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Sample records for percutaneous transcholecystic metallic

  1. Percutaneous Transcholecystic Biliary Interventions Using Gallbladder Anchors: Feasibility Study in the Swine

    SciTech Connect

    Lopera, Jorge E. Kirsch, David; Qian Zhong; Ruiz, Bernardo; Brazzini, Augusto; Gonzales, Arturo; Castaneda-Zuniga, Wilfrido

    2005-05-15

    The purpose of this study was to report our initial experience with a swine model for biliary interventions by using a percutaneous transcholecystic access after suture anchor of the gallbladder. Telepaque tablets were given to five pigs to opacify the gallbladder. Under fluoroscopy, the opacified gallbladder was punctured percutaneously and three suture anchors were used to fix the anterior wall of the gallbladder to the abdominal wall. Two weeks later, the gallbladder was punctured and access into the distal common bile was obtained through the cystic duct. Balloon expandable stents were deployed into the distal common bile duct. Follow-up cholangiograms were obtained at 1 and 2 weeks. Necropsy was performed after 2 weeks to evaluate the relationship between the gallbladder and abdominal wall. Suture anchor placement was successful in all five pigs. One pig with a deep and highly positioned gallbladder developed fever, anorexia, and vomiting secondary to excessive stretch of the gallbladder. Placement of the guidewire through the extremely tortuous and small cystic ducts proved to be the most challenging step of the procedure. Metallic stents were successfully deployed in all four pigs in which it was attempted. Four animals tolerated the procedures without changes in their clinical conditions and no symptoms. Successful follow-up cholangiograms were performed at 1 and 2 weeks post-stent deployment without complications. All stents remained patent during the follow-up period. Necropsy demonstrated close attachment and adherence of the gallbladders to the antero-lateral abdominal wall in all four animals. Suture anchoring of the gallbladder is feasible in most pigs with superficially located gallbladders. This technique allows a safe and repeat access into the biliary system using a transcholecystic approach.

  2. Percutaneous Transcholecystic Placement of an ePTFE/FEP-Covered Stent in the Common Bile Duct

    SciTech Connect

    Krokidis, Miltiadis E.; Hatzidakis, Adam A.

    2010-06-15

    We report the case of a 78-year-old male patient with obstructive jaundice due to a pancreatic head neoplasm. The patient's general condition did not permit an endoscopic approach and the presence of diffuse liver metastases prohibited hepatic puncture for percutaneous biliary drainage, therefore the transcolecystic transperitoneal approach was decided to be the safest decompression route. Through a gallbladder access, a Viabil-covered stent with a mesh extension was placed in the distal common bile duct, without complications. The patient died 8 months later without signs of stent dysfunction or necessity of reintervention. Transcholecystic transperitoneal access is a safe option when diffuse liver metastases prohibit the transhepatic approach, even in cases where placement of a covered stent is considered necessary.

  3. Percutaneous cholangioscopy in obstructed biliary metal stents

    SciTech Connect

    Hausegger, Klaus A.; Mischinger, Hans J.; Karaic, Radenko; Klein, Guenther E.; Kugler, Cristian; Kern, Robert; Uggowitzer, Martin; Szolar, Dieter

    1997-05-15

    Purpose. To reevaluate the reasons for the occlusion of self-expanding biliary metal stents, on the basis of cholangioscopic findings. Methods. Percutaneous transhepatic cholangioscopy (PTCS) was performed in 15 patients with obstructed biliary Wallstents. The reason for stent insertion was a malignant obstruction in 14 patients; 1 had a benign biliary stricture. Conventional noncovered stents had been inserted in 12 patients; in 3 cases a polyurethane-covered prototype Wallstent had been used. Stent occlusions occurred after 1-55 months. PTCS was performed with a 2.3-mm endoscope through an 11 Fr sheath. Biopsies were taken via the working channel of the endoscope. Results. In all patients with noncovered stents the inner surface of the stent was highly irregular with seaweed-like protrusions (biopsy-proven granulation tissue). Stent incorporation varied from absent (n=1) to subtotal (n=8), but was always incomplete, no matter how long the stent had been in place. Tumor ingrowth was histologically proven in 2 patients. One patient had a large occluding concrement at the proximal end of the stent. In patients with covered stents, the inner surface appeared more regular; however, viable granulation tissue was found inside two stents and tumor ingrowth in one of them. Conclusion. PTCS showed that incorporation of the stent is virtually always incomplete. The factors contributing most to stent occlusion are the buildup of granulation tissue, bile sludge, and tumor overgrowth. Stone formation and tumor ingrowth can also be important, although less common causes of occlusion. A polyurethane stent covering could not prevent tumor ingrowth in one patient and the buildup of viable granulation tissue inside the stent in two further patients; mean stent patency in the three patients with such a stent was 3 months.

  4. A Survival Analysis of Patients with Malignant Biliary Strictures Treated by Percutaneous Metallic Stenting

    SciTech Connect

    Brountzos, Elias N. Ptochis, Nikolaos; Panagiotou, Irene; Malagari, Katerina; Tzavara, Chara; Kelekis, Dimitrios

    2007-02-15

    Background. Percutaneous metal stenting is an accepted palliative treatment for malignant biliary obstruction. Nevertheless, factors predicting survival are not known. Methods. Seventy-six patients with inoperable malignant biliary obstruction were treated with percutaneous placement of metallic stents. Twenty patients had non-hilar lesions. Fifty-six patients had hilar lesions classified as Bismuth type I (n = 15 patients), type II (n = 26), type III (n = 12), or type IV (n = 3 patients). Technical and clinical success rates, complications, and long-term outcome were recorded. Clinical success rates, patency, and survival rates were compared in patients treated with complete (n = 41) versus partial (n = 35) liver parenchyma drainage. Survival was calculated and analyzed for potential predictors such as the tumor type, the extent of the disease, the level of obstruction, and the post-intervention bilirubin levels. Results. Stenting was technically successful in all patients (unilateral drainage in 70 patients, bilateral drainage in 6 patients) with an overall significant reduction of the post-intervention bilirubin levels (p < 0.001), resulting in a clinical success rate of 97.3%. Clinical success rates were similar in patients treated with whole-liver drainage versus partial liver drainage. Minor and major complications occurred in 8% and 15% of patients, respectively. Mean overall primary stent patency was 120 days, while the restenosis rate was 12%. Mean overall secondary stent patency was 242.2 days. Patency rates were similar in patients with complete versus partial liver drainage. Mean overall survival was 142.3 days. Survival was similar in the complete and partial drainage groups. The post-intervention serum bilirubin level was an independent predictor of survival (p < 0.001). A cut-off point in post-stenting bilirubin levels of 4 mg/dl dichotomized patients with good versus poor prognosis. Patient age and Bismuth IV lesions were also independent predictors

  5. Percutaneous intracardiac beating-heart surgery using metal MEMS tissue approximation tools.

    PubMed

    Gosline, Andrew H; Vasilyev, Nikolay V; Butler, Evan J; Folk, Chris; Cohen, Adam; Chen, Rich; Lang, Nora; Del Nido, Pedro J; Dupont, Pierre E

    2012-08-01

    Achieving superior outcomes through the use of robots in medical applications requires an integrated approach to the design of the robot, tooling and the procedure itself. In this paper, this approach is applied to develop a robotic technique for closing abnormal communication between the atria of the heart. The goal is to achieve the efficacy of surgical closure as performed on a stopped, open heart with the reduced risk and trauma of a beating-heart catheter-based procedure. In the proposed approach, a concentric tube robot is used to percutaneously access the right atrium and deploy a tissue approximation device. The device is constructed using a metal microelectromechanical system (MEMS) fabrication process and is designed to both fit the manipulation capabilities of the robot as well as to reproduce the beneficial features of surgical closure by suture. The effectiveness of the approach is demonstrated through ex vivo and in vivo experiments.

  6. Percutaneous intracardiac beating-heart surgery using metal MEMS tissue approximation tools

    PubMed Central

    Gosline, Andrew H; Vasilyev, Nikolay V; Butler, Evan J; Folk, Chris; Cohen, Adam; Chen, Rich; Lang, Nora; del Nido, Pedro J; Dupont, Pierre E

    2013-01-01

    Achieving superior outcomes through the use of robots in medical applications requires an integrated approach to the design of the robot, tooling and the procedure itself. In this paper, this approach is applied to develop a robotic technique for closing abnormal communication between the atria of the heart. The goal is to achieve the efficacy of surgical closure as performed on a stopped, open heart with the reduced risk and trauma of a beating-heart catheter-based procedure. In the proposed approach, a concentric tube robot is used to percutaneously access the right atrium and deploy a tissue approximation device. The device is constructed using a metal microelectromechanical system (MEMS) fabrication process and is designed to both fit the manipulation capabilities of the robot as well as to reproduce the beneficial features of surgical closure by suture. The effectiveness of the approach is demonstrated through ex vivo and in vivo experiments. PMID:23750066

  7. Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type.

    PubMed

    Gaglia, Michael A; Torguson, Rebecca; Lipinski, Michael J; Gai, Jiaxiang; Koifman, Edward; Kiramijyan, Sarkis; Negi, Smita; Rogers, Toby; Steinvil, Arie; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2016-02-15

    Although metallic coronary stents significantly reduce angina pectoris compared with optimal medical therapy, angina after percutaneous coronary intervention (PCI) remains frequent. We, therefore, sought to compare the incidence of any angina during the 1 year after PCI among the spectrum of commercially available metallic stents. Metallic stent type was classified as bare metal stent, Cypher, Taxus Express, Xience V, Promus Element, and Resolute. The primary end point was patient-reported angina within 1 year of PCI. Multivariable logistic regression was performed to assess the independent association of stent type with any angina at 1 year. Overall, 8,804 patients were queried in regard to angina symptoms; 32.3% experienced angina at some point in the first year after PCI. Major adverse cardiovascular events, a composite of all-cause mortality, target vessel revascularization, and Q-wave myocardial infarction, increased with angina severity: 6.8% for patients without angina, 10.0% for patients with class 1 or 2 angina, and 19.7% for patients with class 3 or 4 angina (p <0.001 for trend). After multivariable adjustment, there was no significant association between stent type and angina at 1 year after PCI. Baseline Canadian Cardiovascular Society class 3 or 4 angina, history of coronary artery bypass grafting, and history of PCI were associated with a higher likelihood of angina at 1 year; increasing age, male gender, presentation with acute coronary syndrome, and higher stented length were associated with less angina. In conclusion, metallic stent type is not associated with the occurrence of angina at up to 1 year after PCI.

  8. Percutaneous Placement of Metallic Stents in Malignant Biliary Obstruction: One-Stage or Two-Stage Procedure? Pre-Dilate or Not?

    SciTech Connect

    Inal, Mehmet; Aksungur, Erol; Akguel, Erol; Oguz, Mahmut; Seydaoglu, Guelsah

    2003-02-15

    The aim of this paper was to evaluate the necessity of percutaneous transhepatic catheter drainage and balloon dilation procedures performed before stent insertion. One hundred and twenty-six patients with unresectable malignant biliary obstruction underwent palliative therapy by means of percutaneous transhepatic placement of 183 metallic biliary endoprotheses. Forty-four (35%) patients underwent metallic stent insertion in a one-stage procedure and 82(65%) had undergone percutaneous transhepatic catheter drainage before stent insertion. Balloon dilation of the stenosis before stent placement (pre-dilation) was performed in 53 (42%) of 126 patients. The rate of the 30-day mortality was 11%, with no procedure-related deaths. The total rate of early complications was 29%, and 84% of these complications were due to percutaneous transhepatic catheter drainage and pre-dilation procedures. Percutaneous transhepatic catheter drainage and pre-dilation had no clinical or statistically significant effect on the patients' survival and stent patency rate. Percutaneous transhepatic catheter drainage and balloon dilation increased the cost of stent placement 18% and 19%, respectively. Palliation of malignant biliary obstruction with percutaneous transhepatic stent insertion should be done directly, in the simplest way, without performing percutaneous transhepatic catheter drainage and balloon dilation before stent placement. It is more useful, safe, and cost-effective.

  9. Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents for palliative treatment of malignant common bile duct obstruction.

    PubMed

    Fujita, T; Tanabe, M; Takahashi, S; Iida, E; Matsunaga, N

    2013-11-01

    To evaluate clinical safety and efficacy of percutaneous transhepatic hybrid biliary prostheses for palliative treatment in patients with common bile duct obstruction caused by advanced malignancies. A total of 13 consecutive patients was treated with percutaneous transhepatic biliary endoprostheses concurrently using both plastic and metallic stents. Serum total bilirubin levels before and after stent placement were evaluated. The technical success rate, the period with no obstructive jaundice, patient survival and complications were also assessed. Median bilirubin levels decreased from 3.8 mg/dL before to 1.2 mg/dL after stent placement, and this difference was statistically significant. The median no-jaundice period after bile duct stent placement was 6.0 months (range: 2-11 months), and overall survival time was 7.0 months. Of the 13 patients, nine did not have recurrent jaundice by the time of death, whereas four (31%) had recurrent jaundice. A second intervention was performed in these four patients. A new plastic stent was placed and jaundice did not recur up to the time of death. No serious complications such as cholangitis, pancreatitis or bile duct perforation developed. Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents can be useful as non-invasive palliative treatment to relieve jaundice in patients with malignant obstructive jaundice.

  10. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    SciTech Connect

    Pai, Madhava; Valek, Vlastimil; Tomas, Andrasina; Doros, Attila; Quaretti, Pietro; Golfieri, Rita; Mosconi, Cristina; Habib, Nagy

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  11. Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

    PubMed Central

    Baschet, Louise; Bourguignon, Sandrine; Marque, Sébastien; Durand-Zaleski, Isabelle; Teiger, Emmanuel; Wilquin, Fanny; Levesque, Karine

    2016-01-01

    Objective To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. Methods A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival. Effectiveness and costs were modelled over a 5-year horizon using a three-state Markov model. Incremental cost-effectiveness ratios and a cost-effectiveness acceptability curve were calculated for a range of thresholds for willingness to pay per year without major cardiac event gain. Deterministic and probabilistic sensitivity analyses were performed. Results Base case results demonstrated that DES are dominant over BMS, with an increase in event-free survival and a cost-reduction of €184, primarily due to a diminution of second revascularisations, and an absence of myocardial infarction and stent thrombosis. These results are robust for uncertainty on one-way deterministic and probabilistic sensitivity analyses. Using a cost-effectiveness threshold of €7000 per major cardiac event-free year gained, DES has a >95% probability of being cost-effective versus BMS. Conclusions Following DES price decrease, new-generation DES development and taking into account recent meta-analyses results, the DES can now be considered cost-effective regardless of selective indication in France, according to European recommendations.

