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Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.
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Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.
Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.
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Resumen Las características del paciente y la localización de la lesión diana pueden hacer más complejo un procedimiento intervencionista. Una adecuada formación basada en el conocimiento de los instrumentos, manejo de técnicas alternativas y complementos hacen que estos procedimientos sean efectivos y seguros. Destacaremos la planificación anticipada, los enfoques seguros, el papel de la integración y la discusión interdisciplinaria. Los elementos descritos aquí y la bibliografía adjunta pueden tomarse como una guía para comenzar una carrera en radiología intervencionista.
Abstract The characteristics of the patient and the location of the target lesion can make an interventional procedure more complex. An adequate training based on the knowledge of instruments, handling of alternative techniques and supplementary tools make these procedures effective and safe. We will emphasize advanced planning, safe approaches, the role of integration, and interdisciplinary discussion. The items described here and the accompanying bibliography can be taken as a guide to starting a career in interventional radiology.
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Resumen Introducción: La disección carotídea consiste en el desgarro de la pared del vaso. Es una patología infrecuente, pero es la causa más común de enfermedad vascular cerebral (EVC) isquémica en personas menores de 45 años. Las manifestaciones clínicas son muy variables. Método: Utilizamos las recomendaciones CARE para el reporte de casos clínicos. Caso clínico: Hombre de 45 años previamente sano, con debilidad aguda de la extremidad torácica derecha sin causa aparente. La tomografía simple de cráneo no evidenció alteraciones. La resonancia magnética mostró una oclusión completa de la arteria carótida interna en todos sus segmentos y disminución del flujo de la arteria cerebral media izquierda. La evolución clínica fue desfavorable. Conclusión: La disección carotídea debe sospecharse en personas con EVC sin factores de riesgo cardiovascular.
Abstract Introduction: Carotid dissection consists of a tear in the vessel wall. It is a rare pathology, but it is the most common cause of ischemic cerebral vascular disease (CVD) in people under 45 years of age. The clinical manifestations are very variable. Method: We used CARE recommendations for reporting clinical cases. Clinical case: Previously, a healthy 45-year-old man with acute weakness of the right thoracic extremity without apparent cause. The simple skull tomography did not show any alterations. MRI showed complete occlusion of the internal carotid artery in all its segments and decreased flow of the left middle cerebral artery. The clinical evolution was unfavorable. Conclusion: Carotid dissection should be suspected in people with CVD without cardiovascular risk factors.
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Introduction: Endoscopic ultrasound (EUS)-guided drainage and luminal-apposing metal stents (LAMS) are the options for managing symptomatic pancreatic pseudocysts. Aim: To evaluate the effectiveness and safety of LAMS for EUS-guided drainage of symptomatic pancreatic pseudocysts in two referral centers in Colombia. Materials and methods: A multicenter prospective cohort study between June 2019 and December 2021 included 13 patients diagnosed with symptomatic pancreatic pseudocysts who underwent EUS-guided drainage with LAMS. Technical success, clinical success, and successful stent removal were evaluated as outcomes. Safety outcomes included stent-related adverse events and general adverse events. Follow-up was carried out for eight weeks, collecting data on stent removal. Results: The average age was 53.4 years; 8/13 were men. The mean size of the pseudocyst was 9.56 ± 2.3 cm. Technical success was 100%, and clinical success was 92.3%. The stents were removed on average after 8 ± 2 weeks. The mean procedural time from puncture to stent deployment was 3.2 ± 2.4 minutes. In the imaging check-up, the collections had adequate drainage in all cases. There was a low frequency of complications; bleeding was documented in one case requiring surgery. Conclusions: LAMS is safe and effective in managing symptomatic pancreatic pseudocysts, reducing hospital stay and cost overruns. Clinical symptomatology prevails in the surgery decision.
