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Radiol. bras ; 54(4): 254-260, July-Aug. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1287746


Abstract The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases-Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature-for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.

Resumo O objetivo deste estudo foi comparar a simulação de realidade virtual com outros métodos de aprendizagem na radiologia intervencionista. Foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, Medline (PubMed), Embase, Trip Medical, Education Resources Information Center, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online, e Latin-American and Caribbean Health Sciences Literature para estudos comparando a realidade virtual com outros métodos de aprendizagem na radiologia intervencionista. Esta revisão sistemática foi realizada de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses e a Best Evidence Medical Education (BEME) Collaboration. Os estudos elegíveis foram avaliados usando o questionário de Buckley no BEME Guide nº 11 e o modelo de Kirkpatrick. Cinco ensaios clínicos randomizados foram incluídos nesta revisão, após a aplicação de todos os critérios de elegibilidade e qualidade. O nível de evidência educacional encontrado entre os artigos variou, sendo três estudos nível 2B e os demais nível 4B de acordo com o modelo de Kirkpatrick. Não houve divergência entre os estudos de que a realidade virtual agrega conceitos e é benéfica para o ensino da radiologia intervencionista. O uso da realidade virtual para aquisição de conhecimento e aprendizagem em radiologia intervencionista tem se mostrado eficaz, mas ainda faltam estudos que avaliem e estruturem a utilização dessa tecnologia em relação aos inúmeros procedimentos existentes no campo de atuação.

Radiol. bras ; 54(3): 165-170, May-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1250652


Abstract Objective: To evaluate variables affecting the need for analgesia after ultrasound-guided percutaneous liver biopsy performed on an outpatient basis. Materials and Methods: This was a retrospective analysis of 1,042 liver biopsies performed between 2012 and 2018. The data collected included the age and sex of the patient, as well as self-reported pain in the recovery room, the pain treatment used, the indication for the biopsy, and the lobe punctured. As per the protocol of our institution, physicians would re-evaluate patients with mild pain (1-3 on a visual analog scale), prescribe analgesics for those with moderate pain (4-6 on the visual analog scale), and prescribe opioids for those with severe pain (7-10 on the visual analog scale). Results: The main indications for biopsy were related to diffuse disease (in 89.9%), including the follow-up of hepatitis C (in 47.0%) and suspicion of nonalcoholic steatohepatitis (in 38.0%). Pain requiring analgesia occurred in 8.0% of procedures. Of the 485 female patients, 51 (10.5%) needed analgesia, compared with 33 (5.9%) of the 557 male patients (p < 0.05). The need for analgesia did not differ in relation to patient age, the lobe punctured, or the indication for biopsy (nodular or diffuse disease). The analgesic most commonly used was dipyrone (in 75.9%), followed by paracetamol alone (16.4%) and their combination with opioids (7.6%). Conclusion: Ultrasound-guided percutaneous liver biopsy is safe and well tolerated. Postprocedural pain does not correlate with the lobe punctured, patient age, or the indication for biopsy and appears to affect more women than men.

Resumo Objetivo: Avaliar variáveis que afetam a necessidade de analgesia após biópsia hepática guiada por ultrassonografia. Materiais e Métodos: Análise retrospectiva de 1042 biópsias hepáticas realizadas entre 2012 e 2018. Os dados coletados incluíram dor detectada na sala de recuperação, analgesia utilizada, indicação, lobo puncionado, idade e sexo do paciente. O protocolo institucional indicava orientações e reavaliação para dor leve (1-3, segundo a escala visual analógica), analgésicos simples para dor moderada (4-6, segundo a escala visual analógica) e opioides para dor importante (7-10, segundo a escala visual analógica). Resultados: As indicações foram principalmente doença difusa (89,9%), particularmente no seguimento de hepatite C (47,0%) e suspeita de esteato-hepatite não alcoólica (38,0%). Dor com necessidade de analgesia ocorreu em 8,0% dos procedimentos. Mulheres demandaram analgesia em 10,5% das vezes e homens demandaram em 5,9% (p < 0,05). Não houve diferença estatisticamente significante na necessidade de analgesia em relação a idade, lobo hepático puncionado ou indicação por doença nodular versus difusa. O analgésico mais utilizado foi dipirona (75,9%), seguido de paracetamol (16,4%) e associação com opioides (7,6%). Conclusão: Este é um procedimento seguro e bem tolerado. Dor pós-procedimento não se correlaciona com lateralidade da biópsia, idade ou doença nodular versus difusa e parece afetar mais mulheres que homens.

