Prolonged Clinical Benefit with Futibatinib in a Patient with FGFR Inhibitor-Pretreated FGFR2 Fusion-Positive Intrahepatic Cholangiocarcinoma: Case Report.

Multiple FGFR inhibitors have demonstrated significant activity in pretreated advanced FGFR2 fusion-positive intrahepatic cholangiocarcinoma. The irreversible pan-FGFR inhibitor futibatinib has the potential to overcome acquired resistance to ATP-competitive FGFR inhibitors in a subset of patients. We present a case of prolonged clinical benefit using FGFR inhibitors sequentially, initially an ATP-competitive inhibitor followed by futibatinib upon progression, for a total of 36 months of FGFR-targeting therapy. This case supports sequential FGFR-targeting therapies for FGFR2 fusion-positive cholangiocarcinoma, with futibatinib acting as rescue therapy after failure of ATP-competitive inhibitors.

Salvage Therapy With Selpercatinib for RET-Rearranged NSCLC With Pralsetinib-Related Pneumonitis and Leptomeningeal Disease: A Case Report.

Selpercatinib and pralsetinib are RET inhibitors with substantial activity in advanced RET-rearranged NSCLC. We present a case of pralsetinib-related pneumonitis and leptomeningeal and brain metastases progression during treatment suspension for pneumonitis. During recovery, selpercatinib administration led to rapid neurologic response and complete intracranial response and allowed pneumonitis resolution. This case supports the safety of selpercatinib in patients with pneumonitis on pralsetinib and highlights its marked efficacy in leptomeningeal disease.

Successful Treatment of a Left Gastric Artery Pseudoaneurysm by Image Guided Percutaneous Thrombin Injection.

Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. The splenic artery is the commonest artery involved. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature. A 58-year-old female was referred to the Interventional Radiology department with a left gastric artery pseudoaneurysm secondary to acute pancreatitis. Initial Digital Subtraction Angiography revealed the pseudoaneurysm arising from the left gastric artery. Several attempts to cannulate the pseudoaneurysm were unsuccessful due to arterial spasm. Consequently, the left gastric artery proximal to the pseudoaneurysm was embolised with 300 microns of polyvinyl alcohol and two coils. 24 hours post-procedure, a computed tomography (CT) scan was performed which revealed a blush of contrast enhancement within the pseudoaneurysm sac, consistent with unsuccessful embolisation. Using a combination of ultrasound and cone beam CT guidance, a 22-gauge Chiba needle was advanced percutaneously via a transhepatic approach to the patent segment of the pseudoaneurysm. 2.5 ml of human thrombin was then injected directly into the pseudoaneurysm. Image guided injection of thrombin has become a well-recognised treatment for a variety of peripheral and visceral pseudoaneurysms and is often performed following a failed attempt of routine endovascular embolisation. We report the case of a patient affected by a pseudoaneurysm of the left gastric artery, treated with a CT guided percutaneous thrombin injection directly into the pseudoaneurysm. This demonstrates that percutaneous coagulation can be an adjunct or an alternative to endovascular embolisation.

Intraluminal catheter plasty. An alternative technique to remove tethered abdominal surgical drains.

OBJECTIVE: Retained surgical drains can lead to significant complications including gastrointestinal fistulae, abscess formation and intestinal obstruction. Today, there is little in the literature describing the role of Interventional Radiology (IR) in assisting the removal of surgical drains. We describe the use of the well-established intraluminal catheter plasty technique, previously used for the removal of adhered central venous catheters, in order to remove a tethered abdominal drain. METHODS AND MATERIALS: A 67-year-old female was referred to the IR department for the removal of a 24 Fr Robinson's intra-abdominal surgical drain that could not be removed by conventional methods, as there was a concern that it was kinked internally. Both fluoroscopy and cone beam CT were performed, which identified the drain to be sited within the pelvis with no kinks.A first attempt to remove the drain over a 0.035 stiff wire was unsuccessful due to resistance and patient discomfort. We suspected that this was due to adhesions surrounding the drain. Consequently, a 9 × 40 mm angioplasty balloon was used over the wire with serial dilatations along the drain to disrupt the adhesions. Several areas of waisting were identified. The drain was gently withdrawn over the wire with minimal resistance. Ex-vivo inspection of the drain showed no evidence of structural damage and fluoroscopic imaging confirmed no retained fragments. CONCLUSION: We describe a safe and effective novel technique of intraluminal catheter plasty used to remove a tethered surgical drain following failed conventional methods.

The Surgical Management of Tympanic Membrane Retraction Pockets Using Cartilage Tympanoplasty.

Evaluate the surgical treatment of tympanic membrane (TM) retractions with modified cartilage augmentation tympanoplasty. Retrospective review of subjects with Charachon stage II and III TM retractions who underwent modified cartilage augmentation tympanoplasty following excision of the retracted TM segment. Pre and postoperative symptoms and air-bone gaps were recorded. Forty two ears were included in the study. Twenty six ears were of stage II and 16 were stage III retractions. 35 (83 %) ears had ossicular erosion and cholesteatoma was found in 13 (31 %) ears, all in stage III retractions. Follow-up ranged 12-102 months. The air-bone gap (ABG) improved in 29 (76 %) and worsened in seven (19 %). Ears without cholesteatoma had a greater improvement in ABG. The results of our modified cartilage tympanoplasty technique are comparable to the published literature and should provide a safe and acceptable result. The high rate of cholesteatoma found preoperatively in stage III retractions advocates early surgical intervention.