Introducción: el drenaje guiado por ultrasonido endoscópico (USE) y el uso de stent metálico luminal de aposición (LAMS) son de elección en el manejo de los pseudoquistes pancreáticos sintomáticos. Objetivo: evaluar la efectividad y seguridad del LAMS para el drenaje por USE de pseudoquistes pancreáticos sintomáticos en dos centros de referencia en Colombia. Materiales y métodos: estudio de cohorte prospectivo multicéntrico entre junio de 2019 y diciembre de 2021, se incluyeron a 13 pacientes con diagnóstico de pseudoquistes pancreáticos sintomáticos sometidos a drenaje por USE con LAMS. Se evaluaron como desenlaces el éxito técnico, el éxito clínico y la extracción exitosa del stent. Y los desenlaces de seguridad incluyeron eventos adversos relacionados con el stent y los eventos adversos generales. Se realizó seguimiento a 8 semanas, en las que se recopilaron datos relacionados con el retiro del stent. Resultados: la edad promedio fue 53,4 años, 8/13 fueron hombres. El tamaño medio del pseudoquiste fue de 9,56 ± 2,3 cm. El éxito técnico fue del 100% y el éxito clínico fue 92,3%. Los stents fueron retirados en promedio a las 8 ± 2 semanas. El tiempo medio del procedimiento desde la punción hasta el despliegue del stent fue 3,2 ± 2,4 minutos. En el control imagenológico hubo un adecuado drenaje de las colecciones en todos los casos. Hubo baja frecuencia de complicaciones, se documentó sangrado en 1 caso con requerimiento quirúrgico. Conclusiones: el uso de LAMS es seguro y efectivo en el manejo de pseudoquistes pancreáticos sintomáticos, disminuye la estancia hospitalaria y sobrecostos. La sintomatología clínica prima en la decisión de intervención.
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Resumen Antecedentes: El síndrome de Down es la anomalía cromosómica más frecuente y se asocia con defectos cardiacos congénitos, elementos clínicos de una alta morbilidad y mortalidad infantil. Objetivo: Describir los desenlaces clínicos de los pacientes con síndrome de Down sometidos a cirugía e intervencionismo como tratamiento de las cardiopatías congénitas en esta institución. Material y métodos: Estudio retrospectivo que incluyó pacientes menores de 18 años con síndrome de Down y patología cardiaca asociada durante los últimos 10 años. Las variables estudiadas fueron: peso, talla, sexo, edad, tipo de cardiopatía, procedimiento correctivo, tiempo de estancia intrahospitalaria y en unidad de terapia intensiva, morbilidad y mortalidad. Resultados: 368 pacientes pediátricos fueron llevados a corrección quirúrgica o intervencionista, de los cuales 197 (54%) pertenecían al sexo femenino, la mediana de edad fue de 24 meses (rango intercuartílico [RIQ]: 14-48) en el grupo quirúrgico y de 36 meses (RIQ: 17-85) en el intervencionista. Las cardiopatías congénitas más frecuentes fueron: persistencia del conducto arterioso (31%), comunicación interventricular (28%), canal atrioventricular (CAV) (20%), comunicación interauricular (16%) y tetralogía de Fallot con el 4% respectivamente. La estancia hospitalaria fue de 9 días (RIQ: 7-15) en el grupo quirúrgico y de 3 días (RIQ: 2-5) en el hemodinámico. Las morbilidades fueron infección postoperatoria en 30 pacientes (14%) y en 19 pacientes (9%) bloqueo atrioventricular completo. La mortalidad global incluyendo tanto el quirúrgico como el intervencionista fue del 2%. Conclusiones: Los resultados terapéuticos, quirúrgicos e intervencionistas, en los niños con síndrome de Down y cardiopatías congénitas han mejorado en forma muy satisfactoria. Es de destacar la menor prevalencia del CAV en la población mexicana. Es indispensable realizar evaluación cardiológica a los niños con síndrome de Down y aquellos con cardiopatías congénitas llevarlos a corrección de manera oportuna para favorecer la sobrevida y calidad de vida.
Abstract Background: Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of congenital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective: To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution. Material and methods: 368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality. Results: 368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality including both surgical and interventional was 2%. Conclusions: The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of children with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life.
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Resumen Objetivo: Presentar un score ajustado al riesgo de complicaciones durante el cateterismo cardiaco en cardiopatías congénitas. Diseño: Observacional, analítico y ambispectivo de 3,504 casos. Se incluyeron edad, cardiopatía, procedimiento, complicaciones mayores y menores. Métodos: 3,504 procedimientos realizados entre octubre de 1987 y mayo de 2019. Variables independientes: edad, cardiopatía, procedimiento y estadio clínico. Se categorizó como bajo riesgo 5 a 7 puntos, moderado riesgo 8 a 11 puntos y alto riesgo 12 a 22 puntos. El score fue validado mediante la prueba de Hosmer-Lemeshow y la curva ROC (receiver operating characteristic). Resultados: Las complicaciones fueron 177 (5%), 66 mayores (1.9%) y 111 menores (3.1%). Mortalidad de 0.4% (15 pacientes). El grupo de bajo riesgo (n = 825) tuvo 1.5% de complicaciones, el de moderado riesgo (n = 2.221) 4.9% y el de alto riesgo (n = 458) 12% (p < 0.001). El análisis de los datos retrospectivos (n = 2,953) fue validado con los prospectivos (n = 551) mediante la prueba de Hosmer-Lemeshow; dejó en evidencia que los valores predichos son similares a los observados. Conclusiones: Las complicaciones siguen presentándose a pesar de la evolución de la técnica. El score resultó útil para estratificar a los pacientes y conocer la probabilidad de complicaciones antes del procedimiento.
