Joel [Hopital Lariboisiere, AP-HP, Rhumatologie, Centre Viggo-Petersen, Paris Cedex 10 (France)

    2015-11-15

    To investigate the efficacy of percutaneous chemonucleolysis using ethanol gel (PCEG) in alleviating radicular pain due to disc herniation after failure of conservative treatment. After failure of conservative treatment, PCEG was performed under fluoroscopic guidance in 42 patients with sciatica >4/10 on a Visual Analog Scale (VAS) for at least 6 weeks and consistent disc herniation on MRI or CT <3 months. The VAS pain score was determined at baseline, then after 1 and 3 months. We assessed the influence of patient-related factors (age, gender, pain duration) and disc herniation-related factors (level, migration pattern, disc herniation-related spinal stenosis) on outcome of PCEG. Mean pain duration was 6.7 months. Pain intensity decreased by 44 % and 62.6 % after 1 and 3 months, respectively, versus baseline (P = 0.007). A mild improvement was noted by the rheumatologist in 30/42 (71.4 %) and 36/42 (85.7 %) patients after 1 and 3 months, respectively, and in 31/42 (73.8 %) and 33/42 (78.6 %) patients by self-evaluation. Patients who failed PCEG were significantly older (49.8 vs. 37.3 years, P = 0.03). None of the other variables studied were significantly associated with pain relief. PCEG may significantly improve disc-related radicular pain refractory to conservative treatment. (orig.)

  17. A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma.

    Science.gov (United States)

    Welch, B T; Eiken, P W; Atwell, T D; Peikert, T; Yi, E S; Nichols, F; Schmit, G D

    2017-06-01

    Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma. Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)]. Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract. Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

  18. A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Welch, B. T., E-mail: Welch.brian@mayo.edu; Eiken, P. W.; Atwell, T. D. [Mayo Clinic, Department of Radiology (United States); Peikert, T. [Mayo Clinic, Department of Pulmonary and Critical Care Medicine (United States); Yi, E. S. [Mayo Clinic, Department of Pathology (United States); Nichols, F. [Mayo Clinic, Department of Thoracic Surgery (United States); Schmit, G. D. [Mayo Clinic, Department of Radiology (United States)

    2017-06-15

    PurposeMesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma.Materials and MethodsRetrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)].ResultsPercutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract.ConclusionPercutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

  19. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    Science.gov (United States)

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  20. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Tomohiro; Morishita, Hiroyuki; Lida, Shigeharu; Asai, Shunsuke; Masui, Koji; Sato, Osamu (Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan)), Email: t-matsu@koto.kpu-m.ac.jp; Yamagami, Takuji; Nishimura, Tsunehiko (Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan)); Yamazoe, Shoichi (Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan))

    2012-02-15

    Background. Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. Purpose. To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. Material and Methods. Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. Results. An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. Conclusion. CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess

  1. Management of lithiasis in pelvic kidney through laparoscopy-guided percutaneous transperitoneal nephrolithotripsy

    OpenAIRE

    Alesse R. dos Santos; Delson C. B. Rocha Filho; Luis C. F. Tajra

    2004-01-01

    We report the case of a patient with pain and an abdominal palpable mass whose tests showed a left pelvic kidney with a 1.5-cm stone in the renal pelvis. We describe the successful management through videolaparoscopy-guided percutaneous transperitoneal nephrolithotripsy, stressing that this method is a therapeutic option in such cases.

  2. Management of lithiasis in pelvic kidney through laparoscopy-guided percutaneous transperitoneal nephrolithotripsy

    Directory of Open Access Journals (Sweden)

    Alesse R. dos Santos

    2004-02-01

    Full Text Available We report the case of a patient with pain and an abdominal palpable mass whose tests showed a left pelvic kidney with a 1.5-cm stone in the renal pelvis. We describe the successful management through videolaparoscopy-guided percutaneous transperitoneal nephrolithotripsy, stressing that this method is a therapeutic option in such cases.

  3. Management of lithiasis in pelvic kidney through laparoscopy-guided percutaneous transperitoneal nephrolithotripsy.

    Science.gov (United States)

    Dos Santos, Alesse R; Rocha Filho, Delson C B; Tajra, Luis C F

    2004-01-01

    We report the case of a patient with pain and an abdominal palpable mass whose tests showed a left pelvic kidney with a 1.5-cm stone in the renal pelvis. We describe the successful management through videolaparoscopy-guided percutaneous transperitoneal nephrolithotripsy, stressing that this method is a therapeutic option in such cases.

  4. Identifying pathogens of spondylodiscitis: percutaneous endoscopy or CT-guided biopsy.

    Science.gov (United States)

    Yang, Shih-Chieh; Fu, Tsai-Sheng; Chen, Lih-Huei; Chen, Wen-Jer; Tu, Yuan-Kun

    2008-12-01

    Identifying offending pathogens is crucial for appropriate antibiotic administration for infectious spondylitis. Although computed tomography (CT)-guided biopsy for bacteriologic diagnosis is a standard procedure, it has a variable success rate. Some reports claim percutaneous endoscopic discectomy and drainage offer a sufficient amount of tissue for microbiologic examination and easy application. We therefore compared the diagnostic value of CT guidance with that of endoscope guidance in 52 patients with suspected infectious spondylitis. Twenty patients underwent percutaneous endoscopic discectomy and drainage by an orthopaedic surgeon and the other 32 patients underwent CT-guided biopsies by a radiologist. Patients were followed a minimum of 12 months after treatment. Culture results of the biopsy specimens were recorded. Causative bacteria were identified more frequently with percutaneous endoscopy than in CT-guided biopsy (18 of 20 [90%] versus 15 of 32 [47%]). We observed no biopsy-related complications or side effects in either group. The data suggest percutaneous endoscopic discectomy and drainage yield higher bacterial recovery rates than CT-guided spinal biopsy. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  5. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Asai, Nobuhiro; Ohkuni, Yoshihiro; Kaneko, Norihiro; Aoshima, Masahiro; Yamazaki, Ikuo; Kawamura, Yasutaka, E-mail: nobuhiro0204@hotmail.com [Kameda Medical Center, Chiba (Japan)

    2013-03-15

    Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported. We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients' characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years ({+-}18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intraabdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection. (author)

  6. Computed tomography-guided percutaneous core needle biopsy of deep seated bone lesions in two dogs

    International Nuclear Information System (INIS)

    Mori, T.; Sakaida, M.; Yamada, M.; Akiyama, H.; Takai, Y.; Sakai, H.; Maruo, K.

    2006-01-01

    Computed Tomography (CT)-guided percutaneous core needle biopsies were undertaken for the diagnosis of osteosarcoma in the pelvis (case 1) and myeloma (case 2) in the seventh lumber vertebra which were difficult to targeted by palpation, ultrasound or fluoroscopy. In both cases, enough tissue for pathological diagnosis were obtained without any complication. CT-guided biopsy was thought to be a safe, easy and effective technique for the evaluation of the deep seated bone lesion

  7. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation.

    Science.gov (United States)

    Honda, Yohsuke; Araki, Motoharu; Yamawaki, Masahiro; Tokuda, Takahiro; Tsutumi, Masakazu; Mori, Shinsuke; Sakamoto, Yasunari; Kobayashi, Norihiro; Hirano, Keisuke; Ito, Yoshiaki

    2018-04-01

    The aim of this study was to assess clinical benefit of the Echo-guided ProGlide technique in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). The efficacy of the Echo-guided ProGlide technique during percutaneous TF-TAVI was not previously clarified. A total of 121 consecutive patients who underwent percutaneous TF-TAVI at our institution between February 2014 and July 2017 were enrolled in this study. According to the introduction of this novel technique in March 2016, patients were divided into two groups (echo-guided group who underwent TAVI from March 2016 to July 2017, n = 63; not echo-guided group who underwent TAVI from February 2014 to February 2016, n = 58). The incidence of major vascular complications, defined per the Valve Academic Research Consortium-2 criteria, and ProGlide complications including acute femoral artery stenosis or occlusion and bleeding requiring any intervention. The incidence of major vascular complication and ProGlide complication were significantly lower in the echo-guided group than in not echo-guided group (1.6% vs 17.2%, P guided ProGlide technique was independently associated with prevention of ProGlide complications (odds ratio, 0.11; 95% confidential interval, 0.01-0.76; P = 0.03). This novel Echo-guided ProGlide technique was associated with a lower rate of major vascular complications, particularly ProGlide complications during percutaneous TF-TAVI. © 2017, Wiley Periodicals, Inc.

  8. Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang Jeng; Santos, Erich Frank Vater; Guerra, Luiz Felipe Alves; Bitencourt, Almir Galvao Vieira; Barbosa, Paula Nicole Vieira Pinto; Chojniak, Rubens [A. C. Camargo Cancer Center, Sao Paulo, SP (Brazil); Universidade Federal do Espirito Santo (HUCAM/UFES), Vitoria, ES (Brazil). Hospital Universitario Cassiano Antonio de Morais. Radiologia e Diagnostico por Imagem

    2017-03-15

    Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications. (author)

  9. CT-guided percutaneous treatment of osteoid osteoma

    International Nuclear Information System (INIS)

    Mazoyer, J.F.; Kohler, R.; Bossard, D.

    1990-01-01

    The authors of this paper report seven cases of percutaneous destruction of osteoid osteoma. All patients complained of typical pain lasting for several months. In each case, finding of plain radiography, bone scintigraphy, and CT were strongly suggestive of an osteoid osteoma. All the lesions were located on the lower limb (five femoral and two tibial). Under general anesthesia, the nidus was drilled through a trocar inserted percutaneously with CT guidance. Patients were discharged 1-3 days after the procedure with no residual pain, and they are still asymptomatic 18-33 months later, with normal scintigraphic and CT studies. Histologic confirmation was allowed by technical improvement of the method in the last four cases

  10. MR-guided percutaneous cryotherapy of liver metastases

    International Nuclear Information System (INIS)

    Haage, P.; Tacke, J.

    2001-01-01

    The prognosis for patients with liver metastases depends on the therapeutic options regarding the treatment of the primary tumor, co-existing extrahepatic metastases and the extent and treatment possibilities of the hepatic metastases themselves. Numerous curative or palliative oncological therapeutic concepts have been introduced in case of non-resectable liver metastases to prolong survival while maintaining a highest possible quality of life. Cryotherapy, which can be performed percutaneously and under magnetic resonance guidance, is one of these manifold therapeutic modalities, combining the inherent advantages of MRI with minimal invasiveness. Excellent visualization of the frozen liver tissue, precise tumor ablation, as well as an almost painless intervention due to the analgetic effect of the ice are implicating percutaneous cryotherapy as an attractive alternative to other ablation techniques. First clinical results are promising. However, meticulous and extensive long-term evaluation on a broad clinical scale is required. (orig.) [de

  11. Realtime ultrasound guided percutaneous tracheostomy in emergency setting: the glass ceiling has been broken.

    Science.gov (United States)

    Ravi, Parli Raghavan; Vijai, M N; Shouche, Sachin

    2017-01-01

    In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature. We report our early experience with USPCT in emergency setting. Sixteen adult patients who required access to an emergency surgical airway after failure to accomplish emergency oro-tracheal intubation were the study population. Their airway was accessed by USPCT. Recorded data included clinical and demographic data including time taken to perform the procedure and complications. Short term and long term follow ups for a period of 2 years were done for the survivors. Twelve male and four female patients underwent the procedure and the average time of the procedure was 3.6 min with no failures nor conversions to surgical tracheostomy and no complications. The average oxygen saturation was 86% and average Glasgow coma scale was 8.4. This time period included the oxygen insufflation time. 10 patients were decannulated while six patients died due to the pathology of the disease itself. There were no complications in either short term or long term follow up. USPCT has a definitive role in emergency both in trauma and non-trauma setting. It is safe, feasible and faster in experienced hands. Use of USPCT in emergency setting has further narrowed the list of contraindications of percutaneous tracheostomy.

  12. Image-guided percutaneous disc sampling: impact of antecedent antibiotics on yield

    International Nuclear Information System (INIS)

    Agarwal, V.; Wo, S.; Lagemann, G.M.; Tsay, J.; Delfyett, W.T.

    2016-01-01

    Aim: To evaluate the effect of antecedent antimicrobial therapy on diagnostic yield from percutaneous image-guided disc-space sampling. Materials and methods: A retrospective review of the electronic health records of all patients who underwent image-guided percutaneous sampling procedures for suspected discitis/osteomyelitis over a 5-year period was performed. One hundred and twenty-four patients were identified. Demographics, medical history, and culture results were recorded as well as duration of presenting symptoms and whether antecedent antibiotic therapy had been administered. Results: Of the 124 patients identified who underwent image-guided percutaneous disc-space sampling, 73 had received antecedent antibiotic treatment compared with 51 who had not. The overall positive culture rate for the present study population was 24% (n=30). The positive culture rate from patients previously on antibiotics was 21% (n=15) compared with 29% (n=15) for patients who had not received prior antibiotic treatment, which is not statistically significant (p=0.26). Eighty-six percent (n=63) of patients who had antecedent antibiotics received treatment for 4 or more days prior to their procedure, whereas 14% (n=10) received treatment for 1–3 days prior to their procedure. The difference in culture positivity rate between these two groups was not statistically significant (p=0.43). Culture results necessitated a change in antibiotic therapy in a third of the patients who had received antecedent antibiotic therapy. Conclusion: Antecedent antibiotic therapy, regardless of duration, did not result in significantly diminished diagnostic yield from percutaneous sampling for suspected discitis/osteomyelitis. The present results suggest that percutaneous biopsy may nonetheless yield positive diagnostic information despite prior antimicrobial therapy. If the diagnostic information may impact choice of therapeutic regimen, percutaneous biopsy should still be considered in cases where

  13. Fatal paradoxical pulmonary air embolism complicating percutaneous computed tomography-guided needle biopsy of the lung

    International Nuclear Information System (INIS)

    Chakravarti, Rajesh; Singh, Virendra; Isaac, Rethish; John, Joseph

    2004-01-01

    A 63-year-old man with left upper zone haziness on chest X-ray and an infiltrative lesion with a pleural mass in the left upper lobe on CT scan was scheduled for CT-guided percutaneous trans-thoracic needle biopsy. During the procedure, the patient had massive haemoptysis and cardiorespiratory arrest and could not be revived. Post-mortem CT showed air in the right atrium, right ventricle, pulmonary artery and also in the left atrium and aorta. A discussion on paradoxical air embolism following percutaneous trans-thoracic needle biopsy is presented Copyright (2004) Blackwell Publishing Asia Pty Ltd

  14. Ultrasound guided percutaneous removal of wooden foreign bodies in the extremities with hydro-dissection technique

    Energy Technology Data Exchange (ETDEWEB)

    Park, HeeJin; Lee, So Yeon; Chung, Eun Chul; Rho, Myung Ho [Dept. of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Lee, Sung Moon; Son, Eun Seok [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Lee, Sun Joo [Dept. of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan (Korea, Republic of)

    2015-12-15

    We described the technique of ultrasound (US)-guided percutaneous removal of the foreign bodies (FB) with hydro-dissection in the radiologic department and presented video files of several cases.Four patients referred to the radiology department for US evaluation and US-guided percutaneous removal of the FBs in the upper and lower extremities between November, 2006 and November, 2013 were included in this study. The procedures started with US evaluation for the exact location and shape of the FB. A 5 mm-sized skin incision was made at the site of the nearest point from the FB where no passing arteries or tendons were present. We adopted a hydro dissection technique to separate the FB from adjacent tissue using a 2% lidocaine solution. Injected anesthetics detached the FBs from surrounding tissue and thereby facilitated removal. After the tip of the mosquito forceps reached the FB, the wooden FBs were removed. The mean time required for the entire procedure was approximately 20 minutes. There were no significant complications during the US-guided removal or long-term complications after the procedure. All 4 FBs were successfully removed from the soft tissue under US guidance. Ultrasound-guided percutaneous removal of the FBs with hydro-dissection in the radiology department is a less invasive and safe method over surgical removal in the operating room. Additionally, the use of a guide wire and serial dilator may help minimize soft tissue injury and facilitate the introduction of forceps.

  15. Point-of-Care Ultrasound-Guided Percutaneous Cannulation of Extracorporeal Membrane Oxygenation: Make it Simple.

    Science.gov (United States)

    Ahn, Hong Joon; Lee, Jun Wan; Joo, Ki Hyuk; You, Yeon Ho; Ryu, Seung; Lee, Jin Woong; Kim, Seung Whan

    2017-12-30

    Cannulation of the great vessels is required for extracorporeal membrane oxygenation (ECMO). Currently, there is no guideline for optimal imaging modalities during percutaneous cannulation of ECMO. The purpose of this study was to describe percutaneous cannulation guided by point-of-care ultrasound (POCUS) for ECMO and compare it with fluoroscopy and landmark guidance. Three groups (POCUS-, fluoroscopy-, and landmark-guided) of percutaneous cannulation for ECMO were analyzed retrospectively in a tertiary academic hospital. In the POCUS-guided group, visual confirmation of guidewire and cannula by ultrasound in both the access and return cannula were essential for successful cannulation. Fluoroscopy- and landmark-guided groups were cannulated with the conventional technique. A total of 128 patients were treated by ECMO during the study period, of which 94 (73.4%) cases were venoarterial ECMO. This included 56 cases of extracorporeal cardiopulmonary resuscitation. Also, there were 30 (23.4%) cases of venovenous ECMO and 4 (3.1%) cases of venoarteriovenous ECMO. A total of 71 (55.5%) patients were cannulated under POCUS guidance, and 43 (33.6%) patients were cannulated under fluoroscopy guidance and 14 (10.9%) patients were cannulated by landmark guidance. No surgical cut downs were required. Misplacement of cannula occurred in 3 (2.3%) cases. All three occurred in the landmark-guided group. POCUS-guided cannulation is comparable to fluoroscopy-guided cannulation in terms of avoiding cannula misplacement. In our experience, POCUS-guided cannulation is a useful strategy over fluoroscopy- and landmark-guided cannulation during peripheral ECMO. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism

    Science.gov (United States)

    Choi, Kyu Sung; Kim, Ji Dae; Min, Sang-Il; Min, Seung-Kee; Jae, Hwan Jun; Chung, Jin Wook

    2015-01-01

    Objective To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). Materials and Methods Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. Results Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications. Conclusion Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients. PMID:26175572

  17. Ultrasound-guided percutaneous transhepatic biliary drainage: Experiences in 146 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jai Keun [Sohwa Children' s Hospital, Seoul(Korea, Republic of); Yu, Jeong Sik; Kim, Ki Whang; Chung, Soo Yoon; Jeong, Mi Gyoung [Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Deuk Lin; Kwon, Gui Hyang; Lee, Hae Kyung [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1999-03-15

    Percutaneous biliary drainage is an important technique for palliative therapy of obstructive biliary disease and diagnostic information. The purpose of this study is to review and evaluate the experiences of ultrasound-guided percutaneous transhepatic biliary drainage. Ultrasound-guided percutaneous transhepatic biliary drainage was performed on 146 occasions in 134 patients. The causes of biliary obstruction were: benign diseases (19 cases, 14.2%) such as bile duct stones or stricture, cholangiocarcinoma (37 cases, 27.6%), pancreatic carcinoma (35 cases, 26.1%), metastasis (22 cases, 16.5%), gall bladder cancer (14 cases, 10.4%), ampulla of Vater cancer (4 cases, 3.0%), hepatocellular carcinoma (3 cases, 2.2%). Retrospectively reviewing medical records, we found out frequency of external or external/internal biliary drainages, puncture of left or right hepatic duct, and presence of bileinfection. Ultrasound-guided percutaneous transhepatic biliary drainage was compared with conventional biliary drainage of previous reports on the basis of frequency of complications. External (124 procedures, 84.9%) and external/internal biliary drainage (22 procedures, 15.1%) were carried out by puncture of dilated right (59.6%) or left (40.4%) intrahepatic duct. Sixty-nine complications occurred in 47 patients. Catheter related complications (33/69, 47.8%) were most common: catheter dislodgement (17/69, 24.6%), malfunction (9/69, 13.1%), leakage (7/69, 10.1%). Other minor complications such as simple fever (16/69, 23.2%), cholangitis (7/69, 10.1%), hemobilia (4/69, 5.8%), biloma (2/69, 2.9%) and wound infection (1/69, 1.5%) occurred. Major complications including sepsis (4/69, 5.8%) and bile peritonitis (2/69, 2.9%) were also noted. Puncture-related complications such as hemobilia, biloma and bile peritonitis occurred in 8 cases (5.5%). Comparing with conventional X-ray guided drainage, ultrasound-guided percutaneous transhepatic biliary drainage is a safe procedure for

  18. Percutaneous ethanol sclerotherapy for recurrent adventitial cystic disease of external iliac vein after surgical treatment: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Ann, Jun Hyung; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2015-12-15

    Adventitial cystic disease (ACD) is a rare, but well-characterized vascular disease. It is most commonly seen in the popliteal artery, but it has also been reported in the venous system. The most commonly involved segment has been the common femoral vein; the disease resulted in luminal compromise and extremity swelling. We report here on a case of percutaneous aspiration and ethanol sclerotherapy for recurrent ACD after surgery of the external iliac vein in a 70-year-old man who presented with a painless swelling of his left leg.

  19. Fractional Flow Reserve-guided Percutaneous Coronary Intervention: Standing the Test of Time

    Directory of Open Access Journals (Sweden)

    Frederik M. Zimmermann, MD

    2016-05-01

    Full Text Available Percutaneous coronary intervention (PCI improves symptoms and prognosis in ischemia-inducing, functionally significant, coronary lesions. Use of fractional flow reserve allows physicians to investigate the ischemia-inducing potential of a specific lesion and can be used to guide coronary revascularization, especially in multivessel coronary artery disease. Fractional flow reserve-guided PCI has been extensively investigated. Results show that deferral of stenting in non-significant lesions is safe, whereas deferral of stenting in functionally significant lesions worsens outcome. FFR-guided PCI improves outcome in multivessel disease over angiography-guided PCI. Until recently, there was little known about the long-term outcome of FFR-guided revascularization and its validity in acute coronary syndromes. This review aims to address the new evidence regarding long-term appropriateness of FFR-guided PCI, the need for hyperemia to evaluate functional severity, and the use of FFR in acute coronary syndromes.

  20. Analysis of diagnositc accuracy with CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Haiyan; Zhuang Yiping; Zhang Jin; Feng Yong; Zhang Xiao; Xu Lin

    2007-01-01

    Objective: To evaluate the factors which may affect the diagnostic accmracy of CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions. Methods: CT-guided percutaneous transthoracic lung biopsy was performed in 264 patients, all of which were proved by surgical pathology or clinical follow-up. A logistic regression analysis was used to investigate the relationship between the location and the size of the lesions and insertion depth of biopsy needles and the diagnostic accuracy of CT-guided percutaneous transthomcic lung biopsy. The complication rate including pneumatothorax and bleeding rate were record. Results: The diagnostic accuracy was 87.5%. Both the pneumothorax and the bleeding of lesion were 1.9%. The size of lesion was suggested by Logistic regression analysis had a significant influence on the diagnostic accuracy (Wald=12.891, P=0.00034, OR=0.96). Conclusion: CT-guided pereumneous transthoracic lung biopsy has a high diagnostic accuracy for pulmonary lesions. The size of the lesions had significant effect on the diagnostic accuracy. (authors)

  1. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

    Energy Technology Data Exchange (ETDEWEB)

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvao Vieira; Matushita Junior, Joao Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens, E-mail: macellomaciel@me.com [A.C.Camargo Cancer Center, Sao Paulo, SP (Brazil)

    2014-09-15

    Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paraesthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. (author)

  2. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications.

    Science.gov (United States)

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvão Vieira; Matushita Junior, João Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens

    2014-01-01

    To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p guided procedures (p = 0.011). CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.

  3. Multiple Large Splenic Abscesses Managed with Computed Tomography-guided Percutaneous Catheter Drainage in Children

    Directory of Open Access Journals (Sweden)

    Jung Sook Yeom

    2013-12-01

    Full Text Available Splenic abscess is a rare finding in children. Splenectomy combined with broad-spectrum antibiotics has been the treatment of choice for multiple splenic abscesses. Herein, we report the case of a 14-year-old girl with multiple large splenic abscesses that were successfully managed after two image-guided percutaneous drainage procedures and administration of intravenous antibiotics. Initially, an abscess located at the periphery in the lower pole of the spleen was aspirated under ultrasound guidance. Finally, another abscess located near the hilum of the spleen was drained under computed tomography guidance. To the best of our knowledge, this is the first report of multiple large splenic abscesses treated with computed tomography-guided percutaneous drainage.

  4. Ultrasound-Guided Percutaneous Drainage of Neonatal Pyometrocolpos Under Local Anesthesia

    International Nuclear Information System (INIS)

    Algin, Oktay; Erdogan, Cuneyt; Kilic, Nizamettin

    2011-01-01

    Hydrometrocolpos is an uncommon congenital disorder with cystic dilatation of the vagina and uterus that occurs as a result of accumulated secretions from the reproductive tract due to distal genital tract obstruction. Secondary infection may also occur, resulting in pyometrocolpos, a potentially lethal disease. Immediate drainage of the cystic mass in patients determined to have pyometrocolpos is required to prevent or treat uropathy and septicemia until definitive corrective surgery can be performed. We report an unusual cause of obstructive uropathy in three infants: pyometrocolpos due to lower genital tract atresia. Ultrasound-guided percutaneous drainage of the pyometrocolpos resulted in dramatically improved clinical and laboratory findings in these patients. Ultrasound-guided percutaneous drainage under local anesthesia is a simple, minimally invasive, safe, and effective procedure that facilitates later successful corrective surgery and avoids the need for more complex drainage procedures.

  5. Efficacy of Ablation Therapy for Secondary Hyperparathyroidism by Ultrasound Guided Percutaneous Thermoablation.

    Science.gov (United States)

    Zhao, Junfeng; Qian, Linxue; Zu, Yuan; Wei, Ying; Hu, Xiangdong

    2016-05-01

    The objective of this study was to explore the value of ultrasound-guided percutaneous microwave thermoablation to treat secondary hyperparathyroidism (SHPT). One hundred and thirty-eight parathyroid glands from 56 patients with SHPT were ablated in this study. All the parathyroid glands were evaluated by real-time contrast-enhanced ultrasound before, during and after ablation. Changes in serum parathyroid hormone (sPTH) levels were measured before treatment and at 1 h, 1 wk, 1 mo and 6 mo after thermoablation treatment. All 56 cases had a 1-mo follow-up, and 34 cases had a 6-mo follow-up. The sPTH level of the 54 cases 1 mo after ablation was significantly lower than that before (p 0.05). Ultrasound-guided percutaneous microwave thermoablation is a feasible and effective non-surgical alternative treatment for SHPT patients. Copyright © 2016. Published by Elsevier Inc.

  6. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

    OpenAIRE

    Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M.; Hata, Nobuhiko; Fischer, Gregory S.

    2014-01-01

    This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian...

  7. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    Energy Technology Data Exchange (ETDEWEB)

    Becce, Fabio, E-mail: fabio.becce@chuv.ch [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Mouhsine, Elyazid [Clinique Hirslanden Bois-Cerf, Department of Orthopaedic Surgery (Switzerland); Mosimann, Pascal John; Anaye, Anass [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Letovanec, Igor [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (Switzerland); Theumann, Nicolas [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland)

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  8. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    International Nuclear Information System (INIS)

    Becce, Fabio; Mouhsine, Elyazid; Mosimann, Pascal John; Anaye, Anass; Letovanec, Igor; Theumann, Nicolas

    2012-01-01

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography—guided retrograde drilling and debridement.

  9. CT-guided percutaneous radiofrequency ablation of hepatic malignancies located in unusual regions under general anesthesia

    International Nuclear Information System (INIS)

    Pan Jie; Chen Shaohui; Lu Xin; Mao Yilei; Sang Xinting; Chen Fang; Li Yumei; Huang Yuguang; Jin Zhengyu

    2010-01-01

    Objective: To discuss the feasibility of CT-guided percutaneous radiofrequency ablation (RFA) of liver malignancies located in unusual regions under general anesthesia, and to assess its clinical value. Methods: Eighteen patients with a total of 26 malignant hepatic lesions were enrolled in this study. The lesions were located at diaphragmatic surface, hepatic hilum, hepatic subcapsular site,side of inferior vena cava, side of gallbladder or near by colon. Transcatheter arterial chemoembolization was performed in all patients, which was followed by CT-guided percutaneous RFA under general anesthesia. The time used for puncturing and the time used for putting the needles to the scheduled sites were recorded. A follow-up for 115 months was conducted. The complications and the therapeutic results were observed. Results: For all patients,the procedure of puncture and needle placement was completed in 1-3 minutes. A total of 35 RFA procedures were conducted for 26 lesions. No severe complications occurred. Complete necrosis was observed in 20 tumors and partial necrosis in 6 tumors. Conclusion: The result of this study indicates that CT-guided percutaneous RFA under general anesthesia is a feasible technique for the treatment of liver malignancies located at unusual regions. This technique is very helpful for reducing the manipulating difficulty and lowing the complication risk of RFA procedures. (authors)

  10. Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Lipsich, Jose; Questa, Horacio; Moguillansky, Silvia [Hospital Nacional de Pediatria, Department of Interventional Radiology, Buenos Aires (Argentina); Innocenti, Sergio; Lanfranchi, Lucas [Hospital Nacional de Pediatria, Department of Orthopedics, Buenos Aires (Argentina)

    2006-02-01

    Osteoid osteoma is a painful, benign, small osteogenic bone tumor. For a long time, surgery was the only treatment for these lesions. Different minimally invasive therapeutic techniques have been proposed. We report our experience in the treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children. Over a 5-year period, 18 patients (age range 6-17 years, mean age 11.6 years) with osteoid osteomas (femur, n=10; tibia, n=5; humerus, n=2; vertebral body, n=1) were treated with this technique. All procedures were performed under general anesthesia. All procedures were technically successful. Clinical success was achieved in 94.5% of patients (17/18). Only one patient had recurrence of symptoms 8 months after percutaneous resection and was surgically retreated. There were no complications. CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients. (orig.)

  11. Ultrasound-guided percutaneous drainage of meniscal cysts: preliminary clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    MacMahon, P.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)]. E-mail: petermacmahon@yahoo.com; Brennan, D.D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Duke, D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Forde, S. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Eustace, S.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)

    2007-07-15

    Aim: To evaluate the efficacy of ultrasound-guided percutaneous drainage of symptomatic meniscal cysts. Materials and methods: Patients with lateral knee joint tenderness and swelling and confirmed meniscal cyst on magnetic resonance imaging (MRI) were consecutively enrolled for ultrasound-guided percutaneous cyst aspiration. Cysts were injected with local anaesthetic and steroid before completion of procedure. All 18 patients (all male, average age 33 years) were subsequently followed up (average time 10 months) and meniscal cyst symptoms assessed by questionnaire. Fischer's exact test used to analyse the data. Results: In every case the procedure was well tolerated, and each patient indicated that they would be willing to have a repeat procedure in the future. Ten patients reported complete resolution of symptoms secondary to therapeutic cyst aspiration and had resumed participation in high-performance sport. Two patients reported a satisfactory sustained response, reporting only occasional 'twinges of pain'. In the remaining six patients, symptoms returned after an initial pain-free period. The pain-free period ranged from 1-8 weeks. In this study, patient outcome did not significantly correlate with any meniscal cyst characteristic. Conclusion: Ultrasound-guided percutaneous aspiration of meniscal cysts is a well-tolerated, simple, and safe procedure. In this small patient series, it was associated with positive early results with favourable outcomes in the mid to long-term. It should be considered in patients unsuitable for surgical debridement or as an interim therapy if surgery is delayed or postponed.

  12. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D.; Williams, Roger [Emory University Hospital, Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Lin, Roger C. [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States)

    2015-05-01

    To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as ''burning'' (80%), ''pulling'' (37.5%), ''crushing'' (50%), ''pressure'' (84.5%), ''throbbing'' (50%), ''knife-life'' (52%), and ''other'' (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia. (orig.)

  13. Predicting factors for conversion from fluoroscopy guided Percutaneous transthoracic needle biopsy to cone-beam CT guided Percutaneous transthoracic needle biopsy

    International Nuclear Information System (INIS)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo

    2015-01-01

    To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ 2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in

  14. Ultrasound guided percutaneous fine needle aspiration biopsy of the liver with focal lesion

    International Nuclear Information System (INIS)

    Ko, Gang Seok; Yang, Hyun Cheol; Park, Byoung Lan; Kim, Byoung Geun; Sohn, Jang Sihn

    1985-01-01

    The ultrasound-guided fine needle aspirations were performed in order to diagnose a suspected neoplastic or infectious disease in 52 patients with focal liver disease. Of these, neoplastic lesions were suspected in 31 patients and infectious lesions in 21 patients ultrasonically and/or clinically. The overall accuracy for both suspected malignant and infectious disease was 79% (41/52). The primary indication for fine needle aspiration was to document the presence of malignancy and to avoid a diagnostic laparotomy, and to drain hepatic abscess. Consequently we were convinced that the ultrasound-guided percutaneous fine needle aspiration biopsy in the focal liver disease is the best method for a conclusive diagnosis

  15. Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique

    Directory of Open Access Journals (Sweden)

    Bharat R Dave

    2014-01-01

    Full Text Available Background: Percutaneous aspiration of abscesses under ultrasonography (USG and computer tomography (CT scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. Materials and Methods: Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index score at 2 years. Results: PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts ( n = 2, persistent discharge ( n = 1 for 2 weeks, blocked catheter ( n = 2 and catheter pull out ( n = 1 occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. Conclusions: Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.

  16. Sono-Guided Percutaneous Automated Gun Biopsy in Pediatric Renal Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Chul [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1996-12-15

    To evaluate whether sono-guided percutaneous automated gun biopsy is also useful in pediatricpatients with renal diseases. In the prone position of twenty pediatric patients with renal parenchymal diseases, percutaneous biopsy was done through lateral aspect of the lower pole of left kidney with automated biopsy gun under the guidance of ultrasonography. The biopsy needle was either of 18 or 20 gauge. The obtained core of renal tissue was examined with light, immunofluorescent or electron microscope by the renal pathologist. In 18 among 20 patients, adequate renal tissue core sufficient to be pathologically diagnosed was obtained. The histologic findings were as follows : IG A nephropathy (n = 2), lupus nephritis (n =2), minimal change glomerulonephritis (n = 5), membranoproliferative glomerulonephritis (n = 3), mesangialproliferative glomeru-lonephritis (n = 1), diffuse proliferative glomerulonephritis (n = 3), focalglomerulo-sclerosis (n = 1), membranous glomerulopathy (n = 1). No significant complications occurred during or after the biopsy. Sono-guided percutaneous renal biopsy using automated biopsy gun is also useful todiagnose renal parenchymal diseases without significant complications in pediatric patients

  17. Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe University School of Medicine, Department of Radiology, Ankara (Turkey)

    2005-02-01

    Simple renal cysts are rare in children and managed conservatively unless symptomatic. To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n=1), hypertension (n=1), and increasing cyst size and urinary tract infection (n=1). The mean follow-up period was 5.5 years (range 3-7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up. (orig.)

  18. Radiologically guided percutaneous trephine biopsy of the vertebral column

    Energy Technology Data Exchange (ETDEWEB)

    Rau, W.S.

    1985-07-01

    Roentgenographically visuable lesions of the skeleton are subjected for microscopy, if the nature of the lesion is uncertain. Especially the vertebral column needs a big surgical intervention, if an excision has to be performed. The radiologically guided trephine biopsy, in contrast, is a great facilitation for the patient. Using the Jamshidi-needle, 57 punctures of bone were performed. In 53 cases a reliable pathologic diagnosis was found by microscopy. Bacteriology however, was positiv only in 5 out of 23 cases with spondylitis or spondylodiscitis. No complications were observed..

  19. Clinical application of CT-guided percutaneous puncturing biopsy of subcarinal lymph node

    International Nuclear Information System (INIS)

    Yuan Xiaodong; Wang Jianhua; Zuo Changjing; Tian Jianming

    2011-01-01

    Objective: To discuss the safety and clinical significance of CT-guided percutaneous puncturing biopsy of subcarinal lymph node. Methods: During the period of July 2006-July 2010, CT-guided percutaneous puncturing biopsy of subcarinal lymph node was carried out in 17 patients (11 males and 6 females, with an average age of 54 years) with enlarged subcarinal lymph nodes. The clinical data were retrospectively analyzed. Immediately after the puncturing procedure was completed, CT scanning was performed to observe if there any complications and to evaluate the safety of puncturing biopsy. Biopsy specimens were sent for pathological examination to assess the puncturing accuracy and to make the pathologic diagnosis. The clinical usefulness of this technique was evaluated. Results: Of the total 17 cases, successful puncturing into the enlarged subcarinal lymph nodes with single procedure was achieved in 14 and sufficient tissue sample was obtained. The biopsy failed in three cases at initial puncturing procedure as the needle could not be placed into the enlarged subcarinal lymph nodes, the puncturing biopsy had to given up in two patients because of hemoptysis and in another patient the second puncturing biopsy performed one week later was successful. The total technical successful rate was 88.2% (15/17). Of the fifteen cases with successful puncturing, definitive pathological diagnosis was obtained in 13 and the diagnosis was uncertain in the remaining two, with a diagnosis positive rate of 86.7% (13/15). Pathologically, the diagnoses included metastatic lymphadenopathy from lung cancer (n=10), proliferative inflammatory lymphadenopathy (n=2) and tuberculous enlargement of lymph nodes (n=1). Complications occurred in 4 patients (23.5%, 4/17), which mainly were pneumothorax and pulmonary hemorrhage. Conclusion: With high successful rate and diagnostic accuracy, CT-guided percutaneous puncturing biopsy of subcarinal lymph node is a safe and effective technique if the

  20. Feasibility of virtual 3-Fr percutaneous coronary intervention using standard guiding catheters.

    Science.gov (United States)

    Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji

    2014-01-01

    Recent studies have reported the efficacy of sheathless percutaneous coronary intervention (PCI) using hydrophilic-coated 5-Fr guiding catheters that are one to two Fr sizes smaller in diameter than the corresponding introducer sheath (virtual 3-Fr PCI). However, the limited number of shapes of hydrophilic-coated guiding catheters occasionally makes them difficult to engage and control. To evaluate the efficacy and feasibility of virtual 3-Fr PCI using standard guiding catheters of various shapes. We identified 35 consecutive patients with stable angina, who underwent virtual 3-Fr PCI using either hydrophilic-coated guiding catheters (Works™, Medikit, Japan) or standard guiding catheters (Heartrail™, Terumo, Japan). Thirty-five patients were identified (63% men; mean age 70 ±13 years). In 2 cases, hydrophilic-coated guiding catheters were exchanged to standard guiding catheters because of difficulty in engaging the target coronary arteries. Ultimately, standard guiding catheters were used in 20 patients (57%) and hydrophilic-coated catheters were used in 15 (43%). One of 20 patients treated with standard guiding catheters and 1 of 15 treated with hydrophilic-coated guiding catheters underwent the 4-in-3 "slender mother and child" PCI technique due to difficulty of stent deployment. There were no differences between the two groups in PCI procedural variables such as procedural time, fluoroscopy time, radiation dose, or contrast dye volume. There were no access site-related complications in this study. These findings indicate that virtual 3-Fr PCI using standard guiding catheters is as efficient and safe as virtual 3-Fr PCI using hydrophilic-coated guiding catheters.

  1. Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes.

    Science.gov (United States)

    Sawant, Abhishek C; Bhardwaj, Aishwarya; Banerjee, Kinjal; Jobanputra, Yash; Kumar, Arnav; Parikh, Parth; Kandregula, Krishna C; Poddar, Kanhaiya; Ellis, Stephen G; Nair, Ravi; Corbelli, John; Kapadia, Samir

    2018-02-06

    To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI. Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI. We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected. Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications. © 2018 Wiley Periodicals, Inc.

  2. Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Koshy, Linda M; Aberle, Laura H; Krucoff, Mitchell W; Hess, Connie N; Mazzaferri, Ernest; Jolly, Sanjit S; Jacobs, Alice; Gibson, C Michael; Mehran, Roxana; Gilchrist, Ian C; Rao, Sunil V

    2018-01-01

    This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI). Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown. We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference. Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound. This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.

  3. Ultrasound guided percutaneous treatment and follow-up of Baker's cyst in knee osteoarthritis

    International Nuclear Information System (INIS)

    Köroğlu, Mert; Çallıoğlu, Mehmet; Eriş, Hüseyin Naim; Kayan, Mustafa; Çetin, Meltem; Yener, Mahmut; Gürses, Cemil; Erol, Bekir; Türkbey, Barış; Parlak, Ayşe Eda; Akhan, Okan

    2012-01-01

    Objective: Purpose of this study is to assess sonographic changes and clinical response in different subgroups of Baker's cyst patients with knee osteoarthritis after a single session of ultrasound-guided percutaneous aspiration and corticosteroid injection. Materials and methods: Thirty-two knee osteoarthritis patients (46–85 years, mean 58.97 ± 9.88) with symptomatic Baker's cyst diagnosed at ultrasonography were included in the study. To determine the grade of the symptoms, Visual Analogue Scale was applied. The patients were grouped in two, as simple (n = 24) and complex (n = 8) Baker's cyst. Thirty-two ultrasound-guided cyst aspirations concomitant 1 ml betamethasone injection (24 simple, 8 complex subgroups) were performed. Patients were followed clinically as well as via ultrasonography for 6 months after procedures. Results: A significant decrease in volume of the Baker's cysts after percutaneous treatment was accompanied by a significant clinical improvement. Moreover, the volume reduction of Baker's cyst after the treatment was significantly correlated with the clinical improvement (Pearson correlation coefficient = 0.542, p = 0.001). All 6 Baker's cysts relapsed at ultrasonography were complex type. Furthermore, a comparison of patients with simple Baker's cysts and those with complex Baker's cysts demonstrated no significant change in Visual Analogue Scale scores between two groups (p = 0.061, Mann–Whitney U). No complications (minor or major) occurred secondary to percutaneous treatment. Conclusion: Baker's cysts can be grouped as simple and complex groups via ultrasonography prior to the treatment. Cyst aspiration with ultrasound-guided corticosteroid injection yields clinical improvement and cyst volume reduction in all subgroups of patients with Baker's cyst secondary to knee osteoarthritis.

  4. MR imaging-guided percutaneous cryotherapy for lung tumors: initial experience.

    Science.gov (United States)

    Liu, Shangang; Ren, Ruimei; Liu, Ming; Lv, Yubo; Li, Bin; Li, Chengli

    2014-09-01

    To evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging-guided percutaneous cryotherapy of lung tumors. MR imaging-guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39-79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death. Cryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9-12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%. MR imaging-guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  5. Optical coherence tomography to guide percutaneous treatment of coronary bifurcation disease.

    Science.gov (United States)

    Wolfrum, Mathias; De Maria, Giovanni Luigi; Banning, Adrian P

    2017-09-01

    Cardiovascular disease remains the most common cause of death worldwide. Enormous progress in the technology and applicability of percutaneous techniques to treat obstructive coronary heart disease has been made, and the number of percutaneous coronary interventions (PCI) is increasing. Coronary bifurcations are involved in a substantial number of PCIs and despite recent advances, bifurcation PCI remains a challenge in terms of immediate success and long-term outcome. Angiography has a limited capacity for showing important features of the 3 dimensional coronary vessel anatomy, position of stent struts and exact wire positions and is therefore suboptimal for guiding bifurcation PCI. Intracoronary optical coherence tomography (OCT) provides high resolution and the information gained during PCI is unprecedented compared with angiography guidance and intravascular ultrasound. Areas covered: This review will provide an overview of the use of OCT to guide bifurcation-PCI. Expert commentary: OCT is a promising guide for bifurcation-PCI at each individual step: from planning the strategy (provisional versus two-stent strategy), to guidance during PCI, and finally checking the interventional result. Until dedicated randomized trails are complete, we recommend OCT guidance for interventions in complex coronary bifurcation disease and for imaging when unexpected procedural events occur.

  6. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    International Nuclear Information System (INIS)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A.; Akbar, M.

    2016-01-01

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  7. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A. [Heidelberg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Akbar, M. [Heidelberg Univ. (Germany). Dept. of Orthopaedic Surgery and Rehabilitation Medicine

    2016-12-15

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  8. CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Ju Yong [Busan Wooridul Spine Hospital, Busan (Korea, Republic of); Kim, Jin Sung; Jung, Byung Joo; Lee, Sang Ho [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kang, Ho Yeong [Dongrae Wooridul Spine Hospital, Busan (Korea, Republic of)

    2009-04-15

    Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance

  9. A new 4-DOF parallel robot for MRI-guided percutaneous interventions: Kinematic analysis.

    Science.gov (United States)

    Jin Seob Kim; Levi, David; Monfaredi, Reza; Cleary, Kevin; Iordachita, Iulian

    2017-07-01

    In this paper, we present the concept of a novel 4-DOF parallel robot for MRI-guided percutaneous interventions. This system belongs to the class of patient-mounted robots, with two parallel circular stages along which two actuating joints move. As a first step, we present the concept of the robot and its kinematic analysis. This robot has the potential of increased rigidity and reduced inertial effect compared to its predecessor. It also minimizes the number of moving components, which enhances safety during the robot's operation.

  10. Ultrasonographic-guided, percutaneous antegarde pyelography: technique and clinical application in the dog and cat

    International Nuclear Information System (INIS)

    Rivers, B.J.; Walter, P.A.; Polzin, D.J.

    1997-01-01

    Fluoroscopically guided, percutaneous antegrade pyelography in canine patients has been described previously in the veterinary literature. This report describes the technique with ultrasonographic guidance and its clinical application in the diagnosis of four cases (two dogs, two cats) of obstructive uropathy. The technique provided successful diagnosis of ureteral obstruction in all four cases. No complications were observed in three cases. In one feline case, ureteral obstruction with a blood clot occurred following the procedure; however, it could not be ascertained whether this event represented a complication of the technique

  11. Transradial percutaneous coronary interventions using sheathless guiding catheters: a multicenter registry.

    Science.gov (United States)

    Sciahbasi, Alessandro; Mancone, Massimo; Cortese, Bernardo; Pendenza, Gianluca; Romagnoli, Enrico; Fischetti, Dionigi; Tomassini, Francesco; Sardella, Gennaro; Lioy, Ernesto

    2011-10-01

    Transradial approach (TRA) for percutaneous coronary interventions (PCIs) is a common alternative to transfemoral approach associated with lower complications. However, a limitation of TRA is the use of large caliber guiding catheters due to the small size of the radial artery. The sheathless guiding catheter system that is in diameter 1-2 French (Fr) smaller than the corresponding introducer sheath may overcome these difficulties. From January 2010 through December 2010 in 5 Italian high-volume hospitals, 213 consecutive patients who underwent TRA-PCIs using the sheathless Eaucath guiding catheter system because of small radial artery caliber (Group 1) or undergoing bifurcation PCIs (Group 2) were enrolled in this registry. In patients of Group 1 (n = 79), a 6.5-Fr sheathless guiding catheter was employed, whereas in patients of Group 2 (n = 134) a 7.5 Fr was used. Among the 213 patients enrolled, 270 vessels were treated for 316 lesions. No procedures required conversion to a conventional guiding catheter system. There were significantly more female patients in Group 1, and they were, older, shorter, and thinner than patients in Group 2. No cases of major vascular complications were observed in either groups. During procedures, adjunctive devices employed included intravascular ultrasound, thrombectomy catheters, and distal protection systems. The use of the sheathless guiding catheter system is feasible for TRA-PCIs in case of small radial artery caliber or intended coronary bifurcation intervention. ©2011, Wiley Periodicals, Inc.