Radiol. bras ; 54(1): 43-48, Jan.-Feb. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1155227


Abstract Plastic and metal biliary stents can fail to function properly, such failure being due to a positioning error or to the migration, occlusion, or fracture of the stent. An obstructed biliary stent can act as a nidus, causing complications such as recurrent persistent cholangitis. It can also cause vascular complications (such as bleeding and the formation of pseudoaneurysms), perforate the liver capsule (causing biloma or abscess), or, in rare cases, cause intestinal obstruction or perforation. In this pictorial essay, we demonstrate various interventional radiology techniques for the treatment of biliary stent dysfunction in patients with obstructive biliary disease.

Resumo Disfunção das próteses biliares plásticas ou metálicas pode ser causada por migração, oclusão, mau posicionamento ou fratura. Uma prótese disfuncional na via biliar pode atuar como nidus causando complicações como colangite recorrente e persistente. Pode ainda causar complicações vasculares como formação de pseudoaneurismas ou sangramento, e além disso, perfurar a cápsula hepática causando biloma ou abscesso, ou raramente, causar obstrução intestinal e/ou perfuração. Demonstramos diferentes técnicas da radiologia intervencionista no tratamento de endopróteses biliares plásticas e metálicas disfuncionais, em pacientes com doença biliar obstrutiva.

Radiol. bras ; 54(1): 15-20, Jan.-Feb. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1155233


Abstract Objective: To investigate long-term results of biliary biopsy performed with transluminal forceps in the setting of metastatic biliary involvement. Materials and Methods: Between September 2014 and June 2019, 25 patients-18 males (72%)-with a mean age of 65 ± 15 years, underwent 26 biliary biopsy procedures with a dedicated forceps system. All patients presented with obstructive jaundice that was suspected of being malignant and underwent pre-procedural magnetic resonance cholangiopancreatography. The biopsies were performed during percutaneous placement of an internal-external biliary drainage catheter, under fluoroscopic guidance. Results: The technical success rate was 96% (corresponding to 25 of the 26 procedures). The histological diagnosis was inflammatory biliary stricture in five cases, pancreatic adenocarcinoma in six, liver metastases from colorectal cancer in eight, and hepatocellular carcinoma in three, the biliary mucosa being categorized as normal in three cases. In one case, the sample was considered insufficient and the procedure was successfully repeated, after which a diagnosis of pancreatic adenocarcinoma was made. Over a follow-up period of 6-48 months, there were five false-negative results: two findings of inflammatory biliary stricture were later identified as liver metastases from breast and gastric cancer, respectively; and all three patients in which the biliary mucosa was categorized as normal were subsequently diagnosed with metastatic hilar lymph nodes. The procedure was found to have a sensitivity of 77%, a specificity of 100%, and an overall accuracy of 80%. The complication rate was 11.5% (mild, transient hemobilia occurring in three cases). Conclusion: Percutaneous transluminal forceps biopsy is a safe, effective, minimally invasive procedure for histological characterization in patients presenting with obstructive jaundice due to a non-primary biliary tumor.

Resumo Objetivo: Investigar os resultados a longo prazo da biópsia endobiliar realizada com um pinça tipo fórceps transluminal no diagnóstico de neoplasia biliar metastática. Materiais e Métodos: Entre setembro de 2014 e junho de 2019, 25 pacientes - 18 homens (72%), com idade média de 65 ± 15 anos) - foram submetidos a 26 procedimentos de biópsia endobiliar com um conjunto dedicado. Todos os pacientes apresentaram icterícia obstrutiva, suspeita de malignidade e colangiorressonância pré-procedimento. Os procedimentos foram realizados durante o posicionamento percutâneo da drenagem biliar interna-externa, sob orientação fluoroscópica. Resultados: A taxa de sucesso técnico foi de 96% (25 casos), com diagnóstico histológico de estenose benigna (inflamatória) em cinco casos, adenocarcinoma pancreático em seis casos, metástases hepáticas retais no cólon em oito casos, carcinoma hepatocelular em três casos e de mucosa biliar normal em três casos. Em um caso a amostra foi considerada insuficiente pelo patologista (um adenocarcinoma pancreático) e o procedimento foi repetido com sucesso. O seguimento de 6 a 48 meses mostrou cinco casos falso-negativos, em particular dois casos de metástases hepáticas retais sem cólon (câncer de mama e gástrico) e três linfonodos hilares metastáticos. A análise estatística revelou sensibilidade de 77%, especificidade de 100% e precisão geral de 80%. A taxa de complicações foi de 11,5% (três casos com hemobilia transitória). Conclusão: A biópsia biliar transluminal realizada com pinça tipo fórceps é um procedimento minimamente invasivo, seguro e eficaz para caracterização histológica em pacientes que apresentam icterícia obstrutiva no diagnóstico de neoplasia biliar metastática.