Abstract Objetive: to present a risk-ajusted score of complications during cardias catheterization in congenital heart disease. Design: observational, analitic, ambispective of 3.504 cases. The data analyzed included age, heart disease, type of procedure, major and minor complications. Methods: 3.504 procedures performed between october 1987 and may 2019. The variables were age, heart disease, procedere and clinical stege. Each patients was categorized as low risk 5 to 7 points, moderate risk 8 to 11 points and higt risk 12 to 22 points. The score was validated using the Hosmer-Lemeshow test and the ROC curve (Receiver Operating Characteristic). Results: complications 177 (5%) 66 major (1.9%) and 111 minor (3.1%). Mortality was 0.4% (15 patients). The low-risk group (n = 825) had 1.5% complications; moderate risk (n = 2,221) 4.9%; high risk (n: 458) 12% (p < 0.001). The analysis of the retrospective data (n = 2953) was validated with prospective (n = 551) using the Hosmer-Lemeshow test, showed that the predicted values are similar to those observed. Conclusions: Complications continue to occur despite the evolution of the technique. The score was useful for stratifying patients and knowing the probability of complication before the procedere.
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ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB.
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Abstract Carpal tunnel syndrome (CTS) is the most common compressive neuropathy in the human body. Its symptoms result from compression of the median nerve in the carpus. The treatment can be conservative, with medications and/or infiltrations that alleviate the symptoms, or surgical, which is more effective, with decompression of the median nerve by surgical section of the flexor retinaculum of the carpus. The anesthetic technique varies according to the anesthesia method: sedation, venous locoregional anesthesia and, more recently, wide-awake local anesthesia no tourniquet (WALANT), which can be performed by the surgeons themselves. The WALANT technique uses local anesthesia with a vasoconstrictor, and does not require the use of a tourniquet on the upper limb nor sedation. The median nerve block in ultrasound-guided WALANT provides better accuracy to the technique, with greater patient safety; in the present article, its use in the performance of carpal tunnel decompression is described, and the literature is reviewed.
Resumo A síndrome do túnel do carpo (STC) é a neuropatía compressiva mais comum do corpo humano. Seus sintomas decorrem da compressão do nervo mediano no carpo. O tratamento pode ser incruento, com medicações e/ou infiltrações que amenizam os sintomas, ou cruento, mais eficaz, com a descompressão do nervo mediano pela seção cirúrgicadoretináculodos flexores do carpo. A técnica anestésica varia de acordo com o serviço de anestesia: sedação, anestesia locorregional venosa e, mais recentemente, a anestesia local com o paciente acordado e sem torniquete (wide-awake local anesthesia no tourniquet, WALANT), que pode ser realizada pelo próprio cirurgião. Por utilizar anestesia local com vasoconstritor, essa técnica dispensa o uso de torniquete no membro superior e a necessidade de sedação. O bloqueio do nervo mediano na WALANT guiada por ultrassonografiaconfere melhor precisão àtécnica,e mais segurança ao paciente, e, neste artigo seu uso na realização da descompressão do túnel do carpo é descrito, e a literatura, revisada.