  12. CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study

    International Nuclear Information System (INIS)

    Wu, Bin; Xiao, Yue-Yong; Zhang, Xiao; Zhao, Lei; Carrino, John A.

    2011-01-01

    The purpose of this study was to evaluate the safety and efficacy of CT-guided percutaneous cryoablation for osteoid osteoma in children. This study was approved by the institutional ethics committee. From January 2007 to July 2008, six children (four boys, two girls, mean age 12.6 years old) with osteoid osteoma were treated with CT-guided percutaneous cryoablation. The procedures were carried out under conscious sedation and local anesthesia. CT guidance was used for procedural planning, instrument guidance, and monitoring. An argon-based cryoablation system was used. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome for a minimum of 12 months. A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with a t-test. The mean clinical follow-up period was 28.7 months (ranging from 18 to 36 months). Cryoablation was technically and clinically successful for all patients. No major immediate or delayed complications were observed. Significant pain relief (P <0.05) was observed in all patients after operation. Mean VAS were 6.57 ± 0.55 pre-procedure and 0.57 ± 0.10 1 month post-procedure. Patients were allowed to fully bear their weight and function without limitation within 3 days after the procedure. Pain recurrence was not observed in any patient. Percutaneous cryoablation is safe and effective for the treatment of osteoid osteomas in children. Notably, this procedure can be accomplished without general anesthesia. (orig.)

  13. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Kattapuram, Susan V.; Huang, Ambrose J.; Simeone, F.J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Department of Radiology Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

    2017-01-15

    To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence. (orig.)

  14. [Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation].

    Science.gov (United States)

    Buy, Xavier; Cazzato, Roberto Luigi; Catena, Vittorio; Roubaud, Guilhem; Kind, Michele; Palussiere, Jean

    2017-05-01

    Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  15. [Percutaneous CT guided radio-frequency ablation of osteoid osteoma and osteoblastoma].

    Science.gov (United States)

    Liberman, Boaz; Gerniak, Alexander; Eshed, Iris; Chechick, Ahron; Weiss, Israel; Shabshin, Noga

    2010-08-01

    Osteoid osteoma (OO) is a benign osteoblastic bone lesion that causes severe local pain mainly at night, and usually responds to oral administration of NSAID. The lesion is located around the proximal thigh in more than 50% of the cases. Osteoblastoma is similar to OO in their histopathology features, but emerges frequently in the spine, and has a larger diameter than OO. Percutaneous CT-guided radiofrequency ablation (RFA) is becoming the treatment of choice for osteoid osteoma and non-aggressive osteoblastoma in the last decade. During the period 2005-2009, 38 patients were diagnosed with osteoid osteoma (n = 34), and osteoblastoma (n = 4). A total of 34 patients were treated with RFA using a water-cooled, variable ablation size tip. Two patients underwent an open procedure, and 2 had spontaneous remission. Thirty three patients (97%) reported complete remission of their pain after a single treatment; one patient needed a second RFA treatment, and reported full remission of his symptoms after the 2nd treatment. Percutaneous CT-guided radiofrequency ablation of osteoid osteoma and non-aggressive osteoblastoma is simple, safe, and reliable. Meticulous placement of the probe inside the tumor, and the usage of water-cooled, variable ablation size tip, improves the overall outcome and decrease complication rates.

  16. Study of DSA-guided percutaneous puncture location of foramen oval

    International Nuclear Information System (INIS)

    Zhao Xiaojun; He Jiawei; Bai Guanghui; Shi Jianjing; Xu Chongyong; Zhan Gonghao

    2008-01-01

    Objective: To study the technique of digital substraction angiography (DSA)-guided percutaneous puncture location of foramen oval. Methods: 39 cases of trigeminal neuralgia were included in the study from Feb. 2004 to Oct. 2006. The patients were punctured by the amending anterior position. The f0ramen oval was displayed by moving the tube tilted 20-28 degree to the caudal and 16-23 degree to the healthy side. The direction and depth of the needles was determined on the lateral view. Then, radio-frequency thermocoagulation therapy was performed. Results: The needles were located in oval foramen in all the patients. Pain disappeared in 36 cases, alleviated in other cases, and no serious complication occurred during therapy. Conclusions: Oval foramen locations by DSA can improve the successful rate of operation. The foramen oval can be clearly displayed by DSA-guided in amending position, with comfortable position for patients. (authors)

  17. CT-guided percutaneous transthoracic aspiration biopsy of lung lesions: factors influencing the diagnostic accuracy

    International Nuclear Information System (INIS)

    Huang Zhenguo; Zhang Xuezhe; Wang Wu

    2006-01-01

    Objective: To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracic aspiration biopsy of lung lesions. Methods: CT-guided percutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up. Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors (benignancy or malignancy, size, location, depth, presence of cavity), procedure factors (laser-guidance, position of patient) and patient-related factors (sex, age, presence of emphysema); with the accuracy of the diagnosis. Results: 1)289 lesions were diagnosed as malignant ones and 146 as benign ones. The accuracy of CT-guided biopsy was 83.4%(363/435). Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were 88.9%(257/289) and 72.6%(106/146), respectively (χ 2 =18.71, P=0.00002). Laser-group was superior to non-laser group (88.4% versus 80.9%, respectively, χ 2 =4.00, P=0.0456). Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were 3.78±1.64 cm and 3.02±1.26 cm, respectively (F=13.79, P=0.0002). 2)Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses (Wald χ 2 =14.01, P=0.0002) and using laser-guidance(Wald χ 2 =3.92, P=0.0477) were significantly associated with the diagnostic accuracy. Conclusions: Final correct diagnoses (benign, malignant) are closely related to the application of laser-guidance for determining the diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy. (authors)

  18. Conversion of Gasoline Engines to Use Ethanol as the Sole Fuel. Instructor's Guide.

    Science.gov (United States)

    Mishler, Glenn; Spignesi, Bill

    This instructor's guide contains materials that are intended for use as part of the regular auto mechanics curriculum and that provide information necessary to convert a gasoline engine with a niminum of modifications to successfully be operated on ethanol alcohol. It accompanies a student guide that is available separately. Contents include a…

  19. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention

    Science.gov (United States)

    Bakkaloglu, Huseyin; Yanar, Hakan; Guloglu, Recep; Taviloglu, Korhan; Tunca, Fatih; Aksoy, Murat; Ertekin, Cemalettin; Poyanli, Arzu

    2006-01-01

    AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia. METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases. RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 × 103 ± 1.3 × 103 μg/L vs 13 × 103 ± 1 × 103 μg/L, P < 0.05 for 24 h after PC; 13.7 × 103 ± 1.3 × 103 μg/L vs 8.3 × 103 ± 1.2 × 103 μg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2 ± 18.5 mg/L vs 27.3 ± 10.4 mg/L, P < 0.05 for 24 h after PC; 51.2 ± 18.5 mg/L vs 5.4 ± 1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38 ± 0.35°C vs 37.3 ± 0.32°C, P < 0.05 for 24 h after PC; 38 ± 0.35°C vs 36.9 ± 0.15°C, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter. CONCLUSION: As an alternative to surgery, percutan-eous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low

  20. Percutaneous cryoablation of prostate cancer guided by rectal ultrasound: a retrospectively analysis of 42 cases

    International Nuclear Information System (INIS)

    Xing Wenge; Guo Zhi; Wang Haitao; Liu Fang; Li Baoguo; Yu Haipeng; Li Yong

    2008-01-01

    Objective: To evaluate the effectiveness and safety of rectal ultrasound-guided agon-hilium percutaneous cryoablation in treatment of patients with median and or late-stage prostate cancer patients. Methods: Retrospectively analysis of 42 cases of with stage C and D prostate cancer patients treated by rectal ultrasound-guided argon-hilium percutaneous cryoablation during the follow-up of 1-12 months. The prostate specific antigen (PSA), biochemical progression-free survival (bPFS), PSA objective response, transrectal ultrasound of the prostate (TRUS), TRUS-guided biopsy of the prostate, the maximum urinary flow rate(MFR), MRI examination at before, and 3,6,12 months after cryoablation were recorded and evaluated. The results were statistically evaluated by using variance analysis. Results: The PSA value at before and 3,6, 12 months after cryoablation were (4.48±1.35), (3.54±1.67), (3.18±1.76), (2.87±1.89) μg/L, respectively; TRUS-measured prostate volumes at before and 3, 6,12 months after cryoablation were (59.7± 8.2), (46.9±8.3), (26.2±3.9), (25.9±3.7) mm 3 , respectively; MFR before and 3, 6,12 months after cryoablation were (10.4±0.8), (14.3±1.2), (18.3±1.3), (18.9±1.3) ml/s, respectively; Compared with before cryoablation, the differences between before and after cryoablation was statistically significant (F= 53.93,747.92,3843.03, respectively, P<0.01). The bPFS rates in 3 months,6 months and 12 months were 95.2% (40/42), 95.2% (40/42), and 90.5% (38/42), respectively. According to the PSA response, the total effective rate (CR 16 cases, PR 15 cases) at 12 months was 73.8%, and SD was 16.7% (7/42), PD was 9.5% (4/42). Complications included temporary incontinence 2.4% (1/42), Penile tingling/numbness 2.4% (1/42), pelvic pain 4.9% (2/41) and Scrotum Edema 2.4% (1/42). There was no case with severe complications such as severe infection or urethrorectal fistula, etc. Conclusions: Rectal ultrasound-guided agon-hilium percutaneous cryoablation showed

  1. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Akio, E-mail: a.akahane@gmail.com; Kato, Kenichi, E-mail: kkato@iwate-med.ac.jp; Suzuki, Michiko, E-mail: mamimichiko@me.com [Iwate Medical University School of Medicine, Department of Radiology (Japan); Sone, Miyuki, E-mail: msone@me.com [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Tanaka, Ryoichi, E-mail: rtanaka@iwate-med.ac.jp; Nakasato, Tatsuhiko, E-mail: nakasato@iwate-med.ac.jp; Ehara, Shigeru, E-mail: ehara@iwate-med.ac.jp [Iwate Medical University School of Medicine, Department of Radiology (Japan)

    2016-02-15

    PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

  2. Simple localization of peripheral pulmonary nodules - CT-guided percutaneous hook-wire localization

    International Nuclear Information System (INIS)

    Poretti, F.P.; Vorwerk, D.; Brunner, E.

    2002-01-01

    Background: Video-assisted thoracoscopic surgery (VATS) is an alternative approach to small intrapulmonary nodules, if transbronchial or percutaneous biopsy have failed. We investigated the feasibility and effectiveness of the percutaneous CT-guided placement of hook-wires to localize such nodules before video-assisted thoracoscopy. Subjects and Methods: 19 patients with new by diagnosed intrapulmonary nodules underwent CT-guided hook-wire localization by application of a X-Reidy-Set (Cook, Inc., Bjaeverskov, Denmark). The average age of the patient was 63 years (range: 19-80 years), the mean distance between the nodule and the pleura visceral was 7.58 mm (range: 0-25 mm) and the mean diameter was 11.58 mm (range: 5-25 mm). After localization, the patients underwent a VATS resection of the lesion within a mean time of 30 min (range 10-48 min). Results: In all cases, resection of the nodules was successful. In 4 older patients the marking was complicated by poor cooperability. At the end of manipulation the end of the hook was distanced from the nodule. But also in these cases, resection was successfully performed. 8 patients developed an asymptomatic pneumothorax: 5 of them in a minor (max. 1.5 cm rim), three of them in a moderate (max. 3 cm rim) dimension. In 4 patients, in whom the tumor was hit directly by the needle, local bleeding occurred. In one case, haemoptoe was present. In no patient did a dislocation of the hookwire-system occur. Conclusion: CT-guided placement of a hook-wire system is a simple and reasonable procedure which facilitates safe VATS resection of small pulmonary nodules. (orig.) [de

  3. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Ojala, Risto; Kerimaa, Pekka; Tervonen, Osmo; Blanco-Sequeiros, Roberto [Oulu University Hospital, Department of Radiology, Oulu (Finland); Lakovaara, Martti [Oulu Deaconess Institute, Department of Surgery, Oulu (Finland); Hyvoenen, Pekka; Lehenkari, Petri [Oulu University Hospital, Department of Surgery, Oulu (Finland)

    2011-06-15

    The purpose of this study was to evaluate the feasibility of a new method for osteochondritis dissecans (OCD) treatment. Ten OCD lesions of the knee unresponsive to conservative management were treated with MRI-guided percutaneous retrograde drilling to reduce symptoms and promote ossification of the lesion. All lesions were located in distal femoral condyles. Only stable OCD lesions were included (preprocedural MRI grade I or II). Five lesions were of juvenile type and five lesions were of adult type OCD. All the patients had severe limitation of activity due to the OCD-related pain. By using a 0.23 T open MRI scanner and spinal anesthesia, percutaneous retrograde drilling of the OCD lesions was performed (3 mm cylindrical drill, one to three channels). Optical tracking and MRI imaging were used to guide instruments during the procedure. Mean postprocedural clinical follow-up time was 3 years. Eight patients had a post-procedural follow-up MRI within 1 year. All the OCD lesions were located and drilled using the 0.23 T open MRI scanner without procedural complications. All the patients had pain relief, mean visual analog score (VAS) declined from 6 to 2. Follow-up MRI showed ossification in all lesions. Eight patients could return to normal physical activity with no or minor effect on function (Hughston score 3-4). Treatment failed in two cases where the continuation of symptoms led to arthroscopy and transchondral fixation. MR-guided retrograde OCD lesion drilling is an accurate, feasible, and effective cartilage-sparing techique in OCD management. (orig.)

  4. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the knee

    International Nuclear Information System (INIS)

    Ojala, Risto; Kerimaa, Pekka; Tervonen, Osmo; Blanco-Sequeiros, Roberto; Lakovaara, Martti; Hyvoenen, Pekka; Lehenkari, Petri

    2011-01-01

    The purpose of this study was to evaluate the feasibility of a new method for osteochondritis dissecans (OCD) treatment. Ten OCD lesions of the knee unresponsive to conservative management were treated with MRI-guided percutaneous retrograde drilling to reduce symptoms and promote ossification of the lesion. All lesions were located in distal femoral condyles. Only stable OCD lesions were included (preprocedural MRI grade I or II). Five lesions were of juvenile type and five lesions were of adult type OCD. All the patients had severe limitation of activity due to the OCD-related pain. By using a 0.23 T open MRI scanner and spinal anesthesia, percutaneous retrograde drilling of the OCD lesions was performed (3 mm cylindrical drill, one to three channels). Optical tracking and MRI imaging were used to guide instruments during the procedure. Mean postprocedural clinical follow-up time was 3 years. Eight patients had a post-procedural follow-up MRI within 1 year. All the OCD lesions were located and drilled using the 0.23 T open MRI scanner without procedural complications. All the patients had pain relief, mean visual analog score (VAS) declined from 6 to 2. Follow-up MRI showed ossification in all lesions. Eight patients could return to normal physical activity with no or minor effect on function (Hughston score 3-4). Treatment failed in two cases where the continuation of symptoms led to arthroscopy and transchondral fixation. MR-guided retrograde OCD lesion drilling is an accurate, feasible, and effective cartilage-sparing techique in OCD management. (orig.)

  5. Comparison of two percutaneous tracheostomy techniques, guide wire dilating forceps and Ciaglia Blue Rhino: a sequential cohort study.

    NARCIS (Netherlands)

    Fikkers, B.G.; Staatsen, M; Lardenoije, S.G.; Hoogen, F.J.A. van den; Hoeven, J.G. van der

    2004-01-01

    INTRODUCTION: To evaluate and compare the peri-operative and postoperative complications of the two most frequently used percutaneous tracheostomy techniques, namely guide wire dilating forceps (GWDF) and Ciaglia Blue Rhino (CBR). METHODS: A sequential cohort study with comparison of short-term and

  6. Successful Percutaneous Retrieval of a Guiding Catheter Tip that Had Unexpectedly Become Detached Using a Two-Wire Technique.

    Science.gov (United States)

    Kume, Kiyoshi; Yasuoka, Yoshinori; Sasaki, Tatsuya

    2016-12-01

    Device dislodgement during percutaneous coronary intervention (PCI) is a rare but potentially life-threatening complication. We herein report the successful retrieval of a guiding catheter tip that had unexpectedly become detached in the right coronary artery during PCI in a 68-year-old man. Interventional cardiologists must be familiar with a safer and more reliable retrieval technique.

  7. Image-guided percutaneous management of duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP): assessment of efficacy and safety.

    Science.gov (United States)

    McCarthy, C J; Butros, S R; Dawson, S L; Arellano, R S

    2018-03-01

    To evaluate the efficacy and safety of image-guided percutaneous drain placement for duodenal perforation following endoscopic retrograde cholangiopancreatography (ERCP). A retrospective review of 7,249 ERCP examinations over a 10-year period was performed to identify cases of duodenal perforation. Indications for ERCP were documented, along with the clinical, laboratory, and imaging findings following perforation. Technical and clinical success of percutaneous drain placement was reviewed. Duodenal perforation occurred in 35 of 7,249 patients during the study period. Management included primary surgical debridement (n=2), conservative management consisting of bowel rest, nasogastric/nasojejunal tube placement (n=20), and percutaneous catheter drainage (n=13). Twenty-seven percutaneous drainage catheters were placed in 13 patients, with a mean duration of catheter drainage of 30.9 days (range 4-108 days). Ten patients were successfully treated with percutaneous management alone, and three required subsequent surgical intervention. Percutaneous management of duodenal perforation related to ERCP is associated with high technical and clinical success, and may obviate the need for surgical intervention. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  8. CT-guided percutaneous vertebroplasty for the treatment of metastases in the cervical spine

    International Nuclear Information System (INIS)

    Wang Jianhua; Wang Zhentang; Zuo Changjing; Shao Chenwei; Chen Wei; Lv Taozhen; Dong Aisheng

    2009-01-01

    Objective: To assess the clinical efficacy and complications of CT-guided percutaneous vertebroplasty in the treatment of metastases of the cervical spine, and to discuss the proper needle path for different cervical vertebra. Methods: CT-guided percutaneous vertebroplasty was performed in 17 patients with cervical vertebral metastatic neoplasm, and the results of the treatment were retrospectively analyzed. Close observation was carded out after the procedure and a follow-up of 3-17 months was conducted. A comparison of the visual analogue pain scale (VAS) and Frankel's classification between pre-and post- operation was made. The occurrence of complications was recorded. The optimal needle path was summarized. Results: (1) The successful puncture was achieved in all 17 cases. The needle pathway included: the front of carotid sheath (n=4), between carotid sheath and vertebral artery (n=11) and behind the vertebral artery and carotid sheath (n=2). (2) Before the procedure the VAS was 7.24 ± 1.01, and at the time of one hour, one week and three months after the procedure it was decreased to 3.24 ± 1.09, 2.40 ± 0.80 and 1.82 ± 0.53 respectively. Wilcoxon signed-rank test showed that the difference in VAS between pre-and post- operation was statistically significant (T=76.5, P 2 =4.52, P=0.033 and P<0.05 when Kruskal-Wallis test was adopted. (3) CT scanning immediately after the procedure showed that slight leakage of cement to the adjacent disc, epidural fat, parosteal tissue or to the needle path occurred in 35.3% with no serious complications. In a follow-up period of 3-17 months, the metastatic lesions remained stable in 14 cases (82.4%). Conclusion: (1) The optimal needle path for upper cervical vertebrae is posterolateral transpedicular approach while for the lower cervical vertebrae it is more reasonable to puncture via the front carotid sheath or between carotid sheath and vertebral artery. Nevertheless, the puncture pathway should be devised individually

  9. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  10. 4-year experience with percutaneous US-guided radiofrequency ablation of kidney tumors

    International Nuclear Information System (INIS)

    Salagierska-Barwinska, A.; Salagierski, M.; Salagierski, M.

    2007-01-01

    The past decades have significantly changed the diagnosis and management of kidney tumors. There is a growing trend for a less invasive therapeutic approach. The study seeks to present our experience with a number of patients who underwent percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) of renal masses. From July 2002 to December 2006, RFA was carried out in 55 selected patients with an enhancing kidney tumor on computed tomography (CT). The procedure was performed under conscious sedation. The patients were at risk for surgery or had a remaining kidney. Monopolar Cool-tip Tyco or bipolar Celon Olympus RFA devices under US-guidance (convex 3.5 MHz) were used. Abdominal 3-phase multi-slice computed tomography (MSCT) was performed 3, 6 and 12 months post RFA and once yearly thereafter. At a mean follow up of 25 months (range, 6-53 months), 52 of the 55 tumors showed no contrast enhancement on CT. Three incompletely ablated tumors were successfully treated with the second RFA. There were no major complications in any procedure and intervention was well tolerated. So far we have observed one metastasis to a homolateral adrenal gland which was revealed on MSCT. Percutaneous RFA is a minimally invasive technique which appears to be a promising alternative for patients with small renal tumors. 3-phase MSCT improves the imaging of renal masses, enabling not only optimal treatment planning but also a reliable monitoring of tumor destruction after RFA. (author)

  11. Ultrasonography-guided percutaneous radiofrequency ablation of hepatocellular carcinomas: A feasibility scoring system for planning sonography

    Energy Technology Data Exchange (ETDEWEB)

    Rhim, Hyunchul, E-mail: rhimhc@skku.ed [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Choi, Dongil; Kim, Young-sun; Lim, Hyo K. [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Choe, Bong-Keun [Department of Preventive Medicine, Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    Purpose: This study was designed to evaluate whether a feasibility scoring system for planning sonography is a reliable predictor of a safe and complete ablation in ultrasonography (US)-guided percutaneous radiofrequency ablation (RFA) of hepatocellular carcinomas (HCCs). Materials and methods: We retrospectively evaluated the therapeutic outcomes of 108 consecutive patients (M:F, 78:30; mean age, 57.4 years) with a single nodular HCC (mean diameter, 2.0 cm) treated by percutaneous RFA. All patients were assessed for the feasibility of performing an RFA at planning sonography prior to the ablation. The feasibility scoring system consisted of five categories: the safe electrode path (P); the vital organs adjacent to the RFA zone (O); tumor size (S); tumor conspicuity (C); and the heat-sink effect (H). Each category was divided into a four-point scale [1-4]. If a score of 4 in any category was determined, the patient was not considered to be a suitable candidate for percutaneous RFA. We assessed if the score of each category, safety score (P + O), and curability score (S + C + H) correlated with a safe and complete ablation using the chi-squared test and likelihood ratio test for trend. Results: The technical success rate was 100% (108/108) based on CT images obtained immediately after ablation. There was no 30-day mortality after RFA. There were major complications (one case of severe vasovagal reflex, one case of hemoperitoneum and one case of a pseudoaneurysm) in three (2.7%) patients, and minor complications (one case of a biloma, one case of subsegmental infarction and one case of abscess) in three (2.7%) patients. Post-ablation syndrome as a side effect was noted in 38 (35.1%) of 108 patients. The primary technique effectiveness rate at 1 month was 95.1% (105/108). Local tumor progression was noted in eight (7.6%) of 105 patients during the follow-up period (range, 3.0-11.5 months; median, 5.8 months; mean, 5.7 months). There was no significant single category

  12. Image-guided Percutaneous Drainage for Treatment of Post-Surgical Anastomotic Leak in Patients with Crohn's Disease.

    Science.gov (United States)

    Byrne, James; Stephens, Ryan; Isaacson, Ari; Yu, Hyeon; Burke, Charles

    2016-01-01

    Anastomotic leaks with abscess formation are a common complication after bowel surgery in Crohn's disease patients. Image-guided percutaneous drainage is an attractive alternative to reoperation because of decreased morbidity and length of hospital stay. Because data for this specific population are scarce, the purpose of this study is to determine the safety and efficacy of image-guided percutaneous drainage in the management of post-surgical anastomotic leak in patients with Crohn's disease. A total of 41 patients who underwent percutaneous drain placement for the treatment of fluid collections due to anastomotic leak from September 2004 to November 2013 were retrospectively identified from the electronic medical record and picture archiving and communication system. Data recorded included number, size, and location of anastomotic leaks, number of drains placed, number of follow-up visits, post-drainage complications, abscess resolution, and subsequent surgeries. In all, 41 patients with 76 fluid collections were identified as having received percutaneous drains. The mean number of targeted fluid collections per patient was 1.5, and the mean duration between surgery and percutaneous drain placement was 18.5 days. The mean number of drains placed was 1.6, and the median drain size was 10 French [range 8-16 French]. One of 41 [2.4%] patients experienced a minor complication from drain placement [injury to a superficial abdominal artery] and no major complications occurred. Two of 41 [4.9%] patients required repeat surgeries. Image-guided percutaneous drainage for the treatment of post-surgical anastomotic leaks in Crohn's patients is effective and safe, with low rates of complications and reoperations. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  13. Endoscopic ultrasound-guided ethanol ablation of pancreatic neuroendocrine tumours: A case study and literature review.

    Science.gov (United States)

    Armellini, Elia; Crinò, Stefano F; Ballarè, Marco; Pallio, Socrate; Occhipinti, Pietro

    2016-02-10

    Here we offer a review of the literature regarding endoscopic ultrasound-guided ethanol ablation for pancreatic neuroendocrine tumours and describe the case of a cystic tumour completely ablated after a multisession procedure. A total of 35 PubMed indexed cases of treated functioning and non-functioning pancreatic neuroendocrine tumours resulted from our search, 29 of which are well-documented and summarised. Endoscopic ultrasound-guided ethanol ablation appears as a local, minimally invasive treatment of pancreatic neuroendocrine tumours, suitable for selected patients. This technique appears feasible, relatively safe and efficient, especially when applied to symptom relief in functioning tumours, aiming at loss of endocrine secretion. For non-functioning tumours, where the goal is complete tissue ablation, eus guided ethanol ablation can provide good results for patients who are unfit for surgery or for those who refuse surgical resection. Its role in "fit for surgery" patients requires assessment through further studies.

  14. Short-term complications for percutaneous ultrasound-guided biopsy of renal masses in adult outpatients

    DEFF Research Database (Denmark)

    Rasmussen, Lars René; Loft, Martina; Nielsen, Tommy Kjærgaard

    2018-01-01

    Background Ultrasound-guided percutaneous kidney tumor biopsy (UGPKB) plays an important role in the diagnosis of renal tumor but there are no consensuses with respect to the length and the extend of the post-biopsy observation period. Purpose To assess the short-term complication rate after UGPKB...... and to evaluate whether the onset of complications allows for the procedure to be performed in an outpatient setting with same-day discharge. Material and Methods Between March 2012 and March 2014, a total of 287 UGPKB were performed in an outpatient setting at a Danish university referral center. All patient...... records were retrospectively reviewed and post-biopsy complications as well as biochemical parameters were registered. Results The overall complication rate was 3.8% (11 patients). Major complications occurred in 1.0% of all cases (three patients); one patient with ongoing bleeding that required...

  15. Endoscopic computerized tomography guided percutaneous trans-gastric drainage: A case report on this hybrid approach

    Directory of Open Access Journals (Sweden)

    Nobuhiro Tsutsui

    2016-01-01

    A 69-year-old man underwent a pancreaticoduodenectomy for cancer of the inferior section of the common bile duct. Postoperative day 5, the amylase value of the drainage fluid was 1,232 IU/L, we diagnosed a pancreatic fistula developed as a result of pancreaticojejunal anastomotic failure and we performed drainage at the drain which was placed in the foramen of Winslow intraoperatively, however fluid collection dorsal to the stomach was detected on a follow-up abdominal CT scan, and the fluid was a high value of amylase, we judged the drain was not working well and the pancreatic fistula occured. Endoscopy-assisted, CT-guided percutaneous transgastric drainage was therefore performed, and the pancreatic fistula was successfully closed the fistula.

  16. Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience

    International Nuclear Information System (INIS)

    Lencioni, R.; Pinto, F.; Armillotta, N.; Bassi, A.M.; Moretti, M.; Di Giulio, M.; Marchi, S.; Uliana, M.; Della Capanna, S.; Lencioni, M.; Bartolozzi, C.

    1997-01-01

    The objective of our work was to evaluate the long-term results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in patients with liver cirrhosis. A total of 184 cirrhotic patients with HCC underwent PEI as the only anticancer treatment over an 8-year period. Patients were followed after therapy by means of clinical examinations, laboratory tests, and US and CT studies performed at regular time intervals. Survival rates were determined according to the Kaplan-Meier method. The overall survival was 67% at 3 years, 41% at 5 years, and 19% at 7 years. The 3-, 5-, and 7-year survival rates of patients with single HCC≤3 cm (78, 54, and 28%, respectively) were significantly higher (p<0.01) than those of patients with single HCC of 3.1-5 cm (61, 32, and 16, respectively) or multiple HCCs (51, 21, and 0%, respectively). Survival of Child-Pugh A patients (79% at 3 years, 53% at 5 years, and 32% at 7 years) was significantly longer (p<0.01) than that of Child-Pugh B patients (50% at 3 years, 28% at 5 years, and 8% at 7 years). A selected group of 70 patients with Child-Pugh A cirrhosis and single HCC≤3 cm had a 7-year survival of 42%. Long-term survival of cirrhotic patients with HCC treated with PEI is comparable to that reported in published series of matched patients submitted to surgical resection. (orig.)

  17. Percutaneous CT-Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis.

    Science.gov (United States)

    García-Barquín, Paula; Aquerreta Beola, Jesús Dámaso; Bondía Gracía, José María; España Alonso, Agustín; Pérez Cajaraville, Juan; Bartolomé Leal, Pablo; Bastarrika, Gorka

    2017-06-01

    To evaluate the benefits of computed tomography (CT)-guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy. A total of 139 procedures in 108 patients (mean age, 29.89 y ± 10.94), including 50 men and 58 women, with PPHH and therapy-resistance of nonsurgical treatments were retrospectively analyzed. Treatment was performed bilaterally at T2, T3, and T4 levels, reaching 90°C during 8 minutes. Technical success, immediate efficacy, and presence of complications were analyzed. For follow-up, the Hyperhidrosis Disease Severity Scale was used to evaluate the hyperhidrosis before, at one month, and in the long-term through a survey of 42 patients. Patients' satisfaction and complications were also recorded. The technical success rate was 98.56%. The increase in palmar skin temperature was 4.88°C ± 1.85. A total of 85.3% of participants had completely dry hands immediately after treatment. The mean follow-up time was 41.34 months (range, 6-62 mo). One month after treatment, the response rate was 77.38% (P hyperhidrosis at long-term follow-up. Percutaneous CT-guided sympathicolysis is a safe and effective technique for the treatment of PPHH and can be considered as a second choice in patients in whom other nonsurgical therapeutic options have failed, despite the compensatory hyperhidrosis rates. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  18. Computed tomography-guided percutaneous microwave ablation treatment for lung metastases from nasopharyngeal carcinoma.

    Science.gov (United States)

    Qi, H; Wan, C; Li, X; Zhang, L; Song, Z; Fan, W

    2015-12-01

    The objective of this retrospective study was to evaluate the safety and efficacy of percutaneous microwave ablation (MWA) for treating lung metastases from nasopharyngeal carcinoma (NPC). From December 2012 to November 2014, 17 patients (15 males, and two females, averaged 45.7 years old) with lung metastases from NPC accepted computed tomography (CT)-guided percutaneous MWA. The average number of lung metastases was 1.7 (range: 1-4), and the biggest tumor diameter was 4.2 cm (range: 0.8-4.2 cm). Nineteen nodules located in the right lung and 10 nodules located in the left lung. A total of 29 ablation sites were performed to 29 lung metastases in 22 MWA sessions. Postoperative assessments of complete tumor necrosis rate, safety, local tumor progression, and survival period were carried out. Of the 29 lesions, complete response was achieved for 27 lesions; residual tumor was found in one lesion 3 months postoperatively; and another lesion was found enlarged 3-month postoperatively with obvious enhancement. Four patients had a small amount of postoperative parenchyma bleeding and two patients had a small amount of pneumothorax. Six months after MWA treatment, new metastatic lesions appeared in six patients, five patients had new metastatic lesions inside the lung, and the other patient had metastatic lesions in the thoracic vertebra. The time for the appearance of new pulmonary metastases for the five patients was 4-20 months, averaged 7.2 months. CT-guided MWA is a promising treatment alternative for local tumor control in selected patients with lung metastases from NPC.

  19. Modified Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Siu Cheung; Liu, Kar Wai; Liao, Chun Ta; Lee, Tsung Shih; Ng, Shu Hang [Chang Gung Memorial Hospital, Linkou Medical Center and Keelung Hospital, Taoyuan (China); Chu, Winnie Chiu Wing [The Chinese University of Hong Kong, Hong Kong (China)

    2011-04-15

    We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract. Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients. We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure. A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract

  20. Percutaneous inner-ear access via an image-guided industrial robot system.

    Science.gov (United States)

    Baron, S; Eilers, H; Munske, B; Toennies, J L; Balachandran, R; Labadie, R F; Ortmaier, T; Webster, R J

    2010-01-01

    Image-guided robots have been widely used for bone shaping and percutaneous access to interventional sites. However, due to high-accuracy requirements and proximity to sensitive nerves and brain tissues, the adoption of robots in inner-ear surgery has been slower. In this paper the authors present their recent work towards developing two image-guided industrial robot systems for accessing challenging inner-ear targets. Features of the systems include optical tracking of the robot base and tool relative to the patient and Kalman filter-based data fusion of redundant sensory information (from encoders and optical tracking systems) for enhanced patient safety. The approach enables control of differential robot positions rather than absolute positions, permitting simplified calibration procedures and reducing the reliance of the system on robot calibration in order to ensure overall accuracy. Lastly, the authors present the results of two phantom validation experiments simulating the use of image-guided robots in inner-ear surgeries such as cochlear implantation and petrous apex access.

  1. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2006-08-15

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

  2. Determinants of slow flow following stent implantation in intravascular ultrasound-guided primary percutaneous coronary intervention.

    Science.gov (United States)

    Watanabe, Yusuke; Sakakura, Kenichi; Taniguchi, Yousuke; Yamamoto, Kei; Wada, Hiroshi; Fujita, Hideo; Momomura, Shin-Ichi

    2018-03-01

    Slow flow is a serious complication in primary percutaneous coronary intervention (PCI) and is associated with poor clinical outcomes. Intravascular ultrasound (IVUS)-guided PCI may improve clinical outcomes after drug-eluting stent implantation. The purpose of this study was to seek the factors of slow flow following stent implantation, including factors related to IVUS-guided primary PCI. The study population consisted of 339 ST-elevation myocardial infarction patients, who underwent stent deployment with IVUS. During PCI, 56 patients (16.5%) had transient or permanent slow flow. Multivariate logistic regression analysis showed age (OR 1.04, 95% CI 1.01-1.07, P = 0.01), low attenuation plaque on IVUS (OR 3.38, 95% CI 1.70-6.72, P = 0.001), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 2 (vs. TIMI 0: OR 0.44, 95% CI 0.20-0.99, P = 0.046), and the ratio of stent diameter to vessel diameter (per 0.1 increase: OR 2.63, 95% CI 1.84-3.77, P flow. A ratio of stent diameter to vessel diameter of 0.71 had an 80.4% sensitivity and 56.9% specificity to predict slow flow. There was no significant difference in ischemic-driven target vessel revascularization between the modest stent expansion (ratio of stent diameter to vessel diameter flow following stent implantation in IVUS-guided primary PCI.

  3. Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

    International Nuclear Information System (INIS)

    Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung

    2006-01-01

    The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder

  4. Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

    Energy Technology Data Exchange (ETDEWEB)

    Veltri, Andrea; Fazio, Giuseppina De; Malfitana, Valeria; Isolato, Giuseppe; Gandini, Giovanni [University of Turin, Institute of Diagnostic and Interventional Radiology, Turin (Italy); Fontana, Dario; Tizzani, Alessandro [University of Turin, Institute of Urology, Turin (Italy)

    2004-12-01

    Minimally invasive treatment for small renal cell carcinoma (RCC) can be necessary in selected patients and, anyway, is desirable. In situ ablation techniques, including RFA, have been developed. The aim of this study is to evaluate the feasibility, safety and short-term local effectiveness of percutaneous US-guided RFA in a small series, as well as mid-term patient outcome. Thirteen patients with a total of 18 tumors (17 small lesions, 35 mm in size or less, and a larger one, 75 mm in size) underwent 19 RFA sessions. Seven patients had a solitary kidney, and three suffered from VHL disease, too. We treated four lesions in a patient with a bilateral tumor. In another patient, three lesions were ablated. Seventeen tumors were RCC; one was a metastasis from lung cancer. Eight lesions were parenchymal, six exophytic, two parenchymal/exophytic, one parenchymal/central and one central. A monopolar RF system with multitined expandable electrode needles was used. The 35-mm lesion underwent two sessions; the 75-mm lesion was treated with transcatheter arterial embolization before RFA. Tumors with complete loss of contrast enhancement at short-term CT (or MR) were considered successfully treated. Percutaneous US-guided RFA was always feasible without major complications. The success rate after a single treatment in tumors less than 35 mm in size was 88.2% (15/17) and rose to 94.1% (16/17) after the second treatment of the largest lesion. After a mean 14-month follow-up, no successfully treated lesions recurred locally. Only the patient with metastasis from lung cancer died from disease progression in a further location, while all other patients are alive, with renal function still sufficient to avoid dialysis. US guidance allows an easy and safe percutaneous approach for RFA of small non-parahilar RCC. The treatment is locally effective and can be proposed as a minimally invasive therapy for patients with contraindications to surgery or to those expressing an informed

  5. Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

    International Nuclear Information System (INIS)

    Veltri, Andrea; Fazio, Giuseppina De; Malfitana, Valeria; Isolato, Giuseppe; Gandini, Giovanni; Fontana, Dario; Tizzani, Alessandro

    2004-01-01

    Minimally invasive treatment for small renal cell carcinoma (RCC) can be necessary in selected patients and, anyway, is desirable. In situ ablation techniques, including RFA, have been developed. The aim of this study is to evaluate the feasibility, safety and short-term local effectiveness of percutaneous US-guided RFA in a small series, as well as mid-term patient outcome. Thirteen patients with a total of 18 tumors (17 small lesions, 35 mm in size or less, and a larger one, 75 mm in size) underwent 19 RFA sessions. Seven patients had a solitary kidney, and three suffered from VHL disease, too. We treated four lesions in a patient with a bilateral tumor. In another patient, three lesions were ablated. Seventeen tumors were RCC; one was a metastasis from lung cancer. Eight lesions were parenchymal, six exophytic, two parenchymal/exophytic, one parenchymal/central and one central. A monopolar RF system with multitined expandable electrode needles was used. The 35-mm lesion underwent two sessions; the 75-mm lesion was treated with transcatheter arterial embolization before RFA. Tumors with complete loss of contrast enhancement at short-term CT (or MR) were considered successfully treated. Percutaneous US-guided RFA was always feasible without major complications. The success rate after a single treatment in tumors less than 35 mm in size was 88.2% (15/17) and rose to 94.1% (16/17) after the second treatment of the largest lesion. After a mean 14-month follow-up, no successfully treated lesions recurred locally. Only the patient with metastasis from lung cancer died from disease progression in a further location, while all other patients are alive, with renal function still sufficient to avoid dialysis. US guidance allows an easy and safe percutaneous approach for RFA of small non-parahilar RCC. The treatment is locally effective and can be proposed as a minimally invasive therapy for patients with contraindications to surgery or to those expressing an informed

  6. Contribution of computed tomography guided percutaneous drainage of tuberculous cold abscesses adjunctive to pharmaceutical anti-tubercular treatment

    International Nuclear Information System (INIS)

    Tsagouli, Paraskevi; Sotiropoulou, Evagelia; Filippousis, Petros; Sidiropoulou, Nektaria; Georgiadi, Vithleem; Thanos, Loukas

    2012-01-01

    Purpose: To determine the efficiency and safety of the percutaneous aspiration and drainage of rare touberculous cold abscesses under CT guidance. Materials and methods: We retrospectively studied 63 cases of 44 patients, treated in our hospital during the last two years. They suffered from tuberculous infection complicated with tuberculous cold abscesses variously located. All these patients underwent percutaneous aspiration and drainage under CT imaging, following the trocar puncture technique. The catheter remained in place for about a week. A follow up CT scan was performed in all cases before the catheter removal. Some of the patients were under anti tuberculosis medication. Results: All the patients had a successful recovery from the abscesses. There were no major or minor complications observed. No recurrence occurred until today. Conclusion: CT guided percutaneous aspiration and drainage of tuberculous cold abscesses is a safe, minimal invasive and effective method of treatment. Drainage and specific antituberculosis therapy leads to a satisfactory conclusion.

  7. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study.

    Science.gov (United States)

    Bhatt, Kavita M; Tandon, Yasmeen K; Graham, Ruffin; Lau, Charles T; Lempel, Jason K; Azok, Joseph T; Mazzone, Peter J; Schneider, Erika; Obuchowski, Nancy A; Bolen, Michael A

    2018-03-01

    Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P guided sampling (P guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.

  8. MR-guided Periarterial Ethanol Injection for Renal Sympathetic Denervation: A Feasibility Study in Pigs

    Energy Technology Data Exchange (ETDEWEB)

    Streitparth, F., E-mail: florian.streitparth@charite.de; Walter, A.; Stolzenburg, N.; Heckmann, L.; Breinl, J. [Charite, Humboldt University, Department of Radiology (Germany); Rinnenthal, J. L. [Charite, Humboldt University, Department of Neuropathology (Germany); Beck, A.; De Bucourt, M.; Schnorr, J. [Charite, Humboldt University, Department of Radiology (Germany); Bernhardt, U. [InnoRa GmbH (Germany); Gebauer, B.; Hamm, B.; Guenther, R. W. [Charite, Humboldt University, Department of Radiology (Germany)

    2013-06-15

    Purpose. To evaluate the feasibility and efficacy of image-guided periarterial ethanol injection as an alternative to transluminal radiofrequency ablation. Methods. Unilateral renal periarterial ethanol injection was performed under general anesthesia in 6 pigs with the contralateral kidney serving as control. All interventions were performed in an open 1.0 T MRI system under real-time multiplanar guidance. The injected volume was 5 ml (95 % ethanol labelled marked MR contrast medium) in 2 pigs and 10 ml in 4 pigs. Four weeks after treatment, the pigs underwent MRI including MRA and were killed. Norepinephrine (NE) concentration in the renal parenchyma served as a surrogate parameter to analyze the efficacy of sympathetic denervation. In addition, the renal artery and sympathetic nerves were examined histologically to identify evidence of vascular and neural injury. Results. In pigs treated with 10 ml ethanol, treatment resulted in neural degeneration. We found a significant reduction of NE concentration in the kidney parenchyma of 53 % (p < 0.02) compared with the untreated contralateral kidney. In pigs treated with 5 ml ethanol, no significant changes in histology or NE were observed. There was no evidence of renal arterial stenosis in MRI, macroscopy or histology in any pig. Conclusion. MR-guided periarterial ethanol injection was feasible and efficient for renal sympathetic denervation in a swine model. This technique may be a promising alternative to the catheter-based approach in the treatment of resistant arterial hypertension.

  9. MRI-Guided Percutaneous Biopsy of Mediastinal Masses Using a Large Bore Magnet: Technical Feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Garnon, J., E-mail: juliengarnon@gmail.com [Nouvel Hôpital Civil, Department of Interventional Radiology (France); Ramamurthy, N., E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Caudrelier J, J., E-mail: caudjean@yahoo.fr [Nouvel Hôpital Civil, Department of Interventional Radiology (France); Erceg, G., E-mail: erceggorislav@yahoo.com; Breton, E., E-mail: ebreton@unistra.fr [ICube, University of Strasbourg, CNRS (France); Tsoumakidou, G., E-mail: gtsoumakidou@yahoo.com; Rao, P., E-mail: pramodrao@me.com; Gangi, A., E-mail: gangi@unistra.fr [Nouvel Hôpital Civil, Department of Interventional Radiology (France)

    2016-05-15

    ObjectiveTo evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner.Materials and MethodsThis is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed.ResultsTarget lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinum (n = 1), respectively. Mean size was 7.2 cm (range 3.6–11 cm). Average time for needle placement was 9.4 min (range 3–18 min); average duration of entire procedure was 42 min (range 27–62 min). 2–5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100 %, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5 %, respectively.ConclusionMRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.

  10. Automatic path proposal computation for CT-guided percutaneous liver biopsy.

    Science.gov (United States)

    Helck, A; Schumann, C; Aumann, J; Thierfelder, K; Strobl, F F; Braunagel, M; Niethammer, M; Clevert, D A; Hoffmann, R T; Reiser, M; Sandner, T; Trumm, C

    2016-12-01

    To evaluate feasibility of automatic software-based path proposals for CT-guided percutaneous biopsies. Thirty-three patients (60 [Formula: see text] 12 years) referred for CT-guided biopsy of focal liver lesions were consecutively included. Pre-interventional CT and dedicated software (FraunhoferMeVis Pathfinder) were used for (semi)automatic segmentation of relevant structures. The software subsequently generated three path proposals in downward quality for CT-guided biopsy. Proposed needle paths were compared with consensus proposal of two experts (comparable, less suitable, not feasible). In case of comparable results, equivalent approach to software-based path proposal was used. Quality of segmentation process was evaluated (Likert scale, 1 [Formula: see text] best, 6 [Formula: see text] worst), and time for processing was registered. All biopsies were performed successfully without complications. In 91 % one of the three automatic path proposals was rated comparable to experts' proposal. None of the first proposals was rated not feasible, and 76 % were rated comparable to the experts' proposal. 7 % automatic path proposals were rated not feasible, all being second choice ([Formula: see text]) or third choice ([Formula: see text]). In 79 %, segmentation at least was good. Average total time for establishing automatic path proposal was 42 [Formula: see text] 9 s. Automatic software-based path proposal for CT-guided liver biopsies in the majority provides path proposals that are easy to establish and comparable to experts' insertion trajectories.