  12. Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

    PubMed Central

    Baschet, Louise; Bourguignon, Sandrine; Marque, Sébastien; Durand-Zaleski, Isabelle; Teiger, Emmanuel; Wilquin, Fanny; Levesque, Karine

    2016-01-01

    Objective To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. Methods A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival. Effectiveness and costs were modelled over a 5-year horizon using a three-state Markov model. Incremental cost-effectiveness ratios and a cost-effectiveness acceptability curve were calculated for a range of thresholds for willingness to pay per year without major cardiac event gain. Deterministic and probabilistic sensitivity analyses were performed. Results Base case results demonstrated that DES are dominant over BMS, with an increase in event-free survival and a cost-reduction of €184, primarily due to a diminution of second revascularisations, and an absence of myocardial infarction and stent thrombosis. These results are robust for uncertainty on one-way deterministic and probabilistic sensitivity analyses. Using a cost-effectiveness threshold of €7000 per major cardiac event-free year gained, DES has a >95% probability of being cost-effective versus BMS. Conclusions Following DES price decrease, new-generation DES development and taking into account recent meta-analyses results, the DES can now be considered cost-effective regardless of selective indication in France, according to European recommendations. PMID:27621830

  13. Percutaneous cholecystolithotomy.

    PubMed

    Kellett, M J; Wickham, J E; Russell, R C

    1988-02-13

    A percutaneous method was used to remove stones from otherwise normal gall bladders, as assessed by cholecystography and ultrasonography. The procedure was performed in a single stage under general anaesthesia, adopting the method and instruments used for one stage percutaneous nephrolithotomy. A Foley catheter was left in the gall bladder and the system checked with contrast at 10 days to ensure free drainage and exclude residual calculi. Seven out of eight patients had a successful percutaneous cholecystolithotomy. An adequate track could not be secured in one man; he had an uneventful cholecystectomy under the same anaesthetic. Follow up at three months of the seven patients showed no calculi and no complications. Percutaneous cholecystolithotomy may prove complementary to extracorporeal shockwave lithotripsy in patients in whom there is difficulty focusing the shock waves on the gall bladder or who have had incomplete disintegration of stones.

  14. Percutaneous connectors

    NASA Technical Reports Server (NTRS)

    Picha, G. J.; Taylor, S. R.

    1981-01-01

    A surface possessing a regular array of micro-pillars was evaluated with regard to its ability to control epithelial downgrowth at the percutaneous interface. A range of pillar sizes were applied to the vertical segment of T shaped Biomer (R) implants. These percutaneous tabs were implanted into the dorsum of cats for a period of 6 weeks using a standardized surgical technique. Comments were made post-operatively and at the time of retrieval. A quantitative scoring system was applied to these observations as well as histological results. As observed, the pillar morphology used displayed the ability to control epithelial downgrowth. Collagen ingrowth into the interpillar spaces and possibly direct interactions of the epithelial cells with the morphology may account for the inhibition. The reproducibility of epithelial inhibition is, however, limited by other factors which are currently not well understood. These factors and potential methods of assessment are discussed.

  15. Long-term outcomes of intravascular ultrasound-guided implantation of bare metal stents versus drug-eluting stents in primary percutaneous coronary intervention

    PubMed Central

    Cho, Yun-Kyeong; Park, Nam-Hee; Choi, Sang-Woong; Sohn, Ji-Hyun; Cho, Hyun-Ok; Park, Hyoung-Seob; Yoon, Hyuck-Jun; Kim, Hyungseop; Nam, Chang-Wook; Kim, Yoon-Nyun; Kim, Kwon-Bae

    2014-01-01

    Background/Aims While drug-eluting stents (DESs) have shown favorable outcomes in ST-segment elevation myocardial infarction (STEMI) compared to bare metal stents (BMSs), there are concerns about the risk of stent thrombosis (ST) with DESs. Because intravascular ultrasound (IVUS) guidance may help optimize stent placement and improve outcomes in percutaneous coronary intervention (PCI) patients, we evaluated the impact of IVUS-guided BMS versus DES implantation on long-term outcomes in primary PCI. Methods In all, 239 STEMI patients received DES (n = 172) or BMS (n = 67) under IVUS guidance in primary PCI. The 3-year incidence of major adverse cardiac events (MACEs) including death, myocardial infarction (MI), target vessel revascularization (TVR), and ST was evaluated. Results There was no difference in all cause mortality or MI. However, the incidence of TVR was 23.9% with BMS versus 9.3% with DES (p = 0.005). Thus, the number of MACEs was significantly lower with DES (11.0% vs. 29.9%; p = 0.001). The incidence of definite or probable ST was not different (1.5% vs. 2.3%; p = 1.0). IVUS-guided DES implantation (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.08 to 0.78; p = 0.017), stent length (HR, 1.03; 95% CI, 1.00 to 1.06; p = 0.046), and multivessel disease (HR, 3.01; 95% CI, 1.11 to 8.15; p = 0.030) were independent predictors of MACE. Conclusions In patients treated with primary PCI under IVUS guidance, the use of DES reduced the incidence of 3-year TVR versus BMS. However, all cause mortality and MI were similar between the groups. The incidence of ST was low in both groups. PMID:24574835

  16. Percutaneous Pulmonary Valve Implantation

    PubMed Central

    Lee, Hyoung-Doo

    2012-01-01

    Pulmonary regurgitation (PR) is a frequent sequelae after repair of tetralogy of Fallot, pulmonary atresia, truncus arteriosus, Rastelli and Ross operation. Due to patient growth and conduit degeneration, these conduits have to be changed frequently due to regurgitation or stenosis. However, morbidity is significant in these repeated operations. To prolong conduit longevity, bare-metal stenting in the right ventricular outflow tract (RVOT) obstruction has been performed. Stenting the RVOT can reduce the right ventricular pressure and symptomatic improvement, but it causes PR with detrimental effects on the right ventricle function and risks of arrhythmia. Percutaneous pulmonary valve implantation has been shown to be a safe and effective treatment for patients with pulmonary valve insufficiency, or stenotic RVOTs. PMID:23170091

  17. Percutaneous liver biopsy.

    PubMed

    Rustagi, Tarun; Newton, Eric; Kar, Premashish

    2010-01-01

    Percutaneous liver biopsy has been performed for more than 120 years, and remains an important diagnostic procedure for the management of hepatobiliary disorders. Modern biochemical, immunologic, and radiographic techniques have facilitated the diagnosis and management of liver diseases but have not made liver biopsy obsolete. This comprehensive review article will discuss the history of development of percutaneous liver biopsy, its indications, contraindications, complications and the various aspects of the biopsy procedure in detail.

  18. Ultrasonically guided percutaneous pyeloscopy.

    PubMed

    Saitoh, M; Watanabe, H

    1981-05-01

    A method for percutaneous endoscopic study of the renal pelvis has been developed in our clinic. A thin endoscope has been manufactured which is introduced into the dilated renal pelvis via a puncture under ultrasonic real-time guidance to allow inspection. This technique has been named percutaneous pyeloscopy. The method can also be applied to the inspection of the renal cyst, the retroperitoneal space, and the urinary bladder.

  19. Metal contents of liver parenchyma after percutaneous ethanol injection or radiofrequency ablation in patients with hepatocellular carcinoma before and after trientine hydrochloride therapy.

    PubMed

    Fukuda, Hiroyuki; Ebara, Masaaki; Okabe, Shinichiro; Yoshikawa, Masaharu; Sugiura, Nobuyuki; Saisho, Hiromitsu; Kondo, Fukuo; Yukawa, Masae

    2004-06-01

    We administered trientine hydrochloride, a drug used in the treatment of Wilson's disease, to patients with hepatocellular carcinoma after radical treatment with percutaneous ethanol injection or radiofrequency ablation, and examined its effect on the reduction of liver-tissue copper content. We enrolled 24 patients with 3 or fewer primary lesions of Child class A or B hepatocellular carcinoma with diameters of 3 cm or less who had undergone radical treatment with percutaneous ethanol injection or radiofrequency ablation. Trientine hydrochloride was orally administered in a single daily dose of 250 mg to 12 patients before a meal (at fasting, group 1) or at a total daily dosage of 750 mg, divided into 3 doses, to 12 patients (group 2). This study was a randomized between-groups comparative study of 12 weeks' duration. We used the particle-induced x-ray-emission method to determine liver-tissue mineral content. Urine copper and serum mineral levels were also measured, and transaminase levels were examined. Liver-tissue copper content decreased significantly, to 160.1 microg/g dry weight, after treatment, compared with the pretreatment level of 306.8 microg/g dry weight (P <.05). We detected no significant difference in iron or zinc content before and after treatment. The copper content was significantly reduced after treatment in both groups (P <.05). The urine copper level was significantly increased after 1 week of treatment but decreased thereafter. Serum copper levels were significantly reduced after treatment (P <.01). We detected no significant difference in transaminase level before and after treatment. Iron-deficiency anemia in 1 patient after 12 weeks' treatment was the only adverse reaction, and it was improved by the administration of an iron product. We noted no other overt adverse reactions. In patients with hepatocellular carcinoma, trientine hydrochloride therapy may significantly reduce copper content in liver tissue.

  20. Percutaneous vertebroplasty or kyphoplasty.

    PubMed

    Anselmetti, G C; Muto, M; Guglielmi, Giuseppe; Masala, S

    2010-05-01

    Percutaneous vertebral augmentation techniques performed with vertebroplasty or kyphoplasty are safe and effective for the treatment of osteoporotic vertebral compression fractures, primary or secondary spine tumors, and selected traumatic fractures. This article compares the procedures and outlines their advantages and disadvantages. It concludes that vertebroplasty should be performed in most cases, but kyphoplasty is preferable in selected cases.

  1. Percutaneous Transhepatic Biliary Metal Stent for Malignant Hilar Obstruction: Results and Predictive Factors for Efficacy in 159 Patients from a Single Center

    SciTech Connect

    Li, Mingwu Bai, Ming Qi, Xingshun Li, Kai Yin, Zhanxin; Wang, Jianhong; Wu, Wenbing Zhen, Luanluan He, Chuangye; Fan, Daiming; Zhang, Zhuoli; Han, Guohong E-mail: Hangh@fmmu.edu.cn

    2015-06-15

    AimTo investigate and compare the efficacy and safety of percutaneous transhepatic biliary stenting (PTBS) using a one- or two-stage procedure and determine the predictive factors for the efficacious treatment of malignant hilar obstruction (MHO).Methods159 consecutive patients with MHO who underwent PTBS were enrolled between January 2010 and June 2013. Patients were classified into one- or two-stage groups. Independent predictors of therapeutic success were evaluated using a logistic regression model.Results108 patients were treated with one-stage PTBS and 51 patients were treated with two-stage PTBS. The stents were technically successful in all patients. Successful drainage was achieved in 114 patients (71.4 %). A total of 42 early major complications were observed. Re-interventions were attempted in 23 patients during follow-up. The cumulative primary patency rates at 3, 6, and 12 months were 88, 71, and 48 %, respectively. Stent placement using a one- or two-stage procedure did not significantly affect therapeutic success, early major complications, median stent patency, or survival. A stent placed across the duodenal papilla was an independent predictor of therapeutic success (odds ratio = 0.262, 95 % confidence interval [0.107–0.642]). Patients with stents across papilla had a lower rate of cholangitis compared with patients who had a stent above papilla (7.1 vs. 20.3 %, respectively, p = 0.03).ConclusionsThe majority of patients with MHO who underwent one-stage PTBS showed similar efficacy and safety outcomes compared with those who underwent two-stage PTBS. Stent placement across the duodenal papilla was associated with a higher therapeutic success rate.

  2. Percutaneous Pulmonary Valve Placement

    PubMed Central

    Prieto, Lourdes R.

    2015-01-01

    Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle–pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations. PMID:26175629

  3. Percutaneous left ventricular restoration.

    PubMed

    Ige, Mobolaji; Al-Kindi, Sadeer G; Attizzani, Guilherme; Costa, Marco; Oliveira, Guilherme H

    2015-04-01

    The ventricular partitioning device known as Parachute is the first and only percutaneously implantable device aimed at restoration of normal left ventricular geometry in humans. Since its conception, this technology has undergone extensive animal and human testing, with proved feasibility and safety, and is currently being studied in a pivotal randomized clinical trial. This article discusses ventricular remodeling and therapies attempted in the past, details the components of the ventricular partitioning device, describes the implanting technique, and reviews the most current experience of this device in humans.

  4. Percutaneous left ventricular restoration.

    PubMed

    Ige, Mobolaji; Al-Kindi, Sadeer G; Attizzani, Guilherme; Costa, Marco; Oliveira, Guilherme H

    2015-04-01

    The ventricular partitioning device known as Parachute is the first and only percutaneously implantable device aimed at restoration of normal left ventricular geometry in humans. Since its conception, this technology has undergone extensive animal and human testing, with proved feasibility and safety, and is currently being studied in a pivotal randomized clinical trial. This article discusses ventricular remodeling and therapies attempted in the past, details the components of the ventricular partitioning device, describes the implanting technique, and reviews the most current experience of this device in humans. PMID:25834974

  5. [Ultrasound guided percutaneous nephrolithotripsy].

    PubMed

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

  6. [Ultrasound guided percutaneous nephrolithotripsy].

    PubMed

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff. PMID:25807772

  7. Percutaneous Implants with Porous Titanium Dermal Barriers: An In Vivo Evaluation of Infection Risk

    PubMed Central

    Isackson, Dorthyann; McGill, Lawrence D.; Bachus, Kent N.

    2010-01-01

    Osseointegrated percutaneous implants are a promising prosthetic alternative for a subset of amputees. However, as with all percutaneous implants, they have an increased risk of infection since they breach the skin barrier. Theoretically, host tissues could attach to the metal implant creating a barrier to infection. When compared with smooth surfaces, it is hypothesized that porous surfaces improve the attachment of the host tissues to the implant, and decrease the infection risk. In this study, 4 titanium implants, manufactured with a percutaneous post and a subcutaneous disk, were placed subcutaneously on the dorsum of eight New Zealand White rabbits. Beginning at four weeks post-op, the implants were inoculated weekly with 108 CFU Staphylococcus aureus until signs of clinical infection presented. While we were unable to detect a difference in the incidence of infection of the porous metal implants, smooth surface (no porous coating) percutaneous and subcutaneous components had a 7-fold increased risk of infection compared to the implants with a porous coating on one or both components. The porous coated implants displayed excellent tissue ingrowth into the porous structures; whereas, the smooth implants were surrounded with a thick, organized fibrotic capsule that was separated from the implant surface. This study suggests that porous coated metal percutaneous implants are at a significantly lower risk of infection when compared to smooth metal implants. The smooth surface percutaneous implants were inadequate in allowing a long-term seal to develop with the soft tissue, thus increasing vulnerability to the migration of infecting microorganisms. PMID:21145778

  8. Percutaneous nephrolithotomy in children.

    PubMed

    Demarco, Romano T

    2011-01-01

    The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL) in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL) were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi.