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Humans , Carpal Tunnel Syndrome/surgery , Ultrasonography , Decompression, Surgical , Anesthesia, LocalABSTRACT
Objectives: Research, knowledge, and technological advances have promoted minimally invasive image-guided diagnostic and therapeutic intervention. Such interventions are increasingly performed for musculoskeletal diseases by radiologists within outpatient settings. The objective of this study was to ascertain levels of safe practice among musculoskeletal radiologists in the United Kingdom and the Indian public health-care system, as defined by access to spinal surgeons and anesthetists during radiological spinal procedures. Material and Methods: An online cross-sectional survey of eight questions (multiple choice and free text) was circulated among musculoskeletal radiologists in the UK and India, to evaluate: (i) Image-guided practice among musculoskeletal radiologists. (ii) Types of interventions undertaken. (iii) Practice setting. (iv) Availability of supportive, backup access to spinal surgery services. Results: A total of 53 replies were received of which 43 (81.1%) were from musculoskeletal radiologists who perform spinal interventional procedures. Spinal biopsies and injections were the most common procedures performed by the 43 eligible radiologists (79.1% and 74.4%, respectively), with vertebroplasty and sacroplasty performed by only 16.3% and 11.6%, respectively. Less than half (46.5%) of musculoskeletal radiologists performing interventional procedures did so within a hospital setting with both a spinal surgeon and an anesthetist on site, 20.9% had an anesthetist on site but no spinal surgeon and 16.3% had neither on-site. Conclusion: Minimally invasive image-guided diagnostic and therapeutic intervention is a niche sub-specialty practiced by a few musculoskeletal radiologists. Enhanced resource allocation, skills training, and multidisciplinary service provision will ultimately minimize existing deficiencies, improving patient-related clinical outcomes, and quality of care.
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La ecografía es una herramienta segura, portátil, económica y de fácil acceso. Los médicos anestesiólogos pueden beneficiarse con esta herramienta diagnóstica rápida y precisa en su práctica habitual. Existen múltiples áreas potenciales donde la ecografía desempeña un papel importante, para la orientación de intervenciones a ciegas e invasivas, el diagnóstico de condiciones críticas y la evaluación de posibles variaciones anatómicas que pueden conducir a la modificación del plan anestésico. Esta revisión narrativa describe las principales aplicaciones de la ecografía en anestesia, las técnicas ecoguiadas y las tendencias actuales del manejo anestésico perioperatorio del paciente quirúrgico. Se realizó una búsqueda en las bases de datos PubMed y Cochrane, se incluyeron artículos originales, estudios aleatorizados y de revisión, en español y en inglés, publicados entre 2017-2021. El uso de ecografía ha entrado en el campo de la medicina del dolor, anestesia regional y del intervencionismo analgésico durante la última década, e incluso es el estándar de la práctica, por tanto, la capacitación y un adecuado aprendizaje en la ecografía deben ser parte del plan de estudios de cualquier programa de anestesiología
Ultrasound is a safe, portable, inexpensive, and easily accessible tool. Anesthesiologists can benefit from this fast and accurate diagnostic tool in their routine practice. There are multiple potential areas where ultrasound plays an important role in the guidance of blind and invasive interventions, diagnosis of critical conditions, and assessment of possible anatomical variations that may lead to modification of the anesthetic plan. This narrative review describes the main applications of ultrasound in anesthesia, ultrasound-guided techniques, and current trends in the perioperative anesthetic management of the surgical patient. A search was conducted in PubMed and Cochrane databases. Original articles, randomized and review studies in Spanish and English published between 2017-2021 were included. The use of ultrasound has entered the field of pain medicine, regional anesthesia, and interventional analgesia during the last decade and is even the standard of practice. Therefore, training and adequate learning in ultrasound should be part of the curriculum of any anesthesiology program
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Ultrasonography , Anesthesia , Pain , Patients , AnestheticsABSTRACT
Introdução: As diretrizes atuais recomendam o uso da ultrassonografia intravascular de coronárias como ferramenta adjuvante em situações difíceis. Objetivo: Caracterizar a utilização da ultrassonografia intravascular em Portugal e comparar os desfechos após intervenção coronária percutânea no tronco da coronária esquerda, guiada ou não por ultrassonografia intravascular. Métodos: Estudo observacional retrospectivo multicêntrico, que analisou pacientes submetidos à intervenção coronária percutânea entre janeiro de 2012 e dezembro de 2018, incluídos no Portuguese Registry on Interventional Cardiology da Sociedade Portuguesa de Cardiologia. Valor de p bicaudal <0,05 foi considerado estatisticamente significativo. Resultados: Este estudo demonstrou variação significativa na utilização da ultrassonografia intravascular em Portugal (valor de p qui-quadrado para tendência <0,001). O ano com maior utilização foi 2016 (2,4%). Houve aumento progressivo, nos últimos 7 anos, na utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda (valor de p qui-quadrado para tendência <0,001), com importantes diferenças regionais. A população submetida à intervenção coronária percutânea do tronco da coronária esquerda guiada por ultrassonografia intravascular era mais jovem, mas tinha maior prevalência de fatores de risco cardiovascular, disfunção sistólica ventricular e lesões coronárias complexas. Além disso, esse grupo de pacientes teve menor prevalência do desfecho primário intra-hospitalar (1,4% versus 3,9%; p=0,024). Porém, após análise multivariada ajustada para fatores de confusão, este estudo não demonstrou impacto significativo da utilização da ultrassonografia intravascular no desfecho intra-hospitalar. Conclusão: A utilização da ultrassonografia intravascular na intervenção coronária percutânea do tronco da coronária esquerda vem aumentando lentamente nos últimos 7 anos em Portugal. Neste estudo, a utilização desse método não teve impacto estatístico nos desfechos intra-hospitalares.
