Successful application of chemosaturation with percutaneous hepatic perfusion in metastatic uveal melanoma patient progressing after systemic treatment options: a case report.

Uveal melanoma (UM) is a rare subtype of melanoma, accounting for less than 5% of all melanoma cases. Metastatic UM differs notably from cutaneous melanoma, exhibiting variations in etiology, prognosis, driver mutations, metastatic patterns, and poor responses to immune checkpoint inhibitors (ICI). Beyond local treatment options, such as resection, radiation therapy, and enucleation, and systemic treatments, such as ICIs, the approval of tebentafusp, a bispecific gp100 peptide-HLA-directed CD3 T-cell engager, marks a breakthrough in treating HLA-A*02:01 metastatic UM. Despite the advancements in treatment options, the long-term survival rates remain inadequate. We report a patient with metastatic UM who previously received ICI and progressed on tebentafusp treatment but subsequently exhibited a remarkable response to local treatment targeting liver metastasis. Such observations highlight the significance of exploring sequential therapeutic strategies for advanced UM, offering potential avenues to enhance treatment efficacy and patient prognosis.

Double-Puncture Technique for Management of Severe Ureteropelvic Obstruction in Kidney Transplant.

Ureteral obstruction is one of the most common urological complications after kidney transplant. The definitive treatment of ureteral obstruction has been surgicalrevision. Because ofthe increased morbidity of surgery, minimally invasive percutaneous procedures have gained more acceptance in recent years. Presently, interventional radiological procedures are recommended as the first step in treatment of ureteral obstructions. Ureteral occlusions or near-occlusion high-grade stenoses require greater catheter backup force. Antegrade interventions generally prefer upper- to-middle calyx puncture. Cranial/superior proximal ureter stenoses cause severe angulations. Steep angulations of proximal ureter and ureteropelvic tight stenoses may require direct puncture of the renal pelvis or another calyx to achieve a less difficult angle. The double-puncture technique may help to manage severe angulations of proximal ureter and near- occlusion tight stenosis of the ureteropelvic junction.

Diagnostic Value of Perfusion MR Imaging as a Potential Ancillary Test for Brain Death.

OBJECTIVE: The purpose of this study is to determine the potential role of dynamic susceptibility contrast (DSC) magnetic resonance (MR) perfusion imaging in diagnosing brain death. MATERIALS AND METHODS: The study population was composed of 61 subjects (the Glasgow Coma Scale [GCS] score was 3 for all subjects), and 26 subjects were assigned to the control group (GCS scores between 4 and 6). At least four regions of interest (ROIs) from different anatomical regions were measured, the mean transit time (MTT), cerebral blood flow (CBF), and signal intensity time-to-course graphic were calculated. A second neurological examination (including an apnea test) was accepted as the gold standard method for the diagnosis of brain death. RESULTS: DSC-MR perfusion imaging diagnosed brain death with a specificity of 100% (61/61) and a sensitivity of 86.8% (53/61). A cut-off value of maximum 3.5% decrease in the signal intensity time-to-course graphic was calculated by the Youden's index and established for the to differentiate brain death from other conditions. CONCLUSION: DSC-MR perfusion imaging is a promising tool that may be used as a reliable add-on confirmatory diagnostic test for the brain death.

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

AIM: To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease. METHODS: Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays. RESULTS: The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively). CONCLUSION: There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

The 'radical combined approach' in cerebral arteriovenous malformation treatment: Technical note.

AVMs are vessel anomalies where a connection between arterial and venous systems is present and the capillary bed is absent between the two. AVMs tend to present with seizures, headaches, focal neurological deficits and hemorrhage. Hemorrhage is the most common form of presentation. AVM's have a 2-4% annual risk of hemorrhage. Certain studies report this rate as 1%. The greatest discussion in AVM treatment is whether to use interventional treatment or monitor with medical treatment. There are 3 modalities that can be used for interventional treatment; microsurgical resection, endovascular embolization and stereotactic radiosurgery. Combined techniques are also possible. We defined the 'radical combined approach' combines embolization and microsurgery. We will discuss this procedure in this article as we believe it has several advantages.

Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone.

PURPOSE: In some patients with a ureteral stone without uretero-hydronephrosis, it is difficult to determine the location of the stone. The objective of the present study was to investigate the changes in renal papillae using unenhanced computerized tomography (uCT) and determine the side of calculi using the renal papillary findings in patients with a ureteral stone. METHODS: uCT data from 81 patients were retrospectively reviewed for this study. The inclusion criteria were unilateral ureteral calculi, no renal calculi and no hydronephrosis. For each patient, three measurements of CT attenuation of 0.05 cm2 area were made in the tip of the interested renal papillae, both stone side and non-stone side. Student's t test was used for statistical analysis. RESULTS: Forty-one right-sided and 40 left- sided isolated unilateral ureteral calculi patients were evaluated by uCT exam. The average attenuations of the tip of the papillae in stone side and non-stone side were 34.1 Hounsfield units (HU) and 30.6 HU, respectively. There was a statistically significant difference between stone and non-stone sides (p< 0.05). CONCLUSION: During routine practical uCT applications, it can be difficult to distinguish phleboliths, ureteral stone or the existence of non-opaque ureteral stone, so papillae density measurements can be a practical method to identify the existence of ureter stone and its location (side).

Endovascular stent placement of juxtaanastomotic stenosis in native arteriovenous fistula after unsuccessful balloon angioplasty.

BACKGROUND: In hemodialysis patients, the most common problem in arteriovenous fistulas, as the best functional vascular access, is the juxtaanastomotic located lesions. Percutaneous transluminal angioplasty is accepted as the treatment method for juxtanastomotic lesions. OBJECTIVES: To assess juxtaanastomotic stent placement after insufficient balloon angioplasty in the treatment of autogenous radiocephalic or brachiocephalic fistula dysfunction. PATIENTS AND METHODS: Between July 2003 and June 2010, 20 hemodialysis patients with autogenous radiocephalic or brachiocephalic fistula dysfunction underwent stent placement for the lesion located at the juxtaanastomotic region. Indications for stent placement were insufficient balloon dilatation, early recurring stenosis, chronic organizing thrombus and vessel rupture. The Kaplan-Meier method was used to calculate the stent patency rates. All patients who had fistula dysfunction (thrombosis of hemodialysis access, difficult access cannulation, extremity pain due to thrombosis or decreased arterial access blood flow) were evaluated by color Doppler ultrasound. The stenoses were initially dilated with standard noncompliant balloons (3 to 10-mm in diameter). Dilatation was followed by high pressure (Blue Max, Boston Scientific) or cutting balloons (Boston Scientific), if the standard balloon failed to dilate the stenotic segment. RESULTS: Twenty-one stents were applied. The anatomical and clinical success rate was 100%. Seventeen additional interventions were done for 11 (55%) patients due to stent thrombosis or stenosis during follow-up. Our 1- and 2-year secondary patency rates were 76.2% and 65.5%, respectively and were comparable to those after balloon angioplasty and surgical shunt revision. CONCLUSION: Metallic stent placement is a safe and effective procedure for salvage of native hemodialysis fistula after unsuccessful balloon angioplasty.