  9. Percutaneous transtracheal ventilation.

    PubMed

    Smith, R B; Babinski, M; Klain, M; Pfaeffle, H

    1976-10-01

    The technique of percutaneous transtracheal ventilation (intermittent jets of oxygen under high pressure, 50 pounds per square inch [psi]) has been used for resuscitation during anesthesia and prior to tracheostomy, and has been established as an important adjunct to life-support techniques. The technical aspects are described together with experimental evidence that intermittent jet ventilation is necessary to eliminate carbon dioxide. The complications occurring with a series of 80 patients are reported along with experimental work in ventilation of dogs with compressed air sources, including truck tires. Emergency physicians should be familiar with this technique and equipment for its use should be readily available in the emergency department. The potential role of transtracheal ventilation in the mobile intensive care unit at accident sites has been explored and appears promising. Conventional airway support techniques should be applied prior to resorting to transtracheal ventilation.

  10. Bioresorbable scaffolds for percutaneous coronary interventions

    PubMed Central

    Gogas, Bill D.

    2014-01-01

    Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future

  11. Percutaneous nitroglycerin absorption in rats.

    PubMed

    Horhota, S T; Fung, H L

    1979-05-01

    Percutaneous nitroglycerin absorption was studied in shaved rats by monitoring unchanged plasma drug concentrations for up to 4 hr. Drug absorption from the neat liquid state or from an alcoholic solution was considerably poorer than that from a commercial ointment. This observation was unanticipated since the driving force for percutaneous drug absorption was assumed to be drug thermodynamics. Potential artifacts such as drug volatilization from the skin, reduction of surface area through droplet formation, and vehicle occlusion were investigated, but they did not appear to be responsible for the observed results. Two experimental aqueous nitroglycerin gels were prepared with polyethylene glycol 400. One gel contained just sufficient polyethylene glycol to solubilize the nitroglycerin; the other had excess polyethylene glycol to solubilize nitroglycerin far below saturation. Both gels gave extremely low plasma nitroglycerin levels. The composite data suggested that percutaneous nitroglycerin absorption is highly vehicle dependent and that this dependency cannot be explained by simple consideration of drug thermodynamic activity.

  12. Bone Marrow Nails Created by Percutaneous Osteoplasty for Long Bone Fracture: Comparisons Among Acrylic Cement Alone, Acrylic-Cement-Filled Bare Metallic Stent, and Acrylic-Cement-Filled Covered Metallic Stent

    SciTech Connect

    Nakata, Kouhei; Kawai, Nobuyuki; Sato, Morio Cao, Guang; Sahara, Shinya; Sonomura, Tetsuo; Takasaka, Isao; Minamiguchi, Hiroki; Nakai, Motoki

    2011-06-15

    Purpose: This study was designed to compare the strength among bone marrow nails created to treat long bone fractures using interventional procedures. Methods: Twelve resected intact tibiae of healthy swine were used. A circumferential bone fracture was made in nine tibiae and restored with the following created bone marrow nails: acrylic cement alone (ACA) (n = 3), acrylic-cement-filled bare metallic stent (AC-FBMS) (n = 3), and acrylic-cement-filled covered metallic (AC-FCMS) stent (n = 3). The remaining intact tibiae (n = 3) were used as controls. Results: A bone marrow nail was successfully achieved within 30 min in all swine. The maximum injection volume of acrylic cement for creating ACA, AC-FBMS, and AC-FCMS was 1.7 {+-} 0.3, 3.2 {+-} 0.4, and 2.9 {+-} 0.4 mL, respectively. The thickness of bone marrow nail created in the ACA, AC-FBMS, and AC-FCMS groups was 3.6 {+-} 1.0, 10.3 {+-} 0.26, and 9.6 {+-} 0.32 mm, respectively (AC-FBMS group versus AC-FCMS group, p = 0.038), probably because of leakage of acrylic cement surrounding the interstices. The maximum bending power (kilonewton) and bending strength (newton/mm{sup 2}) in the normal long bone, ACA, AC-FBMS, and AC-FCMS groups were: 1.70 {+-} 0.25 and 79.2 {+-} 16.1; 0.21 {+-} 0.11 and 8.8 {+-} 2.8; 0.46 {+-} 0.06 and 18.2 {+-} 1.6; and 0.18 {+-} 0.04 and 7.8 {+-} 2.7, respectively. Conclusions: Although the maximum bending power and bending strength of AC-FBMS were not satisfactory, it was the most robust of the three marrow nails for restoring fractured long bone.

  13. Renopleural fistula after percutaneous nephrolithotomy.

    PubMed

    Palou Redorta, J; Banús Gassol, J M; Prera Vilaseca, A; Ramón Dalmau, M; Morote Robles, J; Ahmad Wahad, A

    1988-01-01

    We present here a 42-year-old female who developed a renopleural fistula after a percutaneous nephrolithotomy through the 11th intercostal space of a calculus of the upper calyces of the right kidney. The fistula was resolved with a chest tube and a double-J ureteral catheter. PMID:3388633

  14. The value of percutaneous cholangiography

    PubMed Central

    Evison, Gordon; McNulty, Myles; Thomson, Colin

    1973-01-01

    Percutaneous cholangiograms performed on fifty patients in a district general hospital have been reviewed, and the advantages and limitations of the examination are described. The investigation is considered to have sufficient diagnostic value to warrant its inclusion in the diagnostic armamentarium of every general radiological department. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:4788917

  15. Advances in percutaneous electrode systems.

    PubMed

    Mooney, V; Roth, A M

    1976-01-01

    In the past eight years, developing a percutaneous electrode system has advanced to a successful, yet simple, method to transmit electrical signals, overcoming the serious problems of excessive mechanical irritation at the skin interface. Experience with over 50-74% in the clinical applications of 1) chronic pain relief; 2) contracture correction; and 3) sensory feedback.

  16. Complications of percutaneous vertebroplasty

    PubMed Central

    Saracen, Agnieszka; Kotwica, Zbigniew

    2016-01-01

    Abstract Percutaneous vertebroplasty (PVP) is a minimally invasive procedure widely used for the treatment of pain due to vertebral fractures of different origins—osteoporotic, traumatic, or neoplastic. PVP is minimally invasive, but the complications are not rare; however, they are in most cases not significant clinically. The most frequent is cement leakage, which can occur onto veins, paravertebral soft tissue, into the intervertebral disk, or to the spinal canal, affecting foraminal area or epidural space. We analyzed results of treatment and complications of vertebroplasty performed with the use of polimethylomethylacrylate cement (PMMA) on 1100 vertebrae, with a special regard to the severity of complication and eventual clinical manifestation. One thousand one hundred PVP were analyzed, performed in 616 patients. There were 468 (76%) women and 148 men (24%), 24 to 94-year old, mean age 68 years. From 1100 procedures, 794 treated osteporotic and 137 fractures due to malignant disease, 69 PVP were made in traumatic fractures. One hundred patients had painful vertebral hemangiomas. Seven hundred twenty-six (66%) lesions were in thoracic, and 374 (34%) in lumbar area. Results of treatment were assessed using 10 cm Visual Analogue Scale (VAS) 12 hours after surgery, 7 days, 30 days, and then each 6 months, up to 3 years. Before surgery all patients had significant pain 7 to 10 in VAS scale, mean 8.9 cm. Twelve  hours after surgery 602 (97.7%) reported significant relief of pain, with mean VAS of 2,3 cm. Local complications occurred in 50% of osteoporotic, 34% of neoplastic, 16% of traumatic fractures, and 2% of vertebral hemangiomas. The most common was PMMA leakage into surrounding tissues—20%; paravertebral vein embolism—13%; intradiscal leakage—8%; and PMMA leakage into the spinal canal—0.8%. Results of treatment did not differ between patients with and without any complications. From 104 patients who had chest X-ray or CT study performed

  17. Transhepatic contemporary palliation of biliary and duodenal stenoses by means of metallic stents.

    PubMed

    Cozzi, G; Chiaraviglio, F; Bonfanti, G; Civelli, E M

    2004-01-01

    We describe the treatment of a stenosing lesion of the horizontal duodenum by means of a large-bore metallic stent inserted percutaneously in a patient with transhepatic biliary drainage. In the same session, we used an expandable metallic stent in the biliary tree to relieve jaundice. We recommend the transhepatic approach for duodenal metallic stent insertion in patients with percutaneous biliary drainage.

  18. Duodenal diversion of percutaneous biliary drain through a percutaneous endoscopic gastrostomy: report of a case.

    PubMed

    Mohandas, K M; Swaroop, V S; Desai, D C; Nagral, A; Jagannath, P; Desouza, L J; Kamble, M

    1991-10-01

    Occasionally, percutaneous biliary drainage is the only possible form of treatment in a patient with a malignant obstruction at the porta hepatis. We report on a case of gallbladder carcinoma with a complete block at the porta hepatis, which was palliated with a percutaneous biliary drain. Enteral reinfusion of bile was accomplished through a duodenal tube placed through a percutaneous endoscopic gastrostomy.

  19. Percutaneous renal surgery for urolithiasis.

    PubMed

    Tan, H M; Cheung, H S

    1990-06-01

    Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.

  20. Percutaneous endoscopic treatment of cholelithiasis.

    PubMed

    Griffith, D P; Rubio, P A; Gleeson, M J

    1990-01-01

    Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

  1. Percutaneous absorption in preterm infants.

    PubMed

    West, D P; Halket, J M; Harvey, D R; Hadgraft, J; Solomon, L M; Harper, J I

    1987-11-01

    The skin of preterm infants varies considerably in its level of maturity. To understand skin absorption in premature infants better, we report a technique for the assessment of percutaneous absorption at various gestational and postnatal ages using stable, isotope-labeled (13C6) benzoic acid. Our results indicate that in the preterm infant, this method detects enhanced skin absorption in the first postnatal days, which declines over three weeks to that expected of a full-term infant. This approach also indicates an inverse relationship between gestational age and skin absorption, as well as postnatal age and skin absorption. The reported technique is a safe and noninvasive method using a model skin penetrant for the study of percutaneous absorption in preterm infants from which basic data may be derived to add to our understanding of skin barrier function. PMID:3422856

  2. Percutaneous nephrolithotomy in early pregnancy.

    PubMed

    Shah, A; Chandak, P; Tiptaft, R; Glass, J; Dasgupta, P

    2004-08-01

    Most cases of urolithiasis in pregnancy are managed conservatively either with ureteric stents or percutaneous nephrostomy tubes, which need to be changed at regular intervals. Definitive management of the stone is usually delayed till after delivery. We describe a patient who presented with pyonephrosis in the fifth week of gestation, due to a stone obstructing the right ureteropelvic junction. This was managed by insertion of a nephrostomy tube. She declined nephrostomy tube/stent changes during the rest of her pregnancy and requested termination as an alternative. She successfully underwent percutaneous nephrolithotomy in the 14th week of pregnancy, with radiation exposure strictly localised to the kidney for 6 s. A healthy male baby was delivered at term.

  3. Percutaneous Ablation in the Kidney

    PubMed Central

    Wood, Bradford J.; Gervais, Debra A.

    2011-01-01

    Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. Clinical studies to date indicate that radiofrequency ablation and cryoablation are effective therapies with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting, with attention to pre-, peri-, and postprocedural detail. The results following percutaneous radiofrequency ablation and cryoablation in the treatment of renal cell carcinoma are reviewed in this article, including those of several larger scale studies of ablation of T1a tumors. Clinical and technical considerations unique to ablation in the kidney are presented, and potential complications are discussed. © RSNA, 2011 PMID:22012904

  4. Percutaneous penetration--methodological considerations.

    PubMed

    Holmgaard, Rikke; Benfeldt, Eva; Nielsen, Jesper B

    2014-07-01

    Studies on percutaneous penetration are needed to assess the hazards after unintended occupational skin exposures to industrial products as well as the efficacy after intended consumer exposure to topically applied medicinal or cosmetic products. During recent decades, a number of methods have been developed to replace methods involving experimental animals. The results obtained from these methods are decided not only by the chemical or product tested, but to a significant degree also by the experimental set-up and decisions made by the investigator during the planning phase. The present MiniReview discusses some of the existing and well-known experimental in vitro and in vivo methods for studies of percutaneous penetration together with some more recent and promising methods. After this, some considerations and recommendations about advantages and limitations of the different methods and their relevance for the prediction of percutaneous penetration are given. Which method to prefer will depend on the product to be tested and the question asked. Regulatory guidelines exist for studies on percutaneous penetration, but researchers as well as regulatory bodies need to pay specific attention to the vehicles and solvents used in donor and sampling fluids so that it reflects in-use conditions as closely as possible. Based on available experimental data, mathematical models have been developed to aid predictions of skin penetration. The authors question the general use of the present mathematical models in hazard assessment, as they seem to ignore outliers among chemicals as well as the heterogeneity of skin barrier properties and skin conditions within the exposed populations. PMID:24373389

  5. [Percutaneous therapy of painful arthritis].

    PubMed

    Chlud, K

    1991-01-01

    Pain in osteoarthrosis of the big weight bearing joints is either derived from periarticular ligaments, tendons, fasciae, muscles, bursae--peri-arthropathy as sign of decompensation--or from the reactive synovitis with or without effusion. NSAIDs systemically administered have been so far considered as first choice medication together with physical therapy. New pharmacokinetic data on the topical, percutaneous application of NSAIDs (ibuprofen, diclofenac, indomethacin, some salicylates and to a lesser degree for etofenamate and piroxicam) have demonstrated relevant advantages of the percutaneous route over the systemic one in soft tissue rheumatism. NSAIDs, mentioned above, locally administered as cream, gel or spray, quickly penetrate through the corneal layer of the skin at the site of application, reach high effective concentrations in subcutis, fasciae, tendons, ligaments and muscles, lesser in joint-capsule and -fluid indicating direct penetration. The blood levels of topical NSAIDs are extremely low with no systemic side effects, especially no gastric toxicity; however, local skin irritation is observed (1 to 2%). In contrast to this, systemic (oral) NSAIDs lead primarily via high blood levels to a much lesser concentration--only one tenth--in particular soft tissues with a high incidence of side effects. In conclusion the percutaneous application of certain NSAIDs has become a well established therapeutic regimen in painful osteoarthrosis and in all other inflammatory degenerative and posttraumatic alterations of soft tissue structures. PMID:2011838

  6. Percutaneous cholecystolithotomy: the first 60 patients.

    PubMed Central

    Chiverton, S G; Inglis, J A; Hudd, C; Kellett, M J; Russell, R C; Wickham, J E

    1990-01-01

    OBJECTIVE--To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN--Prospective study of the first 60 patients treated. SETTING--The London Clinic. PATIENTS--60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS--56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS--The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact. PMID:2369662

  7. A theoretical consideration of percutaneous drug absorption.

    PubMed

    Kubota, K; Ishizaki, T

    1985-02-01

    The percutaneous drug absorption process and its clinical significance are not fully known. In this article we propose a theoretical method to obtain two parameters (kd and kc) of percutaneous drug absorption from in vivo data. These parameters are related to diffusion of a drug through the skin and removal process at the skin-capillary boundary, respectively, characterizing several pharmacokinetic aspects of the drug applied to the skin. Moreover, by employing these two kinetic constants, a simulation of percutaneous drug absorption can be theoretically generated. On the basis of our theoretical considerations on the percutaneous drug absorption process described herein, we conclude that the percutaneous drug absorption process is better understood by employing two kinetic constants in a mathematical model and that its clinical application would be highly possible. PMID:4020622

  8. Percutaneous diode laser disc nucleoplasty

    NASA Astrophysics Data System (ADS)

    Menchetti, P. P.; Longo, Leonardo

    2004-09-01

    The treatment of herniated disc disease (HNP) over the years involved different miniinvasive surgical options. The classical microsurgical approach has been substituted over the years both by endoscopic approach in which is possible to practice via endoscopy a laser thermo-discoplasty, both by percutaneous laser disc nucleoplasty. In the last ten years, the percutaneous laser disc nucleoplasty have been done worldwide in more than 40000 cases of HNP. Because water is the major component of the intervertebral disc, and in HNP pain is caused by the disc protrusion pressing against the nerve root, a 980 nm Diode laser introduced via a 22G needle under X-ray guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. Most patients get off the table pain free and are back to work in 5 to 7 days. Material and method: to date, 130 patients (155 cases) suffering for relevant symptoms therapy-resistant 6 months on average before consulting our department, have been treated. Eightyfour (72%) males and 46 (28%) females had a percutaneous laser disc nucleoplasty. The average age of patients operated was 48 years (22 - 69). The level of disc removal was L3/L4 in 12 cases, L4/L5 in 87 cases and L5/S1 in 56 cases. Two different levels were treated at the same time in 25 patients. Results: the success rate at a minimum follow-up of 6 months was 88% with a complication rate of 0.5%.