Background: Current guidelines recommend the use of coronary intravascular ultrasound as an adjunctive tool in challenging situations. Objective: To characterize the use of intravascular ultrasound in Portugal and compare outcomes after left main percutaneous coronary intervention, with or without intravascular ultrasound. Methods: A retrospective multicentric observational study analyzed patients who underwent percutaneous coronary intervention between January 2012 and December 2018 and were included in the Portuguese Registry on Interventional Cardiology of the Sociedade Portuguesa de Cardiologia. A two-sided p-value<0.05 was considered statistically significant. Results: This study revealed significant variation of intravascular ultrasound usage in Portugal over time (p-value Chi-squared for trend <0.001). The year with maximum use was 2016 (2.4%). Regarding left main percutaneous coronary intervention, there was a progressive increase in use of intravascular ultrasound (p-value Chi-squared for trend<0.001) in the last 7 years, with important regional differences. The population submitted to left main percutaneous coronary intervention with intravascular ultrasound was younger, but had a higher prevalence of some cardiovascular risk factors, ventricular systolic dysfunction, and complex coronary lesions. Moreover, this group of patients had lower prevalence of intrahospital primary endpoint (1.4% versus 3.9%; p=0.024). However, after multivariate analysis adjusted to confounding factors, this study did not demonstrate a significant impact of intravascular ultrasound on intrahospital endpoint. Conclusion: The overall use of intravascular ultrasound in left main percutaneous coronary intervention has been slowly increasing in the last seven years, in Portugal. In this study, the use of this method had no statistical impact in intrahospital endpoints.
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Abstract Purpose: To explore differences in the changes of clinical and CT manifestations related to liver abscess before and after CT-guided interventional therapy between patients with and without Diabetes Mellitus (DM). Materials and methods: Fifty-eight consecutive patients with liver abscesses were retrospectively enrolled in this study. All patients underwent upper abdominal contrast-enhanced CT scans before and after CT-guided interventional therapy. They were divided into two groups including the DM group (n = 30) and the Non-DM group (n = 28) if the liver abscess occurred in patients with and without DM, respectively. The changes in the clinical and CT manifestations related to liver abscess after CT-guided interventional therapy in both groups were statistically analyzed. Results: After CT-guided interventional therapy, the length of hospital stay, white blood cell recovery time and drainage tube removal time in the DM group were longer than in the Non-DM group (all p-values < 0.05). The incidence of postoperative complications in the DM group was higher than in the Non-DM group (p < 0.05). As shown on CT, the postoperative reduced percentage of maximum diameter of abscess cavity and the reduction rate of edema band surrounding the liver abscess in the DM group were smaller than in the Non-DM group (both p-values < 0.05). The time intervals of the previous characteristic changes on CT before and after interventional therapy in the DM group were longer than in the Non-DM group (all p-values < 0.05). Conclusions: The liver abscesses patients with DM could not have a faster recovery and better therapeutic effect than those without DM after the CT-guided interventional therapy.