Article in Chinese | WPRIM | ID: wpr-910618


Objective:To study the use of trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula.Methods:The clinical data of 12 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, pancreatic trauma or pancreatic surgery who were treated at the First Medical Center of Chinese PLA General Hospital from August 2018 to December 2020 were retrospectively analyzed. There were 10 males and 2 females, aged 30 to 65 years, median 43.5 years. These patients underwent trans gastric sinus stent placement and drainage, and were followed-up to study persistence of pancreatic fistula, new pancreatic fluid accumulation, complications and death.Results:In this study, there were 9 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, 2 patients after pancreatic trauma, and 1 patient after pancreatic surgery. The median operation time was 47 min (range 38-54 min). The technical success rate was 100.0% (12/12). The median follow-up was 22.5 months (range 2-29 months). Seven days after stenting, the percutaneous drainage tubes (urinary catheters) of all the patients were removed. One patient (8.3%) developed recurrence of pancreatic fistula 17 days after treatment. The same procedure of placing another stent was done and the patient recovered. Six months after treatment, 2 patients (16.7%) lost their stents, and 1 patient developed a pseudocyst (recurrence of pancreatic fistula). The maximum diameter of this pseudocyst increased gradually to 7cm after 9 months. A double pigtail drainage tube was placed under endoscopy in this patient, and the patients recovered. All the other patients did not develop recurrence of pancreatic fistula or pseudocyst. During the follow-up period, no patient developed any new complications including pancreatic fluid accumulation, fever, bleeding, infection and organ dysfunction, and no patients died.Conclusion:It was safe and efficacious to use trans gastric sinus stent placement for treatment of persistent external pancreatic fistula. However, the long-term outcomes require further studies.

Journal of Clinical Hepatology ; (12): 1392-1397, 2021.
Article in Chinese | WPRIM | ID: wpr-877330


ObjectiveTo investigate the effectiveness and safety of nanoknife ablation guided by real-time virtual sonography (RVS) in the treatment of locally advanced pancreatic cancer (LAPC). MethodsA retrospective analysis was performed for the clinical data of 27 patients with LAPC who attended The Fifth Affiliated Hospital of Zhengzhou University from April 2018 to October 2019, and according to the treatment method, the patients were divided into combination group (12 patients treated with IRE combined with chemotherapy) and control group (15 patients treated with chemotherapy alone). The chemotherapy regimen was gemcitabine combined with tegafur, gimeracil and oteracil potassium for both groups. Adverse reactions and complications were observed for the combination group during the perioperative period, and the two groups were compared in terms of the changes in myocardial enzymes, blood amylase, and carbohydrate antigen 19-9 (CA19-9) before treatment and at different time points after treatment, as well as remission rate (RR) and disease control rate (DCR) at 3 months after treatment and survival status during follow-up. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups, and the Wilcoxon test was used for comparison within each group; the Fisher’s exact test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to analyze the survival status during follow-up. ResultsIn the combination group, there were 12 cases of adverse reactions and mild complications during the perioperative period, i.e., 9 Clavien-Dindo grade I cases and 3 grade II cases. All patients in the combination group experienced a transient increase in myocardial enzymes, which returned to normal within 7 days, and there were no significant changes in creatine kinase and lactate dehydrogenase on day 7 after treatment (P>0.05); 9 patients had a significant increase in blood amylase on day 1 after surgery, which significantly decreased on day 7 after surgery and basically returned to normal on day 14 after surgery, and there was no significant change in blood amylase on days 7、14, and 1 month after surgery (P>0.05). Before treatment, the level of CA19-9 was higher than the normal value in both groups, and the combination group had a significant reduction in CA19-9 at 1, 2, and 3 months after treatment (all P<005); in the control group, the level of CA19-9 firstly decreased for a short time and then increased, while there was no significant change in CA19-9 at 1, 2, and 3 months after treatment (all P>0.05). At 3 months after treatment, the combination group had significantly higher RR and DCR than the control group (RR: 75.0% vs 26.7%, P=0.021; DCR: 91.6% vs 53.3%, P=0043). During the median follow-up time of 13 months, compared with the control group, the combination group had significantly higher median progression-free survival time (10 months vs 5 months, P=0.014) and median overall survival time (18 months vs 10 months, P=0.034). ConclusionRVS-guided percutaneous nanoknife ablation has marked clinical effect and high safety in the treatment of LAPC and can be used as a new treatment option for patients who refuse or cannot tolerate laparotomy for ablation therapy.