  11. Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery.

    Science.gov (United States)

    Osorio, Joseph A; Breshears, Jonathan D; Arnaout, Omar; Simon, Neil G; Hastings-Robinson, Ashley M; Aleshi, Pedram; Kliot, Michel

    2015-09-01

    OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.

  12. Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation.

    Science.gov (United States)

    Klontzas, Michail E; Vassalou, Evangelia E; Karantanas, Apostolos H

    2017-02-01

    Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease.

  13. Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David, E-mail: dpetrover@yahoo.fr; Silvera, Jonathan, E-mail: silvera.jonathan@gmail.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France); Baere, Thierry De, E-mail: Debaere@igr.fr [Gustave Roussy Institute (France); Vigan, Marie, E-mail: marie.vigan@gmail.com [Association pour la recherche en chirurgie de l’épaule et du coude, clinique Drouot (France); Hakimé, Antoine, E-mail: thakime@yahoo.com [Imagerie Médicale Paris Centre Bachaumont-clinique Blomet RamsayGDS, Department of Interventional Radiology (France)

    2017-04-15

    ObjectivesTo evaluate the feasibility and 6 months clinical result of sectioning of the transverse carpal ligament (TCL) and median nerve decompression after ultra-minimally invasive, ultrasound-guided percutaneous carpal tunnel release (PCTR) surgery.MethodsConsecutive patients with carpal tunnel syndrome were enrolled in this descriptive, open-label study. The procedure was performed in the interventional radiology room. Magnetic resonance imaging was performed at baseline and 1 month. The Boston Carpal Tunnel Questionnaire was administered at baseline, 1, and 6 months.Results129 patients were enrolled. Significant decreases in mean symptom severity scores (3.3 ± 0.7 at baseline, 1.7 ± 0.4 at Month 1, 1.3 ± 0.3 at Month 6) and mean functional status scores (2.6 ± 1.1 at baseline, 1.6 ± 0.4 at Month 1, 1.3 ± 0.5 at Month 6) were noted. Magnetic resonance imaging showed a complete section of all TCL and nerve decompression in 100% of patients. No complications were identified.ConclusionsUltrasound-guided PCTR was used successfully to section the TCL, decompress the median nerve, and reduce self-reported symptoms.

  14. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

    Science.gov (United States)

    Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M.; Hata, Nobuhiko; Fischer, Gregory S.

    2014-01-01

    This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure. PMID:26412962

  15. Calcific tendinopathy of the shoulder with intraosseous extension: outcomes of ultrasound-guided percutaneous irrigation

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E. [University Hospital and Department of Radiology, University of Crete, Department of Medical Imaging, Heraklion, Crete (Greece); Imperial College London, Department of Chemical Engineering, London (United Kingdom); Vassalou, Evangelia E.; Karantanas, Apostolos H. [University Hospital and Department of Radiology, University of Crete, Department of Medical Imaging, Heraklion, Crete (Greece)

    2017-02-15

    Rotator cuff calcific tendinopathy (RCCT) with intraosseous extension is a rare complication of tendinous and peritendinous involvement. The purpose of our study is to evaluate the outcome of ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in patients with intraosseous involvement. From January 2011 to June 2014, patients with a clinical and imaging diagnosis of RCCT were prospectively categorised in two groups based on imaging findings: group A (10 patients) with intraosseous RCCT and group B (control group 35 patients) without osseous involvement. US-PICT followed by subacromial injection was applied to all patients in groups A and B. During a 1-year follow-up, treatment outcome in terms of pain and functional improvement was evaluated at 3 weeks, 3 months, 6 months, and 1 year, with the use of a four-grade scale. The study has been approved by our hospital's ethics committee. Mean improvement scores of group A were significantly lower than those of group B at all time points (p < 0.0001). Improvement of group B was noted mainly within the first 3 months post-treatment (p = 0.016). Outcomes of ultrasound-guided treatment in cases of RCCT with intraosseous extension are significantly less favourable than in purely tendinous or peritendinous disease. (orig.)

  16. Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus.

    Science.gov (United States)

    Fang, You-Qiang; Wu, Jie-Ying; Li, Teng-Cheng; Zheng, Hao-Feng; Liang, Guan-Can; Chen, Yan-Xiong; Hong, Xiao-Bin; Cai, Wei-Zhong; Zang, Zhi-Jun; Di, Jin-Ming

    2017-06-01

    This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.

  17. Using sheathless standard guiding catheters for transradial percutaneous coronary intervention to treat bifurcation lesions

    Science.gov (United States)

    Li, Qiyong; He, Yong; Jiang, Rongjian; Huang, Dejia

    2013-01-01

    OBJECTIVE: To investigate the feasibility and safety of using sheathless standard guiding catheters for transradial percutaneous coronary intervention (PCI) to treat bifurcation lesions. METHODS: Coronary bifurcation lesions were identified using angiography in 43 patients with coronary artery disease. These patients underwent transradial PCI using sheathless standard guiding catheters, and the procedural success and complication rates were recorded. RESULTS: All 43 patients underwent successful PCI. The Culotte stenting technique was used in 22 (51.2%) subjects, the Crush stenting technique was used in eight (18.8%) subjects and the crossover stenting implantation technique was used in 13 (30.0%) subjects. Of the 43 coronary artery bifurcation lesions, the final kissing balloon technique was performed in 39 (90.1%) lesions. Adjunctive devices used in the cohort included intravascular ultrasound for 32 (74.4%) patients, thrombus aspiration catheters for two patients and cutting balloon for five patients. During the perioperative period, no major complications associated with vessel puncture or adverse cardiac or cerebrovascular events occurred in any of the 43 patients enrolled in the present study. At day 30, radial artery occlusion was detected in only three (2.5%) patients and radial artery stenosis in four (9.3%) patients. At six-month follow-up, 24 (55.8%) patients exhibited coronary artery patency with no significant intimal hyperplasia. CONCLUSIONS: Transradial PCI using the sheathless technique may be a feasible and safe technique to treat coronary bifurcation lesions. PMID:23940423

  18. Conversion of Gasoline Engines to Use Ethanol as the Sole Fuel. Student Guide.

    Science.gov (United States)

    Mishler, Glenn; Spignesi, Bill

    This student guide is a learning packet that is intended for use as part of the regular auto mechanics curriculum and that provides the information necessary to convert a gasoline engine with a minimum of modifications to successfully be operated on ethanol alcohol. Contents include an introduction, objectives, procedures, list of tasks to be…

  19. Percutaneous ultrasound-guided vs. intraoperative rectus sheath block for pediatric umbilical hernia repair: A randomized clinical trial.

    Science.gov (United States)

    Litz, Cristen N; Farach, Sandra M; Fernandez, Allison M; Elliott, Richard; Dolan, Jenny; Patel, Nikhil; Zamora, Lillian; Colombani, Paul M; Walford, Nebbie E; Amankwah, Ernest K; Snyder, Christopher W; Danielson, Paul D; Chandler, Nicole M

    2017-06-01

    Regional anesthesia is commonly used in children. Our hypothesis was that percutaneous ultrasound-guided (PERC) rectus sheath blocks would result in lower postoperative pain scores compared to intraoperative (IO) rectus sheath blocks following umbilical hernia repair. A single-institution randomized blinded trial was conducted in pediatric patients undergoing elective umbilical hernia repair. The primary outcome was mean postoperative Wong-Baker pain score. Secondary outcomes included narcotic requirements and length of postoperative stay. Fifty-eight patients were included: 28 PERC and 30 IO. Operating room time was significantly longer in the PERC group (41 vs. 35min, pblocks resulted in similar mean postoperative pain scores. There were no differences in secondary outcomes such as time to first narcotic, narcotic requirements, and length of stay. The additional resources required to complete a percutaneous ultrasound-guided rectus sheath block may not be warranted. Randomized controlled trial. Level I. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Risk of axillary nerve injury during percutaneous proximal humerus locking plate insertion using an external aiming guide.

    Science.gov (United States)

    Saran, Neil; Bergeron, Stephane G; Benoit, Benoit; Reindl, Rudolf; Harvey, Edward J; Berry, Gregory K

    2010-10-01

    The purpose of this study was to determine which screws could be safely inserted percutaneously into a proximal humerus locking plate using a new external aiming guide without injuring the axillary nerve. We also sought to evaluate that all the screws could be accurately inserted ina locked position with the external guide. Eight cadaveric specimens were implanted with a proximal humerus locking plate using a minimally invasive direct-lateral deltoid splitting approach using an attached external aiming guide for screw insertion. The anatomic proximity of the axillary nerve to the guidewires and screws was measured following soft tissue dissection and inspection of the nerve. The two superior holes (C1 and C2) were proximal to the axillary nerve with an average distance of 15.1 mm. Screw F was on average 6.6 mm distal to the axillary nerve but within 2 mm of the nerve in two specimens. In all specimens, the locking screws were appropriately seated in a locked position using the external aiming guide. This study suggests that percutaneous fixation of a proximal humerus locking plate with an external aiming guide can be safely used for proximal humerus fractures. The limited number of screws that can be inserted into the proximal fragment using the current external guide arm may compromise fixation of more unstable fractures. Therefore, the indications for percutaneous locking plate fixation of the proximal humerus using an external aiming guide should be limited to stable fracture patterns that can be anatomically reduced. 2010 Elsevier Ltd. All rights reserved.

  1. Ultrasound-guided percutaneous biopsy of digestive tract lesions; Biopsia percutanea de lesiones del tubo digestivo guiada por ecografia

    Energy Technology Data Exchange (ETDEWEB)

    Gil, S.; Martin, I.; Ballesteros, J. M.; Gomez, C. [Hospital General Universitario de Alicante (Spain); Marco, S. F.; Fernandez, P. [Hospital Gneral de Castellon (Spain)

    1999-07-01

    To present our experience in ultrasound-guided percutaneous biopsy of lesions located in the digestive tract. We performed ultrasound-guided percutaneous biopsy in 14 patients (10 men and 4 women) ranging in age from 7 to 71 years (mean; 519 years). The lesions were located throughout the digestive tract, from the pyriform sinus to the sigmoid colon. The biopsy was carried out with a 5 MHz convex probe equipped with a device to direct the needle. An 18G automatic needle or a 20G Chiba needle was used to obtain specimens for histological study in every case, and additional samples were collected with a 22G needle for cytological examination in 13 of the patients. The ultrasound images corresponded to pseudokidney in 9 cases and extrinsic masses in 5. The diagnosis was obtained from the histological examination in every case (100%) and from cytology in 6 (44.4%), the latter results were less specific. The only complication corresponded to a case of bilioperitoneum. Ultrasound-guided percutaneous biopsy is a suitable technique for the histological diagnosis of those lesions of the digestive tract that are visible in ultrasound images, but that for some reason can not be examined by endoscopic biopsy. (Author) 20 refs.

  2. Guide to commercial-scale ethanol production and financing

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-11-01

    This document is designed to lead the potential investor through all the steps necessary to develop a business plan and prepare a feasibility analysis for a site-specific project. Emphasis is placed on marketing, financing, management, and incentives rather than primarily technical matters. The introduction provides an overview of the perspectives and issues in the alcohol fuels industry. Chapter II seeks to surface factors which affect the decisionmaking process. The chapter attempts to lead the investor step-by-step through the series of decisions and choices to be made before reaching the final decision to enter the business. Chapter III describes the types of feedstocks available and relates them to areas within the United States. Trends and fluctuations in the price of the major grain feedstocks are also discussed in terms of their potential use and value compared to other feeds. Chapter IV discusses the market potential of ethanol and its coproducts, and examines how the location of the ethanol markets in relation to those of the feedstock supplies may influence selection of a plant site. Various aspects of plant design are discussed. A 50 million gallon per year plant is analyzed to provide the general technical background and costing data required in analyzing plants of various sizes and designs. Safety aspects and environmental concerns are treated in Chapters VI and VII. The regulations are reviewed and their impact on plant design and operation is discussed. The basic elements of a business plan are described which lead to an approach for development of the feasibility study. Other information on financial assistance, regulations, current legislation, and reference material is given in the Appendices.

  3. Fuel from farms: A guide to small-scale ethanol production: Second edition

    Energy Technology Data Exchange (ETDEWEB)

    1982-05-01

    This guide presents the current status of on-farm fermentation ethanol production as well as an overview of some of the technical and economic factors. Tools such as decision and planning worksheets and a sample business plan for use in exploring whether or not to go into ethanol production are given. Specifics in production including information on the raw materials, system components, and operational requirements are also provided. Recommendation of any particular process is deliberately avoided because the choice must be tailored to the needs and resources of each individual producer. The emphasis is on providing the facts necessary to make informed judgments. 98 refs., 14 figs., 9 tabs.

  4. Fuel from farms: a guide to small-scale ethanol production

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-02-01

    A guide on fermentation processes with emphasis on small-scale production of ethanol using farm crops as a source of raw material is published. The current status of on-farm ethanol production as well as an overview of some of the technical and economic factors is presented. Decision and planning worksheets and a sample business plan for use in decision making are included. Specifics in production including information on the raw materials, system components, and operational requirements are also provided. Diagrams of fermentors and distilling apparatus are included. (DC)

  5. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Kerimaa, Pekka; Ojala, Risto; Markkanen, Paula; Tervonen, Osmo; Blanco Sequeiros, Roberto [Oulu University Hospital, Department of Radiology, Oulu (Finland); Sinikumpu, Juha-Jaakko; Korhonen, Jussi [Oulu University Hospital, Department of Paediatric Surgery, Oulu (Finland); Hyvoenen, Pekka [Oulu University Hospital, Department of Surgery, Oulu (Finland)

    2014-07-15

    The purpose of this study was to evaluate the feasibility of MRI guidance for percutaneous retrograde drilling in the treatment of osteochondritis dissecans of the talus (OCDT). Four patients, one juvenile and three adults, with one OCDT lesion each and persisting ankle pain after conservative treatment, were treated with MRI-guided retrograde drilling. All lesions were stable and located in the middle or posterior medial third of the talar dome. Pain relief and the ability to return to normal activities were assessed during clinical follow-up. MRI and plain film radiographs were used for imaging follow-up. Technical success was 100 % with no complications and with no damage to the overlying cartilage. All patients experienced some clinical benefit, although only one had complete resolution of pain and one had a relapse leading to surgical treatment. Changes in the pathological imaging findings were mostly very slight during the follow-up period. MRI guidance seems accurate, safe and technically feasible for retrograde drilling of OCDT. Larger series are needed to reliably assess its clinical value. (orig.)

  6. Ultrasound-guided percutaneous radiofrequency ablation of liver tumors: How we do it safety and completely

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Woong; Shin, Sang Soo; Heo, Suk Hee; Hong, Jun Hyung; Lim, Hyo Soon; Seon, Hyun Ju; Hur, Young Hoe; Park, Chang Hwan; Jeong, Yong Yeon; Kang, Heoung Keun [Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2015-12-15

    Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

  7. Therapeutic percutaneous ultrasound-guided cholecystocentesis in three dogs with extrahepatic biliary obstruction and pancreatitis.

    Science.gov (United States)

    Herman, Beth A; Brawer, Robert S; Murtaugh, Robert J; Hackner, Susan G

    2005-12-01

    Three dogs were examined because of acute pancreatitis. In all 3, distension of the gallbladder was seen ultrasonographically, and extrahepatic biliary tract obstruction (EHBO) was diagnosed on the basis of ultrasonographic findings and serum biochemical abnormalities (i.e., high serum bilirubin and cholesterol concentrations and increased hepatic enzyme activities). In all 3 dogs, percutaneous ultrasound-guided cholecystocentesis (PUCC) was used to decompress the gallbladder, with cholecystocentesis performed multiple times in 1 dog. Serum bilirubin concentration was substantially decreased following the procedure in all 3 dogs. Two of the 3 dogs did not require surgery to resolve the obstruction. In the third dog, an exploratory laparotomy was performed because of concerns about development of abdominal effusion following the procedure. Bile staining of the mesenteric fat was seen during the laparotomy, but no defect in the gallbladder wall could be identified. In most dogs with EHBO secondary to pancreatitis, the obstruction resolves spontaneously as the acute pancreatitis improves so that surgery is not required. In those few dogs in which EHBO does not resolve or in which EHBO results in complications, therapeutic PUCC may be useful in relieving gallbladder distension.

  8. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study

    International Nuclear Information System (INIS)

    Kerimaa, Pekka; Ojala, Risto; Markkanen, Paula; Tervonen, Osmo; Blanco Sequeiros, Roberto; Sinikumpu, Juha-Jaakko; Korhonen, Jussi; Hyvoenen, Pekka

    2014-01-01

    The purpose of this study was to evaluate the feasibility of MRI guidance for percutaneous retrograde drilling in the treatment of osteochondritis dissecans of the talus (OCDT). Four patients, one juvenile and three adults, with one OCDT lesion each and persisting ankle pain after conservative treatment, were treated with MRI-guided retrograde drilling. All lesions were stable and located in the middle or posterior medial third of the talar dome. Pain relief and the ability to return to normal activities were assessed during clinical follow-up. MRI and plain film radiographs were used for imaging follow-up. Technical success was 100 % with no complications and with no damage to the overlying cartilage. All patients experienced some clinical benefit, although only one had complete resolution of pain and one had a relapse leading to surgical treatment. Changes in the pathological imaging findings were mostly very slight during the follow-up period. MRI guidance seems accurate, safe and technically feasible for retrograde drilling of OCDT. Larger series are needed to reliably assess its clinical value. (orig.)

  9. MRI-guided percutaneous retrograde drilling of osteochondritis dissecans of the talus: a feasibility study.

    Science.gov (United States)

    Kerimaa, Pekka; Ojala, Risto; Sinikumpu, Juha-Jaakko; Hyvönen, Pekka; Korhonen, Jussi; Markkanen, Paula; Tervonen, Osmo; Sequeiros, Roberto Blanco

    2014-07-01

    The purpose of this study was to evaluate the feasibility of MRI guidance for percutaneous retrograde drilling in the treatment of osteochondritis dissecans of the talus (OCDT). Four patients, one juvenile and three adults, with one OCDT lesion each and persisting ankle pain after conservative treatment, were treated with MRI-guided retrograde drilling. All lesions were stable and located in the middle or posterior medial third of the talar dome. Pain relief and the ability to return to normal activities were assessed during clinical follow-up. MRI and plain film radiographs were used for imaging follow-up. Technical success was 100% with no complications and with no damage to the overlying cartilage. All patients experienced some clinical benefit, although only one had complete resolution of pain and one had a relapse leading to surgical treatment. Changes in the pathological imaging findings were mostly very slight during the follow-up period. MRI guidance seems accurate, safe and technically feasible for retrograde drilling of OCDT. Larger series are needed to reliably assess its clinical value. • MRI serves as a useful guidance method for numerous mini-invasive applications. • Retrograde drilling is a cartilage-sparing alternative in the treatment of osteochondritis dissecans. • MRI guidance seems feasible for treatment of osteochondritis dissecans of the talus.

  10. Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk

    International Nuclear Information System (INIS)

    Salagierski, Marek; Salagierski, Maciej; Sosnowski, Marek; Salagierska-Barwinska, Anna

    2006-01-01

    The aim of this study was to describe our experience with percutaneous ultrasound-guided radiofrequency ablation of kidney tumors. From July 2002 to August 2005, 45 radiofrequency ablations (RFA) in 42 selected patients with kidney tumor were performed. The patients had either contraindications to surgery procedures or had a solitary kidney. The average tumor size was 37.5 mm (range, 18-59 mm) with the mean age of 68 years (range, 28-83 years). RFA were performed based on radiographic findings. Needle biopsy was made only twice. Monopolar Cool-tip Tyco or bipolar Celon Olympus radiofrequency devices were used. The procedure was performed under conscious sedation with local anesthesia. Treatment efficacy was assessed by computed tomography and by Doppler ultrasound. The absence of contrast enhancement on computed tomography was considered to be a successful treatment. The average follow up was 14 months (range, 3-36 months). In 42 tumors (93%), total absence of contrast enhancement was obtained after the initial RFA and in three tumors (7%) after the second ablation session. There were no complications following 41 procedures, including all ablations in small (<35 mm) renal masses. In four procedures, minor complications were observed. All patients are alive. There has been no need for chronic hemodialysis and, until now, we have not observed any local recurrences with the exception of one metastasis to an ipsilateral adrenal gland. RFA of kidney tumors is a promising alternative treatment which could be considered for patients who are not suitable for surgery. (author)

  11. CT-guided percutaneous radiofrequency ablation of osteoid osteoma: Our experience in 87 patients

    Directory of Open Access Journals (Sweden)

    Anurag Chahal

    2017-01-01

    Full Text Available Purpose: To evaluate the technical and clinical success of radiofrequency ablation of osteoid osteoma and analyze the factors responsible for clinical success. We also tried to investigate the role of follow-up computed tomography (CT imaging. Materials and Methods: This is a prospective study approved by the institute's ethics committee involving 87 patients with appendicular osteoid osteoma. CT-guided radio frequency ablation was performed using a bipolar ablation system. Patients were followed up over 15.4 (4–24 months for pain, and clinical success/failure was determined using established criteria. Patients with clinical failure were taken for repeat ablation. Follow-up CT was obtained at 6 months and correlated with clinical success. Procedural scans were later reviewed for technical success in a blinded manner and correlated with clinical success along with other imaging and patient characteristics. Results: Mean pre-procedure visual analog scale (VAS score was 7.0 ± 0.8. Primary success rate after single session was 86.2%(75/87 patients, and overall success rate after one/two sessions was 96.6%(84/87. No major complications were noted. Technical success rate was 89.7%(78/87. All 9 patients who had a suboptimal needle positioning had recurrence where as three patients had recurrence despite technical success. None of the imaging characteristics or history of prior intervention was significantly associated with clinical success. Follow-up CT showed advanced bone healing in 48 lesions, and was confined to the treatment success group. Alternately, minimal/absent bone healing was seen in all (12 patients of primary treatment failure and 27 patients with treatment success. Conclusions: CT-guided percutaneous radio frequency ablation is a safe and highly effective treatment for osteoid osteomas even in recurrent and residual cases. Technical success is the most important parameter affecting the outcome. Post radio frequency ablation CT

  12. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

    International Nuclear Information System (INIS)

    Amoretti, Nicolas; Huwart, Laurent; Browaeys, Patrick; Nouri, Yasir; Ibba, Caroline; Hauger, Olivier; Marcy, Pierre-Yves; Boileau, Pascal

    2012-01-01

    To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements ± SD decreased from 7.8 ± 0.9 preoperatively to 1.5 ± 1.1 at the last 2-year follow-up, and from 62.3 ± 17.2 to 15.1 ± 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. (orig.)

  13. European Section of Urotechnology educational video on fluoroscopic-guided puncture in percutaneous nephrolithotomy: all techniques step by step.

    Science.gov (United States)

    Kyriazis, Iason; Liatsikos, Evangelos; Sopilidis, Odysseas; Kallidonis, Panagiotis; Skolarikos, Andreas

    2017-11-01

    To describe the most common fluoroscopic-guided access techniques during percutaneous nephrolithotomy (PCNL) in a step-by-step manner and to assist in the standardisation of their technique and terminology. A high-quality animation video was created for each of the respective fluoroscopic techniques, focusing into the parallel projection of external surgical manoeuvres and their effect in the three-dimensional space of the kidney. Four predominant fluoroscopic-guided percutaneous access techniques are available, each with different advantages and limitations. Monoplanar access is used when a stable single-axis fluoroscopic generator is available and is mostly based on surgeons' experience. Biplanar access uses a second fluoroscopy axis to assess puncture depth. The 'bull's eye' technique follows a coaxial to fluoroscopy puncture path and is associated with a shorter learning curve at the cost of increased hand radiation exposure. Hybrid and conventional triangulate techniques use target projection by two fluoroscopic planes to define the exact localisation of the target in space and access it through a third puncture site. Fluoroscopic guidance during PCNL puncture is a very efficient method for access establishment. The percutaneous surgeon should be familiar with all available variations of fluoroscopic approach in order to be prepared to adapt puncture technique for any given scenario. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  14. Computed tomography- and fluoroscopy-guided percutaneous screw fixation of low-grade isthmic spondylolisthesis in adults: a new technique

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Browaeys, Patrick; Nouri, Yasir; Ibba, Caroline [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Radiology, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France); Marcy, Pierre-Yves [Antoine Lacassagne Cancer Research Institute, Department of Radiology, Nice (France); Boileau, Pascal [Hopital Archet 2, Centre Hospitalo-Universitaire de Nice, Department of Orthopedic Surgery, Nice (France)

    2012-12-15

    To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults. Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores. The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements {+-} SD decreased from 7.8 {+-} 0.9 preoperatively to 1.5 {+-} 1.1 at the last 2-year follow-up, and from 62.3 {+-} 17.2 to 15.1 {+-} 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted. This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis. (orig.)

  15. Percutaneous tenotomy: development of a novel, percutaneous, ultrasound-guided needle-cutting technique for division of tendons and other connective tissue structures

    International Nuclear Information System (INIS)

    Hopkins, James; Sampson, Matthew

    2014-01-01

    A variety of surgical procedures derive therapeutic benefit from the division of retinacular, ligamentous or tendinous structures. Examples include carpal tunnel release for median nerve impingement, annular pulley release for trigger finger and tendon division for spastic muscular contractures. Here, using an animal cadaveric model, we describe the first steps in determining the feasibility of a novel, percutaneous, ultrasound-guided needle-cutting technique to achieve the same ends. The technique we describe involves the creation of an effective needle tenotomy device via a simple modification to an 18G coaxial, beveled needle. The technique holds promise for the development of a minimally invasive alternative approach that utilises readily available technology and equipment with minimisation of morbidity and cost associated with open procedures.

  16. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Scott M., E-mail: Thompson.scott@mayo.edu [Mayo Clinic, Mayo Graduate School, Mayo Medical School and the Mayo Clinic Medical Scientist Training Program, College of Medicine (United States); Callstrom, Matthew R., E-mail: callstrom.matthew@mayo.edu; McKusick, Michael A., E-mail: mckusick.michael@mayo.edu; Woodrum, David A., E-mail: woodrum.david@mayo.edu [Mayo Clinic, Department of Radiology, College of Medicine (United States)

    2015-10-15

    PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA.

  17. Initial Results of Image-Guided Percutaneous Ablation as Second-Line Treatment for Symptomatic Vascular Anomalies

    International Nuclear Information System (INIS)

    Thompson, Scott M.; Callstrom, Matthew R.; McKusick, Michael A.; Woodrum, David A.

    2015-01-01

    PurposeThe purpose of this study was to determine the feasibility, safety, and early effectiveness of percutaneous image-guided ablation as second-line treatment for symptomatic soft-tissue vascular anomalies (VA).Materials and MethodsAn IRB-approved retrospective review was undertaken of all patients who underwent percutaneous image-guided ablation as second-line therapy for treatment of symptomatic soft-tissue VA during the period from 1/1/2008 to 5/20/2014. US/CT- or MRI-guided and monitored cryoablation or MRI-guided and monitored laser ablation was performed. Clinical follow-up began at one-month post-ablation.ResultsEight patients with nine torso or lower extremity VA were treated with US/CT (N = 4) or MRI-guided (N = 2) cryoablation or MRI-guided laser ablation (N = 5) for moderate to severe pain (N = 7) or diffuse bleeding secondary to hemangioma–thrombocytopenia syndrome (N = 1). The median maximal diameter was 9.0 cm (6.5–11.1 cm) and 2.5 cm (2.3–5.3 cm) for VA undergoing cryoablation and laser ablation, respectively. Seven VA were ablated in one session, one VA initially treated with MRI-guided cryoablation for severe pain was re-treated with MRI-guided laser ablation due to persistent moderate pain, and one VA was treated in a planned two-stage session due to large VA size. At an average follow-up of 19.8 months (range 2–62 months), 7 of 7 patients with painful VA reported symptomatic pain relief. There was no recurrence of bleeding at five-year post-ablation in the patient with hemangioma–thrombocytopenia syndrome. There were two minor complications and no major complications.ConclusionImage-guided percutaneous ablation is a feasible, safe, and effective second-line treatment option for symptomatic VA

  18. The prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic neoplasms

    International Nuclear Information System (INIS)

    Li Jianjun; Zheng Jiasheng; Cui Xiongwei; Cui Shichang; Sun Bin

    2011-01-01

    Objective: To discuss the prevention and treatment of biliary complications occurred after CT-guided percutaneous radiofrequency ablation (RFA) for hepatic neoplasms. Methods: A total of 1136 patients, including 920 males and 216 females, with hepatic neoplasms were enrolled in this study. The hepatic tumors consisted of primary hepatocellular carcinoma (n=1037), hepatic metastasis (n=83) and hepatic cavernous hemangioma (n=16). The diameters of the tumors ranged from 0.5 to 16 cm. A total of 1944 RFA procedures were carried out in all patients. Results: Thirty-five patients developed biliary complication (35/1944, 1.80%). Twelve patients developed asymptomatic bile duct dilatation and no special treatment was given. Obstructive jaundice occurred in two patients and percutaneous transhepatic cholangiocholecystic drainage (PTCD) together with subsequent inner stent implantation had to be carried out. Eighteen patients developed biloma, and liver abscess formation secondary to biloma infection occurred in seven of them. Percutaneous transhepatic biloma drainage (PTBD) was adopted in all these patients. One patient suffered from obstructive jaundice complicated by biloma, and both PTCD and PTBD combined with inner stent implantation were simultaneously performed. One patient had the biloma secondary to obstructive jaundice, and PTCD followed by PTBD was conducted in turn. One patient developed obstructive jaundice secondary to biloma, and PTBD followed by PTCD was employed in turn. Conclusion: Obstructive jaundice and biloma are severe biliary complications occurred after CT-guided percutaneous radiofrequency ablation for hepatic tumors, and PTCD and/or PTBD should be carried out without delay to treat these complications. The clinical symptoms can be relieved, or even completely disappear, after treatment. (authors)

  19. Real-time MRI-guided percutaneous sclerotherapy of low-flow head and neck lymphatic malformations in the pediatric population - a stepwise approach

    Energy Technology Data Exchange (ETDEWEB)

    Partovi, Sasan; Vidal, Lorenna; Lu, Ziang; Nakamoto, Dean A.; Buethe, Ji; Clampitt, Mark; Coffey, Michael; Patel, Indravadan J. [University Hospitals Cleveland Medical Center, Case Western Reserve University, Department of Radiology, Section of Vascular and Interventional Radiology, Cleveland, OH (United States)

    2017-05-15

    Real-time MRI-guided percutaneous sclerotherapy is a novel and evolving treatment for congenital lymphatic malformations in the head and neck. We elaborate on the specific steps necessary to perform an MRI-guided percutaneous sclerotherapy of lymphatic malformations including pre-procedure patient work-up and preparation, stepwise intraprocedural interventional techniques and post-procedure management. Based on our institutional experience, MRI-guided sclerotherapy with a doxycycline-gadolinium-based mixture as a sclerosant for lymphatic malformations of the head and neck region in children is well tolerated and effective. (orig.)

  20. Usefulness of rehabilitation in patients with rotator cuff calcific tendinopathy after ultrasound-guided percutaneous treatment.

    Science.gov (United States)

    Abate, Michele; Schiavone, Cosima; Salini, Vincenzo

    2015-01-01

    To evaluate the efficacy of a specific rehabilitation program for patients in whom ultrasound-guided percutaneous treatment (UGPT) was performed for rotator cuff calcific tendinopathy (RCCT). In this prospective observational study, 86 patients (22 males and 64 females) with shoulder calcific tendinopathy treated with UGPT were enrolled. At the end of the procedure, a corticosteroid injection into the subacromial-subdeltoid bursa was performed. The patients were then asked to follow a specific rehabilitation protocol (2 times/week for 5 weeks) that focused on mobility, strength and function. At baseline and after 6 weeks, clinical parameters, visual analog scale (VAS) and Constant-Murley scale (CMS) scores and ultrasound (US) features were collected. The mean age of the patients was 48.9 ± 8.4 years and their mean BMI was 22.7 ± 2.1. Considering the whole cohort, the treatment was effective, with a significant decrease in the VAS score and an improvement in the CMS score. Thereafter, on the basis of the compliance to the rehabilitation program (by self-report), 53 and 33 patients were included in the rehabilitation group (Rehab group; performed exercises ≥2 times/week) and the No Rehab group (performed exercises <2 times/week), respectively. The comparison between the groups showed that the subjects who performed the exercises regularly had better results in terms of pain and functional recovery, and less associated diseases (e.g. adhesive bursitis and tenosynovitis of the long head of the biceps) than those who were less compliant with the program. UGPT, followed by a specific postprocedure rehabilitation program, was an effective treatment for RCCT. © 2014 S. Karger AG, Basel.

  1. Percutaneous image-guided cryoablation: current applications and results in the oncologic field.

    Science.gov (United States)

    Cazzato, Roberto Luigi; Garnon, Julien; Ramamurthy, Nitin; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Arrigoni, Francesco; Zugaro, Luigi; Barile, Antonio; Masciocchi, Carlo; Gangi, Afshin

    2016-12-01

    Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.

  2. Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis.

    Science.gov (United States)

    Xu, Rui-Fang; Zhang, Jing; Han, Zhi-Yu; Zhang, Bing-Song; Liu, Hui; Li, Xiu-Mei; Ge, Hai-Long; Dong, Xue-Juan

    2016-08-01

    Objective The aim of this study was to analyse the significant variables for vaginal discharge after ultrasound-guided percutaneous microwave ablation (PMWA) therapy. Materials and methods PMWA was performed on 117 patients with adenomyosis from October 2012 to July 2014. The presence or absence, colour, quantity and duration of vaginal discharge, which was different from pre-ablation, were recorded within 1 year after PMWA. Patients were categorised into G1 (n = 26, without vaginal discharge), G2 (n = 40, vaginal discharge lasting 1 to 19 days), and G3 (n = 51, vaginal discharge lasting ≥20 days) groups. The potentially correlative variables were analysed. Variables with significant correlations with vaginal discharge post-ablation were identified via binary logistic regression analysis. Results The differences in adenomyosis type, pre-ablation uterine volume, total microwave ablation energy, total non-perfused volume (NPV) and minimum distance from the non-perfused lesion (NPL) margin to the endomyometrial junction (EMJ) among groups were statistically significant (p = 0.005, p = 0.000, p = 0.000, p = 0.005 and p = 0.000, respectively). Minimum distance from the NPL margin to the EMJ was the strongest predictor of vaginal discharge post-ablation with odds ratio (OR) 0.632, p = 0.018, 95% CI 0.432-0.923. Patients with diffuse adenomyosis were more likely to have prolonged vaginal discharge (≥20 days) post-ablation (OR 3.461, p = 0.000, 95% CI 1.759-7.536). Conclusion The minimum distance from the NPL margin to the EMJ and adenomyosis type were significantly associated with vaginal discharge post-ablation.

  3. CT guided percutaneous calcaneoplasty: a case of metastatic intra-articular calcaneus fracture.

    Science.gov (United States)

    Kamalian, S; Hirsch, A E; Growney, M L; Raskin, K A; Yoo, A J; Krag, K J; Hirsch, J A

    2009-12-01

    Symptomatic bone metastases to the calcaneus are rare.1 Minimally invasive percutaneous augmentation is an option in the palliative management of patients with metastatic bone disease, and has been commonly used in the setting of vertebral compression fractures.2 Calcaneal augmentation can potentially allow for earlier weight bearing and a shorter period of disability. A case report is presented of percutaneous intra-articular calcaneal fracture augmentation using polymethyl methacrylate.

  4. Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Garnon, Julien, E-mail: juliengarnon@gmail.com; Koch, Guillaume, E-mail: Guillaume.koch@gmail.com [University Hospital of Strasbourg, Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: Nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Caudrelier, Jean, E-mail: caudjean@yahoo.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France); Rao, Pramod, E-mail: pramodrao@me.com [University of Strasbourg, ICube (France); Tsoumakidou, Georgia, E-mail: Georgia.tsoumakidou@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Gangi, Afshin, E-mail: Afshin.gangi@chru-strasbourg.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France)

    2016-09-15

    ObjectiveTo review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.Materials and MethodsBetween May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.ResultsFour pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.ConclusionPercutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.

  5. MRI-guided percutaneous cryoablation of renal tumors: Use of external manual displacement of adjacent bowel loops

    International Nuclear Information System (INIS)

    Tuncali, Kemal; Morrison, Paul R.; Tatli, Servet; Silverman, Stuart G.

    2006-01-01

    Purpose: We sought to investigate retrospectively the safety and effectiveness of using external hand compression to displace adjacent bowel loops during MRI-guided percutaneous cryoablation of renal tumors. Materials and methods: Fourteen patients (six women, eight men; mean age: 72 years) with 15 renal tumors (mean diameter: 2.4 cm; range: 1.4-4.6 cm) adjacent to bowel were treated with MRI-guided percutaneous cryoablation during which bowel was displaced manually. Bowel loop of concern was ascending colon (n 5), descending colon (n = 8), descending colon and small bowel (n = 1), ascending colon and small bowel (n = 1). To analyze effectiveness of the maneuver, mean distance between tumor margin and bowel before and after the maneuver were compared and analyzed using paired Student's t-test. Minimum distance between iceball edge and adjacent bowel with external manual displacement during freezing was also measured. Safety was assessed by analyzing post-procedural MR imaging for adjacent bowel wall thickening and focal fluid collections as well as patients' clinical and imaging follow-up. Results: Mean distance between tumor margin and closest adjacent bowel increased from 0.8 cm (range: 0-2 cm) before external manual compression to 2.6 cm (range: 1.6-4.1 cm) with manual displacement (p < 0.01). Mean minimum distance between iceball edge and closest adjacent bowel during the procedures was 1.6 cm (range: 0.5-3.5 cm). No evidence of bowel injury was encountered. Twelve of 15 tumors had follow-up (mean: 10 months) that showed no tumor recurrence. Conclusion: MRI-guided percutaneous cryoablation of renal tumors adjacent to bowel can be done safely and effectively using external hand compression to displace bowel loops

  6. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    International Nuclear Information System (INIS)

    Kelogrigoris, M.; Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-01-01

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26–52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  7. Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ho Cheol; Shin, Tae Beom; Park, Mee Jung; Kim, Ji Eun; Choi, Hye Young; Bae, Kyung Soo; Choi, Dae Seob; Na, Jae Boem; Jeong, Seong Hoon [Gyeongsang National University Hospital, College of Medicine, Jinju (Korea, Republic of)

    2011-02-15

    We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess. From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated. 15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5- 27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved. Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure

  8. Percutaneous imaging-guided treatment of hydatid liver cysts: Do long-term results make it a first choice?

    International Nuclear Information System (INIS)

    Kabaalioglu, Adnan; Ceken, Kagan; Alimoglu, Emel; Apaydin, Ali

    2006-01-01

    Aim: To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts. Materials and methods: Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging. Results: Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure. Conclusion: Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts

  9. Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia.

    Science.gov (United States)

    An, Jian-Xiong; Liu, Hui; Chen, Ruo-Wen; Wang, Yong; Zhao, Wen-Xing; Eastwood, Derek; Williams, John P

    2018-01-01

    The aim of this study was to evaluate the therapeutic effect of computed tomography (CT)-guided percutaneous ozone injection for refractory trigeminal neuralgia. A retrospective evaluation was performed in the study. The study was conducted at a university hospital pain center. A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A) and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B). The percutaneous injection was an oxygen-ozone mixture at an ozone concentration of 30 μg/mL into the Gasserian ganglion performed under CT guidance. The number of procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS) pain scores. The combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment ( P ozone injection is a safe and effective treatment for patients with refractory trigeminal neuralgia.

  10. MR-guided percutaneous nephrostomy of the contrast-enhanced, nondilated upper urinary tract: initial experimental results

    International Nuclear Information System (INIS)

    Nolte-Ernsting, C.C.A.; Buecker, A.; Neuerburg, J.M.; Adam, G.B.; Guenther, R.W.; Hunter, D.W.

    1998-01-01

    Purpose: To evaluate technique and practicability of MR-guided percutaneous nephrostomy (MRPCN) in an animal model. Methods: In three domestic pigs, a unilateral percutaneous nephrostomy tube was placed into the nondilated collecting system using exclusively MR-guidance with a standard 1.5 T scanner. The urinary tract was visualized by intravenous injection of Gd-DTPA and low-dose furosemide. The entire interventional procedure was controlled using a T 1 -weighted 'dual stack' 2D TFE sequence in two orthogonal planes. Results: In all three animals, the puncture needle was safely directed into the nondilated target calyx. Even slight deviations of the needle from the optimal path were readily detected on both MR image planes which enabled immediate correction. This technique successfully achieved a 'first attempt' puncture of the targeted calyx in each animal. Over a nitinol guidewire a 5 F catheter was placed into the renal pelvis. Its dysprosium labelled tip was acurately delineated on contrast-enhanced MR images. Conclusions: Percutaneous nephrostomy under MR guidance is a very feasible technique for puncturing the nondilated pelvicalyceal system. This procedure offers some advantages over the current standard modalities. (orig.) [de

  11. Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil); Yamaguchi, Nise Hitomi [Instituto Avanços em Medicina (Brazil); Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de, E-mail: marcos.menezes@hc.fm.usp.br [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil)

    2016-02-15

    A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

  12. Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor.

    Science.gov (United States)

    Panizza, Pedro Sergio Brito; de Albuquerque Cavalcanti, Conrado Furtado; Yamaguchi, Nise Hitomi; Leite, Claudia Costa; Cerri, Giovanni Guido; de Menezes, Marcos Roberto

    2016-02-01

    A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

  13. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Sarma, Asha, E-mail: ashasarma@gmail.com; Shyn, Paul B., E-mail: pshyn@partners.org [Brigham and Women’s Hospital, Department of Radiology (United States); Vivian, Mark A. [University of Manitoba, Department of Radiology (Canada); Ng, Ju-Mei [Brigham and Women’s Hospital, Department of Anesthesiology (United States); Tuncali, Kemal [Brigham and Women’s Hospital, Department of Radiology (United States); Lorch, Jorchen H. [Dana Farber Cancer Institute, Department of Medicine (United States); Zaheer, Sarah N.; Gordon, Michael S. [Brigham and Women’s Hospital, Department of Endocrinology (United States); Silverman, Stuart G. [Brigham and Women’s Hospital, Department of Radiology (United States)

    2015-10-15

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: One was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  14. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).......The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  15. Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

    Energy Technology Data Exchange (ETDEWEB)

    Chiba, Emiko, E-mail: chibaemi23@comet.ocn.ne.jp; Hamamoto, Kohei, E-mail: hkouhei917@gmail.com [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan); Nagashima, Michio, E-mail: nagamic00@gmail.com [Asahikawa Medical University, Department of Emergency Medicine (Japan); Matsuura, Katsuhiko, E-mail: kmatsur@gmail.com; Okochi, Tomohisa, E-mail: t-shachi@dj8.so-net.ne.jp; Tanno, Keisuke, E-mail: tankichi1974@gmail.com; Tanaka, Osamu, E-mail: otanaka@omiya.jichi.ac.jp [Jichi Medical University, Department of Radiology, Saitama Medical Center (Japan)

    2016-10-15

    PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

  16. Efficacy of Ultrasound-Guided Axillary Brachial Plexus Block for Analgesia During Percutaneous Transluminal Angioplasty for Dialysis Access

    International Nuclear Information System (INIS)

    Chiba, Emiko; Hamamoto, Kohei; Nagashima, Michio; Matsuura, Katsuhiko; Okochi, Tomohisa; Tanno, Keisuke; Tanaka, Osamu

    2016-01-01

    PurposeTo evaluate the efficacy and safety of ultrasound (US)-guided axillary brachial plexus block (ABPB) for analgesia during percutaneous transluminal angioplasty (PTA) for dialysis access.Subjects and MethodsTwenty-one patients who underwent PTA for stenotic dialysis access shunts and who had previous experience of PTA without sedation, analgesia, and anesthesia were included. The access type in all patients was native arteriovenous fistulae in the forearm. Two radiologists performed US-guided ABPB for the radial and musculocutaneous nerves before PTA. The patients’ pain scores were evaluated using a visual analog scale (VAS) after PTA, and these were compared with previous sessions without US-guided ABPB. The patient’s motor/sensory paralysis after PTA was also examined.ResultsThe mean time required to achieve US-guided ABPB was 8 min. The success rate of this procedure was 100 %, and there were no significant complications. All 21 patients reported lower VAS with US-guided ABPB as compared to without the block (p < 0.01). All patients expressed the desire for an ABPB for future PTA sessions, if required. Transient motor paralysis occurred in 8 patients, but resolved in all after 60 min.ConclusionUS-guided ABPB is feasible and effective for analgesia in patients undergoing PTA for stenotic dialysis access sites.Level of EvidenceLevel 4 (case series).

  17. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention.

    Science.gov (United States)

    Siebert, Uwe; Bornschein, Bernhard; Schnell-Inderst, Petra; Rieber, Johannes; Pijls, Nico; Wasem, Jürgen; Klauss, Volker

    2008-08-27

    Coronary artery disease (CAD) is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI) are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR) is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. This health technology assessment (HTA) aims to evaluate (1) the diagnostic accuracy, (2) the risk-benefit trade-off and (3) the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation) to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI). Individual studies' case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM), a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT) investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81.7% (95% CI: 77.0-85.7%) and 78.7% (95% CI: 74

  18. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2008-08-01

    Full Text Available Background: Coronary artery disease (CAD is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. Objectives: This health technology assessment (HTA aims to evaluate (1 the diagnostic accuracy, (2 the risk-benefit trade-off and (3 the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. Methods: We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI. Individual studies’ case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM, a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Results: Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81

  19. Percutaneous bone tumor management.

    Science.gov (United States)

    Gangi, Afshin; Buy, Xavier

    2010-06-01

    Interventional radiology plays a major role in the management of bone tumors. Many different percutaneous techniques are available. Some aim to treat pain and consolidate a pathological bone (cementoplasty); others aim to ablate tumor or reduce its volume (sclerotherapy, thermal ablation). In this article, image-guided techniques of primary and secondary bone tumors with vertebroplasty, ethanol injection, radiofrequency ablation, laser photocoagulation, cryoablation, and radiofrequency ionization (coblation) will be reviewed. For each modality, the principles, the indications, and the results will be presented. The technical choice depends on the therapeutic intent-curative or palliative-and the need for consolidation, but also on the general status of the patient and the other therapeutic options. For the most complex cases, combined treatments can be required. However, the less disabling technique should always be considered first.