  9. Percutaneous Therapy of Ureteral Obstructions and Leak After Renal Transplantation: Long-Term Results

    SciTech Connect

    Aytekin, Cueneyt Boyvat, Fatih; Harman, Ali; Ozyer, Umut; Colak, Turan; Haberal, Mehmet

    2007-11-15

    The purpose of this study was to evaluate the long-term outcome of percutaneous therapy of ureteral complications after renal transplantation. Between January 2000 and June 2006 we percutaneously treated 26 renal transplant patients with ureteral obstruction (n=19) and leak (n=7). Obstructions were classified as early (<2 months after transplantation) or late (>2 months). Patients with leak were treated with nephro-ureteral catheter placement and subsequent double-J stenting. Balloon dilatation, stent placement, and basket extraction were used to treat ureteral obstructions. Patients were followed with ultrasonography. No major procedure-related complication occurred. The mean follow-up time was 34.3 months (range: 6 to 74 months). Initial clinical success was achieved in all 19 patients with obstruction and 6 of 7 patients with leak. Four of 9 early obstructions and 4 of 10 late obstructions recurred during the follow-up. All recurrences were initially managed again with percutaneous methods, including cutting balloon technique and metallic stent placement. Although there was no recurrence in patients with successfully treated leak, stricture was seen at the previous leak site in two patients. These strictures were also successfully managed percutaneously. We conclude that in the treatment of ureteral obstruction and leak following renal transplantation, percutaneous therapy is an effective alternative to surgery. However, further interventions are usually needed to maintain long-term patency.

  10. Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal

    PubMed Central

    Agrawal, Madhu Sudan; Agarwal, Ketan; Jindal, Tarun; Sharma, Manoj

    2016-01-01

    Introduction: Percutaneous nephrolithotomy (PCNL) has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP), which makes the use of 11–13F sheaths as compared to 24–30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. Patients and Methods: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. Results: Complete stone fragmentation was achieved in 114 out of 120 patients (95%) using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5%) patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120). There were no significant postoperative complications. Conclusion: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones. PMID:27127356

  11. Fluoroscopy Guided Transurethral Placement of Ureteral Metallic Stents

    PubMed Central

    Myung Gyu, Song; Seo, Tae Seok; Park, Cheol Min; Choi, Jae Woong; Lee, Jong Mee; Park, Yang Shin

    2015-01-01

    Ureteral stent exchange is usually performed under both fluoroscopic and cystoscopic guidance. We experienced two cases with retrograde placement of metallic ureteral stent via urethra under fluoroscopic guidance. When patients with double-J ureteral stent (DJUS)have symptom and want to change DJUS to metallic stent, fluoroscopic guided transurethral placement of ureteral metallic stent is a good option as alternative of cystoscopic procedure or percutaneous procedure through percutaneous nephrostomy tract. PMID:26557281

  12. Percutaneous drainage of a pancreatic pseudocyst.

    PubMed

    Hermans, P; Hubens, A

    1992-12-01

    We present a patient who developed a pancreatic pseudocyst after surgery for a retroperitoneal fibrous histiocytoma invading the pancreatic tail. The diagnosis was made on the basis of CT and the tail pseudocyst resolved with percutaneous drainage only.

  13. Renal drainage after percutaneous nephrolithotomy.

    PubMed

    Srinivasan, Arun K; Herati, Amin; Okeke, Zeph; Smith, Arthur D

    2009-10-01

    Exit strategy after percutaneous nephrolithotomy (PCNL) is an area of continuing innovation to improve postoperative morbidity and operative outcomes for patients. The two important components of an exit strategy after PCNL are hemostasis and renal drainage. We review the different techniques of renal drainage after PCNL-ie, nephrostomy tube, ureteral stents, and totally tubeless strategy with critical discussion of available evidence for and against each of these techniques. We conclude that the optimal renal drainage method depends on patient characteristics and the operative course; hence, it should be individualized. To simplify this, we group patients undergoing PCNL as routine, problematic, and complicated, based on increasing complexity of the procedure and procedural complications. In routine PCNLs, we favor placement of an ureteral stent or a small-bore nephrostomy tube. In problematic and complicated PCNLs, we think the evidence directs toward placement of a nephrostomy tube, small bore being an option in problematic PCNLs.

  14. [Minimally invasive percutaneous nephrolitholapaxy (MIP)].

    PubMed

    Nagele, U; Schilling, D; Anastasiadis, A G; Walcher, U; Sievert, K D; Merseburger, A S; Kuczyk, M; Stenzl, A

    2008-09-01

    Minimally invasive percutaneous nephrolithopaxy (MIP) was developed to combine the excellent stone-free rates of the conventional percutaneous nephrolithopaxy (PCNL) technique with the low morbidity of the miniaturized PCNL (Mini-Perc) and, at the same time, achieve a high level of patient comfort. The procedure is characterized not only by the diameter of the miniaturized 18-Fr Amplatz sheath that was adopted from the Mini-Perc but also by the following features: ultrasound-guided puncture of the kidney; single-step dilatation of the access tract; ballistic lithotripsy; a low-pressure irrigation system together with stone retraction by irrigation with a specially designed nephroscope sheath, for the so-called vacuum cleaner effect; and a sealed and tubeless access tract with primary closure of the channel independent of hemorrhage and without a second-look procedure.The results of the first 57 patients demonstrate primary stone-free rates of 92.9% with operating times averaging 62 (25-123) min. Severe complications, such as sepsis or bleeding requiring blood transfusion, did not occur. The high and predictable stone-free rate and a low morbidity comparable to that of ureteroscopy and extracorporeal shock-wave lithotripsy make MIP an attractive option for patients and urologists. The "vacuum cleaner effect" with quick removal of stone fragments reduces operating time and prevents new stone formation by avoiding residual fragments. The direct and primary closure of the access tract increases patient comfort and is justified by the reintervention rate of less than 8% in the presented cohort.The lack of a need for second-look nephroscopies, the vacuum cleaner effect, improved patient comfort without nephrostomy tubes, as well as surgery times comparable to that of traditional PCNL demonstrate a consequent evolution of the Mini-Perc. MIP therefore represents a promising and future-oriented module in modern stone therapy.

  15. Percutaneous transhepatic management of complex biliary problems.

    PubMed Central

    Zuidema, G D; Cameron, J L; Sitzmann, J V; Kadir, S; Smith, G W; Kaufman, S L; White, R I

    1983-01-01

    A series of 27 patients with complex biliary problems secondary to previous biliary operations is presented. The patients are divided into two groups: (1) patients with acute perioperative biliary problems; all had biliary leak with abscess, biliary cutaneous fistula, and/or stricture following cholecystectomy or common duct exploration and (2) patients with chronic postoperative biliary problems; all had previous repair of biliary stricture or injuries with late stricture formation. Early management of all patients included placement of a percutaneous biliary stent. Abscesses were drained operatively, and biliary leaks or fistulas were allowed to close spontaneously. Jaundice and cholangitis were allowed to resolve. Following stabilization, management of stricture, if present, was addressed. Eight acute patients had strictures, of which four were partial and three were dilated percutaneously. Four were complete and required operative repair. All 12 chronic patients had strictures, of which six were partial and successfully managed with percutaneous dilatation. Four patients also had common duct stones which were successfully crushed percutaneously. The authors conclude that percutaneous transhepatic drainage offers significant advantages in the early stabilization and treatment of patients with complex biliary problems, and that partial strictures of the biliary tree may be managed successfully by percutaneous dilatation. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. Fig. 11. PMID:6847278

  16. Percutaneous minimally invasive treatment of malignant biliary strictures: current status.

    PubMed

    Krokidis, Miltiadis; Hatzidakis, Adam

    2014-04-01

    The concept of percutaneous management of malignant biliary obstruction has not significantly changed in the last two decades and is based on the successful drainage of bile toward the duodenum, which normalizes liver function and prevents the development of cholangitis and sepsis. However, patient survival has changed slightly in the last two decades due to the advance of the diagnostic methods, chemo-radiotherapy protocols, and minimally invasive local control of the disease. Bare metal stents have not improved; however, newly developed covered biliary stents have been designed, and there is now evidence supporting their use in the clinical practice. However, other novel devices that may potentially offer benefit to patients with malignant biliary obstruction have been developed, such as drug-eluting biliary stents and intraductal ablation devices, and first feasibility trials have been published that offer encouraging results. These new technological developments, in combination with increased patient survival, bring new exciting data in this constantly developing area. The purpose of this review article is to investigate the latest published evidence on percutaneous minimal invasive palliation of malignant biliary disease and to delineate current trends.

  17. Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion

    SciTech Connect

    Carnevale, F. C. De Blas, Mariano; Merino, Santiago; Egana, Jose M.; Caldas, Jose G.M.P.

    2004-09-15

    Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 to 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.

  18. Percutaneous Stent Placement as Treatment of Renal Vein Obstruction Due to Inferior Vena Caval Thrombosis

    SciTech Connect

    Stecker, Michael S. Casciani, Thomas; Kwo, Paul Y.

    2006-02-15

    A patient who had undergone his third orthotopic liver transplantation nearly 9 years prior to presentation developed worsening hepatic and renal function, as well as severe bilateral lower extremity edema. Magnetic resonance imaging demonstrated vena caval thrombosis from the suprahepatic venous anastomosis to the infrarenal inferior vena cava, obstructing the renal veins. This was treated by percutaneous placement of metallic stents from the renal veins to the right atrium. At 16 months clinical follow-up, the patient continues to do well.

  19. Percutaneous debridement of posttraumatic infected major hepatic necrosis.

    PubMed

    Sacks, David; Ong, Adrian; Fernandez, Forrest

    2014-08-01

    Although percutaneous drainage of liver abscesses has long been the standard of care, percutaneous drainage of infected necrotic liver tissue is usually used only to stabilize a patient's condition in the setting of sepsis before surgical debridement is ultimately required, frequently in the form of a hepatic lobectomy. The present report describes three cases of curative percutaneous drainage and percutaneous debridement of posttraumatic infected major hepatic necrosis. Techniques used included catheter suction, lavage, and foreign body retrieval.

  20. Percutaneous Cholangioscopy in the Management of Biliary Disease: Experience in 25 Patients

    SciTech Connect

    Hatzidakis, Adam A.; Alexandrakis, George; Kouroumalis, Helias; Gourtsoyiannis, Nicholas C.

    2000-11-15

    Purpose: To present our experience performing percutaneous cholangioscopy in the management of 25 patients with biliary disease.Methods: During the last 3 years, 26 percutaneous cholangioscopies were performed in 25 patients with common bile duct disease (n = 16), intrahepatic ducts disease (n = 6), and gallbladder disease (n = 4). Our patient population group included seven with common bile duct stones, three with intrahepatic lithiasis, and eight with benign strictures (six iatrogenic and two postinflammatory). In four patients malignancy was to be excluded, in two the tumor extent was to be evaluated, whereas in one case the correct placement of a metallic stent needed to be controlled. A 9.9 Fr flexible endoscope URF-P (Olympus, 1.2 mm working channel, 70-cm length) was used.Results: In total, percutaneous cholangioscopy answered 30 diagnostic questions, was technically helpful in 19 cases (performing lithotripsy or biopsy or guiding a wire), and of therapeutic help in 12 (performing stone retrieval). In 24 of 26 cases the therapeutic decision and the patient management changed because of the findings or because of the help of the method. In two cases biliary intervention failed to treat the cause of the disease. No major complication due to the use of the endoscopy was noted.Conclusions: Percutaneous cholangioscopy is a very useful tool in the management of patients with biliary disease. The method can help in diagnosis, in performing complex interventional procedures, and in making or changing therapeutic decisions.

  1. [Percutaneous surgery in renal lithiasis. Current indications].

    PubMed

    Escovar Díaz, P; Rey, M; López, J R; Rodríguez, M; González, R D; la Riva, F; Turinese, L; López, J

    1991-06-01

    The indiscriminate use of extracorporeal shock waves in the treatment of urinary calculi has changed the place of percutaneous surgery in the treatment of renal lithiasis. The authors analyse current indications of PCN highlighting stone size. In their view, calculi greater than 2 cm warrant treatment by PCN since only 15-20% of patients are completely stone-free following a single session of ESWL. Attention is focussed on the staghorn calculus and the percutaneous approach. They describe the difficulty encountered in the fragmentation of the cystine calculus owing to its hardness and discuss the difficulties that may arise when using the percutaneous approach in patients with coexisting renoureteral conditions, in the treatment of lithiasis in children and in the obese patients.

  2. Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

    SciTech Connect

    Cornelis, F.; Neuville, A.; Labreze, C.; Kind, M.; Bui, B.; Midy, D.; Palussiere, J.; Grenier, N.