Radiol. bras ; 53(6): 390-396, Nov.-Dec. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1136116


Abstract Objective: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Resumo Objetivo: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. Materiais e Métodos: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. Resultados: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. Conclusão: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.

Radiol. bras ; 53(3): 141-147, May-June 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1136066


Abstract Objective: To assess trends and predictors of the glomerular filtration rate (GFR) after renal mass cryoablation in patients with and without history of renal impairment. Materials and Methods: This was a retrospective study of 39 patients who underwent computed tomography-guided percutaneous cryoablation of a renal mass, divided into two groups: those with prior renal impairment (PRI+); and those without prior renal impairment (PRI−). The GFR trend and the chronic kidney disease stage were evaluated at baseline, as well as at 1, 6, and 12 months after cryoablation. Predictors of GFR at 1 and 6 months were modeled with linear regression. Results: In both groups, the mean GFR at 1 month and 6 months was significantly lower than at baseline (p < 0.001 and p = 0.01, respectively). Although the GFR was lower across all time points in the PRI+ group (−26.1; p < 0.001), the overall trend was not statistically different from that observed in the PRI− group (p = 0.89). Univariate analysis showed that the decline in GFR at 1 and 6 months correlated with the baseline GFR (0.77 and 0.63; p < 0.001 and p = 0.03, respectively) and with the size of the ablation zone (−7.6 and −12.84, respectively; p = 0.03 for both). However, in the multivariate model, baseline GFR was predictive only of GFR at 1 month (p < 0.001). Conclusion: The trend in GFR decline after cryoablation is similar for patients with and without a history of renal impairment. Baseline GFR predicts the mean GFR in the early post-cryoablation period.

Resumo Objetivo: Medir as tendências iniciais da função renal pela taxa de filtração glomerular (TFG) em pacientes com e sem comprometimento renal prévio após crioablação renal. Materiais e Métodos: Este é um estudo retrospectivo de 39 pacientes submetidos a crioablação percutânea guiada por tomografia computadorizada de massa renal. Os pacientes foram divididos em dois grupos: com comprometimento renal prévio (CRP+) e sem comprometimento renal prévio (CRP-). As tendências da TFG foram avaliadas nos tempos 0, 1, 6 e 12 meses com o estadiamento de doença renal crônica. Preditores da TFG em 1 e 6 meses foram modelados usando regressão linear. Resultados: Em ambos os grupos houve declínio da TFG média após 1 e 6 meses (p < 0,001 e p = 0,01, respectivamente). Apesar de o grupo CRP+ demonstrar média menor da TFG em cada um dos tempos (−26,1; p < 0,001), a tendência de forma geral não foi estatisticamente diferente do grupo CRP- (p = 0,89). Análise univariada mostrou correlação da TFG no tempo 0 (0,77 e 0,63; p < 0,001 e p = 0,03, respectivamente) e tamanho da ablação (−7,6 e −12,84; p = 0,03), com declínio em 1 e 6 meses. Porém, no modelo multivariado, apenas a TFG no tempo 0 foi preditiva da TFG em 1 mês (p < 0,001). Conclusão: A curva de tendência de declínio da TFG após crioablação foi similar entre os pacientes dos grupos CRP+ e CRP-, sem mudanças no estadiamento de função renal. A TFG no tempo 0 foi preditiva da TFG média no período de crioablação inicial.