  20. An optical tracker based robot registration and servoing method for ultrasound guided percutaneous renal access

    Science.gov (United States)

    2013-01-01

    Background Robot-assisted needle steering facilitates the percutaneous renal access (PRA) for their accuracy and consistency over manual operation. However, inaccurate image-robot correspondence and uncertainties in robot parameters make the needle track deviate from the intrarenal target. This paper aims to simplify the image-tracker-robot registration procedure and improves the accuracy of needle alignment for robot assisted ultrasound-guided PRA. Methods First, a semi-automatic rigid registration is used for the alignment of the preoperative MR volume and the intraoperative orthogonal US slices. Passive markers are mounted both on US probe and robot end-effector, the planned puncture path is transferred from the MR volume frame into optical tracker frame. Tracker-robot correspondence and robot calibration are performed iteratively using a simplified scheme, both position and orientation information are incorporated to estimate the transformation matrix, only several key structural robot parameters and joint zero-positions are calibrated for simplicity in solving the inverse kinematic. Furthermore, an optical tracker feedback control is designed for compensating inaccuracies in robot parameters and tracker-robot correspondence, and improving the accuracy of needle alignment. The intervention procedure was implemented by a telemanipulated 5R1P robot, two experiments were conducted to validate the efficiency of robot-tracker registration method and the optical tracker feedback control, robot assisted needle insertion experiment was conducted on kidney phantom to evaluate the system performance. Results The relative positioning accuracy of needle alignment is 0.24 ± 0.08 mm, the directional accuracy is 6.78 ± 1.65 × 10-4rad; the needle-target distance of needle insertion is 2.15 ± 0. 17 mm. The optical tracker feedback control method performs stable against wide range of angular disturbance over (0 ~ 0.4) radians, and the length disturbance

  1. Comparison of needles size in pediatric renal biopsy with sono-guided percutaneous-automated gun technique

    International Nuclear Information System (INIS)

    Kim, Jong Chul; Park, Jin Yong

    1997-01-01

    To compare the efficacy of a 20-gauge and an 18-gauge needle in sono-guided percutaneous automated gun biopsy for establishing the specific diagnosis of renal parenchymal disease in pediatric kidneys. In 60 pediatric patients with renal parenchymal diseases, percutaneous sono-guided gun biopsy was performed by an experienced radiologist. In two groups of 30 patients, regardless of their age, two needle passes were performed, using alternately an 18-gauge or a 20-gauge biopsy needle. The core of renal tissue thus obtained was examined with light, immunofluorescent or electron microscopy by the renal pathologist. The mean number of intact glomeruli of whole tissue core per biopsy, as seen on the light microscopy, and post-bioptic complications were compared between the two different needle size groups. The number (mean±1 standard deviation) of glomeruli obtained per biopsy was 17±8 in the 18-gauge needle group, and 14±5 in the 20-gauge group. Between two groups, there was no major post-bioptic complication requiring specific treatment, nor a statistically significant difference in the frequency of minor complications. Even though more glomeruli were obtained with an 18-gauge needle, the number obtained with a 20-gauge needle also permitted adequate pathologic examination. Both an 18-gauge and a 20-gauge needle may thus be suitable for renal biopsy in pediatric patients

  2. Computed tomography-guided percutaneous ozone injection of the Gasserian ganglion for the treatment of trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    An JX

    2018-01-01

    Full Text Available Jian-Xiong An,1,2 Hui Liu,1 Ruo-Wen Chen,1,2 Yong Wang,1 Wen-Xing Zhao,1 Derek Eastwood,3 John P Williams4 1Department of Anesthesiology, Pain Medicine & Critical Care Medicine, Aviation General Hospital of China Medical University & Beijing Institute of Translational Medicine, Chinese Academy of Sciences, 2Department of Anesthesiology, Weifang Medical University, Beijing, People’s Republic of China; 3Department of Pain Services, Wirral University Teaching Hospital, Wirral, Merseyside, UK; 4Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Objective: The aim of this study was to evaluate the therapeutic effect of computed tomography (CT-guided percutaneous ozone injection for refractory trigeminal neuralgia. Design: A retrospective evaluation was performed in the study. Setting: The study was conducted at a university hospital pain center. Patients and methods: A total of 29 patients with a clinical diagnosis of refractory trigeminal neuralgia were enrolled. All patients were treated with a percutaneous ozone injection and one patient was excluded. There were 21 patients with classical trigeminal neuralgia (group A and seven patients with painful trigeminal neuropathy caused by post-herpetic neuralgia (group B. The percutaneous injection was an oxygen–ozone mixture at an ozone concentration of 30 mg/­mL into the Gasserian ganglion performed under CT guidance. The number of ­procedures performed varied from one to as many as 16. Outcomes were evaluated using visual analog scale (VAS pain scores. Results: The combined VAS scores were 7.11 ± 1.23 pretreatment, 2.86 ± 1.69 posttreatment (P < 0.05 and 3.25 ± 2.01 after 6-month follow-up (P < 0.05. In group A, the VAS scores were 7.10 ± 1.04 pretreatment and 2.90 ± 1.84 posttreatment (P < 0.05. In group B, the VAS scores were 7.14 ± 1.77 pretreatment and 2.71 ± 1.25 posttreatment (P < 0.05. After 6-months follow-up, the VAS score was 3.38

  3. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  4. Difficulties with percutaneous endoscopic gastrostomy (PEG): a practical guide for the endoscopist.

    LENUS (Irish Health Repository)

    O'Mahony, S

    2013-03-01

    Percutaneous endoscopic gastrostomy (PEG) is a widely used and effective means of providing long-term nutrition in patients with inadequate oral intake. The demand for this intervention has risen steadily since the early 1990s. Endoscopists who perform PEG insertion have become increasingly concerned about inappropriate use of this intervention.

  5. Percutaneous transthoracic computed tomography-guided AICD insertion in a patient with extracardiac Fontan conduit.

    LENUS (Irish Health Repository)

    Murphy, Darra T

    2011-02-01

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  6. EMG-Guided Percutaneous Placement of Cement-Augmented Pedicle Screws for Osteoporotic Thoracolumbar Burst Fractures.

    Science.gov (United States)

    Iacopino, Domenico Gerardo; Certo, Francesco; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Visocchi, Massimiliano; Conti, Alfredo; Maugeri, Rosario

    2017-01-01

    Percutaneous techniques have increasingly gained popularity in recent years. The application of technological innovation, including neuromonitoring techniques, has the potential to increase the safety and efficacy of these procedures. Thirty patients suffering from osteoporotic dorsolumbar burst fracture were prospectively enrolled in this study. The patients underwent percutaneous fenestrated pedicle screw fixation augmented with polymethylmethacrylate (PMMA) injection. A novel surgeon-dedicated neuromonitoring device was used in order to increase the safety and the accuracy of the screw insertion. A second group of 30 patients who did not undergo neuromonitoring during percutaneous pedicle screw placement, matched for demographic characteristics, constituted the control group. A total of 296 screws were inserted. All treated patients had a good outcome, documented by an improvement in visual analogue scale (VAS) scores. Excellent trajectories were achieved in all patients. Cobb's angle and anterior vertebral height were satisfactorily restored in all study group patients. Three misplaced screws in three patients and a case of PMMA leakage without neurological deficits were observed in the control group, whereas no complication was recorded in the study group (p = 0.03). Neuromonitoring in cement-augmented percutaneous pedicle screw placement appears to improve surgeon confidence during surgery, reducing the risk of screw misplacement or cement leakage.

  7. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection; Biopsia percutanea de massas pancreaticas guiada por tomografia computadorizada com pneumodisseccao

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang Jeng; Bitencourt, Almir Galvao Vieira; Almeida, Maria Fernanda Arruda; Barbosa, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Junior, Joao Paulo Kawaoka Matushita; Chojniak, Rubens, E-mail: chiangjengtyng@gmail.com [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Imagem; Coimbra, Felipe Jose Fernandez [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Cirurgia Abdominal

    2013-05-15

    Objective: to describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and methods: in the period from June 2011 to May 2012, seven computed tomography guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results: in all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion: Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible. (author)

  8. Alcoolização percutânea de cistos renais: revisão da literatura e apresentação de resultados Percutaneous ethanol sclerotherapy of renal cysts: treatment outcomes and literature review

    Directory of Open Access Journals (Sweden)

    Giuseppe D'Ippolito

    2009-08-01

    (mean, 200 ml. The mean follow-up period following the procedure was of seven months. Two patients had ultrasoud-guided sclerotherapy, and eight, computed tomography-guided sclerotherapy. The hospital stay period ranged between 24 and 72 hours. Complete success corresponded to total cyst regression, and partial success corresponded to recurrence of less than half the original cyst volume. RESULTS: Complete cyst ablation was achieved in seven patients and partial resolution in three. No complication was observed and the therapy was well tolerated by all of the patients. CONCLUSION: Percutaneous ethanol sclerotherapy of symptomatic simple renal cysts is a safe, effective and minimally invasive procedure, with results similar to the ones reported by other studies.

  9. Ultrasound-Guided Percutaneous Dilational Tracheostomy: A Systematic Review of Randomized Controlled Trials and Meta-Analysis.

    Science.gov (United States)

    Gobatto, André L N; Besen, Bruno A M P; Cestari, Mino; Pelosi, Paolo; Malbouisson, Luiz M S

    2018-01-01

    Percutaneous dilational tracheostomy (PDT) is a common and increasingly used procedure in the intensive care unit (ICU). It is usually performed with bronchoscopy guidance. Ultrasound has emerged as a useful tool in order to assist PDT, potentially improving its success rate and reducing procedural-related complications. To investigate whether the ultrasound-guided PDT is equivalent or superior to the bronchoscopy-guided or anatomical landmarks-guided PDT with regard to procedural-related and clinical complications. A systematic review of randomized clinical trials was conducted comparing an ultrasound-guided PDT to the control groups (either a bronchoscopy-guided PDT or an anatomical landmark-guided PDT) in patients undergoing a PDT in the ICU. The primary outcome was the incidence of major procedural-related and clinical complication rates. The secondary outcome was the incidence of minor complication rates. Random-effect meta-analyzes were used to pool the results. Four studies fulfilled the inclusion criteria and they were analyzed. The studies included 588 participants. There were no differences in the major complication rates between the patients who were assigned to the ultrasound-guided PDT when compared to the control groups (pooled risk ratio [RR]: 0.48; 95% confidence interval [CI]: 0.13-1.71, I 2 = 0%). The minor complication rates were not different between the groups, but they had a high heterogeneity (pooled RR: 0.49; 95% CI 0.16-1.50; I 2 = 85%). The sensitivity analyzes that only included the randomized controlled trials that used a landmark-guided PDT as the control group showed lower rates of minor complications in the ultrasound-guided PDT group (pooled RR: 0.55; 95% CI: 0.31-0.98, I 2 = 0%). The ultrasound-guided PDT seems to be safe and it is comparable to the bronchoscopy-guided PDT regarding the major and minor procedural-related or clinical complications. It also seems to reduce the minor complications when compared to the anatomical

  10. MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open high-field MRI scanner with respiratory gating

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Ming; Huang, Jie; Xu, Yujun; He, Xiangmeng; Lue, Yubo; Liu, Qiang; Li, Chengli [Department of Interventional MRI, Shandong Medical Imaging Research Institute affiliated to Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technologies and Applications, Jinan, Shandong (China); Li, Lei [Qingdao Central Hospital, Department of Interventional Radiology, Qingdao, Shandong (China); Blanco Sequeiros, Roberto [Turku University Hospital, The South Western Finland Imaging Centre, Turku (Finland)

    2017-04-15

    To prospectively evaluate the feasibility, safety and accuracy of MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open MR scanner with respiratory gating. Sixty-five patients with 65 solitary pulmonary lesions underwent MR-guided percutaneous coaxial cutting needle biopsy using a 1.0-T open MR scanner with respiratory gating. Lesions were divided into two groups according to maximum lesion diameters: ≤2.0 cm (n = 31) and >2.0 cm (n = 34). The final diagnosis was established in surgery and subsequent histology. Diagnostic accuracy, sensitivity and specificity were compared between the groups using Fisher's exact test. Accuracy, sensitivity and specificity of MRI-guided percutaneous pulmonary biopsy in diagnosing malignancy were 96.9 %, 96.4 % and 100 %, respectively. Accuracy, sensitivity and specificity were 96.8 %, 96.3 % and 100 % for lesions 2.0 cm or smaller and 97.1 %, 96.4 % and 100 %, respectively, for lesions larger than 2.0 cm. There was no significant difference between the two groups (P > 0.05). Biopsy-induced complications encountered were pneumothorax in 12.3 % (8/65) and haemoptysis in 4.6 % (3/65). There were no serious complications. MRI-guided percutaneous biopsy using a 1.0-T open MR scanner with respiratory gating is an accurate and safe diagnostic technique in evaluation of pulmonary lesions. (orig.)

  11. Percutaneous MR Imaging-Guided Cryoablation of Small Renal Masses in a 3-T Closed-Bore MR Imaging Environment: Initial Experience

    NARCIS (Netherlands)

    Oostenbrugge, T.J. van; Langenhuijsen, J.F.; Overduin, C.G.; Jenniskens, S.F.M.; Mulders, P.F.A.; Futterer, J.J.

    2017-01-01

    PURPOSE: To assess the feasibility of percutaneous magnetic resonance (MR) imaging-guided cryoablation of small renal masses (SRMs) in a 3-T environment and to evaluate intraprocedural imaging, procedural safety, and initial outcomes. MATERIALS AND METHODS: The analysis included 9 patients (4 men;

  12. Percutaneous MR-guided focal cryoablation for recurrent prostate cancer following radiation therapy. Retrospective analysis of iceball margins and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Overduin, Christiaan G.; Jenniskens, Sjoerd F.M.; Bomers, Joyce G.R. [Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); Sedelaar, J.P.M. [Radboud University Medical Center, Department of Urology, Nijmegen (Netherlands); Fuetterer, Jurgen J. [Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen (Netherlands); University of Twente, MIRA Institute for Biomedical Engineering and Technical Medicine, Enschede (Netherlands)

    2017-11-15

    To evaluate iceball margins after magnetic resonance (MR)-guided focal salvage prostate cryoablation and determine the correlation with local outcome. A retrospective review was performed on 47 patients that underwent percutaneous MR-guided focal cryoablation for biopsy-proven locally recurrent prostate cancer after primary radiotherapy. Preprocedural diagnostic and intraprocedural MR images were analysed to derive three-directional iceball margins. Local tumour progression after cryoablation was defined as evident tumour recurrence on follow-up MRI, positive MR-guided biopsy or biochemical failure without radiological evidence of metastatic disease. Mean iceball margins were 8.9 mm (range -7.1 to 16.2), 10.1 mm (range 1.1-20.3) and 12.5 mm (range -1.5 to 22.2) in anteroposterior, left-right and craniocaudal direction respectively. Iceball margins were significantly smaller for tumours that were larger (P =.008) or located in the posterior gland (P =.047). Significantly improved local progression-free survival at 1 year post focal cryoablation was seen between patients with iceball margin >10 mm (100%), 5-10 mm (84%) and <5 mm (15%) (P <.001). Iceball margins appear to correlate with local outcome following MR-guided focal salvage prostate cryoablation. Our initial data suggest that freezing should be applied at minimum 5 mm beyond the border of an MR-visible recurrent prostate tumour for successful ablation, with a wider margin appearing desirable. (orig.)

  13. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

    Directory of Open Access Journals (Sweden)

    Zhaohui He

    Full Text Available ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range operative duration was 67 (20-150 min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1 g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86 months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.

  14. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

    Science.gov (United States)

    He, Zhaohui; Zhang, Caixia; Zeng, Guohua

    2016-01-01

    ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis. PMID:27509373

  15. Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles.

    Science.gov (United States)

    Orlandi, Davide; Mauri, Giovanni; Lacelli, Francesca; Corazza, Angelo; Messina, Carmelo; Silvestri, Enzo; Serafini, Giovanni; Sconfienza, Luca Maria

    2017-11-01

    Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ 2 , and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid

  16. Image-guided percutaneous lipiodol-pingyangmycin suspension injection therapy for sacral chordoma

    International Nuclear Information System (INIS)

    Huang, Dexiao; Chen, Yong; Zeng, Qingie; Li, Yanhao; Wu, Renhua

    2013-01-01

    A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

  17. Seeding after ultrasound-guided percutaneous biopsy of liver metastases in patients with colorectal or breast cancer

    DEFF Research Database (Denmark)

    Chen, Inna; Lorentzen, Torben; Linnemann, Dorte

    2016-01-01

    BACKGROUND: Neoplasm seeding is a serious complication after liver metastases biopsy. Reported incidences vary between 10% and 19% for colorectal cancer (CRC) and are unknown for breast cancer (BC). The aim of this retrospective study was to determine the frequency of tumor seeding after ultrasound......-guided percutaneous biopsy of CRC and BC liver metastases. MATERIAL AND METHODS: Unselected liver biopsies performed in the period of 2005-2012 at our institution were extracted from the National Pathology Registry. Medical records including imaging from patients with biopsy-verified BC and CRC liver metastases were...... retrospectively reviewed. The endpoint was the development of abdominal wall recurrence following liver biopsy. RESULTS: Of total 2981 biopsies we identified 278 patients with CRC and 155 patients with BC biopsy-verified liver metastases. During the median follow-up of 25 months after biopsy (range 3-253 months...

  18. The role of CT-guided percutaneous gastrostomy in patients with clinically severe obesity presenting with complications after bariatric surgery.

    Science.gov (United States)

    Petsas, Theodore; Kraniotis, Pantelis; Spyropoulos, Charalambos; Katsanos, Konstantinos; Karatzas, Andreas; Kalfarentzos, Fotis

    2010-10-01

    To retrospectively evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous gastrostomy in patients presenting with complications after bariatric surgery. From January 2003 up to today, 25 patients (20 women), formerly operated for severe obesity, were referred for gastrostomy, after presenting with a complication. The mean age and body mass index were 38±9.3 years and 46±7.1 kg/m, respectively. A gastrostomy tube was placed under CT in all patients. The procedure's technical success rate was 96%, with mean interventional time of 80±42 minutes. In 14 of 25 (56%) cases submucosal spread of air was noticed during air insufflation into the stomach. No major complications were recorded. There was a statistically significant improvement of both albumin and prealbumin values compared with the initial ones (Pbariatric surgery, provides a reliable alternative for nutritional support. It restores the normal absorption route, reversing metabolic deficiencies.

  19. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses.

    Science.gov (United States)

    Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

    2013-10-01

    Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.

  20. Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

    Energy Technology Data Exchange (ETDEWEB)

    Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Pacheco, Rafael A., E-mail: pachecor@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Hsi, Andy C., E-mail: hsia@path.wustl.edu [Washington University School of Medicine, Division of Anatomic Pathology, Department of Pathology & Immunology (United States); Long, Jeremiah, E-mail: longj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-02-15

    BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.

  1. Percutaneous computed tomography-guided core needle biopsy of soft tissue tumors: results and correlation with surgical specimen analysis

    Energy Technology Data Exchange (ETDEWEB)

    Chojniak, Rubens; Grigio, Henrique Ramos; Bitencourt, Almir Galvao Vieira; Pinto, Paula Nicole Vieira; Tyng, Chiang J.; Cunha, Isabela Werneck da; Aguiar Junior, Samuel; Lopes, Ademar, E-mail: chojniak@uol.com.br [Hospital A.C. Camargo, Sao Paulo, SP (Brazil)

    2012-09-15

    Objective: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. Materials and Methods: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. Results: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). Conclusion: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning (author)

  2. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

    International Nuclear Information System (INIS)

    Kim, Young Hwan; Cha, Soon Joo

    2002-01-01

    To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 ±3.8 min. in the right approach and 9.6 ±3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9±2.4 min. in the right approach and 3.8±2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD

  3. US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan; Cha, Soon Joo [College of Medicine, Inje Univ., Kimhae (Korea, Republic of)

    2002-02-01

    To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 {+-}3.8 min. in the right approach and 9.6 {+-}3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9{+-}2.4 min. in the right approach and 3.8{+-}2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD.

  4. Breast cancer: determining the genetic profile from ultrasound-guided percutaneous biopsy specimens obtained during the diagnostic workups.

    Science.gov (United States)

    López Ruiz, J A; Zabalza Estévez, I; Mieza Arana, J A

    2016-01-01

    To evaluate the possibility of determining the genetic profile of primary malignant tumors of the breast from specimens obtained by ultrasound-guided percutaneous biopsies during the diagnostic imaging workup. This is a retrospective study in 13 consecutive patients diagnosed with invasive breast cancer by B-mode ultrasound-guided 12 G core needle biopsy. After clinical indication, the pathologist decided whether the paraffin block specimens seemed suitable (on the basis of tumor size, validity of the sample, and percentage of tumor cells) before sending them for genetic analysis with the MammaPrint® platform. The size of the tumors on ultrasound ranged from 0.6cm to 5cm. In 11 patients the preserved specimen was considered valid and suitable for use in determining the genetic profile. In 1 patient (with a 1cm tumor) the pathologist decided that it was necessary to repeat the core biopsy to obtain additional samples. In 1 patient (with a 5cm tumor) the specimen was not considered valid by the genetic laboratory. The percentage of tumor cells in the samples ranged from 60% to 70%. In 11/13 cases (84.62%) it was possible to do the genetic analysis on the previously diagnosed samples. In most cases, regardless of tumor size, it is possible to obtain the genetic profile from tissue specimens obtained with ultrasound-guided 12 G core biopsy preserved in paraffin blocks. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  5. A comparative study of image-guided percutaneous procedures for the treatment of liver abscesses; Estudos comparativos dos procedimentos percutaneos orientados por metodos de imagem no tratamento das colecoes hepaticas

    Energy Technology Data Exchange (ETDEWEB)

    Mello, Giselle Guedes Netto de; Meirelles, Gustavo de Souza Portes; Oliveira, Jose Marcelo Amatuzzi de; Ajzen, Sergio; D' Ippolito, Giuseppe; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP), SP (Brazil). Dept. de Diagnostico por Imagem

    2001-04-01

    The objective was to determine and compare the efficacy of percutaneous needle aspiration and percutaneous catheter drainage, both guided by imaging methods, for the treatment of liver abscesses. From 52 patients referred to our service for percutaneous treatment of abdominal abscesses, 17 presented liver abscesses, 13 of which were considered non complex and four were considered complex (multiloculated, multiple or associated to fistulas). Percutaneous needle aspiration was performed in 7/17 patients and 10/17 patients were submitted to percutaneous catheter drainage. The method used was considered successful when there was complete abscess resolution with both clinical and laboratorial improvement. The procedures were successful in 82.4% of all cases. In the group submitted to percutaneous needle aspiration the rate of success was 57.1% and in the group submitted to percutaneous catheter drainage the rate of success was 100%. Successful treatment was achieved in 75% of the patients submitted to percutaneous needle aspiration for abscesses smaller than 100 ml, but in only 33.3% of the patients with abscesses between 100 and 250 ml. There was complete resolution of the abscesses with percutaneous needle aspiration in 75% of the simple abscesses and in 25% of the complex abscesses. Percutaneous catheter drainage is more effective than percutaneous needle aspiration for the treatment of liver abscesses. Needle aspiration may probably be used as a valid alternative for smaller and non complex abscesses. (author)

  6. Computed tomography-guided percutaneous trephine removal of the nidus in osteoid osteoma patients: experience of a single center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Petrilli, Marcelo; Senerchia, Andreza Almeida; Petrilli, Antonio Sergio; Lederman, Henrique Manoel; Garcia Filho, Reynaldo Jesus, E-mail: andrezasenerchia@hotmail.com [Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, SP (Brazil). Instituto de Oncologia Pediatrica

    2015-07-15

    Objective: to report the results of computed tomography (CT)-guided percutaneous resection of the nidus in 18 cases of osteoid osteoma. Materials and methods: the medical records of 18 cases of osteoid osteoma in children, adolescents and young adults, who underwent CT-guided removal of the nidus between November, 2004 and March, 2009 were reviewed retrospectively for demographic data, lesion site, clinical outcome and complications after procedure. Results: clinical follow-up was available for all cases at a median of 29 months (range 6-60 months). No persistence of pre-procedural pain was noted on 17 patients. Only one patient experienced recurrence of symptoms 12 months after percutaneous resection, and was successfully retreated by the same technique, resulting in a secondary success rate of 18/18 (100%). Conclusion: CT-guided removal or destruction of the nidus is a safe and effective alternative to surgical resection of the osteoid osteoma nidus. (author)

  7. Changes in disc herniation after CT-guided Percutaneous Laser Disc Decompression (PLDD): MR findings

    Science.gov (United States)

    Brat, Hugues G.; Bouziane, Tarik; Lambert, Jean; Divano, Luisa

    2004-09-01

    The aim of Percutaneous Laser Disc Decompression (PLDD) is to vaporize a small portion of the nucleus pulposus. Clinical efficacy of this technique is largely proven. However, time-evolution of intervertebral disc and its hernia after PLDD is not known. This study analyses changes in disc herniation and its native intervertebral disc at a mean follow-up of 7.5 months after PLDD in asymptomatic patients. Main observations at MRI are appearance of a high signal on T2WI in the hernia in 59%, shrinking of the hernia in 66% and overall stability of disc height.

  8. CT-guided percutaneous gastrostomy: success rate, early and late complications; CT-gesteuerte perkutane Gastrostomie: Technischer Erfolg, Frueh- und Spaetkomplikationen

    Energy Technology Data Exchange (ETDEWEB)

    Gottschalk, A.; Voelk, M. [Radiologie, Bundeswehrkrankenhaus Ulm (Germany); Strotzer, M. [Radiologie, Klinikum Hohe Warte (Germany); Feuerbach, S.; Rogler, G. [Radiologie, Klinikum der Universitaet Regensburg (Germany); Seitz, J. [Radiologie, MVZ Dr. Neumaier und Kollegen (Germany)

    2007-04-15

    Purpose: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are the standard methods of ensuring long-term enteral food intake in patients with dysphagia caused by neoplasia or neurological disorders. High-grade obstructions of the upper digestive tract or inadequate transillumination can prevent PEG. CT-guided percutaneous gastrostomy (PG) represents a special technique for enabling gastrostomy in patients for whom the endoscopic method is impossible. The aim of this study was to evaluate the results and complications of CT-guided percutaneous gastrostomy. Materials and Methods: CT-guided PG was performed in 83 patients, mostly with malignancy of the upper respiratory or digestive tract. Medical records for these patients were reviewed, and the results and complications of the CT-guided PG were analyzed retrospectively. Complications were grouped into four categories: Major and minor complications as well as early and late complications. Results: In 95.2 % of all cases (79/83), CT-guided PG was successful in the first attempt. Within the first 3 days, 5 major complications including 4 tube dislocations and one case of peritonitis were found in 4/79 patients (5.1 %). One of these patients experienced two early major complications. Early minor complications, mainly local skin irritations and temporary stomachache, were observed in 31 patients (39.2 %). Three days after CT-guided PG, 4 cases of major complications were documented, yielding a total rate of major complications was 8.7 % (7/79). Hemorrhage requiring blood transfusion or perforation after gastrostomy was not observed. 29.1 % of the patients (23/79) experienced late minor complications. (orig.)

  9. Fuel From Farms: A Guide to Small-Scale Ethanol Production.

    Science.gov (United States)

    Solar Energy Research Inst., Golden, CO.

    Ethanol and blends of ethanol and gasoline (such as gasohol) offer a near-term fuel alternative to oil. The focus of this handbook is upon the small-scale production of ethanol using farm crops as the source of raw materials. Provided are chapters on ethanol production procedures, feedstocks, plant design, and financial planning. Also presented…

  10. The application of machine learning to the modelling of percutaneous absorption: an overview and guide.

    Science.gov (United States)

    Ashrafi, P; Moss, G P; Wilkinson, S C; Davey, N; Sun, Y

    2015-01-01

    Machine learning (ML) methods have been applied to the analysis of a range of biological systems. This paper reviews the application of these methods to the problem domain of skin permeability and addresses critically some of the key issues. Specifically, ML methods offer great potential in both predictive ability and their ability to provide mechanistic insight to, in this case, the phenomena of skin permeation. However, they are beset by perceptions of a lack of transparency and, often, once a ML or related method has been published there is little impetus from other researchers to adopt such methods. This is usually due to the lack of transparency in some methods and the lack of availability of specific coding for running advanced ML methods. This paper reviews critically the application of ML methods to percutaneous absorption and addresses the key issue of transparency by describing in detail - and providing the detailed coding for - the process of running a ML method (in this case, a Gaussian process regression method). Although this method is applied here to the field of percutaneous absorption, it may be applied more broadly to any biological system.

  11. Efficacy of MR imaging for real-time monitoring of percutaneous ethanol injection in the experimental in vivo model

    International Nuclear Information System (INIS)

    Anzai, Y.; Lufkin, R.B.; Castro, D.J.; Jabour, B.A.; Hirchowiz, S.; Hanafee, W.N.

    1991-01-01

    This paper reports that percutaneous alcohol injection is a valuable technique that can cause focal necrosis in deep tumors. This technique has been used for treatment of small hepatic tumors with US guidance. However, inhomogeneous distribution of the injected alcohol and difficulties in identifying the tumor after previous treatments cause incomplete necrosis. In this study, an experimental model was developed to demonstrate the feasibility and sensitivity of MR imaging as a monitoring technique. A 23-gauge MR-compatible needle was placed into the thigh muscle of the rabbit and 1-3 mL sterile absolute alcohol (98%) was injected slowly (within 1-2 minutes). MR imaging was performed before alcohol injection and continued during as well as after injection. A T2-weighted fast spin-echo technique was used. Animals were killed after MR examination, and the alcohol-injected lesions were processed for pathologic examination

  12. Percutaneous computed tomography-guided lung needle marking without thoracocentesis for small-sized peripheral lung lesions

    International Nuclear Information System (INIS)

    Masuda, Daisuke; Nishida, Tatsuya; Akiduki, Katsuhiro; Tei, Yoshimitsu; Fuji, Yoshitaka; Iwazaki, Masayuki

    2011-01-01

    Because of the difficulty in diagnosing small-sized peripheral lung lesions, pre-operative computed tomography (CT)-guided lung needle marking is performed before video-assisted thoracic surgery (VATS). However, percutaneous CT-guided marking is associated with several complications caused by thoracocentesis. The complications associated with thoracocentesis have already been reported, such as pneumothorax, intrapulmonary hematoma, and hemothorax. Air embolism following CT-guided marking is a rare complication, but efforts must be taken to avoid this complication because it is associated with serious sequelae and mortality. Therefore, we developed a new CT-guided marking method that did not involve thoracocentesis, and found that this method can be performed accurately and safely. After performing chest CT with a patient in the lateral position, we inserted an 18-gauge indwelling needle into the skin up to the parietal pleura above the pulmonary lesions, without causing centesis of the visceral pleura. Next, the external tube of the indwelling needle was placed in the chest wall. Subsequently, VATS was performed. Under one-lung anesthesia, a central vein catheter with guidewire was inserted into the thoracic cavity through the external tube using a double lumen tube with 3 thoracoports. The top of the catheter was equipped with a small staining stype (round-cotton), and the central venous catheter was pulled toward the chest wall. After conventional ventilation, the visceral pleura above the pulmonary lesions was found to be pigmented, and partial resection of the lung was performed. We confirmed the staining of the visceral pleura above small peripheral pulmonary lesions in a specimen. This method was useful for supplementary diagnosis because there were no complications associated with centesis of the visceral pleura. (author)

  13. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  14. Ultrasound-guided percutaneous core needle biopsy of abdominal viscera: Tips to ensure safe and effective biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Woong; Shin, Sang Soo [Chonnam National University Hospital, Chonnam National University Medical School, Gwangju(Korea, Republic of)

    2017-04-15

    Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications.

  15. The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible

    Energy Technology Data Exchange (ETDEWEB)

    Sormaz, Ismail Cem, E-mail: icsormaz@gmail.com [Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery (Turkey); Poyanlı, Arzu, E-mail: arzupoyanli@yahoo.com [Istanbul University, Istanbul Faculty of Medicine, Department of Radiology (Turkey); Açar, Sami, E-mail: acarrsami@gmail.com [Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery (Turkey); İşcan, Ahmet Yalın, E-mail: yaliniscan@gmail.com [Fatih Sultan Mehmet Research and Education Hospital, Department of General Surgery (Turkey); Ozgur, İlker, E-mail: dr.ilkerozgur@gmail.com; Tunca, Fatih, E-mail: drfatihtunca@yahoo.com; Senyürek, Yasemin Giles, E-mail: yasemin.senyurek@gmail.com [Istanbul University, Istanbul Faculty of Medicine, Department of General Surgery (Turkey)

    2017-04-15

    BackgroundThe aim of the study was to evaluate the results of ultrasonography (US)-guided percutaneous radiofrequency ablation (RFA) in hyperparathyroid patients who refused surgery or had high surgical risks.Patients and MethodsFive patients with hyperparathyroidism (HPT) underwent US-guided RFA for a single hyperfunctioning parathyroid lesion. Post-ablation serum calcium and parathormone (PTH) assays were performed. All patients underwent imaging studies 6 months after the ablation to visualize the post-ablation change in the size of the treated parathyroid lesions.ResultsAll patients were normocalcemic on the post-ablation 1st day and 6th month. The post-ablation PTH levels were normal in three patients but remained elevated in two patients. The size of the parathyroid lesion was ≥30 mm in the two patients with elevated PTH, whereas the lesion was smaller than 30 mm in those with normal post-ablation PTH values.ConclusionAlthough this is a limited case series, it demonstrates the potential feasibility of RFA for HPT. Benefits were achieved particularly in patients with small parathyroid lesions.

  16. The Results of Ultrasonography-Guided Percutaneous Radiofrequency Ablation in Hyperparathyroid Patients in Whom Surgery Is Not Feasible

    International Nuclear Information System (INIS)

    Sormaz, Ismail Cem; Poyanlı, Arzu; Açar, Sami; İşcan, Ahmet Yalın; Ozgur, İlker; Tunca, Fatih; Senyürek, Yasemin Giles

    2017-01-01

    BackgroundThe aim of the study was to evaluate the results of ultrasonography (US)-guided percutaneous radiofrequency ablation (RFA) in hyperparathyroid patients who refused surgery or had high surgical risks.Patients and MethodsFive patients with hyperparathyroidism (HPT) underwent US-guided RFA for a single hyperfunctioning parathyroid lesion. Post-ablation serum calcium and parathormone (PTH) assays were performed. All patients underwent imaging studies 6 months after the ablation to visualize the post-ablation change in the size of the treated parathyroid lesions.ResultsAll patients were normocalcemic on the post-ablation 1st day and 6th month. The post-ablation PTH levels were normal in three patients but remained elevated in two patients. The size of the parathyroid lesion was ≥30 mm in the two patients with elevated PTH, whereas the lesion was smaller than 30 mm in those with normal post-ablation PTH values.ConclusionAlthough this is a limited case series, it demonstrates the potential feasibility of RFA for HPT. Benefits were achieved particularly in patients with small parathyroid lesions.

  17. MR-guided percutaneous cryotherapy of liver metastases; MR-gesteuerte perkutane Kryotherapie von Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Haage, P.; Tacke, J. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum der RWTH Aachen (Germany)

    2001-01-01

    The prognosis for patients with liver metastases depends on the therapeutic options regarding the treatment of the primary tumor, co-existing extrahepatic metastases and the extent and treatment possibilities of the hepatic metastases themselves. Numerous curative or palliative oncological therapeutic concepts have been introduced in case of non-resectable liver metastases to prolong survival while maintaining a highest possible quality of life. Cryotherapy, which can be performed percutaneously and under magnetic resonance guidance, is one of these manifold therapeutic modalities, combining the inherent advantages of MRI with minimal invasiveness. Excellent visualization of the frozen liver tissue, precise tumor ablation, as well as an almost painless intervention due to the analgetic effect of the ice are implicating percutaneous cryotherapy as an attractive alternative to other ablation techniques. First clinical results are promising. However, meticulous and extensive long-term evaluation on a broad clinical scale is required. (orig.) [German] Die Prognose eines Patienten mit hepatischen Filiae haengt von den Behandlungsmoeglichkeiten des Primaertumors, vom Vorhandensein weiterer Metastasen und von der Ausdehnung und den Behandlungsmoeglichkeiten der Lebermetastasen selbst ab. Bei chirurigsch nicht resektablen Lebermetastasen kommen zahlreiche kurative oder palliative onkologische Therapiekonzepte in Frage, saemtlich mit dem Ziel einer moeglichst hohen Ueberlebensrate und Lebensqualitaet. Eine dieser Therapiestrategien ist die Kryotherapie, die perkutan unter kernspintomographischer Kontrolle durchgefuehrt werden kann und somit die inhaerenten Vorteile der MRT mit einem wenig invasiven Verfahren verbindet. Eine exzellente Darstellbarkeit gefrorenen Lebergewebes, eine praezise Tumorablation sowie ein nahezu schmerzfreier Eingriff aufgrund des analgetischen Effektes tiefer Temperaturen machen die perkutane Kryotherapie zu einer attraktiven Alternative zu anderen

  18. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results

    Science.gov (United States)

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc

    2014-01-01

    Background Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. Objective To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. Methods A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. Results All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Conclusions Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. Trial registration number ClinicalTrials.gov identifier: NCT02085928. PMID:25122629

  19. Short-term outcomes and safety of computed tomography-guided percutaneous microwave ablation of solitary adrenal metastasis from lung cancer: A multi-center retrospective study

    Energy Technology Data Exchange (ETDEWEB)

    Men, Min; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guang Hui; Wei, Zhigang [Dept. of Oncology, Shandong Provincial Hospital Affiliated with Shandong University, Jinan (China); Fan, Wei Jun [Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou (China); Zhang, Kaixian [Dept. of Oncology, Teng Zhou Central People' s Hospital Affiliated with Jining Medical College, Tengzhou (China); Bi, Jing Wang [Dept. of Oncology, Jinan Military General Hospital of Chinese People' s Liberation Army, Jinan (China)

    2016-11-15

    To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.

  20. Factors influencing the diagnostic yield and accuracy of image-guided percutaneous needle biopsy of pediatric tumors: single-center audit of a 26-year experience.

    Science.gov (United States)

    Blondiaux, Eléonore; Laurent, Méryle; Audureau, Etienne; Boudjemaa, Sabah; Sileo, Chiara; Lenoir, Marion; Dainese, Linda; Garel, Catherine; Coulomb, Aurore; Ducou le Pointe, Hubert

    2016-03-01

    Image-guided percutaneous core needle biopsy is a common procedure for diagnosis of both solid tumors and hematological malignancies in children. Despite recent improvements, a certain rate of non-diagnostic biopsies persists. To assess the factors influencing the diagnostic yield and accuracy of percutaneous core needle biopsies of pediatric tumors. We conducted a single-center retrospective study of a 26-year experience with image-guided biopsies in children and young adults. Using uni- and multivariate analysis, we evaluated the association of diagnostic yield and accuracy with technical factors (image-guided procedure, pathological technique) and clinical factors (complication rate, histological type and anatomical location). We retrieved data relating to 396 biopsies were performed in 363 children and young adults (mean age: 7.4 years). Overall, percutaneous core needle biopsy showed a diagnostic yield of 89.4% (95% confidence interval [CI] 85.9-92.2) and an accuracy of 90.9% (CI 87.6-93.6) with a complication rate of 2.5% (CI 1.2-4.6).The diagnostic yield increased with the use of advanced tissue assessment techniques (95.7% with immunohistochemistry versus 82.3% without immunohistochemistry; P advanced pathological techniques and an increased number of passes are the two main factors influencing the diagnostic success of biopsies in pediatric tumors.

  1. Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters.

    Science.gov (United States)

    Chen, Huang-Chung; Lee, Wei-Chieh; Hsueh, Shu-Kai; Cheng, Cheng-I; Chen, Chien-Jen; Yang, Cheng-Hsu; Fang, Chih-Yuan; Hang, Chi-Ling; Yip, Hon-Kan; Wu, Chiung-Jen; Fang, Hsiu-Yu

    2015-03-01

    Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for

  2. The use of computerised tomography guided percutaneous fine needle aspiration in the evaluation of solitary pulmonary nodules.

    LENUS (Irish Health Repository)

    Khan, K A

    2012-02-01

    The evaluation of a solitary pulmonary nodule (SPN) has changed over the years with increased access to percutaneous computerised tomography (CT) guided fine needle aspiration (FNA), where bronchoscopy is unhelpful. The aim of our study was to evaluate the sample adequacy, diagnostic and complication rate of CT-FNA of a SPN at our academic teaching hospital over an 18 month period. CT-FNA was performed by a radiologist, with a cytopathologist in attendance to confirm the adequacy of the sample obtained. The size of the nodule, sample material and adequacy, diagnosis and complications were recorded. A total of 101 patients were included, 54 male and the mean age was 68 +\\/- 11 years. The mean size of the SPN was 2.3 cm (range 1-11 cm). 56 (56%) patients had a right SPN, 45 (45%) had a left SPN. CT-FNA was diagnostic in 80 (80%) patients and non-diagnostic in 21 (20%) patients. The sample was insufficient for immunocytochemistry, although the morphological appearance was diagnostic in 20 (25%) of the 80 patients. Pneumothorax occurred in 26\\/101 (26%) patients post CT-FNA, of these 7 (27%) required chest drain insertion, while 19 (73%) were managed conservatively. CT FNA is a useful tool for the diagnosis of a SPN, with our diagnostic accuracy comparable to that reported in the literature. However, CT-FNA may not provide adequate sample volume to perform ancillary testing and has a moderate complication rate.

  3. CT-guided Drainage of Deep Pelvic Abscesses via a Percutaneous Presacral Space Approach: A Clinical Report and Review of the Literature.

    Science.gov (United States)

    Peng, Tao; Dong, Liming; Zhu, Zhihua; Cui, Jing; Li, Qian; Li, Xin; Wu, Heshui; Wang, Chunyou; Yang, Zhiyong

    2016-12-01

    Some deep pelvic abscesses are not accessible through anterior or lateral approaches because of the presence of organs and structures. The objective of this study was to assess the feasibility, safety, tolerability, and efficacy of a percutaneous presacral space approach by reviewing our clinical experience and the literature. The outcomes of 12 patients, who have undergone computed tomography (CT)-guided percutaneous presacral space drainage, were retrospectively reviewed, including demographic, clinical, and morphological data in the medical records. From August 2010 to June 2015, 98 patients underwent CT-guided percutaneous drainage of pelvis abscesses in our institution. A percutaneous presacral space approach was adopted in 12 cases. The fluid collections were related to postoperative complications in nine patients (75%) and inflammatory or infectious intraabdominal disease in the remaining three patients (acute diverticulitis: n = 1; appendicitis: n = 1; Crohn disease: n = 1) (25%). The mean duration of drainage was 9.5 days (range 3-33). Escherichia coli was the most frequently present microorganism (in 50.0% of the all samples). No procedure-related complications were observed, either during or after the procedure. Drainage was successful in 10 patients (83.3%). Drainage failed in one patient because of massive anastomotic dehiscence. The other one died from pulmonary embolus 10 days after drainage. When an anterior or lateral transabdominal approach is inaccessible, CT-guided transperineal presacral space approach drainage is a safe, well-tolerated, and effective procedure, except for patients with massive anastomotic dehiscence. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  4. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  5. MR cone-beam CT fusion image overlay for fluoroscopically guided percutaneous biopsies in pediatric patients.

    Science.gov (United States)

    Thakor, Avnesh S; Patel, Premal A; Gu, Richard; Rea, Vanessa; Amaral, Joao; Connolly, Bairbre L

    2016-03-01

    Lesions only visible on magnetic resonance (MR) imaging cannot easily be targeted for image-guided biopsy using ultrasound or X-rays but instead require MR guidance with MR-compatible needles and long procedure times (acquisition of multiple MR sequences). We developed an alternative method for performing these difficult biopsies in a standard interventional suite, by fusing MR with cone-beam CT images. The MR cone-beam CT fusion image is then used as an overlay to guide a biopsy needle to the target area under live fluoroscopic guidance. Advantages of this technique include (i) the ability for it to be performed in a conventional interventional suite, (ii) three-dimensional planning of the needle trajectory using cross-sectional imaging, (iii) real-time fluoroscopic guidance for needle trajectory correction and (iv) targeting within heterogeneous lesions based on MR signal characteristics to maximize the potential biopsy yield.

  6. Percutaneous computed tomography-guided biopsy of the lung: data from a hospital; Biopsia pulmonar percutanea guiada por tomografia computadorizada: dados de um hospital

    Energy Technology Data Exchange (ETDEWEB)

    Carazzai, Emilio Humberto; Rossi, Marcelo D' Andrea [Maximagem Diagnosticos por Imagem, Sao Paulo, SP (Brazil); Andreosi, Maristela [Hospital Beneficencia Portuguesa, Sao Paulo, SP (Brazil); Gonzalez, Fabio Mota; Tornin, Olger de Souza [Hospital Heliopolis, Sao Paulo, SP (Brazil)]. E-mail: olger1@uol.com.br; Gonzalez, Sandra de Quadros Uzeda [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil)

    2006-07-15

    Objective: to present the experience of Santa Cecilia Hospital (Sao Paulo, SP, Brazil) radiology service in the handling of computed tomography-guided fine-needle aspiration biopsy and percutaneous core biopsy of pulmonary lesions, analyzing their importance and associated complications. Materials and methods: one hundred and sixty-eight computed tomography-guided biopsies were performed in 84 men and 84 women. Sixty-four patients underwent fine-needle aspiration biopsy, 68 underwent percutaneous core biopsy and 36 patients underwent both techniques. Results: pneumothorax occurred in 38 patients, and pulmonary hemorrhage in then cases. The biopsied lesions ranged in size from 0.5 to 15 cm. The diagnosis was achieved at the first attempt in 132 cases and at the second attempt, in ten cases. Conclusion: the accuracy of fine-needle aspiration and percutaneous core biopsies depends both on the size of the lesion and the patient's cooperation. These techniques are relatively safe and present a high diagnostic accuracy when performed by an experienced professional. (author)

  7. Percutaneous Imaging-Guided Screw Fixation of Osteoporotic Transverse Fractures of the Lower Sacrum with Cement Augmentation: Report of 2 Cases.

    Science.gov (United States)

    Garnon, Julien; Koch, Guillaume; Ramamurthy, Nitin; Bauones, Salem; Caudrelier, Jean; Tsoumakidou, Georgia; Cazzato, Roberto Luigi; Gangi, Afshin

    2017-07-01

    Osteoporotic fractures of the sacrum usually involve the sacral ala and can be managed with percutaneous cementoplasty if conservative therapy failed to achieve bone consolidation. On the other hand, isolated transverse fractures of the lowest sacrum are more rare, with little literature focusing on their management in the osteoporotic population. If pseudoarthrosis occurs in this location, sacroplasty is not an optimal therapeutic option because of the poor biomechanical resistance of cement to multi-directional stresses. Hence, we report two cases of chronic unhealed transverse fractures of the lowest sacrum successfully managed with percutaneous image-guided screw fixation augmented with cement injection. At last follow-up available, both patients experienced complete pain relief, without evidences of failure of the osteosynthesis on CT-scan controls.