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Objective:To investigate and analyze the eye lens dose to interventional radiology workers in China from 2019 to 2021.Methods:The monitoring data on eye lens dose to interventional radiology workers from 31 province-level units during 2019-2021 were collected through the National Radiological Health Information Platform. The eye lens dose evaluation indicator was Hp(3), with each monitoring period of no more than 3 months. Kusall-Wallis H test was used for the comparison of multiple groups and pairwise. Results:A total of 6 643 interventional radiology workers were investigated from 2019 to 2021. The average annual eye lens dose was 1.03 mSv, with the median of 0.17 mSv and the maximum of 94.88 mSv. The annual eye lens dose to 59 workers exceeded 20 mSv. It was also found that the annual eye lens dose to the doctors in 2019 and 2020 was slightly higher than that to nurses (rank mean difference=118.29, 129.71, P<0.01), and the lens dose to interventional radiology workers who performed cardiac interventions in 2019 was higher than that to workers who performed peripheral vascular interventions (rank mean difference=46.52, P<0.05). Conclusions:The lens dose to interventional radiology workers is lower than the limits given in Chinese national standard currently in effect, but exceed the latest internationally recommended limit for a few ones. In order to protect the occupational health of interventional radiology workers, the monitoring of lens dose should be strengthened.
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Objective:To investigate the safety and efficacy of MR-guided focused ultrasound surgery (MRgFUS) in treating localized prostate cancer.Methods:Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study. The patients were all over 18 years old, with an average age of (68±10) years, and had not received any prior treatment for prostate cancer. Pretreatment pelvic MR and CT scans were performed to determine the region of treatment (ROT). Different urinary catheterization measures were given based on the location of the lesion. Under general anesthesia, the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed. The patients were followed up at 1, 3, and 6 months after treatment and annually thereafter. During follow-up, prostate-specific antigen (PSA) levels, pelvic MR scans, International Prostate Symptom Score (IPSS), International Index of Erectile Function-15 (IIEF-15) scores, and adverse events were assessed.Results:(1) All six patients underwent MRgFUS treatment for six lesions, with an average duration of (126±56) minutes, an average number of (7.3±3.2) focal ultrasound pulses per lesion, and an average non-perfusion volume of (3.8±1.1) cm 3, which covered the entire treatment target area. No treatment-related adverse events were reported. (2) The PSA levels at baseline, 1, 3, 6, and 12 months after treatment were (6.6±0.8), (3.6±1.3), (3.4±3.0), (2.5±1.7), and (2.3±1.8) ng/ml, respectively. PSA levels increased in 2 out of 6 patients during follow-up, and pelvic MR scan revealed recurrent lesions, while PSA levels continued to decrease in the remaining 4 patients, and pelvic MR scan were normal. (3) The IPSS scores at baseline, 1, and 3 months after treatment were 13.0 (4.0, 16.0), 10.0 (4.0, 12.0), and 5.0 (3.0, 6.0) points, respectively. For the three sexually active patients, the IIEF-15 scores at baseline were 40, 51, and 14 points, respectively, and IIEF-15 at 1 month after treatment were 9, 8, and 14 points, respectively, and at 3 months after treatment were 9, 66 and 26 points, respectively. (4) One patient was diagnosed with recurrence 10 months after treatment, and another patient was found to have a new lesion 6 months after treatment. Conclusions:MRgFUS might be a safe, non-invasive, and effective treatment for localized prostate cancer, but regular follow-up is vital for detecting tumor recurrence.
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Objective:To investigate the histopathological and immunohistochemical changes of gastric fundus and duodenum after bariatric embolization of left gastric artery and gastroduodenal artery in obesity New Zealand rabbit models.Methods:Twenty obesity New Zealand rabbit models were successfully established and divided into two groups using stratified randomization. Left gastric artery and gastroduodenal artery were embolized with gelatin sponge (350-560 μm) in experimental group, left gastric artery and gastroduodenal artery were perfused with normal saline in control group. All animals were sacrificed for pathological, immunohistochemical examination and Western Blot analysis 4 weeks post embolization, the density of ghrelin producing cells and the gray ratio of ghrelin protein band were measured and compared by the independent sample t test. Results:Macropathological examination showed ulceration in the anterior wall of the gastric body in one rabbit, histopathological examination showed mucosa ulceration in the gastric body in 3 rabbits in experimental group. Immunohistochemical examination showed that the ghrelin producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group (10.0±5.1 vs.27.7±3.4, t=12.35, P<0.05;5.6±2.6 vs. 12.3±2.1, t=4.73, P<0.05). Western Blot analysis showed that the gray ratio of ghrelin bands of gastric fundus and duodenum in the experimental group were significantly lower than that in the control group (0.65±0.05 vs.1.12±0.09, t=9.62, P<0.05;0.55±0.03 vs. 0.94±0.08, t=7.98, P<0.05). Conclusions:Immunohistochemical and Western Blot analysis showed that the ghrelin-producing cells of gastric fundus and duodenum in the experimental group were significantly less than those in the control group after bariatric embolization, histopathologic analysis indicated that bariatric embolization was a safe technique.