    2013-06-15

    The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

  3. Update on percutaneous mitral commissurotomy.

    PubMed

    Nunes, Maria Carmo P; Nascimento, Bruno Ramos; Lodi-Junqueira, Lucas; Tan, Timothy C; Athayde, Guilherme Rafael Sant'Anna; Hung, Judy

    2016-04-01

    Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure. PMID:26743926

  4. Interval Biliary Stent Placement Via Percutaneous Ultrasound Guided Cholecystostomy: Another Approach to Palliative Treatment in Malignant Biliary Tract Obstruction

    SciTech Connect

    Harding, James Mortimer, Alex; Kelly, Michael; Loveday, Eric

    2010-12-15

    Percutaneous cholecystostomy is a minimally invasive procedure for providing gallbladder decompression, often in critically ill patients. It can be used in malignant biliary obstruction following failed endoscopic retrograde cholangiopancreatography when the intrahepatic ducts are not dilated or when stent insertion is not possible via the bile ducts. In properly selected patients, percutaneous cholecystostomy in obstructive jaundice is a simple, safe, and rapid option for biliary decompression, thus avoiding the morbidity and mortality involved with percutaneous transhepatic biliary stenting. Subsequent use of a percutaneous cholecystostomy for definitive biliary stent placement is an attractive concept and leaves patients with no external drain. To the best of our knowledge, it has only been described on three previous occasions in the published literature, on each occasion forced by surgical or technical considerations. Traditionally, anatomic/technical considerations and the risk of bile leak have precluded such an approach, but improvements in catheter design and manufacture may now make it more feasible. We report a case of successful interval metal stent placement via percutaneous cholecystostomy which was preplanned and achieved excellent palliation for the patient. The pros and cons of the procedure and approach are discussed.

  5. Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy

    SciTech Connect

    Lal, Anupam Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool; Agarwal, Mayank Mohan; Sarkar, Debansu; Khandelwal, Niranjan

    2009-07-15

    We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

  6. Percutaneous Irreversible Electroporation of Unresectable Hilar Cholangiocarcinoma (Klatskin Tumor): A Case Report.

    PubMed

    Melenhorst, Marleen C A M; Scheffer, Hester J; Vroomen, Laurien G P H; Kazemier, Geert; van den Tol, M Petrousjka; Meijerink, Martijn R

    2016-01-01

    Irreversible electroporation (IRE) is a novel image-guided ablation technique that is rapidly gaining popularity in the treatment of malignant tumors located near large vessels or bile ducts. The presence of metal objects in the ablation zone, such as Wallstents, is generally considered a contraindication for IRE, because tissue heating due to power conduction may lead to thermal complications. This report describes a 66-year-old female with a Bismuth-Corlette stage IV unresectable cholangiocarcinoma with a metallic Wallstent in the common bile duct, who was safely treated with percutaneous IRE with no signs for relapse 1 year after the procedure.

  7. Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: A report of two cases

    PubMed Central

    ZHOU, CHUANGUO; WEI, BAOJIE; GAO, KUN; ZHAI, RENYOU

    2016-01-01

    Endobiliary radiofrequency ablation (RFA) has recently been recognized as a beneficial treatment option for malignant biliary obstruction using percutaneous or endoscopic approaches. The feasibility and safety of this method has been demonstrated in clinical studies, with pain, cholangitis and asymptomatic biochemical pancreatitis reported as relatively common complications. By contrast, hepatic coma, newly diagnosed left bundle branch block and partial liver infarction have been reported as uncommon complications. Biliary tract perforation is a serious potential complication of percutaneous intraductal RFA, which may result in severe infection, peritonitis or even mortality, and which has not been previously reported in clinical research. The current study presents the first reports of biliary tract perforation in two patients with unresectable malignant biliary obstruction following percutaneous intraductal RFA. Although the patient in case 1 succumbed 12 days after RFA, the minor biliary tract perforation in case 2 was successfully treated by the deployment of a self-expanding metal stent. This study demonstrates that biliary tract perforation should be recognized as a serious potential complication of endobiliary RFA, and that metal stent deployment should be considered as a treatment option for minor biliary tract perforation. PMID:27313699

  8. Improvements in Intracorporeal Lithotripters for Percutaneous Nephrolithotomy

    NASA Astrophysics Data System (ADS)

    Kuo, Ramsay L.

    2007-04-01

    Percutaneous nephrolithotomy (PNL) is an effective minimally invasive surgical approach for the treatment of large renal stone burden. Intracorporeal lithotripters (ICL) are utilized during PNL to fragment calculi, with some devices capable of concurrently removing fragments as well. Much progress has been made in the design of ICL devices, resulting in potentially more efficient treatment of nephrolithiasis.

  9. Percutaneous Surgery for Severe Hallux Valgus.

    PubMed

    Vernois, Joel; Redfern, David J

    2016-09-01

    Severe hallux valgus is a challenge to treat. If the basal osteotomy is a well known surgery for severe deformity, the chevron osteotomy is usually used in mild to moderate deformity. With a accurent fixation the chevron can also be used in severe deformity. Both techniques can be performed percutaneously and offer reliable techniques. PMID:27524702

  10. Appropriateness of Percutaneous Coronary Intervention

    PubMed Central

    Chan, Paul S.; Patel, Manesh R.; Klein, Lloyd W.; Krone, Ronald J.; Dehmer, Gregory J.; Kennedy, Kevin; Nallamothu, Brahmajee K.; Douglas Weaver, W.; Masoudi, Frederick A.; Rumsfeld, John S.; Brindis, Ralph G.; Spertus, John A.

    2012-01-01

    Context Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. Objective To assess the appropriateness of PCI in the United States. Design, Setting, and Patients Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non–ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. Main Outcome Measures Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. Results Of 500 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103 245 [20.6%]; non–ST-segment elevation myocardial infarction, 105 708 [21.1%]; high-risk unstable angina, 146 464 [29.3%]), and 144 737 (28.9%) for nonacute indications. For acute indications, 350 469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72 911 PCIs (50.4%) were classified as appropriate, 54 988 (38.0%) as uncertain, and 16 838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (≤1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10

  11. [Percutaneous diagnosis and therapy of the bile ducts and gallbladder. Feasibility and status].

    PubMed

    Hauenstein, K H; Wimmer, B; Salm, R; Farthmann, E H

    1991-03-01

    Percutaneous transhepatic access to the bile duct has opened up new possibilities not only for diagnosis by means of cholangiography and cholangioscopy with endoscopically guided biopsy by small-bore equipment, but also for the treatment of benign and malignant obstructive jaundice. In malignant disease recanalization of the obstruction is possible by means of laser, intracavitary irritation, internal bile drainage in Klatskin tumors, large-diameter endoprostheses (e.g., a Y-shaped prosthesis) or metal stents. In benign disease, balloon dilatation of inflammatory stenoses, stone extractions from the bile duct or gallbladder by means of Dormia baskets, ultrasound or piezoelectric shockwave-contact lithotripsy and chemical litholysis are possible. Very often percutaneous access is a real alternative to surgical intervention.

  12. Total Percutaneous Aortic Repair: Midterm Outcomes

    SciTech Connect

    Bent, Clare L. Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

    2009-05-15

    The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 {+-} 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 {+-} 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

  13. Modified Retroperitoneal Access for Percutaneous Intervention after Pancreaticoduodenectomy

    PubMed Central

    Quek, Lawrence H H

    2013-01-01

    Percutaneous access to the surgical bed after pancreaticoduodenectomy can be a challenge, due to the post-operative anatomy alteration. However, immediate complications, such as surgical bed abscess or suspected tumor recurrence, are often best accessed percutaneously, as open surgical or endoscopic approaches are often difficult, if not impossible. We, hereby, describe a safe approach that is highly replicable, in accessing the surgical bed for percutaneous intervention, following pancreaticoduodenectomy. PMID:23690711

  14. Emergency percutaneous nephrostomy in the septic kidney.

    PubMed

    Nicolescu, D; Boja, R; Osanu, V; Bakos, I; Negrut, I; Cantar, C; Schwartz, L

    1992-01-01

    From 250 upper tract obstructive uropathy cases we have studied 64 patients hospitalized with toxico-septic shock. The constant symptom was arterial hypotension. Other 3 patients with long-standing urinary infection due to lithiasis developed this dreaded complication after PNL (staghorn stones-2, pyelic stone-1). In complicated obstructive uropathy cases associated with toxico-septic shock, percutaneous nephrostomy for high urinary derivation in emergency is usually made under local anaesthesia. Its aim is rapid and efficient clearance of kidney obstruction, with minimal damage for the patient; then it is followed by strong antibiotherapy associated with other reanimation and intensive care measures. There were 11 deaths. The stone generating obstructive uropathy was removed subsequently, after the improvement of biological constants and general state of the patient, under the protection of percutaneous nephrostomy.

  15. Percutaneous heart valves; past, present and future.

    PubMed

    Rozeik, M M; Wheatley, D J; Gourlay, T

    2014-09-01

    Percutaneous heart valves provide a promising future for patients refused surgery on the grounds of significant technical challenges or high risk for complications. Since the first human intervention more than 10 years ago, over 50 different types of valves have been developed. The CoreValve and Edwards SAPIEN valves have both experienced clinical trials and the latter has gained FDA approval for implantation in patients considered inoperable. Current complications, such as major vascular bleeding and stroke, prevent these valves from being commonly deployed in patients considered operable in conventional surgery. This review focuses on the past and present achievements of these valves and highlights the design considerations required to progress development further. It is envisaged that, with continued improvement in valve design and with increased clinical and engineering experience, percutaneous heart valve replacement may one day be a viable option for lower-risk operable patients.

  16. Percutaneous Management of Malignant Biliary Obstruction.

    PubMed

    Sutter, Christopher M; Ryu, Robert K

    2015-12-01

    Malignancy resulting in impaired biliary drainage includes a number of diagnoses familiar to the interventional radiologist. Adequate drainage of such a system can significantly improve patient quality of life, and can facilitate the further treatment options and care of such patients. In the setting of prior instrumentation, cholangitis can present as an urgent indication for drainage. Current initial interventional management of malignant biliary duct obstruction frequently includes endoscopic or percutaneous intervention, with local practices and preprocedural imaging guiding interventional approaches and subsequent management. This article addresses the indications for percutaneous drainage, technical considerations in performing such drainage, and specific techniques useful in attempting to achieve clinical end points in patients with malignant biliary duct obstruction.

  17. Brachiocephalic artery haemorrhage during percutaneous tracheostomy.

    PubMed

    Sharma, S D; Kumar, G; Hill, C S; Kaddour, H

    2015-03-01

    Percutaneous tracheostomy was performed on a 69-year-old woman to facilitate weaning. Insertion of the size 7 tracheostomy tube resulted in profuse bleeding around the tracheostomy site. On inflation of the tracheostomy balloon, the bleeding stopped. Urgent computed tomography demonstrated the brachiocephalic artery was abnormally high and lying in an oblique fashion over the trachea, and the tracheostomy tube was displacing the trachea posteriorly. Surgical repair of the defect in the brachiocephalic artery was undertaken and a surgical tracheostomy was performed in theatre. This case raises important issues about the potential dangers of percutaneous tracheostomy in cases of abnormal anatomy. It also emphasises the importance of direct visualisation of the seeker needle using the endoscope. In cases where there is a suspicion of abnormal anatomy, it is safer to obtain preprocedural imaging or perform a surgical tracheostomy. PMID:25723674

  18. Embolic protection devices in percutaneous coronary intervention.

    PubMed

    Meneguz Moreno, Rafael A; Costa, José R; Costa, Ricardo A; Abizaid, Alexandre

    2016-06-01

    Clinical benefit of percutaneous coronary intervention (PCI) depends on both angiographic success at lesion site as well as the restoration of adequate macro and microvascular perfusion. The pathophysiology of embolization from coronary lesions during PCI is multifactorial, being more frequently observed in patients with acute coronary syndrome and in those with lesions at saphenous vein graft (SVG). In this population, despite successful epicardial intervention, distal tissue perfusion may still be absent in up to a quarter of all PCI. Multiple devices and pharmacologic regimens have been developed and refined in an attempt to protect the microvascular circulation during PCI. Among them, embolic protection devices have raised as an attractive adjunctive toll due to their ability to retain debris and potentially prevent distal embolization, reducing major adverse cardiac events. Currently, their use has been validated for the treatment of SVG lesions but failed to show effectiveness in the percutaneous approach of acute coronary syndrome patients, including those with ST elevation myocardial infarction. PMID:27007782

  19. Antiseptic skin agents for percutaneous procedures.

    PubMed

    Lepor, Norman E; Madyoon, Hooman

    2009-01-01

    Infections associated with percutaneously implanted devices, such as pacemakers, internal cardiac defibrillators, and endovascular prostheses, create difficult and complex clinical scenarios because management can entail complete device removal, antibiotic therapy, and prolonged hospitalization. A source for pathogens is often thought to be the skin surface, making skin preparation at the time of the procedure a critical part of minimizing implantation of infected devices and prostheses. The most common skin preparation agents used today include products containing iodophors or chlorhexidine gluconate. Agents are further classified by whether they are aqueous-based or alcoholbased solutions. Traditional aqueous-based iodophors, such as povidone-iodine, are one of the few products that can be safely used on mucous membrane surfaces. Alcohol-based solutions are quick, sustained, and durable, with broader spectrum antimicrobial activity. These agents seem ideal for percutaneous procedures associated with prosthesis implantation, when it is critical to minimize skin colony counts to prevent hardware infection.

  20. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.

  1. A Percutaneous Knotless Technique for SLAP Repair.

    PubMed

    Tennent, Duncan; Pearse, Eyiyemi

    2016-02-01

    We describe a percutaneous technique for repair of type II SLAP lesions. Through the Neviaser portal, a spinal needle is used to pass a FiberStick suture (Arthrex, Naples, FL) through the labrum to create 2 mattress sutures that are secured with PushLock anchors (Arthrex). This technique is simple, reproducible, and knotless and requires no cannulas. At the end of the procedure, minimal suture material remains in the joint.

  2. Percutaneous Vertebral Body Augmentation: An Updated Review

    PubMed Central

    Omidi-Kashani, Farzad

    2014-01-01

    There are many medical conditions like osteoporosis, tumor, or osteonecrosis that weaken the structural strength of the vertebral body and prone it to fracture. Percutaneous vertebral augmentation that is usually applied by polymethylmethacrylate is a relatively safe, effective, and long lasting procedure commonly performed in these situations. In this paper, we updated a review of biomechanics, indications, contraindications, surgical techniques, complications, and overall prognosis of these minimally invasive spinal procedures. PMID:25379561

  3. Percutaneous Retrieval of Chronic Intravascular Foreign Bodies

    SciTech Connect

    Savage, Clare; Ozkan, Orhan S.; Walser, Eric M.; Wang Dongfang; Zwischenberger, Joseph B.