  8. Percutaneous ultrasonographically guided radiofrequency heat ablation for treatment of primary hyperparathyroidism in dogs.

    Science.gov (United States)

    Pollard, R E; Long, C D; Nelson, R W; Hornof, W J; Feldman, E C

    2001-04-01

    To evaluate the efficacy and safety of ultrasonographically guided radiofrequency heat ablation of parathyroid masses in dogs with primary hyperparathyroidism. Clinical trial. 11 dogs. In all dogs, either 1 or 2 parathyroid masses were evident ultrasonographically. Dogs were anesthetized, and a 20-gauge over-the-needle catheter was directed into the parathyroid mass via ultrasonographic guidance. Radiofrequency heat was applied to the stylet of the catheter until there was sonographically apparent change to the entire parenchyma of the mass. Serum total and ionized calcium and parathyroid hormone concentrations were monitored daily for 5 days after the ablation procedure and again at 1, 2, and 3-month intervals, if possible. Dogs were monitored for adverse effects. One treatment was required in 6 dogs, 2 treatments were required in 2 dogs, and treatment was unsuccessful in 3 dogs. Serum total and ionized calcium concentrations were within reference ranges within 2 days of the last procedure in all 8 successfully treated dogs. Serum parathyroid hormone concentration was decreased 24 hours after treatment in all 8 dogs. Hypocalcemia developed in 5 of the 8 successfully treated dogs, all of which required treatment. One dog had a transient voice change. Other adverse effects were not reported. Ultrasonographically guided radiofrequency heat ablation of parathyroid masses is a safe and effective alternative to surgery in dogs with primary hyperparathyroidism.

  9. CT fluoroscopy-guided percutaneous gastrostomy with loop gastropexy and peel-away sheath trocar technique in 31 amyotrophic lateral sclerosis patients

    Energy Technology Data Exchange (ETDEWEB)

    De Bucourt, Maximilian; Collettini, Federico; Althoff, Christian; Streitparth, Florian; Greupner, Johannes; Hamm, Bernd (Dept. of Radiology, Charite - Univ. Medicine, Berlin (Germany)), Email: mdb@charite.de; Teichgraeber, U.K. (Dept. of Radiology, Jena Univ. (Germany))

    2012-04-15

    Background: In amyotrophic lateral sclerosis (ALS) patients with respiratory impairment and/or advanced disease, performing even mild sedation - as is usually necessary for percutaneous endoscopic gastrostomy (PEG) placements - is fraught with risk. These patients are often referred to Interventional Radiology for alternative percutaneous gastrostomy tube placement options. Purpose: To report our experience with CT fluoroscopy-guided percutaneous gastrostomy with a novel loop gastropexy and peel-away sheath trocar technique in ALS patients as an alternative to endoscopic techniques. Material and Methods: A consecutive series of 31 amyotrophic lateral sclerosis patients in whom endoscopic gastrostomy was considered too dangerous or impossible to perform underwent CT-guided percutaneous gastropexy and gastrostomy and prospective follow-up. All procedures were performed with a 15 FR Freka Pexact gastrostomy kit, a 16-row CT scanner (Aquilion 16) and single shot CT fluoroscopy mode. Results: The procedure was performed successfully in 30 of 31 patients (20 men, 11 women; median age 60 years, range 38-80 years). In the remaining case the stomach was punctured under CT fluoroscopy and CO2 insufflation was initiated thereafter, leading to successful gastrostomy without prior gastropexy and without further adverse events during follow-up. Two patients reported unproblematic exchange of a balloon tube due to skin irritations with no further adverse events. One patient reported accidental displacement of an exchanged new balloon tube in domestic environment due to balloon leakage: A new balloon tube was easily re-inserted in a hospital the same day. No serious adverse events such as peritonitis, persistent local bleeding, systemic blood loss, or any local infection requiring surgical intervention were observed. Until August 11, 2011 follow-up resulted in 7473 cumulative gastrostomy-days from the date of first placement. Conclusion: Initial results suggest that the described

  10. Cholangitis and multiple liver abscesses after percutaneous ethanol injection (PEI for recurrent hepatocellular carcinoma (HCC Colangitis y abscesos hepáticos múltiples tras la inyección percutánea de etanol (IPE en el tratamiento del carcinoma hepatocelular recurrente

    Directory of Open Access Journals (Sweden)

    Fernando Macias-García

    2013-02-01

    Full Text Available Percutaneous ablation procedures are minimally invasive treatments for unresectable early stage hepatocellular carcinoma (HCC. These techniques are usually safe, but rare and even fatal complications have been described. We present a fatal result after percutaneous ethanol injection (PEI for the treatment of a recurrent HCC in a non-cirrhotic liver, with subsequent development of diffuse cholangitis and multiple liver abscesses. Although percutaneous drainage and intensive antibiotic treatment were employed, the patient finally died. We discuss about the etiology and the physiopathology of this rare complication in which the therapeutic options are limited and usually unsuccessful.

  11. CT guided puncture aspiration and sclerosing treatment of ovary cyst

    International Nuclear Information System (INIS)

    Peng Yongjun; Du Xiumei; Yuan Jinrong; Chen Chanqing

    2007-01-01

    Objective: To analyze the method and the curative effect with CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst. Method: 22 ovary cysts in 22 patients were treated with percutaneous puncture aspiration and underwent repeated sclerotherapy with 99.7% ethanol injection. Among the 22 patients, 18 patients had solitary ovary cyst and was aspirated with an 18-22G gauge aspiration needle. The amount of aspirated fluid varied from 30ml-500ml and 25%-30% cyst volume was replaced by appropriate ethanol Post treatment follow-up were achieved every 3 months. Results All the Punctures were successfully completed. During the 3 months to one year follow-up, 16 ovary cyst disappeared, 6 cysts were small over 50%, without main complication. Conclusion CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst is a treatment of choice because of its safety, low complication, and high curative effect. (authors)

  12. The clinical application of percutaneous auto-biopsy of small lung nodular under CT-Guided

    International Nuclear Information System (INIS)

    Zhou Yuanmin; Ye Genxin; Zhang Chenghui; Wang Yu; Chen Wei

    2008-01-01

    Objective: To evaluated the clinical value of technology of petcutaneous auto-biopsy of small lung nodular under CT- Guide. Methods: 44 cases of small single lung nodular were underwent biopsy with 20G auto-biopsy needle under CT guidance. All cases underwent pathological diagnosis. Results: All 44 cases were punctured successfully. 41 cases were succeeded in first puncturation. The success ratio was 93.02%. Other 3 cases needed second puncturation. 39 of 44 cases pathological diagnosis were malignant. Only 1 case could not be diagnosed. 6 patients had lightly pneumatothorax after biopsy. 10 cases had mild pneumonorrhagia after biopsy. 2 of them had haemptysis. All cases had no complication such as infection, needle track implantation. Conclusion: The technology of CT Guidance auto-biopsy of small lung nodular is safe and effective; it has extreme diagnostic ratio and less complication. (authors)

  13. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Science.gov (United States)

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  14. Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years

    Directory of Open Access Journals (Sweden)

    Mueller Michael

    2012-12-01

    Full Text Available Abstract Background Ultrasonographically guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Objective of the study was to determine the extent to which the complication rate for ultrasonographically guided punctures of the liver is affected by less comprehensively studied risk factors. Methods A total of 2,229 liver biopsies were performed in 1,961 patients (55.5% males; 44.5% females. We recorded actual complications and assessed the following risk factors: needle gauge, puncture technique, examiner experience, coagulation status, puncture target (focal lesion versus parenchyma, lesion size, patient sex and age. Results he rate of complications stood at 1.2% (n = 27, of which 0.5% (n = 12 were major and 0.7% (n = 15 minor complications. A significant increase in complications involving bleeding was observed with larger-gauge needles compared with smaller-gauge needles and for cutting biopsy punctures compared with aspiration biopsies (Menghini technique. In the bivariate analysis complications were 2.7 times more frequent in procedures performed by experienced examiners compared with those with comparatively less experience. Lower values for Quick’s test and higher partial thromboplastin times were associated with a higher rate of bleeding. Neither the puncture target, lesion size or patient sex exerted any measurable influence on the puncture risk. Advanced patient age was associated with a higher rate of complications involving bleeding. Conclusions Our study helps to establish the importance of potential and less comprehensively studied risk factors and may contribute to further reduction in complications rates in routine clinical practice.

  15. Incidence of Post-ablation Syndrome Following Image-Guided Percutaneous Cryoablation of Renal Cell Carcinoma: A Prospective Study.

    Science.gov (United States)

    Zhong, Jim; Bambrook, Janette; Bhambra, Balbir; Smith, Jonathan; Cartledge, Jon; Ralph, Christy; Vasudev, Naveen; Whiteley, Simon; Wah, Tze

    2018-02-01

    To prospectively evaluate the incidence of post-ablation syndrome (fever and flu-like symptoms) and impact on the quality of life in the first 10 days following percutaneous image-guided cryoablation for renal cell carcinoma (RCC). A prospective study of all cryoablation procedures with biopsy proven RCC was conducted with institutional review board approval between 08/2012 and 04/2016. Sixty-four patients (43 males and 21 females) underwent cryoablation. Mean age was 68 (range 24-86). A telephone questionnaire survey was conducted on days 1, 3, 5, 7 and 10 following cryoablation, and complications were recorded. Data collected included temperature, degree of flu-like symptoms, severity of pain, percentage of pain relief with analgesics, interference with general activity and with work (graded on a 0-10 Numeric Intensity Scale). Following cryoablation, six patients (9%) out of 64 developed post-ablation syndrome. Thirty-three patients (52%) developed flu-like symptoms only, which completely resolved by day 10 in 25 patients (39%). One patient had pyrexia only, which was self- limiting by day 10. Twenty-four patients (38%) were asymptomatic. Pain (mean score = 2.1) and interference on general activities (mean score = 1.8) and work (mean score = 2) following cryoablation peaked on day 3 and improved subsequently. Forty-six patients (72%) had 90-100% pain relief by day 10. No major complications were observed. The full spectrum of post-ablation syndrome following cryoablation occurs in approximately 9% of patients; however, 61% of patients experience flu-like symptoms in the first 10 days, which are self-limiting.

  16. Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Garnon, Julien, E-mail: juliengarnon@gmail.com; Koch, Guillaume, E-mail: Guillaume.koch@gmail.com; Caudrelier, Jean, E-mail: caudjean@yahoo.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: Nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Rao, Pramod, E-mail: pramodrao@me.com [University of Strasbourg, ICube (France); Tsoumakidou, Georgia, E-mail: Georgia.tsoumakidou@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: cazzatorobertoluigi@gmail.com; Gangi, Afshin, E-mail: Afshin.gangi@chru-strasbourg.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France)

    2016-11-15

    ObjectiveThis study was designed to describe the technique of percutaneous image-guided cryoablation with large-volume hydrodissection for the treatment of challenging mediastinal lesions.MethodsBetween March 2014 and June 2015, three patients (mean age 62.7 years) with four neoplastic anterior mediastinal lesions underwent five cryoablation procedures using large-volume hydrodissection. Procedures were performed under general anaesthesia using CT guidance. Lesion characteristics, hydrodissection and cryoablation data, technical success, complications, and clinical outcomes were assessed using retrospective chart review.ResultsLesions (mean size 2.7 cm; range 2–4.3 cm) were in contact with great vessels (n = 13), trachea (n = 3), and mediastinal nerves (n = 6). Hydrodissection was performed intercostally (n = 4), suprasternally (n = 2), transsternally (n = 1), or via the sternoclavicular joint (n = 1) using 1–3 spinal needles over 13.4 (range 7–26) minutes; 450 ml of dilute contrast was injected (range 300–600 ml) and increased mean lesion-collateral structure distance from 1.9 to 7.7 mm. Vulnerable mediastinal nerves were identified in four of five procedures. Technical success was 100 %, with one immediate complication (recurrent laryngeal nerve injury). Mean follow-up period was 15 months. One lesion demonstrated residual disease on restaging PET-CT and was retreated to achieve complete ablation. At last follow-up, two patients remained disease-free, and one patient developed distant disease after 1 year without local recurrence.ConclusionsCryoablation using large-volume hydrodissection is a feasible technique, enabling safe and effective treatment of challenging mediastinal lesions.

  17. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  18. Ultrasound guided percutaneous microwave ablation of benign thyroid nodules: Safety and imaging follow-up in 222 patients

    International Nuclear Information System (INIS)

    Yue, Wenwen; Wang, Shurong; Wang, Bin; Xu, Qingling; Yu, Shoujun; Yonglin, Zhang; Wang, Xiju

    2013-01-01

    Objective: Microwave ablation is a minimally invasive technique that has been used to treat benign and malignant tumors of liver, lung and kidney. Towards thyroid nodules, only a few cases are reported so far. The aim of the study was to investigate the effectiveness and safety of ultrasound-guided percutaneous microwave ablation in the treatment of benign thyroid nodules with a large sample. Materials and methods: A total of 477 benign thyroid nodules in 222 patients underwent microwave ablation in our department from July 2009 to March 2012. Microwave ablation was carried out using microwave antenna (16G) under local anesthesia. Nodule volume, thyroid function and clinical symptoms were evaluated before treatment and at 1, 3, more than 6 months. The study was ethics committee approved and written informed consents were obtained from all patients. Results: All thyroid nodules significantly decreased in size after microwave ablation. A 6-month follow-up was achieved in 254 of 477 nodules, and the mean decrease in the volume of thyroid nodules was from 2.13 ± 4.42 ml to 0.45 ± 0.90 ml, with a mean percent decrease of 0.65 ± 0.65. A volume-reduction ratio greater than 50% was observed in 82.3% (209/254) of index nodules, and 30.7% (78/254) of index nodules disappeared 6-month after the ablation. The treatment was well tolerated and no major complications were observed except pain and transient voice changes. Conclusions: Microwave ablation seems to be a safe and effective technique for the treatment of benign thyroid nodules. Further prospective randomized studies are needed to define the role of the procedure in the treatment of thyroid nodules

  19. Finger movement function after ultrasound-guided percutaneous pulley release for trigger finger: effects of postoperative rehabilitation.

    Science.gov (United States)

    Lu, Szu-Ching; Kuo, Li-Chieh; Hsu, Hsiu-Yun; Jou, I-Ming; Sun, Yung-Nien; Su, Fong-Chin

    2015-01-01

    To develop and test a postoperative rehabilitation protocol for use by individuals with trigger finger undergoing ultrasound-guided percutaneous pulley release. Nonrandomized controlled trial. Hospital and local community. Individuals suffering from trigger finger with joint contracture (N=21) were recruited and grouped into an intervention group (n=9) or a control group (n=12). All the participants underwent the same surgical procedure performed by the same surgeon. A 4-week postoperative rehabilitation program was designed based on the wound healing process. The intervention group received postoperative rehabilitation after the surgery, whereas the control group received no treatment after the surgery. The finger movement functions were quantitatively evaluated before and 1 month after the surgery using a 3-dimensional motion capture system. The fingertip workspace and joint range of motion (ROM) were evaluated while the participant was performing a sequential 5-posture movement, including finger extension, intrinsic plus, straight fist, full fist, and hook fist. The intervention group demonstrated significantly more improvements than the control group in the fingertip workspace (49% vs 17%), ROM of the distal interphalangeal (DIP) joint (16% vs 4%), ROM of the proximal interphalangeal (PIP) joint (21% vs 5%), and total active ROM (17% vs 5%). This pilot study evaluated a postoperative rehabilitation protocol for trigger finger and demonstrated its effects on various finger functions. Participants who underwent the rehabilitation program had significantly more improvements in the fingertip workspace, ROM of the DIP and PIP joints, and total active ROM. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  20. CT fluoroscopy-guided percutaneous osteoplasty for the treatment of osteolytic lung cancer bone metastases to the spine and pelvis.

    Science.gov (United States)

    Wang, Zhiyu; Zhen, Yan; Wu, Chungen; Li, Hongtao; Yang, Yumei; Shen, Zan; Zhao, Hui; Yao, Yang

    2012-09-01

    To retrospectively assess the results of computed tomographic (CT) fluoroscopy-guided percutaneous osteoplasty (PO) of osteolytic lung cancer bone metastases, focusing on pain reduction, improved quality of life, and patient mobility. Over a 43-month interval, 92 patients with lung cancer bone metastases underwent PO, including vertebroplasty and acetabuloplasty. A total of 261 lesions of the vertebral column and 22 lesions of the pelvis, ilium, and femur were treated with the use of CT fluoroscopic guidance. Clinical outcomes were assessed, including pain, quality of life, and mobility, 24 hours before, 24 hours after, and 1 and 3 months after osteoplasty. Pain reduction and improved quality of life and patient mobility were observed in most patients. Visual analog scale and Karnofsky Performance Scale scores changed significantly (P < .05), from 6.1 ± 1.4 and 69.3 ± 5.5 at 24 hours before osteoplasty, respectively, to 3.5 ± 1.2 and 75.2 ± 5.4 at 24 hours after the procedure, 3.3 ± 1.2 and 76.5 ± 5.8 at 1 month, and 2.9 ± 1.5 and 79.6 ± 5.8 at 3 months after PO. Mobility scale score, Frankel classification of spinal cord injury, and Harris hip score also changed significantly (P < .05) after osteoplasty. No major complications occurred. PO was shown to be a highly effective and safe palliative therapy to reduce pain and improve quality of life and patient mobility, not only in vertebral metastases, but also in pelvic, iliac, and femoral metastases. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  1. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Torriani, Martin; Rosenthal, Daniel I. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute for Technology Assessment, Department of Radiology, Boston, MA (United States); Springfield, Dempsey S. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2015-12-15

    To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate ?This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ{sup 2} test or Fisher's exact test. In all, 140 of 963 (15 %) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96 %). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8 %), POC cytology (25 %), or neither (24 %) were significantly different (P < 0.0001). Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a

  2. CT-guided percutaneous neurolysis methods. State of the art and first results; CT-gesteuerte Neurolysen. Stand der Technik und aktuelle Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, B. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Richter, G.M. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Roeren, T. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Kauffmann, G.W. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany)

    1996-09-01

    We used 21G or 22G fine needles. All CT-guided percutaneous neurolysis methods require a proper blood coagulation. Most common CT scanners are suitable for neurolysis if there is enough room for maintaining sterile conditions. All neurolysis methods involve sterile puncture of the ganglia under local anesthesia, a test block with anesthetic and contrast agent to assess the clinical effect and the definitive block with a mixture of 96% ethanol and local anesthetic. This allows us to correct the position of the needle if we see improper distribution of the test block or unwanted side effects. Though inflammatory complications of the peritoneum due to puncture are rarely seen, we prefer the dorsal approach whenever possible. Results: Seven of 20 legs showed at least transient clinical improvement after CT-guided lumbar sympathectomies; 13 legs had to be amputated. Results of the methods in the literature differ. For lumbar sympathectomy, improved perfusion is reported in 39-89%, depending on the pre-selection of the patient group. Discussion: It was recently proved that sympathectomy not only improves perfusion of the skin but also of the muscle. The hypothesis of a steal effect after sympathectomy towards skin perfusion was disproved. Modern aggressive surgical and interventional treatment often leaves patients to sympathectomy whose reservers of collateralization are nearly exhausted. We presume this is the reason for the different results we found in our patient group. For thoracic sympathectomy the clinical treatment depends very much on the indications. Whereas palmar hyperhidrosis offers nearly 100% success, only 60-70% of patients with disturbance of perfusion have benefited. Results in celiac ganglia block also differ. Patients with carcinoma of the pancreas and other organs of the upper abdomen benefit in 80-100% of all cases, patients with chronic pancreatitis in 60-80%. (orig./VHE) [Deutsch] Thorakale und lumbale Sympathikolyse sowie die Zoeliakusblockade

  3. Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to Avoid Ulnar Nerve Injury.

    Directory of Open Access Journals (Sweden)

    Francisco Soldado

    2015-07-01

    Full Text Available Background:  Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF owing to the risk of ulnar nerve injury.  Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization.   Methods: Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. Results:  Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions:  Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.

  4. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr; Rao, Pramod, E-mail: pramodrao@me.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-07-15

    ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.

  5. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management.

    Science.gov (United States)

    Vollherbst, Dominik; Bertheau, Robert; Kauczor, Hans-Ulrich; Radeleff, Boris Alexis; Pereira, Philippe L; Sommer, Christof-Matthias

    2017-03-01

    Background  Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors. Method  10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed. Results and Conclusion  Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression). Key Points: · Treatment failure can be subdivided into residual unablated tumor and local tumor progression.. · Residual unablated tumor occurs in 5.9 % of cases.. · Local tumor progression occurs in 4.7 % of cases.. · Tumor size and location are the major risk factors for treatment failure.. · Repeated RFA is effective and commonly used for management.. Citation Format · Vollherbst D, Bertheau R, Kauczor H et al. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors - A Systematic Review with Description of Type, Frequency, Risk Factors and Management. Fortschr Röntgenstr 2017; 189: 219 - 227. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System

    International Nuclear Information System (INIS)

    Cazzato, Roberto Luigi; Garnon, Julien; Ramamurthy, Nitin; Tsoumakidou, Georgia; Caudrelier, Jean; Thénint, Marie-Aude; Rao, Pramod; Koch, Guillaume; Gangi, Afshin

    2016-01-01

    ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.

  7. CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

    International Nuclear Information System (INIS)

    Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

    2013-01-01

    Objective: To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by 'double needle' technique to treat sacral cyst. Methods: Clinical data of 20 cases with 'double-needle' injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed. All patients had varying degrees of sacral nerve root compression symptoms. The treatment for sacral cyst was carried out after clear diagnosis was made. On the basis of CT-guided percutaneous injection of fibrin glue, the improved CT-guided percutaneous injection of fibrin glue by 'double-needle' technique was used to treat these patients. The average dose of fibrin glue was (5.9 ± 2.4) ml. The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months. The assessment criteria were as follows: excellent, complete resolution of signs and symptoms, with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up, good, symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region, which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up), fair, no improvement in clinical symptoms, but a decrease in cyst size on the imaging study, poor, no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results: Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Nine patients reported excellent recovery, 8 reported good recovery, 2 reported fair recovery, and 1 reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 85%. No serious postoperative complications were discovered. Conclusions: CT guided percutaneous

  8. Interval biliary stent placement via percutaneous ultrasound guided cholecystostomy: another approach to palliative treatment in malignant biliary tract obstruction.

    Science.gov (United States)

    Harding, James; Mortimer, Alex; Kelly, Michael; Loveday, Eric

    2010-12-01

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  9. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    International Nuclear Information System (INIS)

    Harding, James; Mortimer, Alex; Kelly, Michael; Loveday, Eric

    2010-01-01

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  10. Study of percutaneous 125I seeds implantation guided by CT in elderly patients of stage I peripheral non-small cell lung cancer

    International Nuclear Information System (INIS)

    Ke Mingyao; Yong Yazhi; Luo Bingqing; Wu Xuemei; Chen Lingling; Xie Hongqi

    2011-01-01

    Objective: To evaluate the efficacy, feasibility and safety of CT guided percutaneous 125 I seeds implantation in elderly patients of stage I peripheral non-small cell lung cancer (NSCLC). Methods: Clinical data of 16 elderly peripheral stage I NSCLC patients (10 squamous carcinoma and 6 adenocarcinoma; 13 stage I A and 3 stage I B ) who received radioactive 125 I seeds implantation because of refusal or being unsuited to operation or external radiotherapy were retrospectively analyzed. Prescribed dose was 140 - 160 Gy. Under CT guidance, 125 I seeds were implanted percutaneously into tumors for interstitial radiotherapy according to treatment plan system. Results: Mean number of 125 I seeds each patient received was 21.1. 12 complete response (CR) and 4 partial response (PR) were achieved. Total response rate (CR + PR) was 100%. 100% patients completed 10 to 56 months of follow-up, 15, 13, 8 and 6 patients completed 1-, 2-, 3-and 4-years' follow-up, respectively. The median local progression free time was 14 months. The 1-, 2-, 3-and 4-year overall survival rate were 60%, 54%, 50% and 33%, respectively (median : 14 months). 7 cases died of non-tumor disease and 5 died of metastasis. No severe complications were observed. Conclusions: CT guided 125 I seeds implantation is a safe, reliable and effective radical treatment method for elderly stage I peripheral NSCLC patients, who refuse to or are unsuitable to operation or external radiotherapy. (authors)

  11. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process

    Energy Technology Data Exchange (ETDEWEB)

    Fanucci, E.; Masala, S.; Sodani, G.; Varrucciu, V.; Romagnoli, A.; Squillaci, E.; Simonetti, G. [Dept. of Radiology, Univ. of Rome (Italy)

    2001-12-01

    Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation. (orig.)

  12. Percutaneous angioscopy

    International Nuclear Information System (INIS)

    Beck, A.

    1987-01-01

    In dogs and 11 patients a new endoscopic method for arteries has been developed. The approach is transfemoral, and endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), and local lysis. An ultrathin endoscope with a diameter of 2.4 mm is used, which also provides a working channel with a diameter of 0.4 mm. Guide wires, contrast media, and drugs for local lysis can be inserted through this channel. Under fluoroscopic control, the endoscope is placed in the region of interest, followed by a special method for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. No complications have occurred. In all patients, it was possible to demonstrate the results of dilatation, recanalization, or local lysis before and after the interventional procedure. (orig.) [de

  13. Percutaneous ultrasound-guided renal biopsy in supine antero-lateral position: a new approach for obese and non-obese patients.

    Science.gov (United States)

    Gesualdo, Loreto; Cormio, Luigi; Stallone, Giovanni; Infante, Barbara; Di Palma, Anna Maria; Delli Carri, Paolo; Cignarelli, Mauro; Lamacchia, Olga; Iannaccone, Salvatore; Di Paolo, Salvatore; Morrone, Luigi; Aucella, Filippo; Carrieri, Giuseppe

    2008-03-01

    Percutaneous ultrasound (US)-guided renal biopsy is the gold standard in the evaluation of renal diseases, but some patients, such as the obese, may not be eligible for this procedure. Aim of this study was to determine the feasibility, efficacy and safety of US-guided percutaneous renal biopsy in supine antero-lateral position (SALP) in high-risk patients (BMI > 30 and/or respiratory difficulty), as well as to compare the overall outcome of SALP with that of traditional prone position (PP) in low-risk patients (BMI patients scheduled for native kidney biopsy were recruited. Ninety low-risk patients were randomized following a permuted block randomization list to receive either US-guided renal biopsy in PP (Group 1) or SALP (Group 2), whereas 20 high-risk patients received US-guided renal biopsy in SALP (Group 3) and were our observational cohort study. Comfort compliance and breathing difficulty in each group were evaluated by the Visual Analogue Scale (VAS). Bleeding complications were evaluated through US renal scanning. Mean operating time was 7 min. Comfort compliance and breathing difficulty were significantly better for SALP in both low- and high-risk patients; there were no significant differences in pain after biopsy among the three groups. Bleeding complications were slightly higher in Group 1. Diagnostic yield was similar in all groups. SALP is reliable, minimally invasive, easy, highly successful, timesaving and almost free from severe side-effects. A better VAS score for breathing difficulty and comfort compliance characterizes this procedure, making it particularly suitable for obese patients.

  14. Non-healing post-surgical fistulae: treatment with image-guided percutaneous injection of cyanoacrylic glue.

    Science.gov (United States)

    Mauri, Giovanni; Pescatori, Lorenzo C; Mattiuz, Chiara; Poretti, Dario; Pedicini, Vittorio; Melchiorre, Fabio; Rossi, Umberto; Solbiati, Luigi; Sconfienza, Luca Maria

    2017-02-01

    To present the results of our experience with cyanoacrylic glue percutaneous injection to treat post-surgical non-healing enteric fistulae after failure of standard treatments. Eighteen patients (14 males; age range 33-84, mean 69 years) were treated for a non-healing post-surgical enteric fistula after failure of standard treatments. Under computed tomography and/or fluoroscopic guidance, a mixture of cyanoacrylic glue (Glubran 2, GEM, Viareggio, Italy) and ethiodized oil was injected at the site of the fistula. Fistula was considered healed when no material was drained by the percutaneous drainage and a subsequent computed tomography confirmed the disappearance of any fluid collection. In all cases, it was possible to reach the site of the fistula using a percutaneous access. A median of 1 injection (range 1-5) was performed. Fistula healing was achieved in 16/18 (89 %) patients. One patient died for other reasons before fistula healing. Median time for fistula healing was 0 days (mean 8, range 0-58 days). No complications occurred. Reoperation was needed in one patient. Percutaneous injection of cyanoacrylic glue is feasible, safe, and effective to treat non-healing post-surgical enteric fistulae. It may represent a further option to avoid surgical reoperation in frail patients.

  15. An overview of systems for CT- and MRI-guided percutaneous needle placement in the thorax and abdomen

    NARCIS (Netherlands)

    Arnolli, Maarten Menno; Hanumara, Nevan C.; Franken, Michel; Brouwer, Dannis Michel; Broeders, Ivo Adriaan Maria Johannes

    2015-01-01

    Background Minimally invasive biopsies, drainages and therapies in the soft tissue organs of the thorax and abdomen are typically performed through a needle, which is inserted percutaneously to reach the target area. The conventional workflow for needle placement employs an iterative freehand

  16. Anti-diabetic activity-guided screening of aqueous-ethanol Moringa ...

    African Journals Online (AJOL)

    Purpose: To explore the anti-diabetic effects of Moringa oleifera extracts and fractions, and to identify their active/marker compounds. Methods: Five different aqueous ethanol extracts (95, 75, 50, 25 %v/v and 100 % water) of Moringa oleifera were given orally to normal rats to assess their hypoglycemic activities and effect ...

  17. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis.

    Science.gov (United States)

    Mauri, Giovanni; Sconfienza, Luca Maria; Pescatori, Lorenzo Carlo; Fedeli, Maria Paola; Alì, Marco; Di Leo, Giovanni; Sardanelli, Francesco

    2017-08-01

    To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).

  18. Image-guided placement of percutaneous de novo low-profile gastrojejunostomy tubes in the pediatric population: a study of feasibility and efficacy.

    Science.gov (United States)

    Gill, Anne E; Gallagher, Nicholas; McElhanon, Barbara O; Painter, Amy R; Gold, Benjamin D; Hawkins, C Matthew

    2018-02-08

    De novo low-profile gastrojejunostomy tubes in pediatric patients offer less external catheter bulk and decreased propensity for dislodgement as children become more mobile. While small cohort studies have evaluated de novo placement of coaxial, adjustable-length, percutaneous gastrojejunostomy (GJ) tubes in children, placement of de novo low-profile GJ tubes in pediatric patients has not been analyzed. This study evaluates technical feasibility, safety and clinical efficacy of percutaneous, retrograde placement of de novo low-profile GJ tubes in infants and children. Following institutional review board approval, all de novo low-profile GJ tube placements in patients were retrospectively reviewed between May 2014 and May 2017. Technical parameters of fluoroscopy time, tube size, T-fasteners and complications were recorded. Clinical data, including age, indication, weight gain and complications, were analyzed. Thirty-four de novo low-profile GJ tubes were placed in 34 patients (median age: 9.4 months, range: 2 months-11.8 years; median pre-procedural weight: 7.5 kg, range: 2.9-31.6 kg). Twenty-one 14-Fr and 13 16-Fr GJ tubes were placed with technical success rate of 100%. Average weight gain 3 months' post procedure was 1.1 kg (range: 0.3-4.8 kg) and average weight percentile for age increase was 9.6% (range: -48.9% to 53.5%). One major complication occurred following balloon inflation within the tract causing pain requiring urgent replacement of the GJ tube. Minor complications occurred in 11 patients (32%): accidental dislodgement (n=9), skin irritation (n=4), tube dysfunction (n=2), leakage (n=2) and tube migration into the esophagus (n=1). Percutaneous, antegrade, image-guided placement of de novo low-profile GJ tubes is technically feasible, safe and clinically efficacious in appropriately selected pediatric patients.

  19. Innovative techniques for image-guided ablation of benign thyroid nodules: Combined ethanol and radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hye Sun; Baek, Jung Hwan; Choi, Young Jun; Lee, Jeong Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-06-15

    In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.

  20. PET/CT-guided percutaneous liver mass biopsies and ablations: Targeting accuracy of a single 20 s breath-hold PET acquisition

    International Nuclear Information System (INIS)

    Shyn, P.B.; Tatli, S.; Sahni, V.A.; Sadow, C.A.; Forgione, K.; Mauri, G.; Morrison, P.R.; Catalano, P.J.; Silverman, S.G.

    2014-01-01

    Aim: To determine whether a single 20 s breath-hold positron-emission tomography (PET) acquisition obtained during combined PET/computed tomography (CT)-guided percutaneous liver biopsy or ablation procedures has the potential to target 2-[ 18 F]-fluoro-2-deoxy-D-glucose (FDG)-avid liver masses as accurately as up to 180 s breath-hold PET acquisitions. Materials and methods: This retrospective study included 10 adult patients with 13 liver masses who underwent FDG PET/CT-guided percutaneous biopsies (n = 5) or ablations (n = 5). PET was acquired as nine sequential 20 s, monitored, same-level breath-hold frames and CT was acquired in one monitored breath-hold. Twenty, 40, 60, and 180 s PET datasets were reconstructed. Two blinded readers marked tumour centres on randomized PET and CT datasets. Three-dimensional spatial localization differences between PET datasets and either 180 s PET or CT were analysed using multiple regression analyses. Statistical tests were two-sided and p < 0.05 was considered significant. Results: Targeting differences between 20 s PET and 180 s PET ranged from 0.7–20.3 mm (mean 5.3 ± 4.4 mm; median 4.3) and were not statistically different from 40 or 60 s PET (p = 0.74 and 0.91, respectively). Targeting differences between 20 s PET and CT ranged from 1.4–36 mm (mean 9.6 ± 7.1 mm; median 8.2 mm) and were not statistically different from 40, 60, or 180 s PET (p = 0.84, 0.77, and 0.35, respectively). Conclusion: Single 20 s breath-hold PET acquisitions from PET/CT-guided percutaneous liver procedures have the potential to target FDG-avid liver masses with equivalent accuracy to 180 s summed, breath-hold PET acquisitions and may facilitate strategies that improve image registration and shorten procedure times

  1. Ultrasound-guided percutaneous lavage of calcific bursitis of the medial collateral ligament of the knee: a case report and review of the literature.

    Science.gov (United States)

    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; González-Pérez, José; Jiménez-Herranz, Elena; Rodríguez-Fabián, Guillermo

    2016-10-01

    Calcification of the medial collateral ligament (MCL) of the knee is rare. The literature reports no positive outcomes when conservative treatment has been followed. This paper reports a case of such calcification and its treatment using ultrasound-guided percutaneous lavage (UGPL). A 66-year-old patient presented with medial knee pain. X-ray, ultrasound, and magnetic resonance (MR) examinations revealed calcific bursitis of the MCL, which was treated by UGPL. One month after treatment the patient was asymptomatic. X-ray, ultrasound, and MR examinations confirmed the almost complete disappearance of the calcification; only very tiny fragments remained. Calcific bursitis of the MCL of the knee is very uncommon, but should be taken into account in differential diagnoses for medial knee pain. UGPL is proposed as a treatment for this condition.

  2. Role of contrast-enhanced ultrasound in evaluating the efficiency of ultrasound guided percutaneous microwave ablation in patients with renal cell carcinoma

    International Nuclear Information System (INIS)

    Li, Xin; Liang, Ping; Yu, Jie; Yu, Xiao-Ling; Liu, Fang-Yi; Cheng, Zhi-Gang; Han, Zhi-Yu

    2013-01-01

    The aim of the study was to evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS) with Sonovue in assessing of renal cell carcinomas (RCCs) following ultrasound (US)-guided percutaneous microwave ablation (MWA). Seventy-nine patients (60 males and 19 females) with 83 lesions (mean size 3.2±1.6 cm) were treated by US-guided percutaneous MWA. The CEUS results of the third day after the ablation were compared with the synchronous contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) results and biopsy pathological results. The follow-up was performed by CEUS and CT/MRI after 1, 3, 6 months and every 6 months subsequently. The combination of clinical follow-up results and CT/MRI imaging findings was the reference standard of CEUS results for evaluating the therapeutic effect. The identification of residual or recurrence tumour was assessed by two blinded radiologists. On the third day after MWA, CEUS showed 68 of 83 lesions (68/83, 81.9%) successfully ablated and 15 of 83 (18.1%) with residual tumours. Among residual tumours, 13 (86.7%) were confirmed by contrast-enhanced CT/MRI findings and biopsy results. The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS evaluating the short-term MWA effectiveness were 100%, 97.1%, 97.6%, 86.7% and 100%, respectively. During the six years follow-up (median 26 months), the CEUS showed recurrence in 7 patients, and six of them achieved consistent results on CEUS and CT/MRI imaging. The sensitivity, specificity, accuracy, positive and negative predictive value for CEUS evaluating long-term MWA effectiveness were 85.7%, 98.7%, 97.6%, 85.7% and 98.7%, respectively. The post-procedural CEUS demonstrated as an effective and feasible method in evaluating a therapeutic effect of RCCs following MWA

  3. Ultrasound-guided double-tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies in high-risk surgical patients.

    Science.gov (United States)

    Wang, Tao; Chen, Tao; Zou, Shu; Lin, Ning; Liang, Hong-yin; Yan, Hong-tao; Li, Nan-lin; Liu, Li-ye; Luo, Hao; Chen, Qi; Liu, Wei-hui; Tang, Li-jun

    2014-07-01

    Cholecystolithiasis is the most common disease treated by general surgery, with an incidence of about 0.15-0.22%. The most common therapies are open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). However, with a greater understanding of the function of the cholecyst, more and more patients and surgeons are aware that preserving the functional cholecyst is important for young patients, as well as patients who would not tolerate anesthesia associated with either OC or LC. Based on these considerations, we have introduced a notable, minimally invasive treatment for cholecystolithotomy. We performed a retrospective review of patients with cholecystolithiasis who were unable to tolerate surgery or who insisted on preserving the functional cholecyst. Our particular approach can be simply described as ultrasound-guided percutaneous cholecystostomy combined with a choledochoscope for performing a cholecystolithotomy under local anesthesia. Ten patients with cholecystolithiasis were treated via this approach. All except one patient had their gallbladder stones totally removed under local anesthesia, without the aggressive procedures associated with OC or LC. The maximum number of gallbladder stones removed was 16, and the maximum diameter was 13 mm without lithotripsy. After the minimally invasive surgery, the cholecyst contractile functions of all patients were normal, confirmed via ultrasound after a high-fat diet. Complications such as bile duct injury, biliary fistula, and bleeding occurred significantly less often than with OC and LC. The recurrence rates for each of 2 post-operative years were about 11.11% (1/9, excluding a failure case) with uncertainty surrounding recurrence or residue, and 22.22% (2/9, including one non-recurrence patient with follow-up time of 22 months), respectively. Ultrasound-guided percutaneous cholecystostomy combined with choledochoscope is a safe, efficient, and minimally invasive cholecystolithotomy method. We recommend this

  4. CT-guided single high-dose percutaneous acetic acid injection for small hepatocellular carcinoma: A long-term follow-up study

    International Nuclear Information System (INIS)

    Ma Heng; Liu Jing; Liu Fengli

    2012-01-01

    Objective: To evaluate the long-term outcome of CT-guided single high-dose percutaneous acetic acid injection (PAI) for the treatment of small hepatocellular carcinoma (SHCC). Materials and methods: Sixty-eight consecutive patients (37 men and 31 women; age 52 ± 16 years) with SHCC have undergone CT-guided single high-dose PAI therapy since December 2000. Complications of high-dose PAI were recorded. Tumour survival and recurrence rates were assessed. Results: All PAI therapies were successful and no severe complications developed. The average follow-up period was 46 ± 18 months. The overall survival rates at 1, 2, 3, 4 and 5 years were 93%, 82%, 68%, 59% and 51%, respectively. The cumulative local recurrence rates for the main tumour at 1, 2, 3, 4 and 5 years were 18%, 22%, 25%, 28% and 28%, respectively. The cumulative new tumour recurrence rates at 1, 2, 3, 4 and 5 years were 24%, 40%, 43%, 60% and 62%, respectively. Conclusion: CT-guided single high-dose PAI is safe and effective for the treatment of SHCC after long-term follow-up.

  5. Comparison of the analgesic efficacy of ultrasound-guided rectus sheath block and local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children.

    Science.gov (United States)

    Uchinami, Yuka; Sakuraya, Fumika; Tanaka, Nobuhiro; Hoshino, Koji; Mikami, Eri; Ishikawa, Taro; Fujii, Hitomi; Ishikawa, Takehiko; Morimoto, Yuji

    2017-05-01

    Ultrasound-guided rectus sheath block and local anesthetic infiltration are the standard options to improve postoperative pain for children undergoing surgery with a midline incision. However, there is no study comparing the effect of ultrasound-guided rectus sheath block with local anesthetic infiltration for children undergoing laparoscopic surgery. The aim of this trial was to compare the onset of ultrasound-guided rectus sheath block with that of local anesthetic infiltration for laparoscopic percutaneous extraperitoneal closure in children. We performed an observer-blinded, randomized, prospective trial. Enrolled patients were assigned to either an ultrasound-guided rectus sheath block group or a local anesthetic infiltration group. The ultrasound-guided rectus sheath block group (n = 17) received ultrasound-guided rectus sheath block with 0.2 ml·kg -1 of 0.375% ropivacaine per side in the posterior rectus sheath compartment. The local anesthetic infiltration group (n = 17) received local anesthetic infiltration with 0.2 ml·kg -1 of 0.75% ropivacaine. The Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores were recorded at 0, 30, 60 min after arrival at the postanesthesia care unit. Of the 37 patients enrolled in this study, 34 completed the study protocol. A significant difference in the pain scale between the ultrasound-guided rectus sheath block group and local anesthetic infiltration group was found at 0 min (median: 0, interquartile range [IQR]: 0-1.5, vs median: 1, IQR 0-5, confidence interval of median [95% CI]: 0-3, P = 0.048), but no significant difference was found at 30 min (median: 1, IQR: 0-4 vs median: 6, IQR: 0-7, 95% CI: 0-5, P = 0.061), or 60 min (median: 0, IQR: 0-2 vs median: 1, IQR: 0-3, 95% CI: -1 to 1, P = 0.310). No significant difference was found in anesthesia time between the ultrasound-guided rectus sheath block and local anesthetic infiltration groups. No procedure-related complications were observed in either group

  6. Renal Sympathetic Denervation by CT-Guided Ethanol Injection: A Phase II Pilot Trial of a Novel Technique

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J., E-mail: jens.ricke@med.ovgu.de; Seidensticker, M.; Becker, S. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Schiefer, J. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany); Adamchic, I.; Lohfink, K. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Kandulski, M.; Heller, A.; Mertens, P. R. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany)

    2016-02-15

    ObjectivesCT-guided ethanol-mediated renal sympathetic denervation in treatment of therapy-resistant hypertension was performed to assess patient safety and collect preliminary data on treatment efficacy.Materials and MethodsEleven patients with therapy-resistant hypertension (blood pressure of >160 mmHg despite three different antihypertensive drugs including a diuretic) and following screening for secondary causes were enrolled in a phase II single arm open label pilot trial of CT-guided neurolysis of sympathetic renal innervation. Primary endpoint was safety, and secondary endpoint was a decrease of the mean office as well as 24-h systolic blood pressure in follow-up. Follow-up visits at 4 weeks, 3, and 6 months included 24-h blood pressure assessments, office blood pressure, laboratory values, as well as full clinical and quality of life assessments.ResultsNo toxicities ≥3° occurred. Three patients exhibited worsened kidney function in follow-up analyses. When accounting all patients, office systolic blood pressure decreased significantly at all follow-up visits (maximal mean decrease −41.2 mmHg at 3 months). The mean 24-h systolic blood pressure values decreased significantly at 3 months, but not at 6 months (mean: −9.7 and −6.3 mmHg, respectively). Exclusion of five patients who had failed catheter-based endovascular denervation and/or were incompliant for antihypertensive drug intake revealed a more pronounced decrease of 24-h systolic blood pressure (mean: −18.3 and −15.2 mmHg at 3 and 6 months, p = 0.03 and 0.06).ConclusionCT-guided sympathetic denervation proved to be safe and applicable under various anatomical conditions with more renal arteries and such of small diameter.

  7. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Wei; Hao, Bing; Chen, Hao-jun; Zhao, Long; Luo, Zuo-ming; Wu, Hua; Sun, Long [The First Affiliated Hospital of Xiamen University, Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, Xiamen (China)

    2017-01-15

    {sup 18}F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of {sup 18}F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and {sup 18}F-FDG-avid bone lesions after whole-body {sup 18}F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated. A total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin's lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min. PET/CT-guided percutaneous biopsy of {sup 18}F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer. (orig.)

  8. CT-guided percutaneous laser disc decompression with Ceralas D, a diode laser with 980-nm wavelength and 200-{mu}m fiber optics

    Energy Technology Data Exchange (ETDEWEB)

    Gevargez, A. [Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum (Germany); Groenemeyer, D.W.H. [Department of Radiology and Microtherapy, University Witten/Herdecke, Bochum (Germany); Entwicklungs- und Forschungszentrum fuer Mikrotherapie, Bochum (Germany); Czerwinski, F. [Entwicklungs- und Forschungszentrum fuer Mikrotherapie, Bochum (Germany)

    2000-08-01

    The aim of this study was to evaluate the compact, portable Ceralas-D diode laser (CeramOptec; 980+30 nm wavelength, 200-{mu}m optical fiber) concerning clinical usefulness, handling, and clinical results in the CT-guided treatment of herniated lumbar discs. The positioning of the canula in intradiscal space, the placement of the laser fiber into the disc through the lying canula, and the vaporization itself were carried out under CT-guidance. Due to the thin fiber optic, it was possible to use a thin 23-gauge canula. The laser procedure was performed in 0.1- to 1-s shots with 1-s pulse pause and 4-W power output. A total of 1650-2300 J was applied on each percutaneous laser disc decompression (PLDD). Results in 26 patients were established with a visual-analogue scale (VAS). On the follow-up examinations, 46% of the patients were absolutely pain free (>85% VAS) and fully active in everyday life after 4 postoperative weeks. Thirty-one percent of patients were relieved of the leg pain but had occasional back pain without sensorimotor impairment. Fifteen percent sensed a slight alleviation (>50% VAS) of the radiate pain. Eight percent did not experience radicular or pseudo-radicular pain alleviation (<25% VAS). Cerales-D proves to be an efficient tool for CT-guided PLDD on non-sequestered herniated lumbar discs. (orig.)