Radiol. bras ; 53(3): 155-160, May-June 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1136069


Abstract Objective: To analyze the results obtained with a modified antegrade double J catheter insertion (JJ stenting) technique in patients with urinary tract obstruction due to malignancy. Materials and Methods: This was a retrospective analysis of data collected from patients undergoing antegrade JJ stenting for malignant ureteral obstruction in the interventional radiology department of our institution between March 1, 2017 and May 31, 2019. Results: Antegrade JJ stenting was performed in 32 patients (20 women and 12 men). The mean age was 66.2 years among the females and 61.5 years among the males. A total of 53 antegrade JJ stenting procedures were performed. The procedure was successful in 50 cases and failed in 3 (due to migration of the double J catheter in 2 and due to technical failure in 1). Complications occurred in 3 patients (low back pain, in 1, subcapsular hematoma, in 1, and pyelonephritis, in 1). The procedure time ranged from 14 min to 55 min. Conclusion: In patients with ureteral obstruction due to malignancy, antegrade JJ stenting is safe and effective. The technique selected in our study is easily reproduced and can be performed by a trained professional.

Artigos Objetivo: Análise retrospectiva dos resultados de uma técnica modificada de inserção anterógrada de cateter duplo J em pacientes com obstrução do trato urinário por causas oncológicas. Materiais e Métodos: Coleta e análise retrospectiva de dados de pacientes submetidos a inserção anterógrada de cateter duplo J por obstruções ureterais neoplásicas no departamento de radiologia intervencionista da instituição, entre 1º de março de 2017 e 31 de maio de 2019. Resultados: No total, 32 pacientes foram submetidos a inserção anterógrada de cateter duplo J, sendo 20 mulheres e 12 homens. A média de idade foi de 66,2 anos para o sexo feminino e 61,5 anos para o sexo masculino. Cinquenta e três inserções anterógradas de cateter duplo J foram realizadas. O número de procedimentos bem sucedidos foi 50 e houve 3 falhas (2 migrações do cateter duplo J e 1 insucesso técnico). As complicações ocorreram em 3 pacientes (1 dor lombar, 1 hematoma subcapsular e 1 pielonefrite). O tempo de procedimento variou entre 14 e 55 minutos. Conclusão: A inserção anterógrada de cateter duplo J em pacientes com obstrução ureteral por causas malignas é eficaz e segura. A técnica descrita no nosso estudo é de fácil reprodução, podendo ser executada por um profissional capacitado.

Article in Chinese | WPRIM | ID: wpr-799766


Causes of cancer pain are multifactorial and complex.It is an important challenge for the clinicians on how to control cancer pain effectively.Opioids remain the most effective analgesics used in the treatment of cancer pain.But the adverse effects and potential risks associated with chronic use have been paid attention to in clinical work.It is related to molecular discoveries of opioid action that lead to the development of new opioid analgesic on potential new targets in treating cancer pain.Meanwhile, non-pharmacological treatments such as neuromodulation and minimally invasive interventional techniques play an important role in management of cancer pain.It is summarized in this article about the recent advances in biology and management of cancer pain.

Chinese Journal of Radiology ; (12): 53-56, 2020.
Article in Chinese | WPRIM | ID: wpr-798792


Objective@#To explore the therapeutic value of interventional methods for hemorrhage caused by mandibular arteriovenous malformations.@*Methods@#The clinical data of 7 patients (3 males and 4 females) with mandibular arteriovenous malformations treated by interventional therapy from January 2012 to January 2018 in the First Affiliated Hospital, Zhengzhou University were retrospectively analyzed. Of all patients, 4 patients suffered from sudden massive hemorrhage and 3 patients suffered from spontaneous repeated bleeding. The age ranged from 8.0 to 13.0 (10.6±1.7) years. Of the 7 patients, 3 underwent interventional embolization via arteries and veins, and 4 underwent embolization only via arteries. The embolic materials were polyvinyl alcohol granules and coils. The follow-up period was 9—18 months and the curative effect was observed.@*Results@#Among the 7 patients, 4 cases of acute massive hemorrhage were effectively controlled after interventional operation, 3 cases of chronic bleeding disappeared after interventional operation. No recurrence of bleeding occurred during the follow-up period, only 1 patient presented with oral infection and gingival swelling and hyperplasia. The symptoms were effectively controlled after anti-infection and debridement. No severe complications occurred in all patients.@*Conclusion@#Interventional therapy for ateriovenous malformation with hemorrhage is effective, safe and feasible, which is worthy of clinical application.