    2003-09-15

    To evaluate the feasibility of intravascular retrieval of chronic foreign bodies, we retrospectively reviewed an 8 year experience (1993-2001) of percutaneous retrieval of chronically retained intravascular foreign bodies (n = 6). In 6 of 6 cases (4 catheter fragments, 2 guidewires), 5-90 days elapsed before retrieval via the femoral or internal jugular vein. Under fluoroscopy, we determined the foreign body's course, position and size. A guidewire was advanced through a multipurpose catheter to the foreign body. The multipurpose catheter was replaced with a gooseneck snare catheter and the snare advanced to grasp and remove the foreign body. Percutaneous retrieval was successful in all 6 cases. One patient experienced mild hemoptysis, which resolved within 24 hr of observation. No patient experienced long-term sequelae. Given the potential life-threatening complications from intravascular foreign bodies and the low complication rate from percutaneous retrieval, we recommend extraction of the foreign body even if it is asymptomatic in the chronic setting (> 24 hr)

  4. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    PubMed

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  5. Transdermal anaesthesia for percutaneous trigger finger release.

    PubMed

    Yiannakopoulos, Christos K; Ignatiadis, Ioannis A

    2006-01-01

    The purpose of this study was to evaluate the safety and efficiency of transdermal anaesthesia using eutectic mixture of lidocaine and prilocaine (EMLA) in patients undergoing percutaneous trigger finger release and to compare it with lidocaine infiltration. In this prospective, randomised study percutaneous release of the A1 annular pulley was performed to treat stenosing tenosynovitis (trigger finger syndrome) in 50 patients (50 fingers). The procedure was performed either under transdermal anaesthesia using EMLA applied transcutaneously 120 minutes prior to the operation (Group A, n = 25) or using local infiltration anaesthesia using lidocaine (Group B, n = 25). Pain experienced during administration of anaesthesia and during the operation was assessed using a 10-point Visual Analogue Pain Scale (VAPS), while all patients rated the effectiveness of anaesthesia with a 5-point scale. There were no significant differences between the two groups in the VAPS during the operation (1.33 +/- 0.52 versus 1.59 +/- 0.87) and the satisfaction scores (4.6 +/- 0.2 versus 4.4 +/- 0.3). The VAPS score during the administration of anaesthesia was statistically significantly less in the EMLA group (0 versus 5.96 +/- 2.41). All patients were satisfied with the final result of the operation. Percutaneous trigger finger release can be performed as an office procedure with the use of EMLA avoiding the use of injectable local infiltration anaesthesia. PMID:17405199

  6. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    PubMed

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system. PMID:18774684

  7. Simulations of percutaneous RF ablation systems

    NASA Astrophysics Data System (ADS)

    Ryan, Thomas P.; Kwok, Jonathan; Beetel, Robert J.

    2003-06-01

    Breast and liver cancers provide an ongoing challenge in regard to treatment efficacy and successful clinical outcomes. A variety of percutaneous technology has been applied for thermal treatment of the liver and breast, including laser, microwave, cryogenic and radiofrequency (RF) devices. When simplicity and cost are factored in, RF hardware and applicators offer the most cost-effective treatment pathway by interventional radiologists and surgeons. To model percutaneous RF treatments in liver and breast, simulations were done in 3D with a finite element model. Three RF systems were modeled, including 1) single needle; 2) clustered needle, cooled and uncooled; and 3) deployable, hook electrodes. The results show the limitations of the systems in percutaneous procedures, depending on temperature limits, duration of treatment, and whether the devices are cooled or uncooled. For thermal treatment, the isotherm of 55°C was considered the margin of coagulation necrosis. The 3-D volumes of 55°C and 65°C isotherm shells aid in the selection of the best method to improve clinical outcomes, while paying attention to the size and shape of the applicator and duration of treatment.

  8. Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture

    PubMed Central

    Centore, Luca; Soreca, Emilio; Corvino, Antonio; Farbo, Vincenzo; Bencivenga, Alfonso

    2016-01-01

    Background This study evaluated the technical and clinical efficacy of percutaneous bilateral biliary stent-in-stent (SIS) deployment technique with a “Y” configuration using open-cell-design stents in type 4 Klatskin tumor patients. Methods Retrospective evaluation ten patients with type IV Bismuth malignant hilar stricture (MHS) treated with percutaneous bilateral “Y” SIS deployment technique placement followed in our institution between March of 2012 and November of 2014. Results Bilateral SIS deployment was technically successful in all patients. One patient (10%) had major complications (episode of cholangitis); one patient (10%) had minor complications, including self-limiting hemobilia. Successful internal drainage was achieved in nine (90%) patients. Stent occlusion by tumor overgrowth and sludge formation occurred in two patient (20%). The median survival and stent patency time were 298 and 315 days respectively. Conclusions Percutaneous bilateral metal stenting using a Y-stent is a valid option for the palliative treatment of type 4 Bismuth MHS, improving quality patient’ life. PMID:27034794

  9. Failing Hemodialysis Arteriovenous Fistula and Percutaneous Treatment: Imaging with CT, MRI and Digital Subtraction Angiography

    SciTech Connect

    Cavagna, Enrico; D'Andrea, Paolo; Schiavon, Francesco; Tarroni, Giovanni

    2000-07-15

    Purpose: To evaluate failing hemodialysis arteriovenous fistulas with helical CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), and to compare the efficacy of the three techniques in detecting the number, location, grade, and extent of stenoses and in assessing the technical results of percutaneous transluminal angioplasty (PTA) and stenting.Methods: Thirteen patients with Brescia-Cimino arteriovenous fistula malfunction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total of 11 PTAs were performed; in three cases an MR-compatible stent was placed. DSA served as the gold standard for comparison in all patients. The presence, site, and number of stenoses or occlusions and the technical results of percutaneous procedures were assessed with DSA, CTA, and MRA.Results: MRA underestimated a single stenosis in one patient; CTA and MRA did not overestimate any stenosis. Significant artifacts related to stent geometry and/or underlying metal were seen in MRA sequences in two cases.Conclusions: CT and MRI can provide information regarding the degree of vascular impairment, helping to stratify patients into those who can have PTA (single or multiple stenoses) versus those who require an operative procedure (occlusion). Conventional angiography can be reserved for candidates for percutaneous intervention.

  10. [Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy].

    PubMed

    Chu, D; Chamorro, S; Arrieta, F; Cobo, M E; Calañas, A; Botella, J I; Balsa, J; Zamarrón, I; Vázquez, C

    2012-01-01

    Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.

  11. Percutaneous transluminal angioplasty of radiation-induced arterial stenoses

    SciTech Connect

    Guthaner, D.F.; Schmitz, L.

    1982-07-01

    A case of atherosclerosis resulting from previous irradiation was successfully treated using percutaneous transluminal angioplasty for recanalization of the vessel. Irradiation may result in extensive perivascular fibrosis around an area of arterial narrowing; percutaneous transluminal angioplasty appears to be the method of choice for treatment of such lesions.

  12. Carbon Dioxide and Gadopentetate Dimeglumine Venography to Guide Percutaneous Vertebroplasty

    SciTech Connect

    McGraw, J. Kevin; Strnad, Bradley T.; Patzik, Shayle B.; Silber, Jeffrey S.; LaValley, Antoinette L.; Boorstein, Jeffrey M.

    2000-11-15

    Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) is an effective procedure for relieving pain due to vertebral body compression fractures. The technique employs iodinated contrast venography to exclude needle placement directly within the basivertebral complex. We present two cases in which carbon dioxide (CO{sub 2}) and gadopentetate dimeglumine venography was used to guide percutaneous vertebroplasty in patients with a contraindication to iodinated contrast.

  13. Acute endocarditis of a percutaneously placed pulmonary valve

    PubMed Central

    Ramakrishnan, Karthik V; Olivieri, Laura; Jonas, Richard A

    2015-01-01

    Endocarditis of percutaneously placed pulmonary valve is increasingly being recognized and reported as a potentially life-threatening complication. In this report, we discuss a 17-year-old male who presented with septic shock secondary to staphylococcal endocarditis of a percutaneously placed pulmonary valve. PMID:26556969

  14. Percutaneous feeding tube method for use in children.

    PubMed

    Long, B; Rafert, J; Cory, D

    1991-01-01

    Surgical gastrostomy has been a widely accepted method for introducing a percutaneous feeding tube for many years. However, complications are frequent, and many children who need them are not good surgical candidates. This study examines imaging guided percutaneous placement of feeding gastrostomy catheters as a safe and effective alternative to surgery. PMID:1902957

  15. Percutaneous Sclerotherapy With OK-432 of a Cervicomediastinal Lymphangioma.

    PubMed

    Golinelli, Gloria; Toso, Andrea; Borello, Giovanni; Aluffi, Paolo; Pia, Francesco

    2015-11-01

    The present study reports a case of percutaneous sclerotherapy of a giant cystic cervicomediastinal lymphangioma using OK-432. To the best of our knowledge, percutaneous sclerotherapy of a mediastinal lymphangioma using OK 432 has not previously been reported in the English literature.

  16. Percutaneous catheter drainage in treatment of urinary extravasation.

    PubMed

    Selman, S H; Koo, B C; Kropp, K A; Zeiss, J

    1984-01-01

    In the last two decades there has been a rapid growth in the percutaneous manipulation of the genitourinary tract. We would like to present 2 patients in whom CT-guided percutaneous drainage of urinary extravasation was employed successfully and review the pertinent literature.

  17. Percutaneous Image-Guided Ablation of Breast Tumors: An Overview

    PubMed Central

    Sag, Alan A.; Maybody, Majid; Comstock, Christopher; Solomon, Stephen B.

    2014-01-01

    Percutaneous non-surgical image-guided ablation is emerging as an adjunct or alternative to surgery in the management of benign and malignant breast tumors. This review covers the current state of the literature regarding percutaneous image-guided ablation modalities, clinical factors regarding patient selection, and future directions for research. PMID:25049447

  18. Orthopedic surgical analyzer for percutaneous vertebroplasty

    NASA Astrophysics Data System (ADS)

    Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.

    2001-05-01

    Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically

  19. Percutaneous nephrolithotomy and ureteroscopy in children: evolutions.

    PubMed

    Long, Christopher J; Srinivasan, Arun K

    2015-02-01

    The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed. PMID:25455168

  20. Percutaneous Cryoablation and Vertebroplasty: A Case Report

    SciTech Connect

    Masala, Salvatore; Roselli, Mario; Manenti, Guglielmo; Mammucari, Matteo; Bartolucci, Dario Alberto Simonetti, Giovanni

    2008-05-15

    A 70-year-old man with a painful vertebral metastasis was treated with combined percutaneous cryoablation and vertebroplasty therapy (CVT) in one session. The patient was suffering from diffuse visceral metastasized cholangiocarcinoma. After several weeks of back pain, magnetic resonance imaging documented a single L2 bone metastasis. In consultation with the oncologists, palliative combined CVT was administered with the aim of obtaining pain relief and bone stabilization. In our experience this combined treatment is safe and effective for immediate pain relief in painful bone metastases when other standard palliative treatments have failed.

  1. Percutaneous nephrolithotomy and ureteroscopy in children: evolutions.

    PubMed

    Long, Christopher J; Srinivasan, Arun K

    2015-02-01

    The increasing incidence of pediatric stone disease has coincided with significant advances in technology and equipment, resulting in drastic improvements in management. Miniaturization of both ureteroscopes and percutaneous nephrolithotomy (PCNL) equipment has facilitated access to the entirety of the urinary tract and has made ureteroscopy a first-line therapy option along with shock-wave lithotripsy for kidney and ureteral stones. Advances in PCNL have decreased patient morbidity while preserving stone clearance rates. In this review, the advances in operative approach for ureteroscopy and PCNL in children and its applicability to current surgical management of pediatric stone disease are discussed.

  2. Pharmacokinetics and bioavailability of percutaneous ibuprofen.

    PubMed

    Kleinbloesem, C H; Ouwerkerk, M; Spitznagel, W; Wilkinson, F E; Kaiser, R R

    1995-10-01

    The absorption, pharmacokinetics and bioavailability of ibuprofen (CAS 15687-27-1) were investigated for an ibuprofen gel preparation (ibugel) for percutaneous application, and compared to a standard oral ibuprofen tablet preparation. The monocentric, randomised, 2-way cross-over study with 7-day wash-out period was performed on 18 healthy female volunteers with an average age of 26.3 +/- 4.8 years (range: 20-38 years), average weight 60.4 +/- 7.6 kg, and average height 164.7 +/- 5.9 cm. Blood samples were taken from the volunteers before administration of the tablet or gel, and periodically during 24 h after administration. The ibuprofen content in these samples was determined using a validated HPLC method. Main pharmacokinetic parameters derived from individual plasma concentration-time courses included: Cmax, tmax, AUCO-->24, AUCO-->infinity, MRTO-->infinity, t1/2 and Frel. For percutaneous application of 500 mg ibuprofen (10 g 5% gel on the back, area of 20 x 20 cm) with occlusion for 2 h, a Cmax of 7.1 +/- 4.4 micrograms/ml (95% confidence interval (CI): 5.0-9.1) was obtained at 2.4 +/- 0.8 h (95% CI: 2.0-2.8). For oral administration of 400 mg, Cmax was 36.7 +/- 7.5 micrograms/ml (95% CI: 33.2-40.1) at 1.1 +/- 0.8 h (95% CI: 0.7-1.5). The (dose-corrected) relative bioavailability of the topical ibuprofen was found to be 22 +/- 12% (95% CI: 14-30%) of that after oral administration. The plasma elimination half-life was 2.5 +/- 1.4 h (95% CI: 1.9-3.2) for topical administration, and 1.8 +/- 0.5 h (95% CI: 1.6-2.1) after oral administration (not significant, p > 0.05). The surprisingly high levels of ibuprofen found in the plasma after percutaneous application are still below the threshold where systemic side effects might be expected (10 micrograms/ml). The high peak plasma concentration and relative bioavailability of percutaneous ibuprofen are likely due to the galenical formation of the gel preparation, which contains isopropyl alcohol and propylene glycol

  3. Percutaneous distraction osteogenesis for treatment of brachymetatarsia.

    PubMed

    Lamm, Bradley M

    2010-01-01

    Brachymetatarsia is not an unusual deformity and is often associated with functional and cosmetic issues that warrant surgical reconstruction. Lengthening of the affected metatarsal can be undertaken on an acute basis in a single operative procedure that involves the use of a bone graft or by means of gradual callus distraction. Because of the risk of metatarsophalangeal joint malalignment, it is important for the surgeon to take steps to stabilize the joint during the lengthening process. In this report, a percutaneous method of callus distraction for repair of brachymetatarsia and maintenance of metatarsophalangeal joint alignment is presented. PMID:20022524

  4. PET-Based Percutaneous Needle Biopsy.

    PubMed

    El-Haddad, Ghassan

    2016-07-01

    PET can be used to guide percutaneous needle biopsy to the most metabolic lesion, improving diagnostic yield. PET biopsy guidance can be performed using visual or software coregistration, electromagnetic needle tracking, cone-beam computed tomography (CT), and intraprocedural PET/CT guidance. PET/CT-guided biopsies allow the sampling of lesions that may not be clearly visible on anatomic imaging, or of lesions that are morphologically normal. PET can identify suspicious locations within complex tumors that are most likely to contain important diagnostic and prognostic information. PMID:27321036

  5. Direct Percutaneous Embolization of Bleeding Stomal Varices

    SciTech Connect

    Naidu, Sailen G.; Castle, Erik P.; Kriegshauser, J. Scott; Huettl, Eric A.