  9. High Retention and Safety of Percutaneously Implanted Endovascular Embolization Coils as Fiducial Markers for Image-Guided Stereotactic Ablative Radiotherapy of Pulmonary Tumors

    International Nuclear Information System (INIS)

    Hong, Julian C.; Yu Yao; Rao, Aarti K.; Dieterich, Sonja; Maxim, Peter G.; Le, Quynh-Thu; Diehn, Maximilian; Sze, Daniel Y.; Kothary, Nishita; Loo, Billy W.

    2011-01-01

    Purpose: To compare the retention rates of two types of implanted fiducial markers for stereotactic ablative radiotherapy (SABR) of pulmonary tumors, smooth cylindrical gold 'seed' markers ('seeds') and platinum endovascular embolization coils ('coils'), and to compare the complication rates associated with the respective implantation procedures. Methods and Materials: We retrospectively analyzed the retention of percutaneously implanted markers in 54 consecutive patients between January 2004 and June 2009. A total of 270 markers (129 seeds, 141 coils) were implanted in or around 60 pulmonary tumors over 59 procedures. Markers were implanted using a percutaneous approach under computed tomography (CT) guidance. Postimplantation and follow-up imaging studies were analyzed to score marker retention relative to the number of markers implanted. Markers remaining near the tumor were scored as retained. Markers in a distant location (e.g., pleural space) were scored as lost. CT imaging artifacts near markers were quantified on radiation therapy planning scans. Results: Immediately after implantation, 140 of 141 coils (99.3%) were retained, compared to 110 of 129 seeds (85.3%); the difference was highly significant (p < 0.0001). Of the total number of lost markers, 45% were reported lost during implantation, but 55% were lost immediately afterwards. No additional markers were lost on longer-term follow-up. Implanted lesions were peripherally located for both seeds (mean distance, 0.33 cm from pleural surface) and coils (0.34 cm) (p = 0.96). Incidences of all pneumothorax (including asymptomatic) and pneumothorax requiring chest tube placement were lower in implantation of coils (23% and 3%, respectively) vs. seeds (54% and 29%, respectively; p = 0.02 and 0.01). The degree of CT artifact was similar between marker types. Conclusions: Retention of CT-guided percutaneously implanted coils is significantly better than that of seed markers. Furthermore, implanting coils is at

  10. Percutaneous transtracheal jet ventilation as a guide to tracheal intubation in severe upper airway obstruction from supraglottic oedema.

    Science.gov (United States)

    Chandradeva, K; Palin, C; Ghosh, S M; Pinches, S C

    2005-05-01

    We report two cases of severe upper airway obstruction caused by supraglottic oedema secondary to adult epiglottitis and Ludwig's angina. In the former case, attempts to intubate with a direct laryngoscope failed but were successful once percutaneous transtracheal jet ventilation (PTJV) had been instituted. In the case with Ludwig's angina, PTJV was employed as a pre-emptive measure and the subsequent tracheal intubation with a direct laryngoscope was performed with unexpected ease. In both cases recognition of the glottic aperture was made feasible with PTJV by virtue of the fact that the high intra-tracheal pressure from PTJV appeared to lift up and open the glottis. The escape of gas under high pressure caused the oedematous edges of the glottis to flutter, which facilitated the identification of the glottic aperture. We believe that the PTJV should be considered in the emergency management of severe upper airway obstruction when this involves supraglottic oedema.

  11. CT-Guided, Ethanol Sympatholysis for Primary Axillary–Palmar Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Tsitskari, Maria, E-mail: mariadote@hotmail.com [American Medical Center, Vascular & Interventional Radiology (Cyprus); Friehs, Gerhard, E-mail: gerhardf@amc.com.cy; Zerris, Vassilis, E-mail: vassilisz@amc.com.cy [American Medical Center, Neurosurgery (Cyprus); Georgiades, Christos, E-mail: g-christos@hotmail.com [Johns Hopkins Hospital, Vascular & Interventional Radiology (United States)

    2016-12-15

    PurposePrimary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.Materials and MethodsNine consecutive patients with axillary–palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6–26 months). Descriptive statistics was used to report the outcomes.ResultsOne procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner’s or compensatory hyperhidrosis were observed.ConclusionsCT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.

  12. CT-Guided, Ethanol Sympatholysis for Primary Axillary-Palmar Hyperhidrosis.

    Science.gov (United States)

    Tsitskari, Maria; Friehs, Gerhard; Zerris, Vassilis; Georgiades, Christos

    2016-12-01

    Primary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis. Nine consecutive patients with axillary-palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6-26 months). Descriptive statistics was used to report the outcomes. One procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner's or compensatory hyperhidrosis were observed. CT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.

  13. The Role of Vascular Imaging in Guiding Routine Percutaneous Coronary Interventions: A Meta-Analysis of Bare Metal Stent and Drug-Eluting Stent Trials.

    Science.gov (United States)

    Alsidawi, Said; Effat, Mohamed; Rahman, Shahid; Abdallah, Mouhamad; Leesar, Massoud

    2015-12-01

    The routine use of vascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) in guiding percutaneous coronary interventions (PCI) is still controversial especially when using drug-eluting stents. A meta-analysis of trials using bare metal stents was previously published. We conducted a meta-analysis of available published trials that compared imaging-guided PCI and angiography-guided PCI in patients undergoing routine PCI only. Trials that enrolled patients with acute coronary syndrome were excluded to decrease heterogeneity. We aimed to study both drug-eluting stents (DES) as well as bare metal stents (BMS). We identified seven randomized controlled trials on IVUS-guided bare metal stents. We also identified three randomized controlled trials on IVUS-guided drug-eluting stents. To improve the power of the drug-eluting stent data, we identified, and included, nine registries that compared IVUS-guided PCI to angiography-guided PCI in the drug-eluting stent era. Nonrandomized registries that included BMS only were excluded as there are multiple previous meta-analyses that studied these patients. Finally, we identified one registry that compared OCT-guided PCI to angiography-guided PCI using either a BMS or a DES. A total of 14,197 patients were studied overall. The meta-analysis was conducted using a random effect model. Imaging guidance was associated with a significantly larger postintervention minimal luminal diameter (SMD: 0.289. 95% CI: 0.213-0.365. P DES patients (odds ratio: 0.810. 95% CI: 0.719-0.912. P DES and BMS patients (odds ratio: 0.782. 95% CI: 0.686-0.890. P DES patients (odds ratio: 0.654. 95% CI: 0.468-0.916. P DES and BMS patients (odds ratio: 0.727. 95% CI: 0.540-0.980. P DES patients (odds ratio: 0.551. 95% CI: 0.363-0.837. P DES and BMS patients (odds ratio: 0.589. 95% CI: 0.425-0.816. P DES patients (odds ratio: 0.651. 95% CI: 0.499-0.850. P DES and BMS patients (odds ratio: 0.665. 95% CI: 0.513-0.862. P

  14. US-guided percutaneous treatment and physical therapy in rotator cuff calcific tendinopathy of the shoulder: outcome at 3 and 12 months.

    Science.gov (United States)

    Pasquotti, Giulio; Faccinetto, Alex; Marchioro, Umberto; Todisco, Matteo; Baldo, Vincenzo; Cocchio, Silvia; De Conti, Giorgio

    2016-08-01

    To monitor the results of ultrasound (US)-guided percutaneous treatment of calcific tendinopathy of the shoulder at 12 months (T12) after treatment (T0). To verify the possible relations between some pre- and post-procedural variables with the clinical outcome at T12. Forty-seven patients (26 female and 21 male) were enrolled in the study. Patients' approval and written informed consent were obtained. Symptoms were assessed by Constant Shoulder Score (CSS) at T0 and T12. Thirty of these also underwent a CSS control at 3 months (T3). The treatment efficacy was statistically tested for relation with location and type of calcification, characteristics of the tendon and subdeltoid bursa, impingement, and rehabilitation treatments. There was a significant increase in the average CSS value between T0 and T12 (40.7 vs. 75.3). The variables analysed did not show a statistically significant effect on the outcome at T12. A link was noticed only between patients' increasing age and score improvement, particularly among female subjects. US-guided treatment of calcific tendonitis is a viable therapeutic option. No pre- or intra-procedural parameters emerged which might help in predicting the outcome, apart from patients' needs in everyday life. • US-guided tcreatment of shoulder calcific tendinopathy is an excellent therapeutic option • Long-term results seem greatly affected by patients' features and needs in everyday life • No proven pre- or intra-procedural parameters emerged that might predict the outcome.

  15. The role of ultrasound guided percutaneous needle aspiration and lavage (barbotage in the treatment of calcific tendinitis

    Directory of Open Access Journals (Sweden)

    Gamal Niazi

    2015-03-01

    Conclusion: Ultrasound guided aspiration and lavage (barbotage is a highly effective, less aggressive method of treatment in cases of calcific tendinosis, especially for cases with severe pain that does not respond to other conservative methods.

  16. Towards human-controlled, real-time shape sensing based flexible needle steering for MRI-guided percutaneous therapies.

    Science.gov (United States)

    Li, Meng; Li, Gang; Gonenc, Berk; Duan, Xingguang; Iordachita, Iulian

    2017-06-01

    Accurate needle placement into soft tissue is essential to percutaneous prostate cancer diagnosis and treatment procedures. This paper discusses the steering of a 20 gauge (G) FBG-integrated needle with three sets of Fiber Bragg Grating (FBG) sensors. A fourth-order polynomial shape reconstruction method is introduced and compared with previous approaches. To control the needle, a bicycle model based navigation method is developed to provide visual guidance lines for clinicians. A real-time model updating method is proposed for needle steering inside inhomogeneous tissue. A series of experiments were performed to evaluate the proposed needle shape reconstruction, visual guidance and real-time model updating methods. Targeting experiments were performed in soft plastic phantoms and in vitro tissues with insertion depths ranging between 90 and 120 mm. Average targeting errors calculated based upon the acquired camera images were 0.40 ± 0.35 mm in homogeneous plastic phantoms, 0.61 ± 0.45 mm in multilayer plastic phantoms and 0.69 ± 0.25 mm in ex vivo tissue. Results endorse the feasibility and accuracy of the needle shape reconstruction and visual guidance methods developed in this work. The approach implemented for the multilayer phantom study could facilitate accurate needle placement efforts in real inhomogeneous tissues. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Diuretic Agent and Normal Saline Infusion Technique for Ultrasound-Guided Percutaneous Nephrostomies in Nondilated Pelvicaliceal Systems

    Energy Technology Data Exchange (ETDEWEB)

    Yagci, Cemil, E-mail: cemil.yagci@medicine.ankara.edu.tr; Ustuner, Evren, E-mail: evrenustuner@hotmail.com; Atman, Ebru Dusunceli, E-mail: ebrumd2001@yahoo.com [Ankara University, Department of Radiology, School of Medicine (Turkey); Baltaci, Sumer, E-mail: sbaltaci@hotmail.com [Ankara University, Department of Urology, School of Medicine (Turkey); Uzun, Caglar, E-mail: cuzun77@yahoo.com; Akyar, Serdar, E-mail: yusuf.s.akyar@medicine.ankara.edu.tr [Ankara University, Department of Radiology, School of Medicine (Turkey)

    2013-04-15

    Percutaneous nephrostomy (PCN) in a nondilated pelvicaliceal system is technically challenging. We describe an effective method to achieve transient dilatation of the pelvicaliceal system via induction of diuresis using infusion of a diuretic agent in normal saline, therefore allowing easier access to the pelvicaliceal system. Under real-time ultrasound guidance, the technique had been tested in 22 nephrostomies with nondilated system (a total of 20 patients with 2 patients having bilateral nephrostomies) during a 5-year period. Patients were given 40 mg of furosemide in 250 ml of normal saline solution intravenously by rapid infusion. As soon as maximum calyceal dilatation of more than 5 mm was observed, which is usually 15 min later after the end of rapid infusion, patients were positioned obliquely, and PCN procedure under ultrasound guidance was performed. The procedure was successful in 19 of the nephrostomies in 17 patients with a success rate of 86.36 % per procedure and 85 % per patient in nondilated pelvicaliceal systems. No major nephrostomy-, drug-, or technique-related complications were encountered. The technique failed to work in three patients due to the presence of double J catheters and preexisting calyceal perforation which avoided transient dilation of the pelvicaliceal system with diuresis. Diuretic infusion in saline is a feasible and effective method for PCN in nondilated pelvicaliceal systems.

  18. Safety and efficacy analysis of ultrasound-guided percutaneous transhepatic biliary drainage treatment of malignant obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Ye Ben-Gong

    2016-08-01

    Full Text Available Objective: To study the clinical effect and prognosis of percutaneous transhepatic biliary drainage (PTBD treatment of patients with malignant obstructive jaundice. Methods: A total of 112 patients with malignant obstructive jaundice treated in our hospital from April 2009 to February 2014 were retrospectively analyzed. All patients were randomly divided into control group (42 cases and observation group (70 cases, control group received drainage of laparotomy and observation group received PTBD intervention. All patients were followed up for 3 to 23 months. Clinical effect, complication and length of stay were observed and counted after two groups received different treatment, and the results were compared and analyzed. Results: After two groups received different treatment, serum AIL, AST, TBIL and DBIL levels significantly decreased than before treatment, but serum AIL, AST, TBIL and DBIL levels of observation group were lower than those of control group. The levels of WBC and NE of both groups were lower than before treatment, but differences in WBC, NE and PT between the two groups were without statistical significance after treatment. Meanwhile, the incidence of adverse reaction and length of stay of observation group were lower than those of control group, and the differences were statistically significant. Conclusion: Interventional treatment of malignant obstructive jaundice can effectively improve the clinical symptoms, lower incidence of adverse reactions and shorten the length of stay, which is the preferred method for medically inoperable malignant obstructive jaundice and worth clinical popularization.

  19. IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds

    Energy Technology Data Exchange (ETDEWEB)

    Mahmood, Muhammad Muzaffar; Austin, David, E-mail: david.austin@stees.nhs.uk

    2017-01-15

    Summary: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era. - Highlights: • SCAD is an infrequent but important cause of acute coronary syndrome. • Intracoronary imaging is a useful adjunct in the diagnosis of SCAD. • Revascularization is recommended in the presence on-going myocardial infarction. • BVS may be considered preferable to conventional stents in the setting of SCAD.

  20. Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy in Benign Cystic Thyroid Nodules: Preliminary Results

    Directory of Open Access Journals (Sweden)

    Xiaohua Gong

    2017-01-01

    Full Text Available Objective. To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI in treating cystic thyroid nodules. Materials and Methods. A total of 158 cystic or predominantly cystic thyroid nodules (>80% cystic component in 143 patients were evaluated. 114 patients with compressive symptoms or aesthetic complaints were offered PPI. 44 individuals without compressive symptoms and aesthetic complaints who were only followed up clinically were used as the control group. The efficacy and safety of PPI were evaluated for 1 month, 3 months, 6 months, 9 months, and 12 months of follow-up. Results. In the PPI group, the mean baseline volume of 15.6±18.9 cm3 reduced at the 1-month follow-up to 5.1±5.6 cm3 (p<0.001 and 0.6±0.9 (p<0.001, and nodules shrunk according to the time after PPI (p<0.001. A complete response (if ≥70% decrease to PPI at the 12-month follow-up occurred in 100% of the cystic or predominant cystic nodules. None of the nodules recurred at the 12-month follow-up after PPI. The side effects were mild. Twenty patients (17.5% developed mild localized pain, and fourteen cases (12.3% experienced mild or moderate fever after PPI. Conclusions. PPI is a safe and effective alternative to treat benign cystic or predominant cystic thyroid nodules.

  1. Computed tomography guided percutaneous injection of a mixture of lipiodol and methylene blue in rabbit lungs: evaluation of localization ability for video-assisted thoracoscopic surgery.

    Science.gov (United States)

    Jin, Kwang Nam; Lee, Kyung Won; Kim, Tae Jung; Song, Yong Sub; Kim, Dong Il

    2014-01-01

    Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, Pmethylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.

  2. Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Priya Bhattacharji

    2017-01-01

    Full Text Available Introduction. To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study. Materials and Methods. Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated. Results. In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was 2.0±0.7 mm and 2.8±1.1 mm in the liver and 2.7±1.7 mm and 3.0±1.4 mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact. Conclusion. A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.

  3. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio; Ballicu, Nicola; Fele, Rosa Maria; Sotgia, Barbara; Melis, Luca [Oncological Hospital ' ' A. Businco' ' , Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Cagliari (Italy); Fancellu, Alessandro [University of Sassari, Department of Clinical and Experimental Medicine, Sassari (Italy)

    2017-04-15

    To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience. (orig.)

  4. Local Intracoronary Infusion of Glycoprotein IIb/IIIa Inhibitors via a Perfusion Catheter versus Intracoronary Guiding Catheter Injection during Primary Percutaneous Coronary Intervention: A Pilot Observational Study.

    Science.gov (United States)

    Zaki, Tarek; Labib, Salwa; El-Abbady, Maged; El-Kilany, Wael; Mortada, Ayman; Rashid, Tarek; Ragy, Hany; El-Itreby, Adel; Nammas, Wail

    2017-05-01

    Glycoprotein IIb IIIa inhibitors improved short- and long-term outcome when added to primary percutaneous coronary intervention (PPCI) in patients with ST-segment-elevation myocardial infarction (STEMI). We hypothesized that intracoronary eptifibatide infusion via a perfusion catheter improves angiographic and clinical outcome of patients with STEMI undergoing PPCI, versus conventional intracoronary bolus injection. Prospectively, we enrolled 80 patients with acute STEMI and thrombolysis in myocardial infarction (TIMI) thrombus grade ≥ 2. Patients were assigned to receive eptifibatide (180 μg) either via a dedicated coronary perfusion catheter (ClearWay TM ) during PPCI (group I), or guiding catheter (group II). Assessment of TIMI thrombus grade, TIMI flow grade, and TIMI myocardial perfusion (TMP) grade was performed both at baseline and post- procedurally. The primary 'angiographic' endpoint was final TMP grade 0/1. The primary 'clinical' endpoint was a composite of cardiac death, non-fatal re-infarction, target vessel revascularization, and recurrent ischemia at 30-day follow-up. Mean age was 52.3 ± 8.9 years (17.5% females). Clearance of visible thrombus (TIMI thrombus grade 0) at final angiogram was more frequent in group I. Additionally, both final TIMI flow grade 3 and final TMP grade 3 occurred more frequently in group I. The primary angiographic endpoint was more frequent in group II versus group I (17.5% versus 0%, respectively, p = 0.001). The primary clinical endpoint was more frequent in group II (20% versus 0%, respectively, p = 0.003). In patients with STEMI, intracoronary eptifibatide infusion via a perfusion catheter during PPCI improved immediate angiographic outcome, and reduced clinical events at 30-day follow-up, versus bolus injection via the guiding catheter.

  5. Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

    Science.gov (United States)

    Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

    2014-06-01

    The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  6. Therapeutic results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) in the treatment of rectus abdominis-related groin pain in professional footballers: a pilot study.

    Science.gov (United States)

    Moreno, Carlos; Mattiussi, Gabriele; Núñez, Francisco J

    2016-10-01

    Rectus abdominis-related groin pain (RAGP) is one of the possible clinical patterns that determine pubalgia. RAGP is one of the typical patterns in footballers and is due to the degeneration and tendinopathy of the distal tendon, at the level of the two pubic tubercles. Intratissue percutaneous electrolysis (EPI) is a novel technique used in the treatment of tendinopathies. The aim of this study was to examine the therapeutic benefits of EPI by contrasting the two basic components that characterize RAGP: painful symptoms and resultant functional deficits. Eight professional footballers at Udinese Calcio Spa Football Club underwent ultrasound-guided EPI intervention. No other type of treatment was combined with EPI. Pain was monitored with the Verbal Rating Scale, while functional deficit was monitored using the Patient Specific Functional Scale. The scales implementation took place before treatment, then 24 hours, 1 week, 1 month and 6 months after the end of treatment. Treatment with EPI produced a complete reduction of pain symptoms in one month and enabled excellent functional recovery for walking and jogging in one week; for getting out of bed, running, jumping and kicking within one month from the end of the treatment. Treatment with ultrasound-guided EPI has shown encouraging clinical results for RAGP. Data are preliminary: considering the limitations of this study more complex design studies are necessary to test the efficacy of the technique. This study introduces the EPI technique for the first time in the treatment of professional footballers suffering from RAGP. Its future use is proposed as a treatment solution, including complementary to conservative treatment.

  7. Percutaneous intervention in obstructive

    International Nuclear Information System (INIS)

    Souftas, V.

    2012-01-01

    , performed by the urologist. Before performing a lithotripsy, percutaneous access of the renal collecting system is necessary. Percutaneous ureteral lithotripsy is indicated for management of large renal stones. The kidneys are accessed either using ultrasound, if there is a dilated collecting system, or fluoroscopy, if there is a radiopaque stone. The most ideal access is a calyx that bears the stone. Once access is obtained an angled glide wire is used to cross the obstructing stone and gain access to the ureter. Two wires can then be advanced to the bladder to provide a 'working wire' and a 'safety wire'. Success of lithotripsy is 98-99% for targeted renal stones and 88-89% for ureteral stones. If using only fluoroscopy, a sheathed needle may be used to access the bladder under fluoroscopy. Once urine is aspirated through the sheathed needle, a 3Jwire is inserted into the bladder under fluoroscopy. Using an angled guiding catheter, the 3J-wire is exchanged for an Amplatz and serial dilatation of the tract is performed over the Amplatz. Finally, an 8-F to 12-F suprapubic Foley catheter is inserted over the Amplatz wire into the bladder. Success rate for suprapubic tube insertion has been reported to approach 100% and is comparable to surgical insertion. Complications include bleeding, infection, and bladder or bowel perforation. Perinephric/retroperitoneal urinomas/abscesses drainages are usually due to ureteral obstruction/ trauma from calculi and rupture of the collecting system or to iatrogenic trauma. Most often they are performed under CT guidance, with success rates 100% and very low complication rates. Pigtail drainage catheters 8-F (up to 14-F for abscesses) are used. Sometimes these procedures have to be combined with percutaneous nephrostomy and percutaneous or antegrade ureteral stent placement.

  8. Quantitative Discomanometry: Correlation of Intradiscal Pressure Values to Pain Reduction in Patients With Intervertebral Disc Herniation Treated With Percutaneous, Minimally Invasive, Image-Guided Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Filippiadis, Dimitrios K., E-mail: dfilippiadis@yahoo.gr; Mazioti, A., E-mail: argyromazioti@yahoo.gr; Papakonstantinou, O., E-mail: sogofianol@gmail.com; Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital ' Attikon' , Second Radiology Department (Greece); Gouliamos, A., E-mail: agouliam@med.uoa.gr [University General Hospital ' Areteion' , First Radiology Department (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr; Kelekis, A., E-mail: akelekis@med.uoa.gr [University General Hospital ' Attikon' , Second Radiology Department (Greece)

    2012-10-15

    Purpose: To illustrate quantitative discomanometry's (QD) diagnostic efficacy and predictive value in discogenic-pain evaluation in a prospective study correlating intradiscal pressure values with pain reduction after percutaneous image-guided technique (i.e., percutaneous decompression, PD). Materials and Methods: During the last 3 years, 36 patients [21 male and 15 female (mean age 36 {+-} 5.8 years)] with intervertebral disc hernia underwent QD before PD. Under absolute sterilization and fluoroscopy, a mixture of contrast medium and normal saline (3:1 ratio) was injected. A discmonitor performed a constant rate injection and recorded pressure and volume values, thus producing the relative pressure-volume curve. PD was then performed. Pain reduction and improved mobility were recorded at 3, 12, and 24 months after PD using clinical evaluation and a numeric visual scale (NVS; 0 to 10 units). Results: Mean pain values of 7.5 {+-} 1.9 (range 4 to 8) NVS units were recorded before PD; these decreased to 2.9 {+-} 2.44 at 3 months, 1.0 {+-} 1.9 at 12 months, and 1.0 {+-} 1.9 NVS units at 24 months after PD. Recorded correlations (pressure, volume, significant pain-reduction values) with bilateral statistical significance included a maximum injected volume of 2.4 ml (p = 0.045), P{sub o} < 14 psi [initial pressure required to inject 0.1 ml of the mixture inside the disc (p = 0.05)], P{sub max} {<=} 65 psi [greatest pressure value on the curve (p = 0.018)], and P{sub max} - P{sub o} {<=} 47 psi (p = 0.038). Patients meeting these pressure or volume cut-off points, either independently or as a total, had significant pain reduction (>4 NVS units) after PD. No complications were noted. Conclusions: QD is an efficient technique that may have predictive value for discogenic pain evaluation. It might serve as a useful tool for patient selection for intervertebral disc therapies.

  9. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

    Energy Technology Data Exchange (ETDEWEB)

    Strobl, Frederik F.; Haeussler, Sophia M.; Paprottka, Philipp M.; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F.; Trumm, Christoph G. [Institute for Clinical Radiology, Munich (Germany); Pieske, Oliver [Ludwig-Maximilians-University Hospital Munich, Department of Trauma Surgery, Munich (Germany)

    2014-08-15

    To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. (orig.)

  10. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

    International Nuclear Information System (INIS)

    Strobl, Frederik F.; Haeussler, Sophia M.; Paprottka, Philipp M.; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F.; Trumm, Christoph G.; Pieske, Oliver

    2014-01-01

    To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries. Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10-20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed. We treated 99 consecutive patients (mean age 53.1 ± 21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n = 99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n = 1), hemorrhagic shock (n = 1), or cardiac event (n = 1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv ± 7.25 mSv. Mean procedural time was 72.1 ± 37.4 min. CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose. (orig.)

  11. Ultrasound-guided interstitial laser photocoagulation of an autonomous thyroid nodule

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbaek, Finn Noe; Hegedüs, Laszlo

    2003-01-01

    Radioiodine ((131)I) and surgery are the standard therapeutic options for the solitary autonomous thyroid nodule (AFTN). Percutaneous ethanol injection (PEI) has proven to be an effective technique and possible alternative to the conventional treatment options. However, PEI is not devoid of side...... effects and often necessitates multiple treatment sessions. We present a case of a 17-year-old female successfully treated with ultrasound (US)-guided percutaneous interstitial laser photocoagulation (ILP) for an AFTN. Initially, she had a serum thyrotropin (TSH) of 0.01 mU/L and normal peripheral thyroid...

  12. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases

    International Nuclear Information System (INIS)

    Puri, A.; Shingade, V.U.; Agarwal, M.G.; Anchan, C.; Juvekar, S.; Desai, S.; Jambhekar, N.A.

    2006-01-01

    Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, paraspinal area and pelvis are difficult to target, and benefit from CT guidance to improve the accuracy of targeting the lesion for biopsy purposes. A prospective study of CT-guided core needle biopsies for deep-seated musculoskeletal lesions was conducted at a referral cancer institute over a 4-year period with the aim of assessing the safety and efficacy of the procedure. From January 2000 to December 2003, 136 consecutive CT-guided biopsy sessions were undertaken for musculoskeletal lesions in 128 patients comprising 73 males and 55 females. The following data was recorded in all patients: demographic data, suspected clinicoradiological diagnosis, data related to core biopsy session (date, site, approach, total time required in minutes, number of cores, surgeon satisfaction with adequacy of cores), patient discomfort, complications, histopathology report and number of further sessions if material obtained during the first biopsy session was not confirmatory. The sample obtained during the biopsy session was considered inconclusive if, in the opinion of the pathologist, inadequate or non-representative tissue had been obtained. The diagnosis was considered inaccurate if the final histopathological diagnosis did not match with the biopsy diagnosis, or if subsequent clinicoradiological evaluation at follow up did not correlate with the biopsy diagnosis in those patients who were treated with modalities other than surgery. In 121 patients, a single session was sufficient to obtain representative material, whilst for six patients two sessions, and for one patient three sessions were necessary. The time taken for biopsy, including the pre-biopsy CT examination time, varied from 15 min to 60 min (median 30 min). For 110 bony lesions 116 sessions were required, and for 18 soft-tissue lesions 20 sessions were required. 108 biopsy sessions yielded a diagnosis, whilst

  13. Percutaneous MR-Guided Cryoablation of Morton’s Neuroma: Rationale and Technical Details After the First 20 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien [Hôpitaux Universitaires de Strasbourg, HUS (France); Department of Interventional Radiology, Nouvel Hôpital Civil (France); Ramamurthy, Nitin [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia; Caudrelier, Jean; Thenint, Marie-Aude; Rao, Pramod; Koch, Guillaume; Gangi, Afshin [Hôpitaux Universitaires de Strasbourg, HUS (France); Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-10-15

    ObjectivesThe purpose of this study is to discuss technical aspects and rationales of magnetic resonance (MR)-guided cryoablation (CA) of Morton’s neuroma (MN); preliminary clinical experience is also retrospectively reviewed.MethodsProcedures were performed under local anaesthesia on an outpatient basis. Lesion size and location, procedural (technical success, procedural time, complications) and clinical outcomes (patient satisfaction according to a four-point scale, residual pain according to a 0–10 visual analogue scale and instances of “stump neuroma”) were assessed via chart review and cross-sectional telephone survey after the 20th case.ResultsTwenty patients (15 female, 5 male; mean age 50.3 years) were included; 24 MN (mean size 12.7 mm) were treated. Technical success was 100 %. Mean procedural time was 40.9 ± 10.4 min (range 35–60). One minor complication (superficial cellulitis) was reported (4.2 %). Follow-up (mean 19.7 months) was available for 18/24 MN. Patient satisfaction on a per-lesion basis was as follows: “completely satisfied” in 77.7 %, “satisfied with minor reservations” in 16.6 % and “satisfied with major reservations” in 5.7 % of cases. Mean pain score at last follow-up post-CA was 3.0. No instances of “stump neuroma” were reported.ConclusionsMR-guided CA of MN is a novel therapy which appears technically feasible. Clinical advantages of the procedure are high patient satisfaction, reduced risk of “stump neuroma” syndrome and good patient tolerance on an outpatient basis. Further, prospective studies are needed to confirm these encouraging results.

  14. Percutaneous MR-Guided Cryoablation of Morton’s Neuroma: Rationale and Technical Details After the First 20 Patients

    International Nuclear Information System (INIS)

    Cazzato, Roberto Luigi; Garnon, Julien; Ramamurthy, Nitin; Tsoumakidou, Georgia; Caudrelier, Jean; Thenint, Marie-Aude; Rao, Pramod; Koch, Guillaume; Gangi, Afshin

    2016-01-01

    ObjectivesThe purpose of this study is to discuss technical aspects and rationales of magnetic resonance (MR)-guided cryoablation (CA) of Morton’s neuroma (MN); preliminary clinical experience is also retrospectively reviewed.MethodsProcedures were performed under local anaesthesia on an outpatient basis. Lesion size and location, procedural (technical success, procedural time, complications) and clinical outcomes (patient satisfaction according to a four-point scale, residual pain according to a 0–10 visual analogue scale and instances of “stump neuroma”) were assessed via chart review and cross-sectional telephone survey after the 20th case.ResultsTwenty patients (15 female, 5 male; mean age 50.3 years) were included; 24 MN (mean size 12.7 mm) were treated. Technical success was 100 %. Mean procedural time was 40.9 ± 10.4 min (range 35–60). One minor complication (superficial cellulitis) was reported (4.2 %). Follow-up (mean 19.7 months) was available for 18/24 MN. Patient satisfaction on a per-lesion basis was as follows: “completely satisfied” in 77.7 %, “satisfied with minor reservations” in 16.6 % and “satisfied with major reservations” in 5.7 % of cases. Mean pain score at last follow-up post-CA was 3.0. No instances of “stump neuroma” were reported.ConclusionsMR-guided CA of MN is a novel therapy which appears technically feasible. Clinical advantages of the procedure are high patient satisfaction, reduced risk of “stump neuroma” syndrome and good patient tolerance on an outpatient basis. Further, prospective studies are needed to confirm these encouraging results.

  15. Ultrasound-guided percutaneous irrigation in rotator cuff calcific tendinopathy: what is the evidence? A systematic review with proposals for future reporting.

    Science.gov (United States)

    Lanza, Ezio; Banfi, Giuseppe; Serafini, Giovanni; Lacelli, Francesca; Orlandi, Davide; Bandirali, Michele; Sardanelli, Francesco; Sconfienza, Luca Maria

    2015-07-01

    We performed a systematic review of current evidence regarding ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) in the shoulder aimed to: assess different published techniques; evaluate clinical outcome in a large combined cohort; and propose suggestions for homogeneous future reporting. Cochrane Collaboration for Systematic Reviews of Interventions Guidelines were followed. We searched MEDLINE/MEDLINE In-Process/EMBASE/Cochrane databases from 1992-2013 using the keywords 'ultrasound, shoulder, needling, calcification, lavage, rotator cuff' combined in appropriate algorithms. References of resulting papers were also screened. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. Of 284 papers found, 15 were included, treating 1,450 shoulders in 1,403 patients (females, n = 838; mean age interval 40-63 years). There was no exclusion due to risk of bias. US-PICT of rotator cuff is a safe and effective procedure, with an estimated average 55% pain improvement at an average of 11 months, with a 10% minor complication rate. No evidence exists in favour of using a specific size/number of needles. Imaging follow-up should not be used routinely. Future studies should aim at structural uniformity, including the use of the Constant Score to assess outcomes and 1-year minimum follow-up. Alternatives to steroid injections should also be explored. • US-PICT of rotator cuff is a safe and effective procedure. • On average 55% pain improvement with 10% minor complication rate. • No evidence exists in favour of using a specific size/number of needles. • Future need to assess outcome using Constant Score with 1-year minimum follow-up.

  16. Helical-Tip Needle for Transthoracic Percutaneous Image-Guided Biopsy of Lung Tumors: Results of a Pilot Prospective Comparative Study with a Standard Tru-Cut Needle

    Energy Technology Data Exchange (ETDEWEB)

    Veltri, Andrea, E-mail: andrea.veltri@unito.it; Busso, Marco; Sardo, Diego; Angelino, Valeria; Priola, Adriano M. [University of Torino, Department of Radiology, San Luigi Gonzaga Hospital (Italy); Novello, Silvia [University of Torino, Department of Oncology, San Luigi Gonzaga Hospital (Italy); Barba, Matteo [University of Torino, Department of Radiology, San Luigi Gonzaga Hospital (Italy); Gatti, Gaia; Righi, Luisella [University of Torino, Department of Pathology, San Luigi Gonzaga Hospital (Italy)

    2017-06-15

    PurposeTo prospectively evaluate feasibility and diagnostic performance of the 14-gauge helical-tip (Spirotome™, Cook{sup ®} Medical, Bloomington, USA) needle in transthoracic needle biopsy (TTNB) of lung lesions, compared to a conventional 18-gauge Tru-Cut needle.Materials and MethodsStudy was institutional review board approved, with informed consent obtained. Data from synchronous Spirotome and Tru-Cut image-guided TTNB of 20 consecutive patients with malignant peripheral lung tumors larger than 3 cm were enrolled for pathologic characterization and mutational analysis. Samples obtained with Spirotome and Tru-Cut needle were compared for fragmentation, length, weight, morphologic and immunohistochemistry typifying, tumor cellularity (TC) and DNA concentration.ResultsThe technical success rate for TTNB with Spirotome was 100%, and no major complications occurred. Less fragmentation (mean 2 vs. 3 fragments, P = .418), greater weight (mean 13 vs. 8.5 mg, P = .027) and lower length (mean 10.2 vs. 12.6 mm, P = .174) were observed with Spirotome compared to Tru-Cut needle. Accuracy of Spirotome and Tru-Cut needle in defining cancer histotype was similar (90%). Absolute and relative TC (mean 42 vs. 38, 124 vs. 108/10HPF), and DNA concentration (mean 49.6 vs. 39.0 ng/μl) were higher with Spirotome compared to Tru-Cut needle, with no statistical significance (P = .787 and P = .140, respectively).Conclusions Percutaneous 14-gauge Spirotome TTNB of selected lesions is feasible and accurate. It provides adequate samples for diagnosis, comparable to 18-gauge Tru-Cut needle, with a higher amount of tumor tissue (weight, TC, DNA concentration) even in shorter samples.

  17. Clinical effect of ultrasound-guided injection of lauromacrogol versus anhydrous ethanol as sclerotherapy for simple hepatic cyst: a comparative analysis

    Directory of Open Access Journals (Sweden)

    DONG Jinbin

    2016-06-01

    Full Text Available ObjectiveTo investigate the clinical effect of ultrasound-guided injection of lauromacrogol versus anhydrous ethanol as the sclerotherapy for simple hepatic cyst, as well as the incidence rates of adverse events and changes in liver function and the results of routine blood test after surgery, and to evaluate the advantages and disadvantages of these two sclerosing agents in the treatment of simple hepatic cyst. MethodsA total of 62 patients with simple hepatic cyst who were treated in Department of Gastroenterology, Shanghai Pudong New Area Gongli Hospital were enrolled and randomly divided into observation group (lauromacrogol group and control group (anhydrous ethanol group. The patients in these two groups were given ultrasound-guided injection of lauromacrogol and anhydrous ethanol, respectively. The incidence rates of intraoperative and postoperative adverse events, cure rate, changes in the serum levels of serum total bilirubin (TBil, alanine aminotransferase (ALT, aspartate aminotransferase (AST, cholinesterase (CHE, and alkaline phosphatase (ALP, and changes in the results of routine blood test within 24 hours after surgery were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the observation group had significantly lower incidence rates of adverse events and a significantly lower blood alcohol concentration (both P<0.05. The cure rate (1 and 6 months after surgery and the changes in the results of routine blood test within 24 hours after surgery showed no significant differences between the two groups (both P >0.05. At 1 week after surgery, theserum levels of ALT and AST showed significant differences between the observation group and the control group for single hepatic cyst (t=-3.680 and -5.571, P=0.001 and <0.001, while the serum levels of ALT and AST

  18. Influence able and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique-Case Report, Systematic Literature Review, and a Technical Note

    International Nuclear Information System (INIS)

    Rott, G.; Boecker, F.

    2014-01-01

    Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influence able or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemo static valve.

  19. Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation.

    Science.gov (United States)

    Alaid, Awad; von Eckardstein, Kajetan; Smoll, Nicolas Roydon; Solomiichuk, Volodymyr; Rohde, Veit; Martinez, Ramon; Schatlo, Bawarjan

    2018-04-01

    Postoperative wound healing can pose a problem in patients undergoing instrumented surgery for pyogenic spondylodiscitis. Robotic guidance allows the minimally invasive placement of pedicle screws in the thoracolumbar spine. We assessed whether using this technique to perform minimally invasive surgery had an impact on wound healing in patients with pyogenic spondylodiscitis when compared to conventional open fluoroscopy-guided surgery. We reviewed charts of 206 consecutive patients who underwent instrumentation for pyogenic spondylodiscitis. The need for wound revision was the primary outcome measure. Patient variables and comorbidities as well as surgical technique (robotic versus fluoroscopy-guided) were analyzed. We also compared fluoroscopy times between the two groups. Multivariate regression analysis was performed to identify predictors of wound breakdown. A total of 206 patients underwent surgery for spondylodiscitis. Robotic surgical assistance was used for percutaneous instrumentation in 47.6% of cases (n = 98). Wound healing problems requiring revision occurred in 30 out of 206 patients (14.6%). Univariate analysis revealed a potential association of wound breakdown with (1) robotic technique, (2) age > 70 years, and (3) the presence of methicillin-resistant Staphylococcus aureus. After multivariate correction however, only robotic technique retained significance with an odds ratio of 0.39 (CI 95% 0.16-0.94; p = 0.035). Wound revision was required in eight out of 98 patients (8.1%) in the robot group and 22/108 (20%) in the conventional surgery group. Fluoroscopy times were significantly lower in the robot group with a mean of 123 ± 86 s in comparison with a mean of 157 ± 99 s in the conventional group (p = 0.014). While initially designed to improve the accuracy of pedicle screw placement, robot-assisted minimally invasive technique had a tangible effect on both radiation exposure and the rate of wound breakdown in patients with pyogenic

  20. Percutaneous vertebroplasty

    International Nuclear Information System (INIS)

    Hierholzer, J.; Fuchs, H.; Depriester, C.; Venz, S.; Maier-Hauff, K.; Schulz, R.; Koch, K.

    2002-01-01

    Purpose: To describe the procedure of percutaneous vertebroplasty and to present our first clinical results of patients treated for benign or malignant painful vertebral body disease. Material and Methods: We performed percutaneous vertebroplasty in 31 painful lesions of the spine. Liquid bone cement was injected into the affected vertebral body using fluoroscopic guidance through a bilateral transpedicular approach. Etiology of the bone disease was assessed by biopsy. Pain intensity was assessed before and 1 week after the procedure by standardized catalogue. Results: Percutaneous vertebroplasty was performed in 17 thoracic and in 14 lumbar spine bodies of benign (n = 23) or malignant (n = 8) disease; no clinically relevant complications occurred. All patients reported significant pain relief 1 week after the intervention. One week after treatment, patients were pain-free in 15/31 vertebral bodies, and reported mild residual pain not necessitating narcotic medication in 16/31 cases. Conclusion: In accordance with the literature, percutaneous vertebroplasty proved to be a highly effective, minimal invasive interventional procedure to treat severely painful bone lesions of benign and malignant origin. (orig.) [de

  1. Comparison of diagnostic yield and safety profile of radial endobronchial ultrasound-guided bronchoscopic lung biopsy with computed tomography-guided percutaneous needle biopsy in evaluation of peripheral pulmonary lesions: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ayush Gupta

    2018-01-01

    Full Text Available Background: Peripheral pulmonary lesions (PPLs pose a diagnostic challenge, and the optimal investigation in many such cases remains unclear. Computed tomography (CT-guided percutaneous needle biopsy (CT-PNB has been the modality of choice for such lesions with a high diagnostic accuracy but with high rates of pneumothorax. Endobronchial ultrasound (EBUS with a radial probe is an alternate diagnostic modality with increased diagnostic yield of bronchoscopy in the evaluation of PPL. We conducted a randomized controlled trial comparing the diagnostic accuracy and complication rates of radial EBUS with CT-guided lung biopsy for the evaluation of PPL. Methods: Fifty patients with PPL surrounded by lung parenchyma on all sides were randomly assigned to either radial EBUS or CT-PNB group (25 each. Results: Both groups had similar clinicoradiologic characteristics. The diagnostic accuracy of radial EBUS was comparable to CT-PNB with no statistically significant difference (72 vs. 84%; P = 0.306. However, the yield was significantly lower in right upper lobe lesions (20% vs. 83.3%; P = 0.03. CT-PNB group had significantly higher pneumothorax rates than radial EBUS (20% vs. 0%; P = 0.03. The lesions that were more than 2 cm, those with ultrasound feature of continuous hyperechoic margin around the lesion (P = 0.007, and the position of the ultrasound probe within the lesion (P < 0.001 were associated with a higher diagnostic yield with radial EBUS. Conclusion: Our findings suggest that radial EBUS is a safer investigation than CT-PNB with a comparable diagnostic accuracy for PPL not abutting the chest wall (CTRI/2017/02/007762.

  2. CT fluoroscopy-guided percutaneous vertebroplasty in spinal malignancy: technical results, PMMA leakages, and complications in 202 patients

    Energy Technology Data Exchange (ETDEWEB)

    Trumm, Christoph G.; Pahl, Anne; Zech, Christoph J.; Stahl, Robert; Paprottka, Philipp M.; Sandner, Torleif A.; Reiser, Maximilian F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen-Grosshadern, Department of Clinical Radiology, Munich (Germany); Helmberger, Thomas K. [Klinikum Bogenhausen, Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, Muenchen (Germany); Jakobs, Tobias F. [Krankenhaus Barmherzige Brueder Muenchen, Department of Radiology, Muenchen (Germany); Hoffmann, Ralf-Thorsten [Universitaetsklinikum Carl Gustav Carus Dresden, Department and Policlinics of Diagnostic Radiology, Dresden (Germany)

    2012-11-15

    To retrospectively evaluate the incidence and clinical impact of local polymethylmethacrylate (PMMA) leaks and pulmonary cement embolisms occurring under CT fluoroscopy-guided vertebroplasty of symptomatic malignant vertebral osteolyses. From December 2001 to June 2009, 202 cancer patients (116 women, 86 men; age 63.2 {+-} 8.6 years) with painful malignant vertebral osteolyses underwent vertebroplasty, with or without vertebral compression fracture. A total of 331 vertebrae were treated in 231 sessions under CT fluoroscopy guidance (120kV; 10-25mA; single slice, 4-, 16-, and 128-row CT). In the pre-vertebroplasty CT, the following items were assessed: osteolytic destruction (0, {<=}25, {<=}50, {<=}75, or {<=}100%) of vertebral cross-sectional area, posterior wall, and circumference; presence of perivertebral and degree of epidural (no, mild, moderate) soft tissue involvement. Local PMMA leaks were analyzed using the post-vertebroplasty CT. Pulmonary cement embolisms were evaluated in all patients having undergone radiography (CR; n = 53) or CT (n = 88) of the chest after vertebroplasty due to their underlying disease. Patient charts were reviewed regarding adverse events. Of 331 treated vertebrae, 32, 20.2, and 15.7% showed more than 50% osteolytic involvement of the vertebral cross-sectional area, posterior wall, and circumference, respectively. Mild or moderate epidural involvement was seen in 13.0 and 8.4%. Local PMMA leakage rate was 58.6% (194 of 331 vertebrae). Pulmonary cement embolisms (segmental, n = 10; central, n = 1) were seen after 7.8% of the procedures with follow-up imaging of the chest. No major complications occurred within a 30-day period after vertebroplasty. Vertebroplasty of spinal malignancy can be safely performed under CT fluoroscopy guidance even in patients with substantial osteolytic involvement. In our patient collective, PMMA leaks and pulmonary cement embolisms visualized in post-procedural radiography and CT images had no clinical

  3. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-10-15

    AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

  4. Efficacy of triamcinolone acetate and methylprednisolone acetonide for intrabursal injection after ultrasound-guided percutaneous treatment in painful shoulder calcific tendonitis: a randomized controlled trial.