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Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.
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Objective:To evaluate the safety and efficacy of drug-coated balloon (DCB) in the treatment of symptomatic intracranial atherosclerotic stenosis.Methods:Forty-nine patients with symptomatic intracranial atherosclerotic stenosis treated with DCB in the People′s Hospital of Zhengzhou University from January 2018 to August 2021 were retrospectively included. The location and number of lesions were as follows: 21 cases of the middle cerebral artery, 11 cases of the intracranial segment of vertebral artery, 12 cases of the basilar artery, and 5 cases of the intracranial segment of internal carotid artery. Pre-dilatation of the lesion with a normal balloon followed by DCB angioplasty. Clinical follow-up (outpatient or telephone) was carried out at 30 days, 3 months, 6 months, and 1 year after the operation. Imaging follow-up was carried out at 6 months postoperatively. The surgical success rate (defined as the proportion of patients with residual stenosis<50% after balloon dilatation), perioperative safety (any strokes, TIA, and deaths within 1 month), stroke recurrence, and restenosis were analyzed.Results:The operation was performed in all patients successfully. The median stenosis level was 80% (75%, 85%) preoperatively and 20% (15%, 30%) at the time after the operation. The success rate of the operation was 91.8% (45/49). Stenting was given in 11 cases (22.4%, 11/49) for severe flow-limiting vascular entrapment, or non-flow-limiting entrapment, owing to the concern of subsequent progression of the entrapment. Three cases (6.1%, 3/49) had significant vascular elastic retraction and implement stent implantation. One patient (2.0%, 1/49) developed symptomatic cerebral infarction during perioperative period, and the symptoms improved after treatment. No fatal or disabling stroke occurred. All patients were followed-up successfully. The median follow-up time was 12 months. Two patients (4.1%, 2/49) had a stroke in the responsible vascular area, and 1 (2.0%, 1/49) patient had a stroke in the non-responsible vascular area. Thirty-eight patients (77.6%, 38/49) had followed-up images. The median follow-up time of postoperative imaging was 6 months. Restenosis occurred in two cases (1 case had symptomatic restenosis), and the incidence of restenosis was 5.3% (2/38).Conclusions:DCB in the treatment of symptomatic intracranial atherosclerotic stenosis has a high technical success rate, good perioperative safety, and low stroke recurrence rate in short-term follow-up, demonstrating the good feasibility, safety, and efficacy of DCB.
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Objective:To investigate the clinical efficacy of qualitative and staging diagnosis of rectal tumors with dual contrast-enhanced ultrasonography and interventional biopsy.Methods:A total of 300 patients with rectal tumors who received treatment in The First People's Hospital of Huzhou from December 2019 to March 2022 were included in this study. All patients underwent dual contrast-enhanced ultrasonography and interventional biopsy followed by focus resection. Taking the postoperative histopathological test results as the gold standard, the efficacy of dual contrast-enhanced ultrasonography and interventional biopsy in the localization, qualitative analysis, and staging of rectal tumors was analyzed.Results:The compliance rate of dual contrast-enhanced ultrasonography and interventional biopsy in the localization of rectal tumors was 100%. The sensitivity, specificity, and accuracy of the dual contrast-enhanced ultrasonography and interventional biopsy for qualitative diagnosis of rectal tumors were 94.8%, 97.8%, and 96.7%, respectively. The Kappa value used for assessing agreement in the qualitative diagnosis of rectal tumors between dual contrast-enhanced ultrasonography and interventional biopsy and postoperative tissue pathological examination results was 0.947. The area under the curve plotted for qualitative diagnosis of rectal tumors was 0.974. The sensitivity, specificity, and sensitivity of dual contrast-enhanced ultrasonography and interventional biopsy for diagnosis of stage I-III rectal cancer were 94.1%-97.8%. The Kappa values used for assessing agreement in staging diagnosis of stage I-III rectal cancer between dual contrast-enhanced ultrasonography and interventional biopsy and postoperative tissue pathological examination results were 0.923, 0.912, and 0.927, respectively. The areas under the curve plotted for staging diagnosis of rectal cancer were 0.961, 0.955, and 0.970, respectively.Conclusion:Dual contrast-enhanced ultrasonography and interventional biopsy have a high efficacy in the localization, qualitative diagnosis, and staging diagnosis of rectal tumors.