    2010-02-15

    Stomal variceal bleeding can develop in patients with underlying cirrhosis and portal hypertension. Most patients are best treated with transjugular intrahepatic portosystemic shunt (TIPS) creation because this addresses the underlying problem of portal hypertension. However, some patients are not good candidates for TIPS creation because they have end-stage liver disease or encephalopathy. We describe such a patient who presented with recurrent bleeding stomal varices, which was successfully treated with percutaneous coil embolization. The patient had bleeding-free survival for 1 month before death from unrelated causes.

  6. Percutaneous endoscopic gastrostomy in children: a single center experience

    PubMed Central

    Koca, Tuğba; Sivrice, Ayşe Çiğdem; Dereci, Selim; Duman, Levent; Akçam, Mustafa

    2015-01-01

    Aim: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction. Material and Methods: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files. Results: Forty seven percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy related procedures were performed in 34 children during a three-year period. The median age of the patients was 2.25 years (3 months-16 years, first and third quartiles=1.0–6.0) and the mean body weight was 13.07±8.6 kg (3 kg-47 kg). Before percutaneous endoscopic gastrostomy procedure, the mean weight z score was −2.26±1.2 (−5–0) and the mean height z score was −2.25±0.96 (−3.85–0.98). The follow-up mean height and weight Z scores at the 12th month after the percutaneous endoscopic gastrostomy procedure could be reached in 24 patients. A significant increase in the mean weight Z score from −2.41 to −1,07 (p=0.000) and in the mean height Z score from −2.29 to −1.99 (p=0.000) was found one year after percutaneous endoscopic gastrostomy catheter was placed in these 24 patients. Patients with neurological and metabolic diseases constituted the majority (64.7% and 26.5% respectively). Peritoneal leakage of food was detected in one patient and local stoma infections were detected in three patients after the procedure. During the follow up period, “Buried bumper syndrome” was observed in one patient. Following percutaneous endoscopic gastrostomy, the number of patients using anti-reflux medication increased from 16 (47.1%) to 18 (52.9%) (p=0.62). One patient with cerebral palsy who had aspiration pneumonia after percutaneous endoscopic gastrostomy insertion

  7. Percutaneous external fixator pins with bactericidal micron-thin sol-gel films for the prevention of pin tract infection.

    PubMed

    Qu, Haibo; Knabe, Christine; Radin, Shula; Garino, Jonathan; Ducheyne, Paul

    2015-09-01

    Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported. The infection rate is even greater, up to 32.2%, with external fixation of femoral fractures. The use of percutaneous implants for certain clinical applications, such as percutaneous implants for external fracture fixation, still represents a challenge today. Currently, bone infections are very difficult to treat. Very potent antibiotics are needed, which creates the risk of irreversible damage to other organs, when the antibiotics are administered systemically. As such, controlled, local release is being pursued, but no such treatments are in clinical use. Herein, the use of bactericidal micron-thin sol-gel films on metallic fracture fixation pins is reported. The data demonstrates that triclosan (2,4,4'-trichloro-2'-hydroxydiphenylether), an antimicrobial agent, can be successfully incorporated into micron-thin sol-gel films deposited on percutaneous pins. The sol-gel films continuously release triclosan in vitro for durations exceeding 8 weeks (longest measured time point). The bactericidal effect of the micron-thin sol-gel films follows from both in vitro and in vivo studies. Inserting percutaneous pins in distal rabbit tibiae, there were no signs of infection around implants coated with a micron-thin sol-gel/triclosan film. Healing had progressed normally, bone tissue growth was normal and there was no epithelial downgrowth. This result was in contrast with the results in rabbits that received control, uncoated percutaneous pins, in which abundant signs of infection and epithelial downgrowth were observed. Thus, well-adherent, micron-thin sol-gel films laden with a bactericidal molecule successfully prevented pin tract infection.

  8. Percutaneous endoscopic lumbar discectomy - early clinical experience.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Takeda, Masaaki; Itoh, Yasunobu; Matsuoka, Hidenori; Watanabe, Kazuo

    2012-01-01

    We report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011. Thirty-seven patients with lumbar HNP were treated by PELD. PELD was carried out under local anesthesia, and the endoscope was continuously irrigated with saline. Twenty-eight patients were treated through the transforaminal approach, 5 were treated through the interlaminar approach, and 4 were treated through the extraforaminal approach. Surgery was discontinued due to uncontrollable intraoperative pain or anatomical inaccessibility in one case of the interlaminar approach and 2 cases of the extraforaminal approach. In the other 34 patients, the elapsed time of surgery was 34 to 103 minutes (mean 62.4 minutes). Extracorporeal blood loss was insignificant. Immediate symptom relief was achieved in all patients, and postoperative magnetic resonance imaging revealed sufficient removal of the HNP. The length of the postoperative hospital stay was 1 or 2 days in all patients. The surgical method of PELD is completely different from percutaneous nucleotomy, and the aim is to directly remove the HNP with minimum damage to the musculoskeletal structure. Although this study is based on our early clinical outcomes, PELD seemed to be a promising minimally invasive surgery for HNP in the lumbar spine. PMID:23006872

  9. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

    Dimofte, Mihail-Gabriel; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel

    2014-01-01

    Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt. PMID:25489214

  10. Standardizing the reporting of percutaneous nephrolithotomy complications

    PubMed Central

    Violette, Philippe D.; Denstedt, John D.

    2014-01-01

    Accurate reporting of complications is an essential component to critical appraisal and innovation in surgery and specifically with percutaneous nephrolithotomy (PCNL). We review the evolution of complication reporting for PCNL and suggest future directions for innovation. A selective review was carried out using Pubmed. Key search terms and their combinations included percutaneous, anatrophic, nephrolithotomy, PCNL, complications, Clavien, Martin score, bleeding, bowel injury, perforation, fever, sepsis. The references from relevant papers and reviews as well as AUA and EAU guidelines were also scanned for inclusion. PCNL has become the procedure of choice for large renal stones owing to decreased morbidity over alternative procedures. Both common and rare complications have been described in large case series, small randomized controlled trials, and case reports in an unstandardized form. Although these reports have provided an informative starting point, a standardized complication reporting methodology is necessary to enable appropriate comparisons between institutions, time periods, or innovations in technique. The Clavien-Dindo grading system has become widely accepted in urology and has facilitated the study of PCNL complications. Future research should focus on adaptions of this system to render it more comprehensive and applicable to PCNL. PMID:24497689

  11. Percutaneous scaphoid pinning using ultrasound guidance

    NASA Astrophysics Data System (ADS)

    Beek, Maarten; Abolmaesumi, Purang; Chen, Thomas; Sellens, Richard W.; Pichora, David

    2006-03-01

    A new procedure for percutaneous screw insertion in the scaphoid is proposed. The procedure involves pre-surgery planning using computed tomography imaging and intra-operative guidance using three-dimensional ultrasound. Preoperatively, the desired screw location and orientation is chosen on a three-dimensional surface model generated from computed tomography images. During the surgery, ultrasound images are captured from the targeted anatomy of the patient using an ultrasound probe that is tracked with a Certus optical camera. The tracked probe enables the registration of the surface model and the surgical plan to the patient in the operating room. The surgical drill, used by the surgeon for screw insertion, is also tracked with the optical camera. A graphical user interface has been developed to display the surface model, the surgical plan and the drill in real-time. By means of this interface, the surgeon is guided during the screw insertion procedure. Our experiments on scaphoid phantoms demonstrate that the accuracy of the proposed procedure is potentially of the same order as an open reduction and screw fixation surgery. The advantages of this new procedure are a reduced risk of infections and minimal soft tissue damage due to its percutaneous nature. The procedure also reduces the exposure to ionizing radiation for patients and operating room staff due to the employment of ultrasound imaging instead of fluoroscopy.

  12. [Percutaneous tracheostomy in the ventilated patient].

    PubMed

    Añón, J M; Araujo, J B; Escuela, M P; González-Higueras, E

    2014-04-01

    The medical indications of tracheostomy comprise the alleviation of upper airway obstruction; the prevention of laryngeal and upper airway damage due to prolonged translaryngeal intubation in patients subjected to prolonged mechanical ventilation; and the facilitation of airway access for the removal of secretions. Since 1985, percutaneous tracheostomy (PT) has gained widespread acceptance as a method for creating a surgical airway in patients requiring long-term mechanical ventilation. Since then, several comparative trials of PT and surgical tracheostomy have been conducted, and new techniques for PT have been developed. The use of percutaneous dilatation techniques under bronchoscopic control are now increasingly popular throughout the world. Tracheostomy should be performed as soon as the need for prolonged intubation is identified. However a validated model for the prediction of prolonged mechanical ventilation is not available, and the timing of tracheostomy should be individualized. The present review analyzes the state of the art of PT in mechanically ventilated patients--this being regarded by many as the technique of choice in performing tracheostomy in critically ill patients.

  13. Percutaneous gallbladder aspiration for acute cholecystitis

    PubMed Central

    Rassameehiran, Supannee; Nugent, Kenneth

    2016-01-01

    Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2–4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis. PMID:27695167

  14. Percutaneous gallbladder aspiration for acute cholecystitis

    PubMed Central

    Rassameehiran, Supannee; Nugent, Kenneth

    2016-01-01

    Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2–4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis.

  15. [Percutaneous tracheostomy in the ventilated patient].

    PubMed

    Añón, J M; Araujo, J B; Escuela, M P; González-Higueras, E

    2014-04-01

    The medical indications of tracheostomy comprise the alleviation of upper airway obstruction; the prevention of laryngeal and upper airway damage due to prolonged translaryngeal intubation in patients subjected to prolonged mechanical ventilation; and the facilitation of airway access for the removal of secretions. Since 1985, percutaneous tracheostomy (PT) has gained widespread acceptance as a method for creating a surgical airway in patients requiring long-term mechanical ventilation. Since then, several comparative trials of PT and surgical tracheostomy have been conducted, and new techniques for PT have been developed. The use of percutaneous dilatation techniques under bronchoscopic control are now increasingly popular throughout the world. Tracheostomy should be performed as soon as the need for prolonged intubation is identified. However a validated model for the prediction of prolonged mechanical ventilation is not available, and the timing of tracheostomy should be individualized. The present review analyzes the state of the art of PT in mechanically ventilated patients--this being regarded by many as the technique of choice in performing tracheostomy in critically ill patients. PMID:23347906

  16. Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.

    PubMed

    Bender, Matthew T; Bettegowda, Chetan

    2016-07-01

    Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. Each is associated with relatively low, but variable rates of complications. Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients.

  17. Percutaneous Procedures for the Treatment of Trigeminal Neuralgia.

    PubMed

    Bender, Matthew T; Bettegowda, Chetan

    2016-07-01

    Three major percutaneous procedures are currently used to treat trigeminal neuralgia (TN). Percutaneous balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation interrupt afferent pain fibers by injury to the trigeminal nerve root or ganglion. Each is capable of offering immediate and durable pain relief. Each is associated with relatively low, but variable rates of complications. Patient heterogeneity, technical variation, and nonstandard outcomes plague the existing outcomes literature and limit comparisons of treatments. Rendering treatment selection a function of individual physician preference and practice patterns. Randomized, prospective trials are needed; in the meantime, percutaneous rhizotomy remains an excellent treatment for selected patients. PMID:27324995

  18. Percutaneous Relief of Tension Pneumomediastinum in a Child

    SciTech Connect

    Chau, Helen Hoi-lun; Kwok, Philip Chong-hei; Lai, Albert Kwok-hung; Fan, Tsz Wo; Chan, Susan Chi-hum; Miu, Ting Yat; Chan, Grace Lai-har

    2003-11-15

    The purpose of this article was to describe the experience of relieving tension pneumomediastinum by a fluoroscopic-guided percutaneous method. We inserted a percutaneous drainage catheter with a Heimlich valve under fluoroscopic guidance to relieve the tension pneumomediastinum in a 2-year-old girl who suffered from dermatomyositis with lung involvement. This allowed immediate relief without the need for surgery. The procedure was repeated for relapsed tension pneumomediastinum. Good immediate results were achieved in each attempt. We conclude that percutaneous relief of pneumomediastinum under fluoroscopic guidance can be performed safely and rapidly in patients not fit for surgery.

  19. Percutaneous pulmonary valve endocarditis: incidence, prevention and management.

    PubMed

    Patel, Mehul; Malekzadeh-Milani, Sophie; Ladouceur, Magalie; Iserin, Laurence; Boudjemline, Younes

    2014-11-01

    The epidemiology of infective endocarditis is changing rapidly due to the emergence of resistant microorganisms, the indiscriminate use of antibiotics, and an increase in the implantation of cardiovascular devices including percutaneous valves. Percutaneous pulmonary valve implantation has achieved standard of care for the management of certain patients with right ventricular outflow tract dysfunction. With its expanding use, several cases of early and delayed infective endocarditis with higher morbidity and mortality rates have been reported. This review summarizes the trends in percutaneous pulmonary valve infective endocarditis, postulates proposed mechanisms, and elaborates on the prevention and management of this unique and potentially fatal complication.

  20. Percutaneous embolization of varicocele: technique, indications, relative contraindications, and complications

    PubMed Central

    Halpern, Joshua; Mittal, Sameer; Pereira, Keith; Bhatia, Shivank; Ramasamy, Ranjith

    2016-01-01

    There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele. PMID:26658060

  1. Percutaneous Transpedicular Interbody Fusion Technique in Percutaneous Pedicle Screw Stabilization for Pseudoarthrosis Following Pyogenic Spondylitis.