    Science.gov (United States)

    Battaglia, Milva; Guaraldi, Federica; Gori, Davide; Castiello, Emanuela; Arvat, Emanuela; Sudanese, Alessandra

    2017-08-01

    Background Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US-PICT) with intrabursal steroid injection is an elective treatment for painful rotator cuff calcific tendinopathy. Purpose To compare the efficacy of post-US-PICT intrabursal 40 mg injection of triamcinolone acetonide (TA) versus methylprednisolone acetate (MA). Material and Methods Forty patients (22 women; mean age 48.7 ± 7.2 years) with painful shoulder calcific tendinopathy, treated with TA or MA injected intrabursally after US-PICT, were included in this randomized controlled trial. At baseline and after 1, 7, 15, 30, 45, and 180 days, patients underwent US and clinical examination, using Constant (CS) and VAS (VS) scores. Complications and analgesic use were also recorded. Results Compared to baseline, at the 45-day follow-up, TA and MA group showed a similar improvement (Δ) in CS (42 ± 10 versus 36 ± 9 points) and VS (-4.4 ± 1.3 versus -3.6 ± 1.3 points). At the 180-day follow-up, the improvement was higher in TA versus MA (ΔCS: 53 ± 7 versus 44 ± 7 points; ΔVS: -4.9 ± 1.1 versus -3.9 ± 1 points). Multivariate analysis showed a mean CS higher ( P = 0.02) in TA versus MA group, while VS was similar. TA had a 5 × higher ( P = 0.007) chance of reaching complete remission (CS = 100 points) than MA group. A progressive decrease in analgesic use, concomitant to a significant and similar reduction of bursitis and calcifications, was observed in both groups. No major complications occurred. Conclusion Two-needle US-PICT with intrabursal steroid injection is safe and effective. The chance of reaching better scores and, even more important for a clinical perspective, of functional recovery, is higher in patients treated with TA than MA.

  5. The study protocol for a non-randomized controlled clinical trial using a genotype-guided strategy in a dataset of patients who undergone percutaneous coronary intervention with stent.

    Science.gov (United States)

    Dávila-Fajardo, Cristina Lucía; Sánchez-Ramos, Jesús; Villamarín, Xando Diaz-; Martínez-González, Luis Javier; Frías, Pablo Toledo; Huertas, Susana Martínez; Gómez, Francisco Burillo; Borrego, Juan Caballero; Pavés, Alicia Bautista; Guzmán, Mª Carmen Marín; Hernández, José Antonio Ramirez; Vilches, Concepción Correa; Barrera, Jose Cabeza

    2017-02-01

    This article contains data related to the research article entitled "Results of genotype-guided antiplatelet therapy in patients undergone percutaneous coronary intervention with stent" (J. Sánchez-Ramos, C.L. Dávila-Fajardo, P. Toledo Frías, X. Díaz Villamarín, L.J. Martínez-González, S. Martínez Huertas, F. Burillo Gómez, J. Caballero Borrego, A. Bautista Pavés, M.C. Marín Guzmán, J.A. Ramirez Hernández, C. Correa Vilches, J. Cabeza Barrera, 2016) (1). This data article reports, for the first time, about the non-randomized clinical trial protocol that check if CYP2C19/ABCB1 genotype-guided strategy in which the choice of antiplatelet therapy is based on the genetic test, reduces the rates of cardiovascular events and bleeding compared to a non-tailored strategy in patients undergone percutaneous coronary intervention (PCI) with stent. The data included in this article are: design and setting of the study, study population, inclusion and exclusion criteria, definition of the intervention, objectives, variables (baseline characteristics and during the follow-up), study procedures, collection and treatment of the biological sample, genotyping, withdrawal criteria, sample size, statistic analysis, ethical aspects, information sheet and consent form. The authors confirm that this study has been registered in Eudra CT (Eudra CT: 2016-001294-33).

  6. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  7. Percutaneous absorption of chlorhexidine in neonatal cord care.

    OpenAIRE

    Aggett, P J; Cooper, L V; Ellis, S H; McAinsh, J

    1981-01-01

    The percutaneous absorption of chlorhexidine during its routine use in topical antiseptic preparations used in umbilical cord care was investigated by determining plasma chlorhexidine concentrations at ages 5 and 9 days. These showed that percutaneous absorption of chlorhexidine occurred in preterm neonates treated with a 1% solution of chlorhexidine in ethanol, but not in term infants similarly treated, or in preterm infants treated only with a dusting powder containing 1% chlorhexidine and ...

  8. Percutaneous Tracheostomy

    Science.gov (United States)

    Mehta, Chitra; Mehta, Yatin

    2017-01-01

    Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists. This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU. PMID:28074819

  9. Percutaneous gastroenterostomy

    Energy Technology Data Exchange (ETDEWEB)

    Wittich, G.R.; Van Sonnenberg, E.; Casola, G.; Jantsch, H.; Walter, R.; Lechner, G.

    1987-05-01

    Percutaneous gastrostomies or gastroenterostomies serve for temporary or permanent enteric feeding in patients with obstruction or functional derangement of the esophagus or hypopharynx. In addition, this radiological procedure may be indicated for small bowel decompression. The authors present their experience in 71 patients. Insufflation of air through a nasogastric tube or catheter is the preferred method for gastric distension. The inferior margin of the left lobe of the liver and the transverse colon are localized sonographically and fluoroscopically prior to puncture. Either Seldinger or Trocartechniques have proven effective in establishing access to the stomach. The feeding tube is advanced into the proximal jejunum to reduce the likelyhood of gastroesophageal reflux and possible aspiration. Complications were encountered in four patients and included catheter dislocation in three and respiratory distress in one patient.

  10. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    Energy Technology Data Exchange (ETDEWEB)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  11. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  12. CT scan-guided percutaneous osteosynthesis of a complex, multifocal fracture of the pelvic girdle in a 14-year-old adolescent

    International Nuclear Information System (INIS)

    Gagne, Pierre-Thomas; Bertrand, Anne-Sophie; Caudal, Amandine; El Hayek, Tony; Amoretti, Nicolas

    2014-01-01

    We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient's parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient. (orig.)

  13. Percutaneous epidural drainage through a burr hole

    Directory of Open Access Journals (Sweden)

    Priscila M Falsarella

    2016-01-01

    Full Text Available Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

  14. Graft Loss Due to Percutaneous Sclerotherapy of a Lymphocele Using Acetic Acid After Renal Transplantation

    International Nuclear Information System (INIS)

    Adani, Gian Luigi; Baccarani, Umberto; Bresadola, Vittorio; Lorenzin, Dario; Montanaro, Domenico; Risaliti, Andrea; Terrosu, Giovanni; Sponza, Massimo; Bresadola, Fabrizio

    2005-01-01

    Development of lymphoceles after renal transplantation is a well-described complication that occurs in up to 40% of recipients. The gold standard approach for the treatment of symptomatic cases is not well defined yet. Management options include simple aspiration, marsupialization by a laparotomy or laparoscopy, and percutaneous sclerotherapy using different chemical agents. Those approaches can be associated, and they depend on type, dimension, and localization of the lymphocele. Percutaneous sclerotherapy is considered to be less invasive than the surgical approach; it can be used safely and effectively, with low morbidity, in huge, rapidly accumulating lymphoceles. Moreover, this approach is highly successful, and the complication rate is acceptable; the major drawback is a recurrence rate close to 20%. We herewith report a renal transplant case in which the patient developed a symptomatic lymphocele that was initially treated by ultrasound-guided percutaneous sclerotherapy with ethanol and thereafter using acetic acid for early recurrence. A few hours after injection of acetic acid in the lymphatic cavity, the patient started to complain of acute pain localized to the renal graft and fever. An ultrasound of the abdomen revealed thrombosis of the renal vein and artery. The patient was immediately taken to the operating room, where the diagnosis of vascular thrombosis was confirmed and the graft was urgently explanted. In conclusion, we strongly suggest avoiding the use of acetic acid as a slerosating agent for the percutaneous treatment of post-renal transplant lymphocele because, based on our experience, it could be complicated by vascular thrombosis of the kidney, ending in graft loss

  15. PERCUTANEOUS ELECTROHEMOSTASIS AFTER PERCUTANEOUS NEPHROLITHOTOMY

    Directory of Open Access Journals (Sweden)

    R. N. Trushkin

    2017-01-01

    Full Text Available The article describes the clinical case in a patient with bilateral nephrolithiasis, chronic kidney disease of the 4th stage, after which bleeding from the left kidney developed after simultaneous bilateral percutaneous nephrolithotomy (PNL, leading to severe hemic hypoxia. Conservative therapy, blood transfusion did not lead to a persistent effect, the bleeding continued to recur. Given the presence of chronic renal failure (CRF from the embolization of the branches of the renal artery, it was decided to abstain, given the extremely high risk of aggravation of nephropathy after the administration of the contrast drug. Left-sided nephrectomy would inevitably lead to the development of terminal chronic renal failure. Patients performed an electrocoagulation of the fistula wall with a Karl Storz 26C resectoscope in 60W mode. The bleeding was completely stopped. The patient is discharged from the hospital in a satisfactory condition. At the time of discharge in the conduct of replacement renal therapy did not need. When analyzing publications in The Cochrane Library, PubMed, Medline and Web of Science, we did not find a description of such a method of hemostasis.

  16. MR-guided percutaneous nephrostomy of the contrast-enhanced, nondilated upper urinary tract: initial experimental results; MR-tomographisch gesteuerte perkutane Nephrostomie des kontrastangehobenen, nicht dilatierten oberen Harntraktes: Erste experimentelle Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Nolte-Ernsting, C.C.A.; Buecker, A.; Neuerburg, J.M.; Adam, G.B.; Guenther, R.W. [RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik; Hunter, D.W. [Minnesota Univ. (United States). Dept. of Radiology

    1998-06-01

    Purpose: To evaluate technique and practicability of MR-guided percutaneous nephrostomy (MRPCN) in an animal model. Methods: In three domestic pigs, a unilateral percutaneous nephrostomy tube was placed into the nondilated collecting system using exclusively MR-guidance with a standard 1.5 T scanner. The urinary tract was visualized by intravenous injection of Gd-DTPA and low-dose furosemide. The entire interventional procedure was controlled using a T{sub 1}-weighted `dual stack` 2D TFE sequence in two orthogonal planes. Results: In all three animals, the puncture needle was safely directed into the nondilated target calyx. Even slight deviations of the needle from the optimal path were readily detected on both MR image planes which enabled immediate correction. This technique successfully achieved a `first attempt` puncture of the targeted calyx in each animal. Over a nitinol guidewire a 5 F catheter was placed into the renal pelvis. Its dysprosium labelled tip was acurately delineated on contrast-enhanced MR images. Conclusions: Percutaneous nephrostomy under MR guidance is a very feasible technique for puncturing the nondilated pelvicalyceal system. This procedure offers some advantages over the current standard modalities. (orig.) [Deutsch] Ziel: Ueberpruefung von Technik und Durchfuehrbarkeit einer MR-tomographisch gesteuerten perkutanen Nephrostomie (MR-PNS) im Tierexperiment. Methoden: Bei drei Hausschweinen wurde eine einseitige perkutane Nephrostomie des nicht dilatierten Hohlraumsystems ausschliesslich unter MR-tomographischer Kontrolle mit einem geschlossenen 1,5-T-System durchgefuehrt. Die Kontrastierung des oberen Harntraktes erfolgte durch eine intravenoese Injektion von Gd-DTPA und niedrigdosiertem Furosemid. Die einzelnen Interventionsschritte wurden mit einem T{sub 1}-gewichteten `Doppel-Schichtstapel` 2D-TFE Sequenz in zwei orthogonalen Schichtebenen kontrolliert. Ergebnisse: Bei allen drei Versuchstieren liess sich die Punktionsnadel unter MR

  17. Bioprocess design guided by in situ substrate supply and product removal: process intensification for synthesis of (S)-1-(2-chlorophenyl)ethanol.

    Science.gov (United States)

    Schmölzer, Katharina; Mädje, Katharina; Nidetzky, Bernd; Kratzer, Regina

    2012-03-01

    We report herein on bioprocess development guided by the hydrophobicities of substrate and product. Bioreductions of o-chloroacetophenone are severely limited by instability of the catalyst in the presence of aromatic substrate and (S)-1-(2-chlorophenyl)ethanol. In situ substrate supply and product removal was used to protect the utilized Escherichia coli whole cell catalyst based on Candida tenuis xylose reductase during the reaction. Further engineering at the levels of the catalyst and the reaction media was matched to low substrate concentrations in the aqueous phase. Productivities obtained in aqueous batch reductions were 21-fold improved by addition of 20% (v/v) hexane, NAD(+), expression engineering, cell permeabilization and pH optimization. Reduction of 300 mM substrate was accomplished in 97% yield and use of the co-solvent hexane in subsequent extraction steps led to 88% recovery. Product loss due to high catalyst loading was minimized by using the same extractant in bioreduction and product isolation. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Severe thrombocytopenia induced by iodinated contrast after coronary angiography: The use of gadolinium contrast and intravascular ultrasound as an alternative to guide percutaneous coronary intervention.

    Science.gov (United States)

    Cubero-Gómez, José María; Guerrero Márquez, Francisco J; Diaz-de la-Llera, Luis; Fernández-Quero, Mónica; Guisado-Rasco, Agustín; Villa-Gil-Ortega, Manuel

    2017-01-01

    Acute contrast-induced thrombocytopenia is a rare event with the use of modern low osmolarity iodinated contrast media. The pathophysiological mechanism that causes platelet counts to drop has not been identified, but an immunological mechanism is suspected due to cytotoxicity after previous exposure to contrast. We report the case of a 47-year-old male patient with acute severe thrombocytopenia due to iodinated contrast media exposure. His platelet count after the procedure with the highest amount of contrast was zero, which is the lowest reported platelet count to date. Percutaneous coronary revascularization under both intravascular ultrasound and gadolinium contrast guidance was performed without complications. The most feared complication after the use of gadolinium is nephrogenic systemic fibrosis, especially in patients on hemodialysis. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. CT scan-guided percutaneous osteosynthesis of a complex, multifocal fracture of the pelvic girdle in a 14-year-old adolescent

    Energy Technology Data Exchange (ETDEWEB)

    Gagne, Pierre-Thomas; Bertrand, Anne-Sophie; Caudal, Amandine; El Hayek, Tony; Amoretti, Nicolas [Centre Hospitalier Universitaire de Nice, Nice (France)

    2014-08-15

    We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient's parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient. (orig.)

  20. Ethanol Basics

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-01-30

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  1. Computed tomography-guided percutaneous core needle biopsy for diagnosis of mediastinal mass lesions: Experience with 110 cases in two university hospitals in Isfahan, Iran

    Directory of Open Access Journals (Sweden)

    Masoud Rabbani

    2016-01-01

    Conclusion: CT-guided PCNB is a safe and reliable procedure that can provide a precise diagnosis for patients with both benign and malignant mediastinal masses, and it is considered the preferred first diagnostic procedure use for this purpose.

  2. The Effect of Needle Gauge on the Risk of Pneumothorax and Chest Tube Placement After Percutaneous Computed Tomographic (CT)-Guided Lung Biopsy.

    Science.gov (United States)

    Kuban, Joshua D; Tam, Alda L; Huang, Steven Y; Ensor, Joe E; Philip, Asher S; Chen, Geraldine J; Ahrar, Judy; Murthy, Ravi; Avritscher, Rony; Madoff, David C; Mahvash, Armeen; Ahrar, Kamran; Wallace, Michael J; Nachiappan, Arun C; Gupta, Sanjay

    2015-12-01

    The aim of this study was to evaluate the effect of coaxial guide needle gauge (18 vs. 19 gauge) on the risk of pneumothorax and chest tube placement after CT-guided lung biopsy. Imaging records of all patients who had undergone CT-guided lung biopsies at our institution from March 1, 2006 to December 9, 2010 were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to assess the effect of various patient-, lesion-, and procedure-related variables on subsequent pneumothorax and chest tube placement rates. The study included 4262 biopsies (2304 with 18-gauge and 1958 with 19-gauge coaxial guide needles) in 3917 patients. The rates of pneumothorax and chest tube placement were 30.2 and 15%, respectively. Pneumothorax occurred in 35% of procedures performed with 18-gauge needles and in 24.5% of procedures performed with 19-gauge needles (p gauge needles and in 13.1% of procedures performed with 19-gauge needles (p = 0.0011). Multivariate logistic regression models demonstrated that the use of an 18-gauge needle was associated with a higher rate of pneumothorax (p gauge coaxial guide needle significantly decreases the risk of pneumothorax and chest tube placement compared with an 18-guage needle.

  3. Training for percutaneous renal access on a virtual reality simulator.

    Science.gov (United States)

    Zhang, Yi; Yu, Cheng-fan; Liu, Jin-shun; Wang, Gang; Zhu, He; Na, Yan-qun

    2013-01-01

    The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training. Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt. During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively). The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in

  4. Identifying indications for percutaneous (PTC) vs. endoscopic ultrasound (EUS)- guided "rendezvous" procedure in biliary obstruction and incomplete endoscopic retrograde cholangiography (ERC).

    Science.gov (United States)

    Albert, J G; Finkelmeier, F; Friedrich-Rust, M; Kronenberger, B; Trojan, J; Zeuzem, S; Sarrazin, C

    2014-10-01

    The variety of rendezvous (RV) procedures has recently been extended by EUS- and PTCD-guided procedures as a complementary means to conventional ERCP. We have identified indication criteria and the potential of biliary PTCD-guided vs. EUS-guided RV. Consecutive patients with bile duct obstruction who underwent RV were included. In all, ERCP alone was unable to achieve treatment success. Indication, technical success, and outcome in PTCD- vs. EUS-guided RV were retrospectively compared to identify criteria that indicate preference of RV technique. Site of obstruction, clinical scenario (stenosis with abscess vs. no abscess) and reason for previous failure of ERC were evaluated. In 32 patients, three different indications for RV procedures were identified: First, a one-step access to assist in failed ERCP (type 1, intra-ductal RV); second, temporary drainage for prolonged treatment of complex biliary disease (type 2, intra-ductal RV), and drainage of cholangio-abscess with re-establishing bile outflow (type 3, intra-abscess RV). Indication of PTCD- vs. EUS-guided rendezvous was competitive in type 1, but exclusive in favor of PTCD in types 2 and 3. The site of biliary obstruction indicated the anatomic location of RV procedures. This classification may help to define inclusion criteria for prospective studies on biliary RV procedures. Choice of therapeutic strategy depends on the anatomic location of the biliary obstruction and the type of the biliary lesion. PTCD-guided RV might improve outcome in cholangio-abscess. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Optical Coherence Tomography Guided Percutaneous Coronary Intervention With Nobori Stent Implantation in Patients With Non-ST-Segment-Elevation Myocardial Infarction (OCTACS) Trial

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Maehara, Akiko

    2015-01-01

    (s). A final OCT was performed in case of reintervention. Six-month OCT follow-up was available in 85 patients. Twenty-three (46%) OCT-guided patients had additional postdilation or stenting. The percentage of acutely malapposed struts was substantially lower in the OCT-guided group (3.4% [interquartile range......, 0.3-7.6] versus 7.8% [interquartile range, 2.3-19.4]; Pinterquartile range, 1.2-9.8] versus 9.0% [interquartile range, 5.5-14.5], P

  6. Impact of Surgical Infection Society/Infectious Disease Society of America-recommended antibiotics on postoperative intra-abdominal abscess with image-guided percutaneous abscess drainage following gastrointestinal surgery.

    Science.gov (United States)

    Okita, Yoshiki; Kobayashi, Minako; Araki, Toshimitsu; Fujikawa, Hiroyuki; Koike, Yuhki; Yuki, Koike; Otake, Kohei; Kohei, Otake; Mikihiro, Inoue; Mikihiro, Inoue; Toiyama, Yuji; Yuji, Toiyama; Ohi, Masaki; Ohi, Msaki; Tanaka, Koji; Inoue, Yasuhiro; Uchida, Keiichi; Mohri, Yasuhiko; Yamakado, Koichiro; Kusunoki, Masato

    2015-08-01

    The aims of this study were to reveal how using the antibiotics recommended by the 2010 Surgical Infection Society (SIS) and Infectious Disease Society of America (IDSA) guidelines can affect the therapeutic outcomes. We reviewed the cases of 53 patients with a postoperative intra-abdominal abscess without anastomotic leakage after gastrointestinal surgery who underwent image-guided percutaneous abscess drainage (PAD) and concomitant antibiotic therapy. The type of antibiotic initially administered was determined based on the surgeon's judgment. A persistent abscess was defined as one or more PAD procedures resulting in complete resolution after 21 or more days. The recommended antibiotics were defined according to 2010 SIS/IDSA guidelines. All 53 patients had complete resolution without the need for surgery. The results of a multivariable analysis revealed that a C-reactive protein level ≥12 mg/dL and non-recommended antibiotics were significant risk factors for a persistent abscess (P = 0.042 and 0.013, respectively). With regard to a fever lasting more than 48 h, there was a significant difference between the recommended (45.1%) and non-recommended (72.7 %) antibiotic groups (P = 0.046). Using the recommended antibiotics may shorten the time to defervescence and reduce the risk of a persistent abscess in patients undergoing PAD for a postoperative abscess after gastrointestinal surgery.

  7. Large-sized hepotocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT)

    Energy Technology Data Exchange (ETDEWEB)

    Zangos, Stephan; Eichler, Katrin; Balzer, Joern O.; Straub, Ralf; Hammerstingl, Renate; Herzog, Christopher; Lehnert, Thomas; Heller, Mathias; Thalhammer, Axel; Mack, Martin G.; Vogl, Thomas J. [University Hospital Frankfurt, Johann Wolfgang Goethe-University, Department of Diagnostic and Interventional Radiology, Frankfurt/Main (Germany)

    2007-02-15

    This study aims to evaluate the efficacy and safety of a neoadjuvant treatment protocol with repeated transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for large-sized hepatocellular carcinomas (HCC). Repeated TACE (mean, 3.5 treatments per patient) was performed in 48 patients with neoadjuvant intention (the largest lesion was between 50 and 80 mm in diameter, and there were no more than five lesions). For the TACE treatment, we used 10 mg/m{sup 2} mitomycin, 10 ml/m{sup 2} Lipiodol and microspheres. The tumor volume was measured by MRI. Lipiodol retention of the tumors was evaluated with CT. After the diameter of the tumors had decreased to less than 50 mm, the patients were treated with MR-guided LITT 4 to 6 weeks after embolization. Repeated TACE reduced the tumor size in 32 patients (66.7%), forming the basis for performing MR-guided LITT procedures. These patients received one to four laser treatments (mean, 1.9 per patient) for tumor ablation, resulting in a median survival of 36.0 months after the first treatment. For the remaining patients, no reduction in tumor size was achieved in 12 patients and disease progression in 4 patients. Neoadjuvant TACE appears to be an effective treatment of large-sized HCC, which extends the indication for MR-guided LITT. (orig.)

  8. Percutaneous CT fluoroscopy-guided core biopsy of pancreatic lesions: technical and clinical outcome of 104 procedures during a 10-year period.

    Science.gov (United States)

    Strobl, Frederik Franz; Schwarz, Jens Benjamin; Haeussler, Sophia Marie; Paprottka, Philipp Marius; Rist, Carsten; Thierfelder, Kolja Martin; Boeck, Stefan; Heinemann, Volker; Reiser, Maximilian Ferdinand; Trumm, Christoph Gregor

    2017-08-01

    Background In unclear pancreatic lesions, a tissue sample can confirm or exclude the suspected diagnosis and help to provide an optimal treatment strategy to each patient. To date only one small study reported on the outcome of computed tomography (CT) fluoroscopy-guided biopsies of the pancreas. Purpose To evaluate technical success and diagnostic rate of all CT fluoroscopy-guided core biopsies of the pancreas performed in a single university center during a 10-year period. Material and Methods In this retrospective study we included all patients who underwent a CT fluoroscopy-guided biopsy of a pancreatic mass at our comprehensive cancer center between 2005 and 2014. All interventions were performed under local anesthesia on a 16-row or 128-row CT scanner. Technical success and diagnostic rates as well as complications and effective patient radiation dose were analyzed. Results One hundred and one patients (54 women; mean age, 63.9 ± 12.6 years) underwent a total of 104 CT fluoroscopy-guided biopsies of the pancreas. Ninety-eight of 104 interventions (94.2%) could be performed with technical success and at least one tissue sample could be obtained. In 88 of these 98 samples, a definitive pathological diagnosis, consistent with clinical success could be achieved (89.8%). Overall 19 minor and three major complications occurred during the intra- or 30-day post-interventional period and all other interventions could be performed without complications; there was no death attributable to the intervention. Conclusion CT fluoroscopy-guided biopsy of pancreatic lesions is an effective procedure characterized by a low major complication and a high diagnostic rate.

  9. Ultrasound guided peritubal infiltration of 0.25% Bupivacaine versus 0.25% Ropivacaine for postoperative pain relief after percutaneous nephrolithotomy: A prospective double blind randomized study

    Directory of Open Access Journals (Sweden)

    Geeta P Parikh

    2014-01-01

    Full Text Available Background and Aim: Percutaneous nephrolithotomy (PCNL is a common for managing renal calculi. Pain in the initial post operatie period is relieved by infiltration of local anaesthetic around the nephrostomy tract.We aimed to compare the analgesic efficacy of bupivacaine and ropivacaine. Methods: A total of 100 adult patients undergoing elective PCNL- under balanced general anaesthesia were randomly divided into bupivacaine group (Group B and ropivacaine group (Group R. After completion of procedure, 23G spinal needle was inserted at 6 and 12 O′clock position under ultrasonic guidance up to renal capsule along the nephrostomy tube. A volume of 10 ml of either 0.25% bupivacaine or 0.25% ropivacaine solution was infiltrated in each tract while withdrawing the needle. Post-operative pain was assessed using visual analogue scale (VAS and dynamic visual analogue scale (D-VAS for initial 24 h. Intravenous tramadol was given as rescue analgesia when VAS >4. Time to first rescue analgesic, number of doses and total amount of tramadol required in initial 24 h and side-effects were noted. Results: Visual analogue scale and D-VAS at 6 h and 8 h in Group B was significantly higher than Group R. Mean time to first rescue analgesia in Group R was significantly longer than Group B. Mean number of doses of tramadol and total consumption of tramadol in 24 h was less in Group R, though not statistically significant. Conclusion: Peritubal infiltration of 0.25% ropivacaine infiltration along the nephrostomy tract is more effective than 0.25% bupivacaine in alleviating initial post-operative pain after PCNL.

  10. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao [Shandong Provincial Hospital Affiliated to Shandong University, Department of Oncology, Jinan, Shandong Province (China); Zhang, Kaixian [Teng Zhou Central People' s Hospital Affiliated to Jining Medical College, Department of Oncology, Tengzhou, Shandong Province (China)

    2015-10-15

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  11. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    International Nuclear Information System (INIS)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao; Zhang, Kaixian

    2015-01-01

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  12. Percutaneous Relief of Tension Pneumomediastinum in a Child

    International Nuclear Information System (INIS)

    Chau, Helen Hoi-lun; Kwok, Philip Chong-hei; Lai, Albert Kwok-hung; Fan, Tsz Wo; Chan, Susan Chi-hum; Miu, Ting Yat; Chan, Grace Lai-har

    2003-01-01

    The purpose of this article was to describe the experience of relieving tension pneumomediastinum by a fluoroscopic-guided percutaneous method. We inserted a percutaneous drainage catheter with a Heimlich valve under fluoroscopic guidance to relieve the tension pneumomediastinum in a 2-year-old girl who suffered from dermatomyositis with lung involvement. This allowed immediate relief without the need for surgery. The procedure was repeated for relapsed tension pneumomediastinum. Good immediate results were achieved in each attempt. We conclude that percutaneous relief of pneumomediastinum under fluoroscopic guidance can be performed safely and rapidly in patients not fit for surgery

  13. Computed tomography guided navigation assisted percutaneous ablation of osteoid osteoma in a 7-year-old patient: the low dose approach

    Energy Technology Data Exchange (ETDEWEB)

    Krokidis, Miltiadis; Tappero, Carlo; Bogdanovic, Daniel; Stamm, Anna-Christina [Inselspital, Bern University Hospital, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Ziebarth, Kai [Inselspital, Bern University Hospital, Department of Pediatric Surgery, Bern (Switzerland)

    2017-07-15

    Osteoid osteoma (OO) is a benign tumour that can cause severe pain and functional limitation to children and young adults; the treatment of choice is image-guided ablation. Due to the very small size of the lesion, detection and accurate needle placement may be challenging. Computed tomography (CT) offers very detailed imaging of the skeleton and is the modality of choice for the detection of small OO and for ablation guidance. Nevertheless, CT-guided positioning of the ablation applicator is linked to significant radiation exposure, particularly for the paediatric population. This case describes the successful use of a novel CT-based navigation system that offers the possibility of accurate ablation with only minimal radiation exposure in a paediatric patient. (orig.)

  14. Estudo comparativo dos procedimentos percutâneos orientados por métodos de imagem no tratamento das coleções hepáticas A comparative study of image-guided percutaneous procedures for the treatment of liver abscesses

    Directory of Open Access Journals (Sweden)

    Giselle Guedes Netto de Mello

    2001-04-01

    Full Text Available OBJETIVO: Verificar e comparar a eficácia da punção aspirativa e da drenagem percutânea, orientadas por métodos de imagem, no tratamento das coleções hepáticas. MATERIAIS E MÉTODOS: Foram encaminhados, ao nosso setor, 52 pacientes para tratamento percutâneo de coleções abdominais. Destes, 17 apresentavam coleções hepáticas, sendo 13/17 não-complexas e 4/17, complexas (multiloculadas, múltiplas ou associadas a fístulas. Foram submetidas a punção aspirativa 7/17 coleções (41,2% e a drenagem percutânea, 10/17 (58,8%. Considerou-se como sucesso do método a resolução completa da coleção, com melhora clínica e laboratorial do paciente. RESULTADOS: O sucesso do procedimento ocorreu em 82,4% dos casos. Nas coleções submetidas exclusivamente a punção aspirativa, obteve-se sucesso em 57,1%, enquanto nas submetidas a drenagem percutânea o sucesso foi de 100%. O índice de sucesso no grupo submetido a punção aspirativa foi de 75% nas coleções menores que 100 ml, e de 33,3% naquelas entre 100 e 250 ml. Houve sucesso com a punção aspirativa em 75% das coleções não-complexas e em 25% das complexas. CONCLUSÃO: A drenagem percutânea é mais eficaz que a punção aspirativa no tratamento das coleções hepáticas. A punção aspirativa talvez possa ser empregada como alternativa válida nas coleções de menor volume e não-complexas.OBJECTIVE: To determine and compare the efficacy of percutaneous needle aspiration and percutaneous catheter drainage, both guided by imaging methods, for the treatment of liver abscesses. MATERIALS AND METHODS: From 52 patients referred to our service for percutaneous treatment of abdominal abscesses, 17 presented liver abscesses, 13 of which were considered noncomplex and four were considered complex (multiloculated, multiple or associated to fistulas. Percutaneous needle aspiration was performed in 7/17 patients and 10/17 patients were submitted to percutaneous catheter drainage. The

  15. CT-guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver malignancies; CT-gesteuerte Brachytherapie. Eine neue perkutane Technik zur interstitiellen Ablation von Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J.; Wust, P.; Stohlmann, A.; Beck, A.; Cho, C.H.; Pech, M.; Wieners, G.; Spors, B.; Werk, M.; Rosner, C.; Haenninen, E.L.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite Virchow-Klinikum, Humboldt-Univ. zu Berlin (Germany)

    2004-05-01

    Purpose: to assess safety and efficacy of CT-guided brachytherapy of liver malignancies. Patients and methods: 21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a {sup 192}Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size {>=} 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters. Results: the mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively. Conclusion: CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization. (orig.) [German] Ziel: Analyse der Sicherheit und Effektivitaet CT-gesteuerter Brachytherapie zur Ablation von Lebermalignomen. Patienten und Methodik: 21 Patienten mit 21 Lebermalignomen (19 Metastasen, zwei primaere Lebermalignome) wurden mit perkutaner, CT-gesteuerter interstitieller Brachytherapie mit {sup 192}Ir behandelt. Alle Patienten wiesen Umstaende auf, die eine bildgefuehrte thermische Ablation mit Radiofrequenz oder laserinduzierter Thermotherapie (LITT) einschraenkten

  16. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study.

    Science.gov (United States)

    Huang, Bing-Yang; Li, Xin-Min; Song, Xiao-Yong; Zhou, Jun-Jun; Shao, Zhuang; Yu, Zhi-Qi; Lin, Yi; Guo, Xin-Yu; Liu, Da-Jiang; Li, Lu

    2018-03-16

    This study was performed to retrospectively evaluate the 10-year overall survival (OS), progression-free survival (PFS), and local control rates of patients with inoperable stage Ia non-small cell lung cancer (NSCLC) who underwent computed tomography (CT)-guided radiofrequency ablation (RFA) in a single center. Fifty patients with inoperable NSCLC underwent RFA between 2004 and 2016. Thoracic surgeons evaluated the patients and performed RFA under CT guidance. Follow-up CT and positron emission tomography/CT scans were obtained. Local control rates and recurrence patterns were analyzed. Seventy-three lesions in 50 patients (M:F = 22:28; median age: 73 years; range: 52-82 years) were treated with CT-guided RFA. The mean lesion size was 2.2 cm (range: 1-3 cm). No procedure-related deaths occurred. Low-grade fever was the most common post-ablation complication, with an incidence rate of 36%. The 1-, 2-, 3-, 5-, and 10-year OS rates of patients with Ia NSCLC were 96.0%, 86.5%, 67.1%, 36.3%, and 1%, respectively, and the 1-, 2-, 3-, and 5-year PFS rates were 94.0%, 77.5%, 43.5%, and 10.8%, respectively. The most common pattern of recurrence was local, and 15 patients with recurrence were treated with repeat RFA. Tumor size Ia NSCLC. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

    Science.gov (United States)

    Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

    2017-12-01

    To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (ptechnical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

    1982-01-01

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  19. CT-guided percutaneous intratumoral chemotherapy with a novel cisplatin/epinephrine injectable gel for the treatment of unresectable malignant liver tumors

    International Nuclear Information System (INIS)

    Engelmann, K.; Mack, M.G.; Straub, R.; Eichler, K.; Zangos, S.; Vogl, T.J.

    2000-01-01

    Purpose: To evaluate prospectively the volumetric changes of tumor and necrosis in unresectable malignant liver tumors and the clinical aspects after CT-guided direct intratumoral administration of a novel cisplatin/epinephrine injectable gel in a clinical phase II study. Patients and methods: 8 patients with 17 colorectal liver metastases with a mean volume of 42 ml were treated with a mean of 5.1 injections and 8 patients with 11 HCC nodules (mean volume of 22.1 ml) with a mean of 3.25 treatments with CT-guided local administration of a novel cisplatin/epinephrine gel. This method of administration provides a higher local and lower systemic drug concentration. Volumes of tumor and necrosis prior to and after treatment were measured by computer-generated volumetric analysis. Results: Contrast-enhanced studies verified pretherapeutic tumor necrosis with a value of 12.6% in the metastases and 0.6% in the HCC nodules. Intratumoral drug administration resulted in a necrotic volume of 110% in metastases and 128% in HCC versus the mean initial tumor volume, at least 4 treatments resulted in 122% necrosis in metastases and 130% in HCC. Local therapy control rate for the follow-up to 6 months was 38% and 83.3% for the group of metastases and HCC, respectively. Conclusions: Direct intratumoral injection of a novel cisplatin/epinephrine injectable gel results in an induction of a relevant necrosis in malignant liver tumors, with a substantially higher local therapy control rate for HCC compared to colorectal metastases. (orig.) [de

  20. Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

    International Nuclear Information System (INIS)

    Hoffer, F.A.; Gow, K.; Davidoff, A.; Flynn, P.M.

    2001-01-01

    Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. (orig.)

  1. Percutaneous dilatational tracheostomy

    DEFF Research Database (Denmark)

    Johnsen, R.

    2015-01-01

    Introduction Since the introduction and development of percutaneous dilatational tracheostomy (PDT), this procedure is accepted and incorporated in ICUs worldwide. In spite of obvious benefits for the patients, who obtain more comfort and mobility and less use of sedatives, the procedure also...... providers' notes are entered. When searching for -percutaneous dilatation tracheostomy' in the electronic system, we found all patients who had undergone this specific procedure. Afterwards we analyzed each of these patients' hospital records, looking for any periprocedure or postprocedure complications...

  2. Simulation center training as a means to improve resident performance in percutaneous noncontinuous CT-guided fluoroscopic procedures with dose reduction.

    Science.gov (United States)

    Mendiratta-Lala, Mishal; Williams, Todd R; Mendiratta, Vivek; Ahmed, Hafeez; Bonnett, John W

    2015-04-01

    The purpose of this study was to evaluate the effectiveness of a multifaceted simulation-based resident training for CT-guided fluoroscopic procedures by measuring procedural and technical skills, radiation dose, and procedure times before and after simulation training. A prospective analysis included 40 radiology residents and eight staff radiologists. Residents took an online pretest to assess baseline procedural knowledge. Second-through fourth-year residents' baseline technical skills with a procedural phantom were evaluated. First-through third-year residents then underwent formal didactic and simulation-based procedural and technical training with one of two interventional radiologists and followed the training with 1 month of supervised phantom-based practice. Thereafter, residents underwent final written and practical examinations. The practical examination included essential items from a 20-point checklist, including site and side marking, consent, time-out, and sterile technique along with a technical skills portion assessing pedal steps, radiation dose, needle redirects, and procedure time. The results indicated statistically significant improvement in procedural and technical skills after simulation training. For residents, the median number of pedal steps decreased by three (p=0.001), median dose decreased by 15.4 mGy (p<0.001), median procedure time decreased by 4.0 minutes (p<0.001), median number of needle redirects decreased by 1.0 (p=0.005), and median number of 20-point checklist items successfully completed increased by three (p<0.001). The results suggest that procedural skills can be acquired and improved by simulation-based training of residents, regardless of experience. CT simulation training decreases procedural time, decreases radiation dose, and improves resident efficiency and confidence, which may transfer to clinical practice with improved patient care and safety.

  3. Percutaneous absorption of several chemicals, some pesticides included, in the red-winged blackbird

    Science.gov (United States)

    Rogers, J.G.; Cagan, R.H.; Kare, M.R.

    1974-01-01

    Percutaneous absorption in vivo through the skin of the feet of the red-winged blackbird (Agelaius phoeniceus) has been investigated. Absorption after 18-24 hours exposure to 0.01 M solutions of salicylic acid, caffeine, urea, 2,4-D, dieldrin, diethylstilbesterol, and DDT was measured. Of these, only DDT and diethylstilbesterol were not absorbed to a measurable degree. The solvents ethanol, dimethylsulfoxide (DMSO), and vegetable oil were compared with water in their effects on the absorption ofcaffeine, urea, and salicylic acid. Ethanol, DMSO,and oil each decreased percutaneous absorption of salicylic acid. DMSO increased absorption of caffeine, and ethanol had no effect on it. Neither DMSO nor ethanol affected penetration of urea. Partition coefficients (K) (epidermis/water) were determined for all seven penetrants. Compounds with higher values of K showed lower percutaneous absorption. These findings suggest that K may be useful to predict percutaneous absorption in vivo. It appears unlikely that percutaneous absorption contributes greatly to the body burden of 2,4-D and dieldrin in A. phoeniceus.

  4. Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, C.M., E-mail: christof.sommer@med.uni-heidelberg.de [Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Katharinenhospital, Stuttgart (Germany); Pallwein-Prettner, L., E-mail: leo.pallwein-prettner@bhs.at [Department of Diagnostic and Interventional Radiology, Krankenhaus der Barmherzigen Schwestern Linz, Linz (Austria); Vollherbst, D.F., E-mail: dominik@vollherbst.de [Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn (Germany); Seidel, R., E-mail: roland.seidel@uks.eu [Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar (Germany); Rieder, C., E-mail: christian.rieder@mevis.fraunhofer.de [Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen (Germany); Radeleff, B.A., E-mail: boris.radeleff@med.uni-heidelberg.de [Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Kauczor, H.U., E-mail: hu.kauczor@med.uni-heidelberg.de [Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg (Germany); Wacker, F., E-mail: wacker.frank@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); Richter, G.M., E-mail: g.richter@klinikum-stuttgart.de [Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Katharinenhospital, Stuttgart (Germany); Bücker, A., E-mail: arno.buecker@uks.eu [Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar (Germany); Rodt, T., E-mail: rodt.thomas@mh-hannover.de [Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); and others

    2017-01-15

    Highlights: • TAE as add-on to percutaneous RFA is feasible, safe, and very effective. • State-of-the-art embolization materials include tightly-size-calibrated microspheres. • MWA, cryoablation and IRE are TA systems beyond RFA. • Visible beads rank among the most promising innovative embolization materials. • Software-based solutions will be increasingly important for treatment guidance. - Abstract: Percutaneous radiofrequency ablation (RFA) for the treatment of stage I renal cell carcinoma has recently gained significant attention as the now available long-term and controlled data demonstrate that RFA can result in disease-free and cancer-specific survival comparable with partial and/or radical nephrectomy. In the non-controlled single center trials, however, the rates of treatment failure vary. Operator experience and ablation technique may explain some of the different outcomes. In the controlled trials, a major limitation is the lack of adequate randomization. In case reports, original series and overview articles, transarterial embolization (TAE) before percutaneous RFA was promising to increase tumor control and to reduce complications. The purpose of this study was to systematically review the literature on TAE as add-on to percutaneous RFA for renal tumors. Specific data regarding technique, tumor and patient characteristics as well as technical, clinical and oncologic outcomes have been analyzed. Additionally, an overview of state-of-the-art embolization materials and the radiological perspective of advanced image-guided tumor ablation (TA) will be discussed. In conclusion, TAE as add-on to percutaneous RFA is feasible and very effective and safe for the treatment of T1a tumors in difficult locations and T1b tumors. Advanced radiological techniques and technologies such as microwave ablation, innovative embolization materials and software-based solutions are now available, or will be available in the near future, to reduce the limitations of

  5. Evaluacion de la biopsia transpedicular guiada por TAC Avaliação da biópsia transpedicular guiada por TC Evaluation of transpedicular percutaneous biopsy guided by CT

    Directory of Open Access Journals (Sweden)

    Luis Miguel Rosales Olivarez

    2012-09-01

    o diagnóstico. CONCLUSÃO: A biópsia guiada por tomografia axial computadorizada é uma técnica simples, útil, de baixo custo e eficaz para o estudo da destruição vertebral; a sistematização de estudos permite corroborar o diagnóstico da biópsia.OBJECTIVE: To evaluate the usefulness of percutaneous transpedicular biopsy guided by CT together with systematic studies such as diagnostic tests of the etiology of vertebral destruction. METHODS: Case series, prospective and crossover study of 21 patients who underwent percutaneous transpedicular biopsy guided by CT and laboratory tests and radiological studies from March to July 2011, to evaluate its usefulness in the diagnosis of vertebral destruction. RESULTS: We analyzed 21 patients, 14 men and 7 women, mean age 59.2 years, whose most affected levels were L1, L2, and L3. The biopsy report had diagnostic accuracy of 90.4%. In 2 patients the clinical correlation between biopsy and systematization of diagnostic studies was carried out. CONCLUSION: CT-guided biopsy is a simple, useful, inexpensive, and effective technique for the study of vertebral destruction; the systematic studies allow us to corroborate the diagnosis made by biopsy.

  6. Percutaneous drainage for post-traumatic hepatic abscess in children under ultrasound imaging

    International Nuclear Information System (INIS)

    Taguchi, T.; Ikeda, K.; Yakabe, S.; Kimura, S.

    1988-01-01

    Hepatic abscess is rare in children. A patient with a post-traumatic hepatic abscess was successfully treated by ultrasound-guided percutaneous drainage. Although he underwent a drainage operation for the perihepatic abscesses, high fever continued. It was then considered that the traumatic hematoma had been infected and had become an abscess. Sonographically-guided percutaneous aspiration is useful for the definite diagnosis of hepatic abscess. Subsequent percutaneous drainage under ultrasound imaging is a safe und useful therapeutic method even in a poor-risk patient. (orig.)

  7. Percutaneous transhepatic sphincterotomy

    International Nuclear Information System (INIS)

    Gandin, G.; Zanon, E.; Righi, D.; Fonio, P.; Ferrari, A.; Recchia, S.

    1990-01-01

    The authors describe the techique employed for percutaneous trans-hepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all aptients endoscopy was useful to check the position of the diethermic loop inserted percutaneously. Conplete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (γGt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes

  8. Percutaneous Penetration - Methodological Considerations

    DEFF Research Database (Denmark)

    Holmgaard, Rikke; Benfeldt, Eva; Nielsen, Jesper B

    2014-01-01

    developed to replace methods involving experimental animals. The results obtained from these methods are decided not only by the chemical or product tested, but to a significant degree also by the experimental set-up and decisions made by the investigator during the planning phase. The present Mini......Studies on percutaneous penetration are needed to assess the hazards after unintended occupational skin exposures to industrial products as well as the efficacy after intended consumer exposure to topically applied medicinal or cosmetic products. During recent decades, a number of methods have been...... and their relevance for the prediction of percutaneous penetration are given. Which method to prefer will depend on the product to be tested and the question asked. Regulatory guidelines exist for studies on percutaneous penetration, but researchers as well as regulatory bodies need to pay specific attention...

  9. Percutaneous penetration characteristics and release kinetics of contact allergens encapsulated in ethosomes

    DEFF Research Database (Denmark)

    Madsen, Jakob Torp; Vogel, Stefan; Johansen, Jeanne Duus

    2011-01-01

    Formulation of the contact allergens dinitrochlorobenzene and isoeugenol in ethanolic liposomes (ethosomes) increases their sensitizing properties in the local lymph node assay compared with an ethanol-water formulation of the allergens. Likewise, isoeugenol and methyldibromo-glutaronitrile formu......-glutaronitrile formulated in ethosomes enhanced the patch test reactions in sensitized human volunteers. The relationship between the percutaneous penetration/absorption and sensitization/elicitation phases of contact allergy is not well elucidated....

  10. Imaging in percutaneous musculoskeletal interventions

    International Nuclear Information System (INIS)

    Gangi, Afshin; Guth, Stephane; Guermazi, Ali

    2009-01-01

    This is one of the first books to deal specifically with imaging in percutaneous musculoskeletal interventions. The use of different imaging modalities during these procedures is well described. In the first chapter, the basic procedures and different guidance techniques are presented and discussed. The ensuing chapters describe in exhaustive detail the abilities and uses of imaging in guiding procedures ranging from biopsy and joint injection to management of pain and tumors. These procedures are extensively documented in adults as well as in the pediatric population. The third part of the book describes the different indications for vascular interventions in musculoskeletal lesions. The final chapter focuses on ultrasound-guided interventions, as they are more common and tend to be fashionable. The book is well illustrated with carefully chosen and technically excellent images. Each of the 18 chapters is written by an expert of international repute, making this book the most current and complete treatment of the subject available. It should be of great interest to interventional radiologists and also musculoskeletal and general radiologists. (orig.)