Chinese Journal of Radiology ; (12): 42-47, 2020.
Article in Chinese | WPRIM | ID: wpr-798790


Objective@#To explore the relationship between cerebral hemorrhagic transformation (HT) and angiographic early venous filling (EVF) following mechanical thrombectomy for acute ischemic stroke.@*Methods@#A retrospective imaging analysis was performed in the consecutive patients treated from January 2015 to November 2018 for acute anterior circulation large vessel occlusion using mechanical thrombectomy on the Affiliated Hospital of Yangzhou University. The demography, vascular risk factors and other clinical data of the patients were also collected. According to the experimental study of European Cooperative Acute Stroke Study Ⅱ (ECASS Ⅱ), the modified classification of HT after mechanical thrombectomy was divided into HT negative, HT-Ⅰ type and HT-Ⅱ type. The differences in EVF, clinical and demographic characteristics were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for HT and clinical outcome. Diagnostic test characteristics of EVF for HT-Ⅱ type were determined using a receiver operating characteristic curve (ROC) analysis.@*Results@#A total of 98 patients with acute ischemic stroke who received mechanical thrombectomy were enrolled, including HT negative in 48 cases (49.0%, 48/98), HT-Ⅰ in 40 cases (40.8%, 40/98) and HT-Ⅱ in 10 cases (10.2%, 10/98). Significant differences were noted in age, and incidence of atrial fibrillation, EVF and poor outcomes among three groups (P<0.05). Multivariate logistic regression analysis showed that EVF [odds ratio (OR) 5.960, 95%CI 1.750-8.960, P=0.001] and atrial fibrillation (OR 3.485, 95%CI 1.962-18.986, P=0.028) were risk factors for the occurrence of HT-Ⅱ after mechanical thrombectomy. No risk factor for HT-Ⅰ was noted. Baseline National Institute of Health Stroke Scale (NIHSS) score (OR 1.162, 95%CI 1.021-1.345, P=0.038), EVF (OR 5.358, 95%CI 1.665-13.653, P=0.006) and HT-Ⅱ (OR 1.326, 95%CI 1.226-2.038, P=0.032) were independent risk factors for poor outcomes. And the sensitivity and specificity of EVF in prediction for HT-Ⅱ were 80.0% and 86.4% respectively, with the area under the ROC curve of 0.832.@*Conclusion@#Presence of EVF after mechanical thrombectomy may be the predictor for HT-Ⅱ, which indicates the poor clinical outcomes for acute ischemic stroke patients.

Article in Chinese | WPRIM | ID: wpr-861928


Objective: To observe the safety and efficacy of coaxial puncture 125I seed implantation in treatment of locally advanced pancreatic head and neck cancer. Methods: Totally 21 patients with locally advanced pancreatic cancer were retrospectively analyzed. Preoperative planning was performed with treatment planning system (TPS) and fan-shaped distributed system simulated in the same plane. 125I seeds were implanted using coaxial puncture technology, and was operative plan real-timely adjusted during operation. After operation, CT images were imported into TPS for dose verification. Abdominal CT scanning were performed 2, 4 and 6 months after operation to evaluate the treatment efficiency and local control rate, and intraoperative and postoperative complications were counted. Results: The operations were successfully completed in all patients. The effective rate of treatment 2, 4 and 6 months after operation was 38.10% (8/21), 47.62% (10/21) and 52.38% (11/21),and the local control rate was 95.24% (20/21), 80.95% (17/21) and 80.95% (17/21), respectively. Intraoperative complications included 2 cases of local abdominal hemorrhage, 2 cases of subcutaneous soft tissue hematoma and wrong puncture of pancreatic duct in 1 case. Post operation, fever and appetite loss occurred in 10 and 3 cases, respectively. Among 21 patients, grade 0 and grade acute radiation enteritis were observed in 18 and 3 cases, respectively. Conclusion: Coaxial puncture 125I particle implantation technology is safe and effective for treatment of locally advanced pancreatic head and neck cancer.

Article in Chinese | WPRIM | ID: wpr-861901


Objective: To observe the effect of DSA-guided foam sclerotherapy for lower extremity varicose veins and its influence on patients' quality of life. Methods: Totally 573 patients (744 limbs) with lower extremity varicosities were treated with DSA-guided foam sclerotherapy and were followed up for 4 years. The health survey short form 12 (SF-12) and venous clinical severity score (VCSS) were counted before treatment and 1, 2, 3 and 4 years after treatment. The expectation for efficacy and treatment satisfaction were collected through filling questionnaires for the lower extremity symptom improvement 4 years after treatment. Results: All the limbs were successfully treated, the average usage of the foam was (21.62±10.83) ml/limb, and no severe side effects such as deep venous thrombosis or pulmonary embolism happened during or after procedures. Both physical component summary (PCS) score and mental component summary (MCS) score in SF-12 scale increased 1, 2, 3 and 4 years after treatment compared with that before treatment (all P<0.05), while VCSS decreased compared with that before treatment (all P<0.01). Upon the time of 4-year follow-up, the proportions of patients' expectations for improvement of appearance, pain, itching, swelling and heaviness of the affected limbs exceeded expectations + reached expectations were 100% (91/91), 100% (36/36), 93.55% (29/31), 88.46% (23/26) and 91.38% (53/58), respectively. The patients' overall satisfaction on the treatment was 100% (72/72). Conclusion: The medium- and long-term efficacy of DSA-guided foam sclerotherapy for lower extremity varicose veins were good, and the quality of life was improved.

Article in English | WPRIM | ID: wpr-876544


@#Herein is a case report of a 70 years old man with a tenacious benign prostatic hyperplasia (BPH). The aim of this manuscript is to briefly discuss the usage and advantage of EmbozeneTM Microsphere in embolization of the prostate arteries in the treatment of failed medical and surgical therapy for BPH.

Radiol. bras ; 52(5): 305-311, Sept.-Oct. 2019. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1040950


Abstract Objective: To compare two percutaneous techniques used in the treatment of malignant obstructive uropathy-antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy-in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system. Materials and Methods: In this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures. Results: The sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20). Conclusion: In the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.

Resumo Objetivo: Comparar a relação custo-efetividade de duas técnicas percutâneas utilizadas no tratamento da uropatia obstrutiva maligna - inserção anterógrada de cateter duplo J (JJ) versus nefrostomia percutânea - sob a perspectiva do sistema de saúde pública brasileira. Materiais e Métodos: Nesta análise de custo-efetividade por modelo analítico de decisão, os custos de material foram calculados a partir dos preços de fábrica de 2017 listados pela Câmara Brasileira de Regulamentação de Medicamentos (para medicamentos) e publicados na Revista Simpro (para dispositivos médicos). Custos relacionados ao procedimento e taxas de sucesso técnico e clínico foram avaliados. Essas medidas foram então usadas como insumos para uma análise de custo-efetividade comparando os dois procedimentos. Resultados: A amostra foi composta de 41 pacientes, dos quais 16 foram submetidos a 26 procedimentos de inserção anterógrada de JJ e 10 foram submetidos a 15 nefrostomias percutâneas. Registros de pacientes, relatórios de radiologia e relatórios de despesas do serviço de radiologia intervencionista do hospital onde o estudo foi conduzido foram analisados retrospectivamente. Não houve complicações significativas: um paciente apresentou lombalgia e um apresentou hematoma retroperitonial transitório. O tempo médio de procedimento foi 24 minutos e o sucesso clínico (melhora da creatinina sérica e resolução da hidronefrose) foi alcançado em 97,5% dos casos. O custo médio da inserção de JJ (US$ 164.10) foi significativamente menor do que o da nefrostomia percutânea (US$ 552.20). Conclusão: Na ausência de qualquer contraindicação clínica, a inserção anterógrada de JJ é uma alternativa adequada à nefrostomia percutânea e inserção retrógrada em pacientes com sistema coletor renal dilatado secundário a obstrução maligna, proporcionando economia significativa e altas taxas de sucesso.

Radiol. bras ; 52(5): 331-336, Sept.-Oct. 2019. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1040961


Abstract Interventional radiology has been constantly developing in terms of the techniques, materials, and methods of intervention. It interacts with all areas of medicine, always with the ultimate goal of ensuring the well-being of patients. Advances in imaging techniques, especially in the last two decades, have led to a paradigm shift in the field of urological imaging interventions. Many urologic diseases that were previously treated only surgically can now be effectively managed using minimally invasive image-guided techniques, often with shorter hospital stays and requiring only local anesthesia or conscious sedation.

Resumo A radiologia intervencionista vem se desenvolvendo constantemente por meio de técnicas, materiais e métodos de intervenção. Interage com todas as áreas da medicina, sempre visando, como objetivo final, o bem-estar dos pacientes. Os avanços das técnicas de imagem, especialmente nas últimas duas décadas, levaram a uma mudança de paradigma no campo das intervenções guiadas por imagens na urologia. Muitas doenças urológicas que eram tratadas somente cirurgicamente, podem agora ser manejadas efetivamente usando técnicas minimamente invasivas guiadas por imagem, muitas vezes com redução do tempo de internação e utilizando apenas anestesia local ou sedação consciente.

Article in Chinese | WPRIM | ID: wpr-791805


Objective To investigate the effectiveness and safety of intraoperative sac coiling embolization among patients who are athigh-risk developing type-Ⅱ endoleak after endovascular aortic repair (EVAR).Methods From Jan 2014 to Jan 2018,one hundred and twelve consecutive patients with infrarenal AAA were enrolled for this study,There were 76 patients undergoing standard EVAR (standard-group) and 36 patients doing aneurysmal sac coiling embolization (embo-group).Baseline characteristics,aneurysmal sac parameters,radiological intervention details and follow up results were recorded.Results Mean follow-up time was 25.9 m for embo-group.During follow-up period,no coils-related complications were noted and no type-Ⅱ endoleak associated secondary interventions were reported.A mean of (2.72 ± 1.16) coils (range 1-7) was used in the embo-group.The incidence of type Ⅱ endoleak was 30.3% (23/76) in standard-group and 11.1% (4/36) in embo-group(x2 =4.90,P =0.027).Logistic multivariate analysis revealed that the independent risk factors of type Ⅱ endoleak after endovascular aortic repair for high-risk patients were those EVAR without sac embolization and sac volume ≥ 128 cm3.In the subgroup analysis (sac volume≥ 128 cm3),the incidence of type-Ⅱ endoleak was lower in embo-group compared to standard-group (x2 =6.07,P =0.014).Conclusion Intraoperative sac coiling embolization in high-risk patients is safe and effective in prevention of type Ⅱ endoleak.This preventive effect is more significant with large sac aneurysm compared to small sac aneurysm.

Chinese Journal of Pediatrics ; (12): 103-107, 2019.
Article in Chinese | WPRIM | ID: wpr-810418


Objective@#To access the feasibility, effectiveness and safety of transcatheter closure of ventricular septal defect (VSD) with right coronary cusp bulge.@*Methods@#The study population consisted of 40 children (22 boys and 18 girls) undergoing transcatheter intervention for VSD with right coronary cusp bulge in Shanghai Children′s Medical Center from August 2013 to June 2017. All patients were examined using transthoracic echocardiography and cardiovascular angiography before occlusion and received transcatheter closure of VSD by placing an occlude. During the operation, angiography and transthoracic echocardiography were used to detect residual shunts, new-onset or aggravation of aortic regurgitation, and surface electrocardiogram was used to assess the impact of occlusion on the conduction system. The children were followed up to evaluate the degree of aortic regurgitation and the presence of heart block by transthoracic echocardiography and electrocardiogram in outpatient department. Comparative analysis between two groups was used by t test.@*Results@#The average age of the patients was (5.1±3.2) years, weight(20.6±10.7) kg. The diameter of defect shunt was (3.3±0.9) cm. The VSD of all 40 patients were successfully occluded immediately, and three patients (8%) with filament residual shunt were observed during the operation. No major surgical complication such as death, pericardial tamponade, embolism of important organs, infective endocarditis occurred during the perioperative period. During the follow-up period, the positions of all the occluders were good, the residual shunt in three patients disappeared, and no new-onset or aggravated aortic regurgitation occurred. Electrocardiogram did not reveal any atrioventricular block, and one patient suffered from an incomplete right bundle branch block. There were significant differences between pre- and post-occlusion regarding the left ventricular end diastolic diameter ((3.8±0.5) vs. (3.7±0.5) cm, t=2.092, P=0.043), the left ventricular end systolic diameter ( (2.4±0.3) vs. (2.2±0.4) cm, t=2.068, P=0.045), and the QRS interval ((75.4±10.4) vs. (79.8±11.4) ms, t=-2.277, P=0.028). No significant differences were found between pre- and post-operation regarding the left ventricular ejection fraction (67.8%±4.7% vs. 68.1%±4.6%, t=-0.447, P=0.657) and the PR interval ((125.6±14.7) vs. (122.6±14.2) ms, t=1.540, P=0.132).@*Conclusions@#Interventional closure of VSD with right coronary cusp bulge has small impact on aortic valve activity in children. With appropriate indications and methods, transcatheter interventional occlusion should be considered because it is effective for children diagnosed with VSD combined with right coronary cusp bulge.