Study of Correlation of High-Resolution Ultrasonography and Ultrasonography Guided Fine Needle Aspiration Cytology in Diagnosis of Pure Neuritic Leprosy in a Tertiary Care Hospital

This study assesses the features of high-resolution ultrasonographic and ultrasound-guided FNAC of peripheral nerves and correlates the findings in clinically suspected cases of pure neuritic leprosy (PNL). As per the study protocol, clinically screened pure neuritic leprosy cases from January 2017 to June 2018 were subjected to high resonance ultrasonography and ultrasonography-guided FNAC. The aspirated material was stained with modified ZN stain for AFB. Nerves showed hypoechogenicity, loss or distorted echogenic rim, and fibrillary echotextures in ultrasonography. Epithelioid cells, epithelioid cell granuloma was found in the histopathology sections of FNAC specimens with the presence of AFB in some cases. From these findings it may be concluded that HRUS and ultrasound-guided FNAC could be incorporated as rapid and reliable diagnostic tools for PNL. It may enlighten the future path as an early indicator of neural damage and be critical and useful to prevent the disabilities.

Endoscopic ultrasonography features of malignant mediastinal and abdominal lymphadenopathy / 中华消化内镜杂志

Objective:To investigate the features of endoscopic ultrasonography in the diagnosis of malignant mediastinal and abdominal lymphadenopathy and to provide more evidence for endoscopic ultrasound-guided fine-needle aspiraiton (EUS-FNA).Methods:A case-control study was performed on 83 consecutive patients who underwent EUS in the Second Affiliated Hospital of Soochow University from September 2016 to February 2021. Lymph node properties were identified by pathological results of EUS-FNA and (or) surgery and follow-up for at least 6 months. According to the final diagnosis, patients were divided into malignant lymph node group ( n=56) and benign lymph node group ( n=27). Univariate analysis and multivariate logistic analysis were performed to identify independent risk factors for malignant lymphadenopathy in terms of EUS features. Results:Univariate analysis showed that the length of short axis, short-long axis ratio, shape, border, presence or absence of hilum, heterogeneous echo, and the growth pattern of lymph node were risk factors for malignant lymph nodes ( P<0.10). Multivariate logistic regression analysis showed that short axis>10 mm ( P=0.021, OR=9.751, 95% CI: 1.407-57.573), clear border ( P=0.009, OR=20.587, 95% CI: 2.149-197.251), absence of hilum ( P=0.019, OR=28.502, 95% CI: 1.725-470.864), nodal matting ( P=0.004, OR=45.539, 95% CI: 3.429-604.822), partial nodal fusion ( P=0.004, OR=50.012, 95% CI: 3.497-715.266) were independent risk factors for malignant mediastinal and abdominal lymph nodes. Conclusion:EUS is useful to differentiate the lymph node properties in the mediastinal or abdominal cavity. Short axis>10 mm, clear border, absence of hilum, nodal matting and partial nodal fusion are high-risk EUS features of malignant mediastinal or abdominal lymphadenopathy, where priority should be given to EUS-FNA.

Management of prostatic abscess, our experience over 5 year

Background: The objective of our study was to perform retrospective analysis of management of prostatic abscess in a tertiary care hospital in northeast India.Methods: This was a single tertiary care hospital based retrospective analysis of management of 24 patients diagnosed with prostatic abscess, between January 2015 and January 2020. Diagnosis of prostatic abscess was confirmed by trans-rectal ultrasonography (TRUS) and/or computed tomography (CT) scan/magnetic resonance imaging (MRI) prostate. Various treatment modalities used in our study were conservative, transurethral resection of prostatic abscess (TURP), TRUS-guided trans-rectal drainage/aspiration, trans-urethral drainage (TUD) + trans-urethral incision (TUI).Results: On analysing 24 patients diagnosed with prostatic abscess, mean age was 46.12 years (range, 17 to 73 years), the mean prostate-specific antigen (PSA) was 17.3 ng/ml (range, 2 to 40.0 ng/ml), mean prostatic abscess volume was 33 cubic mm (range, 10 to 75 gm). All patients were hospitalised, on admission all patients were started on intravenous antibiotics (3rd-generation cephalosporin along with an amino-glycoside) or antibiotics as per urine culture report. Diabetes mellitus was most common associated co-morbidity present in almost 50% of patients. Patients presented with dysuria (75%), urinary retention (29%) fever (25%) and perineal pain. Cases were managed by surgical approach after failure of conservative management.Conclusions: Early surgical intervention for prostatic abscess reduces morbidity and mortality associated with it. TRUS guided drainage can be performed under local anaesthesia, are better suited for small localised abscess but associated with increase hospital stay. Trans-urethral drainage are better suited for elderly patient with large prostate volume.

Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures

BACKGROUND/AIMS: It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis. METHODS: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. RESULTS: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively. CONCLUSIONS: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.

A Case of Lemierre's Syndrome, Misdiagnosed as a Simple Deep Neck Infection on Initial Ultrasonography Followed by an Abscess Aspiration Trial / 대한두경부종양학회지

Lemierre's syndrome is rare disease characterized by anaerobic sepsis, internal jugular vein thrombosis, septic emboli that resulted from head and neck infection. Lemierre's syndrome has significant morbidity, so immediate, accurate diagnosis and treatment is needed. It is necessary to perform contrast-enhanced computed tomography (CT) for diagnosis. Systemic antibiotics is recommended, and surgical interventions, anticoagulation may beis considered for treatment. We report misdiagnosed case as a simple deep neck infection on initial ultrasonography with simultaneous abscess aspiration but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.We report a case of a 45-year-old patient, who was diagnosed with a simple deep neck infection and treated with simultaneous abscess aspiration, but finally diagnosed and treated internal jugular vein thrombophlebitis (Lemierre's syndrome) on CT scan.

The efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage.Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017.All the patients undrwent contrast-enhanced CT,urinary tract imaging,ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst.The patients (38 males,26 females) were divided into single flexible ureteroscope group [group A,32 cases of patients,average age (54.2 ±6.6) years,unilateral or bilateral cystic patients:19 cases/ 13cases,simple cyst of kidney or polycystic kidney:24 cases/8 cases,average maximum diameter of the renal cyst (5.4 ± 1.3) cm,combined with renal calculus:8 cases,combined with hydronephrosis:7 cases,1 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B,32 cases of patients,average age (52.3 ± 9.3) years,unilateral or bilateral cystic patients:21 cases/11 cases,simple cyst of kidney or polycystic kidney:25 cases/7 cases.Average maximum diameter of the renal cyst (5.3 ±1.2) cm,combined with renal calculus:9 cases,combined with hydronephrosis:8 cases,2 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture].The double J stent was placed two weeks before the surgery into the body of patients.During the operation,the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J,20 Hz),combined with ultrasound B in the monitoring,to find the suitable incision position.It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B.According to the standard,the result of operation wound be defined compared to before operation (success:shrink more than 80％ or maximum diameter was smaller than 1 cm;improvement:shrink about 50％-79％;ordinary result:shrink about 30％-49％;failure:shrink smaller than 30％).Effective rate =(success cases + improvement cases)/total cases.We compared the differences of two groups in the time,efficacy,safety and complication of surgery.Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery,after 8-30 months following-up,total operative complication rate was [8 cases(25％)vs.1 case(3.1％)],success rate of operation in 6 month later [(20 cases (62.5％) vs.28 cases (87.5％)].Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P ＜ 0.05).However,there was no statistical difference for the two groups in the time of operation [(33.4 ± 6.7) min vs.(35.1 ± 8.6) min],single operative complication (intraoperative wounding bleeding:3 cases vs.1 case,postoperative urinary infection:3 cases vs.0 case,perinephric space effusion:2 cases vs.0 case,renal function impairment:1 case vs.0 case)(P ＞0.05).Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively.

Therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy for high malignant biliary obstructive jaundice / 中华消化内镜杂志

Objective@#To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy(EUS-HG) for patients with high malignant biliary obstructive jaundice.@*Methods@#A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group (n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge(PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed.@*Results@#(1)The success rates were 100% in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362.15±138.27 μmol/L, 56.85±28.57 μmol/L in the EUS-HG group and 356.47±130.69 μmol/L, 60.93±25.79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896.57±357.29 U/L, 146.59±48.63 U/L in the EUS-HG group and 883.65±364.32 U/L, 151.57±49.73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252.36±38.77 U/L, 60.29±31.57 U/L in the EUS-HG group and 246.26±32.57 U/L, 62.56±32.87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259.37±30.64 U/L, 62.28±26.58 U/L in the EUS-HG group and 242.37±29.52 U/L, 60.28±29.57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52.57±31.95 mg/L, 16.95±8.77 mg/L in the EUS-HG group and 53.42±35.79 mg/L, 25.13±14.77 mg/L in the PTCD group (P<0.05). (3)There was significant difference in remission rate of anorexia and abdominal distension between the two groups [80.0%(16/20) VS 52.8%(19/36), P<0.05]. There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [90.0%(18 /20)VS 91.7%(33/36), P>0.05]. (4) The incidence of total complications in the EUS-HG group (20.0%, 4/20) was significantly lower than that in the PTCD group (47.2%, 17/36, P<0.05). (5)The cost of operation in the EUS-HG group (22 685.26±2 356.16 yuan) was slightly higher than that in the PTCD group (20 529.57±4 135.63 yuan, P>0.05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days.@*Conclusion@#EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.

Establishment of pancreatic cancer organoids with endoscopic ultrasonography-guided fine-needle aspiration specimen: a prospective pilot study / 中华消化内镜杂志

Objective@#To study the feasibility of establishing human 3D pancreatic cancer organoids with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimen.@*Methods@#A total of 9 patients with suspected pancreatic masses were prospectively included in this study from June 2017 to January 2018. EUS-FNA was performed for initial diagnosis. The biopsy tissues were obtained from a COOK 22-gauge FNA needle for organoid establishment, and the growth status in vitro was observed.@*Results@#Nine specimens of pancreatic lesions obtained from EUS-FNA were enrolled. Successful establishment of organoids was achieved in 5 cases, which were all confirmed to be pancreatic cancer histopathologically. In the process of generating, the growth rate of organoids increased correspondingly. The pathological morphology of these organoids was similar to the corresponding pancreatic tissues in HE staining.@*Conclusion@#Pancreatic cancer organoids can be successfully created by means of EUS-FNA. Establishment of these organoids can potentially provide excellent models for patients with pancreatic cancer in guiding precision treatment.

Therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy for high malignant biliary obstructive jaundice / 中华消化内镜杂志