  11. Ultrasound guided Percutaneous Catheter drainage of Biloma ...

    African Journals Online (AJOL)

    all favourable cost analysis. Complications though ... This report underscores the importance of adequate preparations including use of interventionary methods to solve problems complicating laparoscopic surgery. Key Words: Biloma ...

  12. Percutaneous Transhepatic Cholangiography

    African Journals Online (AJOL)

    1974-03-30

    Mar 30, 1974 ... Percutaneous transhepatic cholangiography can play a major role in expediting the early diagnosis of surgically correctable jaundice. The need for this is emphasised by the fact that in a group of 46 patients the delay between the onset of jaundice and diagnosis ranged from 20 to 90 days. Transhepatic ...

  13. Ethanol dehydration

    OpenAIRE

    Ana María Uyazán; Iván Dario Gil; J L Aguilar; Gerardo Rodríguez Niño; Luis Alfonso Caicedo

    2004-01-01

    This review outlines ethanol dehydration processes and their most important characteristics. It also deals with the main operating variables and some criteria used in designing the separation scheme. A differentiation is made between processes involving liquid steam balance in separation operations and those doing it by screening the difference in molecule size. The last part presents a comparison between the three main industrial processes, stressing their stengths and weaknesses from the op...

  14. Ethanol dehydration

    Directory of Open Access Journals (Sweden)

    Ana María Uyazán

    2004-09-01

    Full Text Available This review outlines ethanol dehydration processes and their most important characteristics. It also deals with the main operating variables and some criteria used in designing the separation scheme. A differentiation is made between processes involving liquid steam balance in separation operations and those doing it by screening the difference in molecule size. The last part presents a comparison between the three main industrial processes, stressing their stengths and weaknesses from the operational, energy consumption and industrial services points of view.

  15. Percutaneous Dilatational Tracheostomy via Griggs Technique.

    Science.gov (United States)

    Karimpour, Hasan Ali; Vafaii, Kamran; Chalechale, Maryam; Mohammadi, Saeed; Kaviannezhad, Rasool

    2017-01-01

    Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps. We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU). This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded. The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia. PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.

  16. CT guidance of percutaneous hepatic abscess drainage

    International Nuclear Information System (INIS)

    Li Jiahua; Zhang Jiaxing; Cao Chuanwu; Li Maoquan; Lu Fuming; Zheng Manhua

    2008-01-01

    Objective: To discuss the method and effectiveness of percutaneous drainage for hepatic abscess under CT guidance. Methods: 20 patients were enrolled into this retrospective research, including 13 males and 7 females with age form 18 to 84 yrs. The diagnosis were made by clinical examination, laboratory test and CT imaging. Hepatic abscess focus involved right lobe in 9 cases, left lobe of 6 cases, both lobes with 5 cases. All patients received percutaneous abscess drainage subsequently. Results: There were 14 cases with solitary abscess, in which 9 disappeared completely after single procedure of aspiration under CT guidance, 1 disappeared after twice aspirations. Multiple or multi-lobular abscesses were found in six cases, which were treated by aspirating the larger one first or by splitting multi-aspiration. In all cases, drainage catheters were placed and lavage was done with a mean time of 19.2 days together with intravenous antibiotics. There was no recurrence until the end-piont of research. Conclusions: Percutaneous CT-guided aspiration and drainage is an effective way in the treatment of hepatic abscess. (authors)

  17. Percutaneous Ablation Therapy for Hepatocellular Carcinoma: Current Practice and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Teh-Ia Huo

    2005-04-01

    Full Text Available Worldwide, hepatocellular carcinoma (HCC is a common, refractory, malignant tumor. Surgical resection is feasible in only a few patients, because of limited hepatic reserve and multifocality of tumors at diagnosis. Percutaneous ablation therapies, including injection of ethanol (PEI or acetic acid (PAI, radiofrequency ablation (RFA, and microwave coagulation therapy (MCT, have been the major treatments for unresectable HCC in the past decade. PEI is well established for small (< 3 cm HCC, and PAI is equally as effective as PEI, but with fewer treatment sessions. RFA has recently been suggested to have excellent tumor-ablating ability because it produces a fixed and predictable tumor necrosis zone. Although RFA is also effective for medium-sized HCC, the overall complication rate may be higher than previously assumed. MCT is similar to RFA in its clinical application and potential adverse effects. A combination approach using percutaneous ablation therapy and transcatheter arterial embolization was shown to be effective for large HCC. Other approaches, such as injection of hot saline or yttrium-90 microspheres, cryoablation, or interstitial laser photocoagulation, are less often used nowadays. Multimodal, image-guided, tailored therapy, rather than a fixed treatment algorithm, might be more practical for unresectable HCC. In conclusion, although long-term survival is possible in selected patients with HCC, the overall prognosis remains suboptimal, especially in patients with unfavorable tumor characteristics. While newer anti-tumor therapies with improved efficacy are needed, information about a more rational approach to the use of existing therapeutic options may help to enhance treatment strategies for HCC.

  18. Percutaneous absorption and disposition of Tinopal EMS

    International Nuclear Information System (INIS)

    Black, T.G.; Moule, R.C.; Philp, J.

    1977-01-01

    A cotton-substantive, anionic, fluorescent whitening agent manufactured by several suppliers under various trade names e.g. Tinopal EMS, has been synthesized in radioactive form. Intubation of detergent or aqueous solution into rats resulted in little absorption from the intestinal tract as evidenced by low radioactivity in the urine and tissues. Most of the dose was excreted rapidly in the faeces. After parenteral administration to rats, the radioactivity was rapidly excreted in the faeces with small amounts remaining in tissues and organs. There was slight evidence of retention of radioactivity in the kidneys. Very small amounts of Tinopal EMS in detergent were absorbed through rat skin, but only when concentrations greater than those normally used by the consumer, together with occlusion of the skin were employed. Small amounts were absorbed through skin when applied in ethanol. It is concluded that the possibility of systemic toxic effects in man as a result of percutaneous absorption is remote

  19. Percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

    2004-01-01

    Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

  20. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning

  1. Percutaneous peritoneovenous shunt positioning: technique and preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Marinucci, Irene [Division of Radiology, European Institute of Oncology, Milan (Italy); Monti, Cinzia [Institute of Radiology, University of Milan (Italy); Bellomi, Massimo [Division of Radiology, European Institute of Oncology, Milan (Italy); Institute of Radiology, University of Milan (Italy)

    2002-05-01

    Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life. (orig.)

  2. Cellulosic ethanol

    DEFF Research Database (Denmark)

    Lindedam, Jane; Bruun, Sander; Jørgensen, Henning

    2010-01-01

    Background Variations in sugar yield due to genotypic qualities of feedstock are largely undescribed for pilot-scale ethanol processing. Our objectives were to compare glucose and xylose yield (conversion and total sugar yield) from straw of five winter wheat cultivars at three enzyme loadings (2...... yields than coarse particles. The amount of coarse particles from the cultivar with lowest sugar yield was negatively correlated with sugar conversion. Conclusions We conclude that genetic differences in sugar yield and response to enzyme loading exist for wheat straw at pilot scale, depending...

  3. Percutaneous management of bile duct injury after laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.

    2012-01-01

    Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.

  4. Percutaneous necrosectomy in patients with acute, necrotizing pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Bruennler, T.; Langgartner, J.; Lang, S.; Salzberger, B.; Schoelmerich, J. [University Hospital of Regensburg, Department of Internal Medicine 1, Regensburg (Germany); Zorger, N.; Herold, T.; Feuerbach, S.; Hamer, O.W. [University Hospital of Regensburg, Department of Radiology, Regensburg (Germany)

    2008-08-15

    The objective of this retrospective study was to evaluate the outcome of patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy. By searching the radiological, surgical and internal medicine databases, all patients with acute necrotizing pancreatitis treated by active percutaneous necrosectomy between 1992 and 2004 were identified. Demographic, laboratory, and clinical data, and details about invasive procedures were collected by reviewing patient charts, radiological and surgical reports. The computed tomography severity index (CTSI) scores were determined by reviewing CT images. Eighteen patients were identified. Median Ranson score on admission was 2. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was median 22. Median CTSI score was 7. Initially all patients were treated with CT-guided drainage placement. Because passive drainage proved not to be effective, subsequent minimally invasive, percutaneous necrosectomy was performed. Eight out of 18 patients recovered fully without the need for surgery. Ten of 18 patients required additional surgical necrosectomy. For one of ten patients, percutaneous necrosectomy allowed postponing surgery by 39 days. Four of ten surgically treated patients died: three from septic multiorgan failure, one from pulmonary embolism. Percutaneous minimally invasive necrosectomy can be regarded as a safe and effective complementary treatment modality in patients with necrotizing pancreatitis. It is suitable for a subset of patients to avoid or delay surgery. (orig.)

  5. Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism

    Energy Technology Data Exchange (ETDEWEB)

    Tokue, Hiroyuki, E-mail: tokue@s2.dion.ne.jp; Shibuya, Kei [Gunma University Hospital, Department of Diagnostic and Interventional Radiology (Japan); Ueno, Hiroyuki [Isesaki Municipal Hospital, Department of Radiology (Japan); Tokue, Azusa; Tsushima, Yoshito [Gunma University Hospital, Department of Diagnostic and Interventional Radiology (Japan)

    2016-09-15

    There are many treatment options in high-flow priapism. Those mentioned most often are watchful waiting, Doppler-guided compression, endovascular highly selective embolization, and surgery. We present a case of high-flow priapism in a 57-year-old man treated by percutaneous direct puncture embolization of a post-traumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate. Erectile function was preserved during a 12-month follow-up. No patients with percutaneous direct puncture embolization for high-flow priapism have been reported previously. Percutaneous direct puncture embolization is a potentially useful and safe method for management of high-flow priapism.

  6. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    International Nuclear Information System (INIS)

    Kelekis, Alexis D.; Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-01-01

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  7. Percutaneous Transhepatic Cholangiography | Goldin | South ...

    African Journals Online (AJOL)

    Percutaneous Transhepatic Cholangiography. AR Goldin, EM Bass. Abstract. Our experience with percutaneous transhepatic cholangiography in 46 cases is presented and compared with other series. The technique is safe, simple and accurate and can play a major role in the early diagnosis of obstructive jaundice.

  8. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    International Nuclear Information System (INIS)

    Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-01-01

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites

  9. Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Hawkins, C.M. [Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, GA (United States); Kukreja, Kamlesh [Texas Children' s Hospital, Department of Radiology, Houston, TX (United States); Singewald, Timothy; Johnson, Neil D.; Racadio, John M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Minevich, Eugene; Reddy, Pramod [Cincinnati Children' s Hospital Medical Center, Department of Urology, Cincinnati, OH (United States)

    2016-04-15

    Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. Technical success was 100%. There were no complications. Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems. (orig.)

  10. Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents.

    Science.gov (United States)

    Hawkins, C Matthew; Kukreja, Kamlesh; Singewald, Timothy; Minevich, Eugene; Johnson, Neil D; Reddy, Pramod; Racadio, John M

    2016-04-01

    Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. Technical success was 100%. There were no complications. Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems.

  11. [PERCUTANEOUS ENCOSCOPIC GASTROSTOMY

    Science.gov (United States)

    Tagle A, Martín

    1998-01-01

    Percutaneous endoscopic gastrostomy is an increasingly utilized method of enteral nutrition in patients who for a variety of reasons, are unable to swallow or possess a high risk of aspiration. This method has replaced both surgical gastrostomy and the prolonged used of nasogastric tubes since its creation, in 1980. The most frequent indications are severe neurological diseases such as cerebrovascular accidents, Parkinson's, multiple sclerosis and other processes such as severe trauma, multi-infarct dementia or diverse head and neck tumors. The procedure involves the performance of an upper endoscopy in the usual manner, followed by an insertion of a plastic catheter percutaneously in the area of maximum contact between the gastric and abdominal walls, under direct endoscopic view. Then, a guidewire is introduced through the lumen of the catheter and is enlaced by a polypectomy snare passed through the working channel of the endoscope, utilizing the guidewire to tie the distal portion of the feeding tube, which will be pulled to its final position. The complications associated to this procedure are minimal, most of them related to the endoscopy itself, like reactions to sedation, aspiration of oropharyngeal secretions, etc. There is also a possibility of local infection at the insertion site, perforation of the colon and excessive leaking of gastric contents around the tube, and for these reasons the procedure should only be performed by trained physicians, familiarized with the management of these events. The goal of this review is to illustrate the reader about the indications, contral indications, complications and general considerations in the patients who will have a percutaneous endoscopic gastrostomy.

  12. Percutaneous drainage and alcoholization of hepatic abscesses in five dogs and a cat.

    Science.gov (United States)

    Zatelli, Andrea; Bonfanti, Ugo; Zini, Eric; D'Ippolito, Paola; Bussadori, Claudio

    2005-01-01

    Hepatic abscesses are rare and difficult to diagnose in dogs and cats. Ultrasonographic examination is essential to thoroughly examine hepatic abnormalities, and it may also help in the localization of hepatic abscesses. In this retrospective study, five dogs and one cat with focal hepatic lesions compatible with a hepatic abscess were treated with percutaneous ultrasound-assisted drainage and alcoholization using 95% ethanol. The procedure was performed rapidly under injectable anesthesia and provided excellent results in all animals. No complications or relapses were noted for 120 days following the procedure. The technique of percutaneous ultrasound-assisted drainage and alcoholization of hepatic abscesses in the dog and cat is also described.

  13. Diagnostic CT and percutaneous procedures after pancreatic transplantation

    International Nuclear Information System (INIS)

    Letourneau, J.G.; Hunter, D.W.; Thompson, W.M.; Sutherland, D.E.R.

    1987-01-01

    CT evaluation of the abdomen and pelvis is of great value after pancreatic transplantation. The expected CT appearance after pancreas transportation with both enteric and bladder drainage of exocrine function are presented, as is the appearance of infected and ischemic grafts. The CT detection and CT- and US-guided percutaneous aspiration and drainage of abdominal fluid collections are described. At the authors' institution, such aspiration and drainage procedures have obviated transplant pancreatectomy or surgical abscess drainage in 29% of patients

  14. Orthopedic surgical analyzer for percutaneous vertebroplasty

    Science.gov (United States)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  15. Percutaneous management of prosthetic valve thrombosis.

    Science.gov (United States)

    Hariram, Vuppaladadhiam

    2014-01-01

    Thrombosis of a prosthetic valve is a serious complication in patients with prosthetic heart valves. Thrombolysis is the initial choice of treatment. Patients who do not respond to thrombolysis are subjected to surgery which carries a high risk. We report a case series of 5 patients with prosthetic mitral valve thrombosis who did not respond to thrombolysis and were subjected to percutaneous manipulation of the prosthetic valves successfully and improved. Five patients who were diagnosed to have prosthetic mitral valve thrombosis and failed to respond to a minimum of 36 h of thrombolysis (persistent symptoms with increased gradients, abnormal findings on fluoroscopy),were subjected to percutaneous treatment after receiving proper consent. None of them had a visible thrombus on transthoracic echocardiogram. All patients underwent transseptal puncture following which a 6F JR4 guiding catheter was passed into the left atrium. The valve leaflets were repeatedly hit gently under fluoroscopic guidance till they regained their normal mobility. Mean age was 38.8 years. Average peak and mean gradients prior to the procedure were 38 and 25 and after the procedure were 12 and 6 mm of Hg respectively. All patients had successful recovery of valve motion on fluoroscopy with normalization of gradients and complete resolution of symptoms. None of the patients had any focal neurological deficits, embolic manifestations or bleeding complications. Percutaneous manipulation of prosthetic valves in selected patients with prosthetic valve thrombosis who do not respond to thrombolytic therapy is feasible and can be used as an alternative to surgery. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  16. Understanding the Growth of the Cellulosic Ethanol Industry

    Energy Technology Data Exchange (ETDEWEB)

    Sandor, D. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wallace, R. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Peterson, S. [Peterson Group, Anchorage, AK (United States)

    2008-04-01

    Report identifies and documents plausible scenarios for producing significant quantities of lignocellulosic ethanol in 2017 as a guide for setting government policy and targeting government investment to areas with greatest potential impact.

  17. Percutaneous cholecystostome; 60 cases of experience

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

  18. Percutaneous transpedicular management of discitis.

    Science.gov (United States)

    Arya, S; Crow, W N; Hadjipaviou, A G; Nauta, H J; Borowski, A M; Vierra, L A; Walser, E

    1996-01-01

    To present the technique of percutaneous transpedicular biopsy and debridement of discs in diagnosis and management of discitis. Fifteen patients underwent disc biopsy through a transpedicular approach with local anesthesia and fluoroscopic guidance. An attempt was made to debride the disc as much as possible. A surgical vacuum drain was deployed through the transpedicular tract when there was persistent drainage. Fifteen patients underwent percutaneous transpedicular disc biopsy and debridement of disc for suspected discitis. Three patients underwent biopsy only and 12 underwent percutaneous discectomy. Six patients had at least one positive culture. Eight patients who underwent discectomy had immediate improvement of pain or neurologic symptoms, obviating emergency surgical debridement of the disc. Four patients did not improve and underwent surgical debridement and fusion. Transpedicular biopsy of the disc is an effective technique for adequate tissue retrieval and diagnosis of discitis. Adequate debridement in selected patients with antibiotic therapy may be definitive. Epidural extension of discitis and massive vertebral destruction precludes percutaneous treatment.

  19. Percutaneously inserted central catheter - infants

    Science.gov (United States)

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  20. Percutaneous Nephrolithotomy in Children

    Directory of Open Access Journals (Sweden)

    Romano T. DeMarco

    2011-01-01

    Full Text Available The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi.

  1. Outcome of Percutaneous Nephrolithotomy

    International Nuclear Information System (INIS)

    Ali, S.; Kumar, N.; Baloch, U.

    2014-01-01

    Objective: To assess the implementation of Percutaneous Nephrolithotomy (PCNL) in renal stone management and evaluate the factors for efficacy and safety of PCNL. Study Design: Case series. Place and Duration of Study: Department of Urology at Jinnah Postgraduate Medical Centre, Karachi, from January 2008 to December 2011. Methodology: Patients aged above 12 years of age, irrespective of gender with normal renal function, mean stone size > 2 cm, lower pole stones > 1 cm, and ESWL failure were selected. After the procedure, on the first postoperative day, a plain abdominal radiograph was obtained to verify stone clearance. A nephrostomy tube was clamped overnight and subsequently removed when no residual stone which needs second sitting was seen. Results: In 175 patients, 62.86% (n=110) were male and the mean age was 35 A +- 9.56 years. One hundred and seventeen (66.85%) patients were primarily stone free and 13.71% (n=24) patients needed a second look procedure, thus, a total of 80.57% (n=141) patients were stone free in the same admission. Complications included failure in 4.0% (n=7) patients, bleeding in 8.57% (n=15) patients, a small residual stone in 15.43% (n=27) patients; and puncture site pain almost in every patient. Transient fever occurred in 55.43% (n=97) patients, urinary leakage in 8.57% (n=15) patients, urinary tract infections in 5.14% (n=9) patients, ureteric colic in 3.43% (n=6) patients, colonic injury in 0.57% (n=1) patient; and nephrectomy was required in 0.57% (n=1) patient due to severe bleeding. One patient (0.57%) expired due to anaesthesia complications. Conclusion: Percutaneous nephrolithotomy (PCNL) has a good success rate. There is minimal blood loss, and few major complications. (author)

  2. Results of percutaneous abscess drainage

    International Nuclear Information System (INIS)

    Daehnert, W.; Guenther, R.; Klose, K.; Gamstaetter, G.

    1983-01-01

    Between 1978 and 1983 fifty-two abdominal abscesses in 44 patients were drained percutaneously, 79% of the abscesses occurred as postoperative complications. The overall success rate was 60%, whereas only 42% of left subphrenic abscesses were cured. Complications were encountered in 4.5%. Reasons for drainage failures were: liver sequestration, loculation, fistulae and recurrences. Percutaneous abscess drainage in an alternative, and valuable addition, to surgery. (orig.) [de

  3. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    Science.gov (United States)

    Teoh, Anthony Yuen Bun; Dhir, Vinay; Jin, Zhen-Dong; Kida, Mitsuhiro; Seo, Dong Wan; Ho, Khek Yu

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities. RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits. CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities. PMID:27014427

  4. Percutaneous catheter drainage of tuberculous psoas abscesses

    International Nuclear Information System (INIS)

    Pombo, F.; Martin-Egana, R.; Cela, A.; Diaz, J.L.; Linares-Mondejar, P.; Freire, M.

    1993-01-01

    Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still in medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses. (orig.)

  5. Fuel ethanol discussion paper

    International Nuclear Information System (INIS)

    1992-01-01

    In recognition of the potential benefits of ethanol and the merits of encouraging value-added agricultural development, a committee was formed to develop options for the role of the Ontario Ministry of Agriculture and Food in the further development of the ethanol industry in Ontario. A consultation with interested parties produced a discussion paper which begins with an outline of the role of ethanol as an alternative fuel. Ethanol issues which require industry consideration are presented, including the function of ethanol as a gasoline oxygenate or octane enhancer, environmental impacts, energy impacts, agricultural impacts, trade and fiscal implications, and regulation. The ethanol industry and distribution systems in Ontario are then described. The current industry consists of one ethanol plant and over 30 retail stations. The key issue for expanding the industry is the economics of producing ethanol. At present, production of ethanol in the short term depends on tax incentives amounting to 23.2 cents/l. In the longer term, a significant reduction in feedstock costs and a significant improvement in processing technology, or equally significant gasoline price increases, will be needed to create a sustainable ethanol industry that does not need incentives. Possible roles for the Ministry are identified, such as support for ethanol research and development, financial support for construction of ethanol plants, and active encouragement of market demand for ethanol-blended gasolines

  6. T-Fastener Gastropexy and Percutaneous Gastrostomy Under CT-Fluoroscopic Guidance in a Patient with Partial Gastrectomy

    Directory of Open Access Journals (Sweden)

    Siu-Cheung Chan

    2006-01-01

    Full Text Available The real-time images of computed tomography (CT-fluoroscopy provide an excellent means of guidance for percutaneous interventions. We describe the performance of T-fastener gastropexy and percutaneous gastrostomy under CT-fluoroscopic guidance in a 59-year-old woman who had received total pharyngolaryngectomy for hypopharyngeal cancer and partial gastrectomy with Billroth II anastomosis for bleeding gastric ulcer 10 years before this operation. The previous gastric operation altered the gastrointestinal anatomy and made conventional fluoroscopic-guided percutaneous gastrostomy extremely difficult and risky. The T-fastener gastropexy and percutaneous gastrostomy were accomplished smoothly in a single session using CT-fluoroscopic guidance. This modified method of percutaneous gastrostomy may be useful in patients with anatomic distortion due to previous gastric surgery.

  7. Endoscopic ultrasound-guided drainage of pancreatic pseudocysts

    DEFF Research Database (Denmark)

    Saftoiu, Adrian; Vilmann, Andreas; Vilmann, Peter

    2015-01-01

    Pancreatic pseudocysts are fluid collections in the peripancreatic tissues associated with acute or chronic pancreatitis. Endoscopic ultrasound (EUS)-guided drainage has become an established indication, having better results as compared to percutaneous drainage, nonguided endoscopic drainage...

  8. Direct percutaneous radiologic jejunostomy (PR)and duodenostomy: a retrospective analysis

    International Nuclear Information System (INIS)

    Rieker, O.; Pitton, M.; Herber, S.; Vomweg, T.; Teifke, A.; Dueber, C.

    2005-01-01

    Purpose: To present our experience with direct percutaneous radiologic duodenostomy and jejunostomy (PRJ) for alimentation. Materials and Methods: A retrospective study identified 24 patients who had undergone percutaneous jejunostomy or duodenostomy guided by CT and fluoroscopy over a period of 9 years. Whenever possible, the jejunum was inflated with a 5 French diagnostic catheter and jejunopexy was performed using Cope anchors (T-fasteners). A 12 to 14 French locking pigtail drain was inserted for alimentation. In 8 patients, percutaneous direct jejunostomy was performed using only fluoroscopy. In 9 patients, both CT and fluoroscopy were used to guide the jejunostomy. In all 7 patients who underwent duodenostomy, a combination of CT and fluoroscopy was used. The reports were reviewed for complications and the technical success rate. The technical success rate was determined. Results: Percutaneous radiologic jejunostomy was attempted in 17 patients and failed in 5 patients. PRJ was successful in all 8 procedures guided by fluoroscopy and in 4 of 9 procedures guided by CT and fluoroscopy. Direct percutaneous duodenostomy guided by CT and fluoroscopy was successful in all 7 cases. There were no procedure-related laparotomies and no mortality related to the jejunostomy. Minor complications were infection of the abdominal wall (n=1), lingering pain requiring a new jejunostomy (n=1) and aspiration because of persistent reflux (n=1). Conclusion: PRJ is a safe procedure even in critically ill patients. It is technically difficult and may fail if the jejunum cannot be distended. Percutaneous radiologic duodenostomy and jejunostomy are recommended for prolonged alimentation of malnourished patients following esophageal or gastric surgery. (orig.)

  9. Ethanol Basics (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)

    2015-01-01

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  10. The influence of Adh function on ethanol preference and tolerance in adult Drosophila melanogaster.

    Science.gov (United States)

    Ogueta, Maite; Cibik, Osman; Eltrop, Rouven; Schneider, Andrea; Scholz, Henrike

    2010-11-01

    Preference determines behavioral choices such as choosing among food sources and mates. One preference-affecting chemical is ethanol, which guides insects to fermenting fruits or leaves. Here, we show that adult Drosophila melanogaster prefer food containing up to 5% ethanol over food without ethanol and avoid food with high levels (23%) of ethanol. Although female and male flies behaved differently at ethanol-containing food sources, there was no sexual dimorphism in the preference for food containing modest ethanol levels. We also investigated whether Drosophila preference, sensitivity and tolerance to ethanol was related to the activity of alcohol dehydrogenase (Adh), the primary ethanol-metabolizing enzyme in D. melanogaster. Impaired Adh function reduced ethanol preference in both D. melanogaster and a related species, D. sechellia. Adh-impaired flies also displayed reduced aversion to high ethanol concentrations, increased sensitivity to the effects of ethanol on postural control, and negative tolerance/sensitization (i.e., a reduction of the increased resistance to ethanol's effects that normally occurs upon repeated exposure). These data strongly indicate a linkage between ethanol-induced behavior and ethanol metabolism in adult fruit flies: Adh deficiency resulted in reduced preference to low ethanol concentrations and reduced aversion to high ones, despite recovery from ethanol being strongly impaired.

  11. Percutaneous umbilical cord blood sampling - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100196.htm Percutaneous umbilical cord blood sampling - series—Normal anatomy To use the ... or blood disorder, your doctor may recommend percutaneous umbilical cord blood sampling (PUBS), which is performed at 18 ...

  12. Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

    African Journals Online (AJOL)

    A. Bansal

    2016-06-03

    Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...

  13. Radiologic Percutaneous Gastrostomy in Nondistended Stomach: A Modified Approach

    Energy Technology Data Exchange (ETDEWEB)

    Petrocelli, Francesco, E-mail: francesco.petrocelli@hsanmartino.it; Salsano, Giancarlo, E-mail: giancarlo.salsano@yahoo.it; Bovio, Giulio, E-mail: giulio.bovio@hsanmartino.it; Camerano, Francesco, E-mail: francesco.camerano@gmail.com; Utili, Alice, E-mail: aliceutili@gmail.com; Ferro, Carlo, E-mail: carlo.ferro@hsanmartino.it [IRCCS San Martino University Hospital, Department of Radiology and Interventional Radiology (Italy)

    2016-07-15

    IntroductionGastrostomy tube placement for patients requiring long-term nutritional support may be performed using different techniques including endoscopic, surgical, and percutaneous radiologically guided methods. Radiologically inserted gastrostomy (RIG), typically performed when percutaneous endoscopic gastrostomy is not possible, requires proper gastric distension that is achieved by insufflating air through a nasogastric tube. We describe a simple technique to prevent air escape from the stomach during gastrostomy tube placement. To the best of our knowledge, this technique has not yet been described in the literature.Materials and MethodsFour patients with unsuccessful percutaneous endoscopic gastrostomy were referred for fluoroscopic-guided gastrostomy. One patient had a pyriform sinus tumor and three had an ischemic stroke causing dysphagia. Gastric distention was not achieved in the patients due to air escaping into the bowel during the standard RIG procedure. A modified approach using a balloon catheter inflated in the pylorus to avoid air passing into the duodenum permitted successful RIG.ResultsThe modified RIG procedure was successfully carried out in all cases without complications.DiscussionInadequate air distension of the stomach is an unusual event that causes a failure of gastrostomy tube placement and an increased risk of both major and minor complications. The use of a balloon catheter inflated in the first part of the duodenum prevents the air passage into the bowel allowing the correct positioning of the gastrostomy.

  14. Percutaneous treatment of cervical and lumbar herniated disc.

    Science.gov (United States)

    Kelekis, A; Filippiadis, D K

    2015-05-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Percutaneous treatment of cervical and lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D.K., E-mail: dfilippiadis@yahoo.gr

    2015-05-15

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.

  16. Sensitivity of Computed Tomography‑guided Transthoracic Biopsies ...

    African Journals Online (AJOL)

    Introduction: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography‑guided (CT‑guided) biopsy, thoracoscopy or video‑assisted thoracoscopy, and bronchoscopy. CT‑guided percutaneous ...

  17. Percutaneous transbiliary biopsy.

    Science.gov (United States)

    Andrade, Gustavo Vieira; Santos, Miguel Arcanjo; Meira, Marconi Roberto; Meira, Mateus Duarte

    2017-01-01

    Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct. RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.

  18. Percutaneous cholecystostomy at the community hospital: value evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  19. Early mediastinal seroma secondary to modified Blalock-Taussig shunts - successful management by percutaneous drainage

    International Nuclear Information System (INIS)

    Connolly, Bairbre L.; Temple, Michael J.; Chait, Peter G.; Restrepo, Ricardo; Adatia, Ian

    2003-01-01

    Large symptomatic mediastinal seroma following modified-BT shunts, traditionally required revisional thoracotomy. We describe percutaneous image-guided pigtail catheter drainage in the successful treatment of early mediastinal seroma secondary to PTFE Blalock-Taussig shunt, avoiding thoracotomy. A retrospective review of all relevant clinical and imaging records in five patients was performed. All five presented with intermittent stridor, respiratory distress and/or episodic desaturation within 6 weeks of their surgery. In four of five infants, percutaneous drainage was effective and reoperation was avoided. In one of five, rather than urgent surgical evacuation and BT shunt revision, we were able to perform an elective stage-II bidirectional Glenn SVC-RA anastamosis in a stable infant. There were no complications. Percutaneous image-guided drainage of mediastinal seroma secondary to PTFE-BT shunt is a safe, minimally invasive, and effective treatment. This may avoid BT shunt revision. (orig.)

  20. Painful percutaneous transthoracic needle biopsy of Schwannoma: a case report

    International Nuclear Information System (INIS)

    Kim, Sung Hoon; Chun, Kyung Ah; Kim, Young Joo; Park, Seog Hee; Shin, Kyung Sub; Lee, Eun Jung

    1995-01-01

    Percutaneous aspiration needle biopsy of the intrathoracic disease is a safe, easy, and accurate diagnostic method. It usually causes mild pain or discomfort during the procedure. We had a patient who complained of severe sharp pain, well localized at the biopsy site of the target mass during CT-guided transthoracic aspiration biopsy. It was pathologically confirmed as an intrathoracic schwannoma after special staining. To our knowledge, there has been no published report of such a painful percutaneous needle biopsy in a patient with schwannoma in Korea. Two cases were reported in other radiologic journals. The severe sharp pain developed during the transthoracic aspiration needle biopsy is a reliable sign of neurogenic tumor, therefore the participating radiologist should recommend specific immumochemical stain for neurogenic tumor to pathologist

  1. Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

    LENUS (Irish Health Repository)

    Given, M F

    2008-12-01

    To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

  2. Minimizing radiation exposure during percutaneous nephrolithotomy.

    Science.gov (United States)

    Chen, T T; Preminger, G M; Lipkin, M E

    2015-12-01

    Given the recent trends in growing per capita radiation dose from medical sources, there have been increasing concerns over patient radiation exposure. Patients with kidney stones undergoing percutaneous nephrolithotomy (PNL) are at particular risk for high radiation exposure. There exist several risk factors for increased radiation exposure during PNL which include high Body Mass Index, multiple access tracts, and increased stone burden. We herein review recent trends in radiation exposure, radiation exposure during PNL to both patients and urologists, and various approaches to reduce radiation exposure. We discuss incorporating the principles of As Low As reasonably Achievable (ALARA) into clinical practice and review imaging techniques such as ultrasound and air contrast to guide PNL access. Alternative surgical techniques and approaches to reducing radiation exposure, including retrograde intra-renal surgery, retrograde nephrostomy, endoscopic-guided PNL, and minimally invasive PNL, are also highlighted. It is important for urologists to be aware of these concepts and techniques when treating stone patients with PNL. The discussions outlined will assist urologists in providing patient counseling and high quality of care.

  3. Percutaneous nephrolithotomy and its legacy

    NARCIS (Netherlands)

    Skolarikos, A.; Alivizatos, G.; de la Rosette, J. J. M. C. H.

    2005-01-01

    Objective: We review the indications of Percutaneous Nephrolithotomy (PNL), its safety and efficacy when applied to various patient groups as well as the different points of technique, giving emphasis on new tips and ongoing debates. Methods: A literature search was performed using MEDLINE database

  4. Robotics in percutaneous cardiovascular interventions.

    Science.gov (United States)

    Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

    2017-11-01

    The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

  5. An update on percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Tefekli, A; Cordeiro, E; de la Rosette, J J M C H

    2013-01-01

    Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageo...

  6. Incidence of delayed complications following percutaneous CT-guided biopsy of bone and soft tissue lesions of the spine and extremities: A 2-year prospective study and analysis of risk factors

    International Nuclear Information System (INIS)

    Huang, Ambrose J.; Rosenthal, Daniel I.; Halpern, Elkan F.

    2013-01-01

    To prospectively evaluate the incidence of delayed complications (bleeding, pain, infection) following CT-guided biopsies of bone or soft tissue lesions and to identify risk factors that predispose to their occurrence. All adults presenting for CT-guided biopsy of a bone or soft tissue lesion were eligible for the study. Risk factors considered included patient gender and age, bone versus soft tissue, lesion location, lesion depth, anticoagulation, conscious sedation, coaxial biopsy technique, bleeding during the biopsy, dressing type and duration of placement, final diagnosis, needle gauge, number of passes, and number of days to follow-up. Outcomes measured included fever, pain, bruising/hematoma formation, and swelling and were collected by a follow-up phone call within 14 days of the biopsy. Fisher's exact test, the Wald Chi-square test, and univariate, multivariate, and stepwise logistic regression were performed to evaluate the influence of the risk factors on the outcomes. A total of 386 patients participated in the study. The rates of post-biopsy fever, pain, bruising, and swelling were 1.0, 16.1, 15.6, and 9.6 %, respectively. Anticoagulants were identified as a risk factor for fever. Increasing patient age was identified as a risk factor for pain. Female gender and lesion location were identified as risk factors for bruising. Increasing patient age and lesion location were identified as risk factors for swelling. Patient age, female gender, and lesion location are risk factors for delayed minor complications following CT-guided biopsy of a bone or soft tissue lesion. There were no major complications. None of the complications in this series altered patient management. (orig.)

  7. Treatment of refractory idiopathic supraorbital neuralgia using percutaneous pulsed radiofrequency.

    Science.gov (United States)

    Luo, Fang; Lu, Jingjing; Ji, Nan

    2018-02-26

    No ideal therapeutic method currently exists for refractory idiopathic supraorbital neuralgia patients who don't respond to conservative therapy, including medications and nerve blocks. Pulsed radiofrequency is a neuromodulation technique that does not produce sequelae of nerve damage after treatment. However, the efficacy of percutaneous pulsed radiofrequency for the treatment of refractory idiopathic supraorbital neuralgia is still not clear. The purpose of our study was to evaluate the efficacy and safety of pulsed radiofrequency treatment of the supraorbital nerve for refractory supraorbital neuralgia patients. We prospectively investigated the long-term effects of ultrasound-guided percutaneous pulsed radiofrequency in the treatment of 22 refractory idiopathic supraorbital neuralgia patients. A reduction of verbal pain numerical rating scale score of more than 50% was used as the standard of effectiveness. The effectiveness rates at different time points within two years were calculated. After a single pulsed radiofrequency treatment, the effectiveness rate at one and three months was 77%, and the rates at six months, one year, and two years were 73%, 64%, and 50%, respectively. Except for a small portion of patients (23%) who experienced mild upper eyelid ecchymosis that gradually disappeared after approximately two weeks, no obvious complications were observed. In conclusion, the results of our study demonstrate that for patients with refractory idiopathic supraorbital neuralgia, percutaneous pulsed radiofrequency may be an effective and safe treatment choice. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms

    International Nuclear Information System (INIS)

    Elford, Julian; Burrell, Christopher; Freeman, Simon; Roobottom, Carl

    2002-01-01

    Purpose: Thrombin injection is becoming well established for the percutaneous management of iatrogenic pseudoaneurysms. All the published series to date use bovine thrombin,and there have been reports of adverse immunologic effects following its use. Our study aimed to assess the efficacy of human thrombin injection for pseudoaneurysm occlusion. Methods:Fourteen patients with iatrogenic pseudoaneurysms underwent a color Doppler ultrasound examination to assess their suitability for percutaneous human thrombin injection. Human thrombin 1000 IU was then injected into the pseudoaneurysm sac under sterile conditions and with ultrasound guidance. A further color Doppler ultrasound examination was performed 24 hr later to confirm occlusion. Results: All 14 pseudoaneurysms were successfully occluded by human thrombin injection. In two cases a second injection of thrombin was required,but there were no other complications, and all pseudoaneurysms remained occluded at 24 hr. Conclusion: Ultrasound-guided human thrombin injection is simple to perform, effective and safe. We recommend that human thrombin becomes the agent of choice for percutaneous injection into iatrogenic pseudoaneurysms

  9. Percutaneous gastrostomy with gastropexy: experience in 125 patients.

    Science.gov (United States)

    Saini, S; Mueller, P R; Gaa, J; Briggs, S E; Hahn, P F; Forman, B H; Tung, G A; Silverman, S G; Lee, M J; Morrison, M C

    1990-05-01

    We report our experience with radiologically guided percutaneous tube gastrostomy in 125 patients by using a gastropexy technique in which the anterior gastric wall is nonsurgically sutured to the anterior abdominal wall with percutaneously placed T-fasteners before catheter insertion. Short-term follow-up of up to 2 weeks was available in all patients. In 63 patients, long-term follow-up (greater than 4 weeks; average, 3.5 months; maximum, 1 year) was available. Catheter placement was successful in 124 (99%) of 125 patients, including three patients with anatomic changes after Bilroth II hemigastrectomy and two patients with failed endoscopic attempts. There were no deaths related to the procedure, and no patients required surgical intervention for complications attributable to the gastrostomy procedure. The 30-day mortality rate was 11% (n = 7). These deaths were due to cardiorespiratory arrest and were not attributable to the gastrostomy procedure. Major complications occurred in 1.6% (n = 1) and minor complications in 9.5% (n = 6). These results indicate that percutaneous gastrostomy with gastropexy is a safe and effective technique for placement of catheters in the stomach.

  10. Percutaneous N-Butyl cyanoacrylate embolization of a pancreatic pseudoaneurysm after failed attempts of transcatheter embolization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ri Hyeon; Yoo, Roh Eul; Kim, Hyo Cheol [Seoul National University Medical Research Center, and Clinical Research Institute, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-10-15

    One common complication after major pancreatic surgery is bleeding. Herein we describe a case of pancreatic pseudoaneurysm which developed after pylorous preserving pancreaticoduodenectomy for common bile duct cancer. Three attempts of transcatheter embolization failed since feeders to the pseudoaneurysm had unfavorable anatomy. Direct percutaneous N-butyl cyanoacrylate injection was performed under fluoroscopy-guidance and the pseudoaneurysm was successfully treated. Percutaneous fluoroscopy-guided direct N-butyl cyanoacrylate injection may be a useful alternative when selective transcatheter embolization fails or is technically challenging.

  11. Percutaneous Thrombin Injection to Complete SMA Pseudoaneurysm Exclusion After Failing of Endograft Placement

    International Nuclear Information System (INIS)

    Szopinski, Piotr; Ciostek, Piotr; Pleban, Eliza; Iwanowski, Jaroslaw; Krol, Malgorzata Serafin-; Marianowska, Agnieszka; Noszczyk, Wojciech

    2005-01-01

    Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence

  12. Market penetration of ethanol

    International Nuclear Information System (INIS)

    Szulczyk, Kenneth R.; McCarl, Bruce A.; Cornforth, Gerald

    2010-01-01

    This research examines in detail the technology and economics of substituting ethanol for gasoline. This endeavor examines three issues. First, the benefits of ethanol/gasoline blends are examined, and then the technical problems of large-scale implementation of ethanol. Second, ethanol production possibilities are examined in detail from a variety of feedstocks and technologies. The feedstocks are the starch/sugar crops and crop residues, while the technologies are corn wet mill, dry grind, and lignocellulosic fermentation. Examining in detail the production possibilities allows the researchers to identity the extent of technological change, production costs, byproducts, and GHG emissions. Finally, a U.S. agricultural model, FASOMGHG, is updated which predicts the market penetration of ethanol given technological progress, variety of technologies and feedstocks, market interactions, energy prices, and GHG prices. FASOMGHG has several interesting results. First, gasoline prices have a small expansionary impact on the U.S. ethanol industry. Both agricultural producers' income and cost both increase with higher energy prices. If wholesale gasoline is $4 per gallon, the predicted ethanol market penetration attains 53% of U.S. gasoline consumption in 2030. Second, the corn wet mill remains an important industry for ethanol production, because this industry also produces corn oil, which could be converted to biodiesel. Third, GHG prices expand the ethanol industry. However, the GHG price expands the corn wet mill, but has an ambiguous impact on lignocellulosic ethanol. Feedstocks for lignocellulosic fermentation can also be burned with coal to generate electricity. Both industries are quite GHG efficient. Finally, U.S. government subsidies on biofuels have an expansionary impact on ethanol production, but may only increase market penetration by an additional 1% in 2030, which is approximately 6 billion gallons. (author)

  13. Absolute Ethanol Embolization of Arteriovenous Malformations in the Periorbital Region

    Energy Technology Data Exchange (ETDEWEB)

    Su, Li-xin, E-mail: sulixin1975@126.com [Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People’s Hospital (China); Jia, Ren-Bing, E-mail: jrb19760517@hotmail.com [Shanghai Jiao Tong University School of Medicine, Department of Ophthalmology, Ninth People’s Hospital (China); Wang, De-Ming, E-mail: wdmdeming@hotmail.com; Lv, Ming-Ming, E-mail: lvmingming001@163.com; Fan, Xin-dong, E-mail: fanxindong@aliyun.com [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Ninth People’s Hospital (China)

    2015-06-15

    ObjectiveArteriovenous malformations (AVMs) involving the periorbital region are technically challenging clinical entities to manage. The purpose of the present study was to present our initial experience of ethanol embolization in a series of 16 patients with auricular AVMs and assess the outcomes of this treatment.MethodsTranscatheter arterial embolization and/or direct percutaneous puncture embolization were performed in the 16 patients. Pure or diluted ethanol was manually injected. The follow-up evaluations included physical examination and angiography at 1- to 6-month intervals.ResultsDuring the 28 ethanol embolization sessions, the amount of ethanol used ranged from 2 to 65 mL. The obliteration of ulceration, hemorrhage, pain, infection, pulsation, and bruit in most of the patients was obtained. The reduction of redness, swelling, and warmth was achieved in all the 16 patients, with down-staging of the Schobinger status for each patient. AVMs were devascularized 100 % in 3 patients, 76–99 % in 7 patients, and 50–75 % in 6 patients, according to the angiographic findings. The most common complications were necrosis and reversible blister. No permanent visual abnormality was found in any of the cases.ConclusionEthanol embolization is efficacious and safe in the treatment of AVMs in the periorbital region and has the potential to be accepted as the primary mode of therapy in the management of these lesions.

  14. An Indirect Route for Ethanol Production

    Energy Technology Data Exchange (ETDEWEB)

    Eggeman, T.; Verser, D.; Weber, E.

    2005-04-29

    The ZeaChem indirect method is a radically new approach to producing fuel ethanol from renewable resources. Sugar and syngas processing platforms are combined in a novel way that allows all fractions of biomass feedstocks (e.g. carbohydrates, lignins, etc.) to contribute their energy directly into the ethanol product via fermentation and hydrogen based chemical process technologies. The goals of this project were: (1) Collect engineering data necessary for scale-up of the indirect route for ethanol production, and (2) Produce process and economic models to guide the development effort. Both goals were successfully accomplished. The projected economics of the Base Case developed in this work are comparable to today's corn based ethanol technology. Sensitivity analysis shows that significant improvements in economics for the indirect route would result if a biomass feedstock rather that starch hydrolyzate were used as the carbohydrate source. The energy ratio, defined as the ratio of green energy produced divided by the amount of fossil energy consumed, is projected to be 3.11 to 12.32 for the indirect route depending upon the details of implementation. Conventional technology has an energy ratio of 1.34, thus the indirect route will have a significant environmental advantage over today's technology. Energy savings of 7.48 trillion Btu/yr will result when 100 MMgal/yr (neat) of ethanol capacity via the indirect route is placed on-line by the year 2010.

  15. Neotendon infilling of a full thickness rotator cuff foot print tear following ultrasound guided liquid platelet rich plasma injection and percutaneous tenotomy: favourable outcome up to one year [v1; ref status: indexed, http://f1000r.es/xz

    Directory of Open Access Journals (Sweden)

    Arockia Doss

    2013-01-01

    Full Text Available This is a case report on excellent clinical outcome and neotendon infilling at one year follow up in a degenerative rotator cuff full thickness tear following percutaneous tenotomy and platelet rich plasma injection.

  16. Percutaneous tracheostomy: a comprehensive review

    Science.gov (United States)

    Rashid, Ashraf O.

    2017-01-01

    Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world. Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications. PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective. Experience with the technique and careful planning is needed to minimize any avoidable potential complication. PMID:29214070

  17. Percutaneous cryoablation for hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Kyoung Doo Song

    2016-12-01

    Full Text Available Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC. Although radiofrequency (RF ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct