Experience with wide and narrow caliber percutaneous radiologically guided gastrostomy tubes

Objective: To compare the percutaneous radiologically guided gastrostomy [PeRG] tubes of wide caliber with narrow caliber tubes

Methodology: This retrospective study was performed on 36 patients who were referred to Radiology department for PeRG tube placement between 2008 till 2012. Comparison of wide caliber gastrostomy tubes [18-24 Fr] was done with narrow caliber tubes [14 Fr] considering procedure success rate, procedure related complications and catheter related minor and major complications

Results: Out of 36 patients, 18 patients were present in each group. Mean age of patients was 53.944 +/- 19.380. Procedure success rate was 100% in both groups and procedure related immediate complications were none in either groups. Peri-catheter leakage was observed in 1 patient in each group. Tube occlusion was present in 2 patients in narrow caliber group. Two patients had severe pain in wide caliber group and also 3 patients had wound infection in this group

Conclusion: Regardless of the type of radiologic catheter placed, PeRG can be considered as safe and highly successful procedure. Use of a 24 Fr gastrostomy tubes may show promising results if placed under radiological guidance with comparable technical success and complication rates to other caliber tubes

Does gauge of needle effects causation of pneumothorax following ultrasound guided thoracentesis?

Objective: to determine the frequency of pneumothorax following ultrasound guided thoracentesis in our department and its association with gauge of needle in causation of pneumothorax

Methadology: this is descriptive cross sectional study conducted at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital [SIH], Islamabad from January 2010 to April, 2012. A total of 359 ultrasound guided thoracentesis were performed followed by a chest radiograph between January 2010 and April, 2012 fulfilling the inclusion criteria. All procedures were performed by radiology consultants and residents. Generally 18 and 16 G cannulas were used. A few were done with 16 and 18 G spinal needle and 21G syringe needle. Relevant data was collected from hospital data base system on the performa and was analyzed for demographic variables, frequency of pneumothorax, and its association with operator's experience [residents or consultants] and gauge of needle by applying chi square test. P value of < 0.05 was considered significant

Results: 309 patients had thoracocentesis while performed by residents and 50 by consultants. Pneumothorax occurred in 22 of these 359 cases with an overall frequency of 6%. In 219 patients 18 G cannula was used and 8 of these developed pneumothorax [3.6%]. In 94 patients 16 G cannula was used. Pneumothorax occurred in 11 [11.6%]. Statistical analysis confirmed that the frequency of pneumothorax was significantly increased following use of 16G as compared to 18G [p=0.02]

Conclusion: the frequency of pneumothorax following ultrasound guided thoracentesis increases significantly with use of 16G as compared to 18G [p=0.02]

Role of non coaxial bone marrow biopsy needle and bone biopsy needle in CT guided core needle biopsies

Objective: to compare bone marrow biopsy needle [BMBN] with bone biopsy needle [BBN] in CT guided core biopsies considering size of core, diagnostic yield and cost of needles

Methodology: retrospective study was done on 50 out of 68 patients referred to Interventional Radiology department for CT guided bone biopsy from 2008 till 2013. Grading of specimen length was done as small, medium and large. Diagnostic yield was determined on basis of clinical, imaging and histopathology data. Local cost of both needle types was determined. Comparison was made and statistical analysis was performed

Results: biopsy was performed by BBN in 16 patients and by BMBN in 34 patients. Overall diagnostic yield of bone biopsies was 82% [41 of 50 biopsies]. Diagnostic yield with BMBN was 85% and with BBN was 75%. Overall longer specimen length was obtained using BMBN. Statistically, there was no significant difference between them in diagnostic yield and specimen length; however, BMBN costs almost one half than BBN

Conclusion: diagnostic yield and sample length using bone marrow biopsy needle proved to be equivalent to bone biopsy needle. Bone marrow biopsy needle has an added benefit of being low in cost. Despite being a non-coaxial technique these needles can achieve diagnostic yield comparable to that of coaxial techniques as reported in past literature