Objective To study the therapeutic value of endoscopic ultrasonography-guided hepaticogastrostomy( EUS-HG) for patients with high malignant biliary obstructive jaundice. Methods A total of 56 patients with high malignant obstructive jaundice hospitalized at the Second Affiliated Hospital of Nanjing Medical University and the Second Affiliated Hospital of Xuzhou Medical University from January 2014 to December 2017 were included in the study. There were 29 males and 27 females with median age of 72 (60-82) years. Patients were randomized into two groups according to the random number table, the EUS-HG group ( n=20) treated with EUS-HG and the percuteneous transhepatic cholangiodrainge( PTCD) group (n=36) treated with PTCD. The operative success rate, curative effect, complications and operation cost were compared between the two groups, and the median unblock period of plastic double pig tail stent was observed. Results (1) The success rates were 100％ in both groups. (2) Preoperative and one-month postoperative levels of the following were tested and compared. Levels of total bilirubin were 362. 15 ± 138. 27 μmol/L, 56. 85 ± 28. 57 μmol/L in the EUS-HG group and 356. 47 ± 130. 69 μmol/L, 60. 93 ± 25. 79 μmol/L in the PTCD group, respectively. Levels of alkaline phosphatase were 896. 57±357. 29 U/L, 146. 59±48. 63 U/L in the EUS-HG group and 883. 65 ± 364. 32 U/L, 151. 57 ± 49. 73 U/L in the PTCD group, respectively. Levels of alanine aminotransferase were 252. 36±38. 77 U/L, 60. 29±31. 57 U/L in the EUS-HG group and 246. 26 ± 32. 57 U/L, 62. 56 ± 32. 87 U/L in the PTCD group. Levels of aspartate aminotransferase were 259. 37 ± 30. 64 U/L, 62. 28 ± 26. 58 U/L in the EUS-HG group and 242. 37 ± 29. 52 U/L, 60. 28±29. 57 U/L in the PTCD group, and there was no significant difference between the two groups (P>0. 05). CRP levels were 52. 57±31. 95 mg/L, 16. 95±8. 77 mg/L in the EUS-HG group and 53. 42± 35. 79 mg/L, 25. 13 ± 14. 77 mg/L in the PTCD group ( P<0. 05) . ( 3 ) There was significant difference in remission rate of anorexia and abdominal distension between the two groups [ 80. 0％( 16/20) VS 52. 8％( 19/36) , P<0. 05] . There was no significant difference in symptom relief of jaundice, pruritus or abdominal pain between the two groups [ 90. 0％( 18 /20) VS 91. 7％( 33/36) ,P>0. 05] . ( 4) The incidence of total complications in the EUS-HG group ( 20. 0％,4/20) was significantly lower than that in the PTCD group (47. 2％,17/36, P<0. 05). (5)The cost of operation in the EUS-HG group (22685. 26±2356. 16 yuan) was slightly higher than that in the PTCD group (20529. 57±4135. 63 yuan, P>0. 05). (6) The median unblock period of double pig tail plastic stents in EUS-HG group patients was 102 days. Conclusion EUS-HG is a safe and effective method for the treatment of high malignant biliary obstructive jaundice. It can be used as the first choice for treatment after failure of conventional ERCP.

Establishment of pancreatic cancer organoids with endoscopic ultrasonography-guided fine-needle aspiration specimen:a prospective pilot study / 中华消化内镜杂志

Objective To study the feasibility of establishing human 3D pancreatic cancer organoids with endoscopic ultrasound-guided fine-needle aspiration ( EUS-FNA ) specimen. Methods A total of 9 patients with suspected pancreatic masses were prospectively included in this study from June 2017 to January 2018. EUS-FNA was performed for initial diagnosis. The biopsy tissues were obtained from a COOK 22-gauge FNA needle for organoid establishment, and the growth status in vitro was observed. Results Nine specimens of pancreatic lesions obtained from EUS-FNA were enrolled. Successful establishment of organoids was achieved in 5 cases, which were all confirmed to be pancreatic cancer histopathologically. In the process of generating, the growth rate of organoids increased correspondingly. The pathological morphology of these organoids was similar to the corresponding pancreatic tissues in HE staining. Conclusion Pancreatic cancer organoids can be successfully created by means of EUS-FNA. Establishment of these organoids can potentially provide excellent models for patients with pancreatic cancer in guiding precision treatment.

Factors influencing the diagnostic positivity of endoscopic ultrasound guided fine needle aspiration for small pancreatic cancer and the occurrence of postoperative advent events / 中华胰腺病杂志

Objective To evaluate the factors influencing the diagnostic positivity of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) for small size pancreatic carcinoma (SSPC) and the occurrence of the adverse events after the aspiration.Methods 51 patients with SSPC ≤2 cm in diameter treated in Changhai hospital from February 2008 to January 2015 were retrospectively studied.The gender,age,tumor diameter,location,the dilation of pancreatic ducts,the number of aspirations and the needle passages,the usage of negative pressure during aspiration,the pathological examination of the specimens and postoperative adverse events and the like were collected.Univariate analysis and logistic regression analyze were applied to determine the factors influencing the diagnostic positivity of EUS-FNA for SSPC and postoperative adverse events.Results Among the 51 patients,positive cytology outcome were identified in 30 patients,which were negative in 21 patients.Univariate analysis identified that there were no statistical differences on the age,sex,dilated pancreatic duct,the number of aspirations and needle passages between two groups (P value ＞0.05).The diagnostic positivity using the 10ml minor negative pressure was obviously higher than that using 20 ml negative pressure,and the differences were statistically significant (P =0.028).Multivariate logistic regression identified 10ml minor negative pressure was easier to obtain positive cytology outcome (Odds Ratio 0.2810,95％ CI 0.093-0.851).In addition,the number of passages in patients with postoperative adverse events was greater than those without postoperative adverse events (30 vs 20),and the difference was statistically significant (P =0.034).Conclusions The introduction of 10 ml negative pressure could improve the diagnostic positivity of EUS-FNA for SSPC,and the increased number of needle passages may increase the occurrence rate of postoperative adverse events.

Risks of transesophageal endoscopic ultrasonography-guided biliary drainage

SUMMARY OF EVENT: Pneumoderma, mediastinal emphysema, and bilateral pneumothorax were developed in the patient who had undergone transesophageal endoscopic ultrasonography-guided rendezvous technique. Chest drainage was performed immediately. TEACHING POINT: Transesophageal approach carries the potential risks of severe complications such as mediastinal emphysema, mediastinitis, and pneumothorax. To prevent puncturing through the esophagus, clipping the esophagogastric junction using a forward-viewing scope before procedure is very useful. In cases of inadvertent transesophageal puncture, devices other than the needle should not be passed through the site.

Revision of loop colostomy under regional anaesthesia and sedation

Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.

Diagnosis of Zygomaticus Muscle Paralysis Using Needle Electromyography With Ultrasonography

A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

Gastric Schwannoma Diagnosed by Endoscopic Ultrasonography-Guided Trucut Biopsy

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.

Punção aspirativa com agulha fina guiada pelo ultrassom em nódulos de tireoide: avaliação do número ideal de punções / Ultrasound-guided fine-needle aspiration of thyroid nodules: assessment of the ideal number of punctures

OBJETIVO: Determinar o número de punções aspirativas necessárias para o diagnóstico citológico de nódulos tireoidianos com segurança. MATERIAIS E MÉTODOS: Estudo transversal com enfoque diagnóstico. A amostra foi composta por 94 pacientes. RESULTADOS: A idade média dos participantes do estudo foi de 52 anos (desvio-padrão = 13,7), dos quais 90,4% eram do sexo feminino. Considerando cada punção como um evento independente, a primeira punção apresentou resultado conclusivo em 78,7% dos casos, a segunda punção mostrou resultado conclusivo em 81,6% dos casos e a terceira punção mostrou resultado conclusivo em 78,1% dos casos. Considerando-se a chance de se obter o diagnóstico conclusivo a cada nova punção, tem-se que com duas punções obteve-se 89,5% de resultados conclusivos e com três punções, 90,6% apresentaram pelo menos um resultado conclusivo. Analisando-se todos os resultados obtidos, identificaram-se 70,2% de nódulos benignos, 5,3% de nódulos malignos, 17,0% de resultados indeterminados e 7,4% de amostras não diagnósticas. CONCLUSÃO: Duas punções permitiram a realização do diagnóstico de nódulos de tireoide em 89,5% dos casos, na amostra estudada, sugerindo que não há necessidade de múltiplas punções para se obter o diagnóstico de nódulos tireoidianos com segurança.

OBJECTIVE: To determine the number of punctures in fine-needle aspiration biopsies required for a safe cytological analysis of thyroid nodules. MATERIALS AND METHODS: Cross-sectional study with focus on diagnosis. The study population included 94 patients. RESULTS: The mean age of the patients participating in the study was 52 years (standard-deviation = 13.7) and 90.4% of them were women. Considering each puncture as an independent event, the first puncture has showed conclusive results in 78.7% of cases, the second, in 81.6%, and the third, in 71.8% of cases. With a view to the increasing chance of a conclusive diagnosis at each new puncture, two punctures have showed conclusive results in 89.5% of cases, and three punctures, in 90.6% of cases with at least one conclusive result. CONCLUSION: Two punctures in fine-needle aspiration biopsies of thyroid nodules have lead to diagnosis in 89.5% of cases in the study sample, suggesting that there is no need for multiple punctures to safely obtain the diagnosis of thyroid nodules.

Simultaneous Duodenal Metal Stent Placement and EUS-Guided Choledochoduodenostomy for Unresectable Pancreatic Cancer

Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both biliary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was reported to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simultaneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was performed. The second case was a 63-year-old man who previously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in patients with pancreatic cancer with both duodenal and biliary malignant obstruction.

Efficacy of Ultrasonography Guided Stellate Ganglion Blockade in the Stroke Patients with Complex Regional Pain Syndrome

OBJECTIVE: To compare the efficacy of ultrasonography guided stellate ganglion block (US-SGB) with that of blind SGB in management of the stroke patients with complex regional pain syndrome (CRPS) type 1. METHOD: Forty-two patients with post-stroke CRPS were randomly assigned to either US-guided SGB (22 patients) or blind SGB group (20 patients). The mean age of US-guided SGB and blind SGB groups was 61.3+/-5.6 years and 59.1+/-4.5 years. We performed two blockades at 7-day intervals on the affected side of patients with CRPS. Pain intensity, using a visual analog score (VAS), score of CRPS clinical severity, and the amounts of affected hand swelling with a hand volumeter were assessed before, 2 weeks and 4 weeks after treatment. RESULTS: In both groups, VAS and the amount of hand swelling were significantly decreased after 2 weeks and after 4 weeks. Between two groups, VAS difference of US-guided SGB group and that of blind SGB group were 2.61+/-1.09, 1.88+/-0.62 at 2 weeks and 3.67+/-1.03, 3.13+/-0.62 at 4 weeks, respectively. US-guided SGB group showed more significant improvement in mean change of VAS compared to the blind SGB group (p-value<0.05). CONCLUSION: Both US-guided SGB and blind SGB techniques were effective in relieving pain in subacute stroke patients with CRPS. US-guided SGB was better in pain relief but has no advantages in reduction of hand swelling in this study.

EUS-Guided Biliary Drainage

Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fine-needle aspiration (EUS-FNA) using a curved linear-array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD.

Recent advances in non-vascular interventional diagnosis and treatment of thyroid nodules / 介入放射学杂志

Non-vascular interventional diagnostic methods of thyroid nodules include ultrasonography-guided fine-needle aspiration cytology(USgFNAC)and ultrasonography-guided core-needle biopsy(USgCNB).USgFNAC is a practical method used to select and to guide the treatment of various thyroid nodules, however, it is difficult to make a differentiation between benign and malignant lesions simply to rely on the findings of a small number of cells.USgCNB has the advantage of being able to obtain satisfactory specimen enough for making a histological diagnosis, although this procedure is contraindicated in some patients.Non-vascular interventional treatments of thyroid nodules include percutaneous ethanol injection(PEI) and ultrasonography-guided interstitial laser photocoagulation(USgILP).Both PEI and USgILP have fine effect on the benign thyroid nodules.Compared with PEI, laser-induced necrosis can be well controlled, thus, the adverse reactions, such as the formation of fibrosis adjacent to the nodule, vocal cord paralysis, etc.can be avoided.Non-vascular interventional treatments may cause some untoward effects.For the diagnosis and treatment of thyroid nodules, the non-vascular interventional procedure is simple, safe, effective and economic with less complications, therefore, this technique is worth being popularized in clinical practice.