    PubMed

    Ikuta, Ko; Masuda, Keigo; Yonekura, Yutaka; Kitamura, Takahiro; Senba, Hideyuki; Shidahara, Satoshi

    2016-04-01

    This report introduces a percutaneous transpedicular interbody fusion (PTPIF) technique in posterior stabilization using percutaneous pedicle screws (PPSs). An 81-year-old man presented with pseudoarthrosis following pyogenic spondylitis 15 months before. Although no relapse of infection was found, he complained of obstinate low back pain and mild neurological symptoms. Radiological evaluations showed a pseudoarthrosis following pyogenic spondylitis at T11-12. Posterior stabilization using PPSs from Th9 to L2 and concomitant PTPIF using autologous iliac bone graft at T11-12 were performed. Low back pain and neurological symptoms were immediately improved after surgery. A solid interbody fusion at T11-12 was completed 9 months after surgery. The patient had no restriction of daily activity and could play golf at one year after surgery. PTPIF might be a useful option for perform segmental fusion in posterior stabilization using PPSs. PMID:27114777

  2. Percutaneous Biopsy of Osteoid Osteomas Prior to Percutaneous Treatment Using Two Different Biopsy Needles

    SciTech Connect

    Laredo, Jean-Denis Hamze, Bassam; Jeribi, Riadh

    2009-09-15

    Biopsy is usually performed as the first step in percutaneous treatment of osteoid osteomas prior to laser photocoagulation. At our institution, 117 patients with a presumed diagnosis of osteoid osteoma had a trephine biopsy before a percutaneous laser photocoagulation. Biopsies were made using two different types of needles. A Bonopty biopsy needle (14-gauge cannula, 16-gauge trephine needle; Radi Medical Systems, Uppsala, Sweden) was used in 65 patients, and a Laurane biopsy needle (11-gauge cannula, 12.5-gauge trephine needle; Laurane Medical, Saint-Arnoult, France) in 43 patients. Overall biopsy results were positive for osteoid osteoma in 83 (70.9%) of the 117 cases. The Laurane needle provided a significantly higher positive rate (81.4%) than the Bonopty needle (66.1%; p < 0.05). This difference was not due to the size of the nidus, which was similar in the two groups (p < 0.05) and may be an effect of differences in needle caliber (12.5 vs. 14 gauge) as well as differences in needle design. The rate of positive biopsy results obtained in the present series with the Laurane biopsy needle is, to our knowledge, the highest rate reported in series dealing with percutaneous radiofrequency ablation and laser photocoagulation of osteoid osteomas.

  3. Percutaneous Management of Abscess and Fistula Following Pancreaticoduodenectomy

    SciTech Connect

    AAssar, O. Sami; LaBerge, Jeanne M.; Gordon, Roy L.; Wilson, Mark W.; Mulvihill, Sean J.; Way, Lawrence W.; Kerlan, Robert K.

    1999-01-15

    Purpose: To evaluate the efficacy of percutaneous drainage of fluid collections following pancreaticoduodenectomy (Whipple's procedure). Methods: We performed a retrospective review of 19 patients referred to our service with fluid collections following pancreaticoduodenectomy. The presence of associated enteric or biliary fistulas, the route(s) of access for image-guided drainage, the incidence of positive bacterial cultures, and the duration and success of percutaneous management were recorded. Results: Fistulous communication to the jejunum in the region of the pancreatico-jejunal anastomosis was demonstrable in all 19 patients by gentle contrast injection into drainage tubes. Three patients had concurrent biliary fistulas. In 18 of 19 patients, fluid samples yielded positive bacterial cultures. Successful percutaneous evacuation of fluid was achieved in 17 of 19 patients (89%). The mean duration of drainage was 31 days. Conclusion: Percutaneous drainage of abscess following pancreaticoduodenectomy is effective in virtually all patients despite the coexistence of enteric and biliary fistulas.

  4. Embolic protection devices in saphenous percutaneous intervention.

    PubMed

    Morís, Cesar; Lozano, Iñigo; Martín, María; Rondán, Juán; Avanzas, Pablo

    2009-05-01

    Saphenous veins remain a source of conduit for use in surgical coronary bypass graft revascularisation procedures. Saphenous vein grafts have a progressive closure rate estimated to be 12% to 20% at the end of the first year, and approximately 50% by 10 years. Regarding secondary revascularisation in these cases, reoperation carries substantially increased morbidity and mortality rates, making saphenous coronary intervention, in particular stent implantation, a more attractive means of revascularisation. However, this procedure carries a significant risk of major adverse clinical events, predominantly myocardial infarction or reduced antegrade flow (non-reflow phenomenon), mainly due to distal embolisation of atherothrombotic debris and distal microvascular occlusion. Embolic protection devices are used to reduce the risk of distal embolisation. There are two different designs: filter and occlusion-aspiration devices. In this article we present the different systems of embolic protection devices in saphenous percutaneous intervention and the previously published information is reviewed. PMID:19736070

  5. Therapy of percutaneous infection around craniofacial implants.

    PubMed

    Klein, Martin; Weisz, Ilana; Camerer, Christian; Menneking, Horst; Kim, Doris Maria

    2009-01-01

    This study sought to develop treatment strategies for managing percutaneous infection around craniofacial implants. The present general pathogen situation together with a bacterial resistance were determined in 57 infected peri-implant sites. Forty-four implants were randomly assigned for wound cleaning and split into three groups-two with local antibiotics of proven efficacy and one with 3% hydrogen peroxide (H2O2). The pathogen spectrum differed depending on the severity of the infection, with Staphylococcus aureus clearly correlated with the degree of inflammation (positive correlation: R = 0.72). It was observed that the use of additional local antibiotics was not superior to conventional wound cleaning with 3% H2O2. It is suggested that sulcus fluid flow rate measurements could serve as a simple and reliable objective parameter for recall examinations.

  6. Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy

    PubMed Central

    Kaler, Kamaljot S.; Cwikla, Daniel

    2016-01-01

    Abstract Pleural effusions due to pleural injury following supracostal percutaneous nephrolithotomy (PCNL) occur in upwards of 15% of patients; however, these effusions are invariably diagnosed immediately postoperative or during the hospital stay. Herein, we report our initial experience with a delayed nephropleural fistula. A 52-year-old female underwent an uneventful supracostal right PCNL staghorn stone procedure and was discharged on postoperative day 1. She presented to the emergency department 8 days after her original procedure and one day after ureteral stent removal in the office, with right pleural effusion, concomitant contralateral renal colic secondary to migration of a left pelvic stone into her left proximal ureter, and acute renal failure/oliguria. She was treated with right chest tube drainage, bilateral nephrostomy tube placement, and subsequent left holmium laser ureterolithotripsy. PMID:27579431

  7. Percutaneous endoscopic gastrostomy and early mortality.

    PubMed

    Clarkston, W K; Smith, O J; Walden, J M

    1990-12-01

    To assess morbidity, mortality, and benefit associated with percutaneous endoscopic gastronomy (PEG), we retrospectively studied 42 patients who had had PEG. Mortality was exceptionally high during the first 60 days after PEG (43%), and then stabilized. In nearly half of the cases (20/42) the PEG tube was removed during the first 60 days because of either death or improvement. Patients with malignancy had a significantly higher morbidity and 60-day mortality than the neurologically impaired. We concluded that patients should be carefully selected for PEG because early mortality is high; a 60-day trial of soft nasogastric feedings should be considered before PEG, and could reduce by nearly half the number of patients failing to receive long-term benefit; and patients with malignancy have significantly greater morbidity and mortality after PEG and may not receive the same advantage from the procedure.

  8. Status quo of percutaneous nephrolithotomy in children.

    PubMed

    Bogris, Sotirios; Papatsoris, Athanasios G

    2010-02-01

    Paediatric nephrolithiasis is quite challenging in terms of management because of the smaller size of the urinary tract and the bigger risk for stone recurrence. Children bear a higher risk of metabolic and infectious causes of stone disease and a longer lifetime risk for recurrence, especially in cases of residual fragments. Complete stone clearance should become the absolute objective and clinically insignificant residual fragments should be avoided. Nowadays, percutaneous nephrolithotomy (PCNL) arises as a logical first-line treatment option for considerable paediatric nephrolithiasis as miniaturization of endoscopes and advances in energy sources for stone fragmentation have facilitated stone-free rates. In this review we present the evolution of PCNL in children and we demonstrate its safety and efficacy. As appropriate instruments are available and relevant surgical experience is accumulating, age should no longer exist as a limiting factor for performing PCNL.

  9. Percutaneous Vertebroplasty in Painful Schmorl Nodes

    SciTech Connect

    Masala, Salvatore Pipitone, Vincenzo; Tomassini, Marco; Massari, Francesco; Romagnoli, Andrea; Simonetti, Giovanni

    2006-02-15

    The Schmorl node represents displacement of intervertebral disc tissue into the vertebral body. Both Schmorl nodes and degenerative disc disease are common in the human spine. We performed a retrospective study, for the period from January 2003 to February 2005, evaluating 23 patients affected by painful Schmorl nodes, who underwent in our department percutaneous transpedicular injection of polymethylmethacrylate (vertebroplasty) in order to solve their back pain not responsive to medical and physical management. Eighteen patients reported improvement of the back pain and no one reported a worsening of symptoms. Improvement was swift and persistent in reducing symptoms. Painful Schmorl nodes, refractory to medical or physical therapy, should be considered as a new indication within those vertebral lesions adequately treatable utilizing Vertebroplasty procedure.

  10. Delayed Nephropleural Fistula After Percutaneous Nephrolithotomy.

    PubMed

    Kaler, Kamaljot S; Cwikla, Daniel; Clayman, Ralph V

    2016-01-01

    Pleural effusions due to pleural injury following supracostal percutaneous nephrolithotomy (PCNL) occur in upwards of 15% of patients; however, these effusions are invariably diagnosed immediately postoperative or during the hospital stay. Herein, we report our initial experience with a delayed nephropleural fistula. A 52-year-old female underwent an uneventful supracostal right PCNL staghorn stone procedure and was discharged on postoperative day 1. She presented to the emergency department 8 days after her original procedure and one day after ureteral stent removal in the office, with right pleural effusion, concomitant contralateral renal colic secondary to migration of a left pelvic stone into her left proximal ureter, and acute renal failure/oliguria. She was treated with right chest tube drainage, bilateral nephrostomy tube placement, and subsequent left holmium laser ureterolithotripsy. PMID:27579431

  11. Percutaneous renal biopsy as an outpatient procedure.

    PubMed Central

    Alebiosu, Christopher O.; Kadiri, Solomon

    2004-01-01

    Percutaneous renal biopsy (PRB) is a safe and effective tool in the diagnosis and management of renal disease. It is the gold standard for evaluating renal parenchymal disease. It is both useful for diagnosis and monitoring progress of renal diseases. Where facilities and personnel are available to carry out the procedure in developing countries, it has become increasingly difficult for patients to pay for hospital admission fees, the procedure, and processing of the samples obtained. Information on the success rate and safety of the procedure is of interest to nephrologists for cost-benefit considerations and medicolegal purposes. This paper reports the outcome of outpatient PRB done among patients of the University College Hospital, Ibadan, Nigeria. With the use of ultrasound guidance, PRB remains a safe procedure and can be done on an outpatient basis. PMID:15481751

  12. Percutaneous transtracheal ventilation: experimental and practical aspects.

    PubMed

    Neff, C C; Pfister, R C; Van Sonnenberg, E

    1983-02-01

    Percutaneous transtracheal ventilation can be a lifesaving procedure when endotracheal intubation is not possible, but an understanding of the technique and necessary instruments is essential. This study, performed on adult sheep, defined the limited circumstances under which a 15-gauge needle, connected to oxygen at 50 pounds per square inch (psi), can provide an emergency transtracheal airway. There are situations, such as complete airway obstruction, when this combination is contraindicated. In addition, transtracheal ventilation might have to be performed using simpler equipment, such as a self-inflating resuscitation bag (AMBU-type) or with no equipment other than the transtracheal airway. A 3.0-mm I.D. cannula provided an adequate transtracheal airway under all circumstances examined. A 3.5-mm cannula is commercially available and physicians who deal with airway problems should be familiar with its use.

  13. Percutaneous stone removal: new approaches to access and imaging.

    PubMed

    Slater, Rick C; Ost, Michael

    2015-05-01

    Percutaneous renal access and removal of large renal calculi was first described nearly 40 years ago and has since become the gold standard in management of large and complex renal calculi. In this same time period, technological and medical advances have allowed this procedure to develop in improved efficacy and morbidity. The following review offers an update to new approaches to percutaneous renal access and imaging in the management of large and complex renal calculi.

  14. [Percutaneous nephrostomy as a pretreatment in extracorporeal shockwave lithotripsy].

    PubMed

    Liu, D Y

    1992-04-01

    ESWL was performed in 572 patients with renal and ureteral stones between Dec. 1988 and Dec. 1990. All the patients recovered uneventfully without any serious complications. In 6 of these patients with bilateral urinary stones complicated by bilateral hydronephrosis or azotemia, unilateral percutaneous nephrostomy was done before ESWL. We conclude that in such cases a unilateral percutaneous nephrostomy before ESWL is helpful in reducing renal pelvic pressure, improving renal function, decreasing complication and shortening the period of treatment.

  15. Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy

    SciTech Connect

    Popovic, Peter Kuhelj, Dimitrij; Bunc, Matjaz

    2011-02-15

    A case of acute superior mesenteric artery embolism treated with percutaneous thrombus aspiration is described. A 63-year-old man with chronic atrial fibrillation was admitted to the hospital with progressive abdominal pain. Computed tomography angiography revealed an occlusion of the distal part of the superior mesenteric artery. The patient was effectively treated using transaxillary percutaneous mechanical thrombectomy using a 6F Aspirex thrombectomy catheter.

  16. Ultrasonic-Guided Percutaneous Injection of Pancreatic Pseudoaneurysm with Thrombin

    SciTech Connect

    Sparrow, Patrick Asquith, John; Chalmers, Nick

    2003-06-15

    Pancreatic pseudoaneurysm is a relatively uncommon complication of chronic pancreatitis, with an associated high mortality if rupture or hemorrhage occurs. We present a case of pancreatic pseudoaneurysm complicating pancreatitis which was successfully treated by direct percutaneous injection of thrombin into the aneurysmal sac. Follow-up at 8 weeks did not demonstrate recurrence. This case indicates that percutaneous thrombin injection offers effective treatment of visceral arterial pseudoaneurysms.

  17. Emergent Percutaneous Nephrostomy for the Diagnosis and Management of Pyonephrosis

    PubMed Central

    Li, Albert C.; Regalado, Sidney P.

    2012-01-01

    Emergent percutaneous nephrostomy is a potentially lifesaving procedure with a high technical success rate, minimal morbidity, and long safety record that is often used in the setting of an obstructed and infected renal collecting system (i.e., pyonephrosis). This article discusses all aspects of the emergent placement of nephrostomy catheters including indications, techniques, results, and complications. Differences between emergent and nonemergent placement of percutaneous nephrostomy catheters are also addressed. PMID:23997415

  18. Percutaneous ablation therapies of inoperable pancreatic cancer: a systematic review

    PubMed Central

    Ierardi, Anna Maria; Lucchina, Natalie; Bacuzzi, Alessandro; Marco, De Chiara; Bracchi, Elena; Cocozza, Eugenio; Dionigi, Gianlorenzo; Tsetis, Dimitrios; Floridi, Chiara; Carrafiello, Gianpaolo

    2015-01-01

    Initial studies about ablation therapies of the pancreas were associated with significant morbidity and mortality, which limited widespread adoption. Development of techniques with high quality imaging used as guidance improve outcomes reducing complications. Moreover, only few experiences of percutaneous pancreatic ablations are reported. They are performed by very skilled operators in highly specialized centers. This review presents the current status of percutaneous local ablative therapies in the treatment of advanced pancreatic cancer. PMID:26424487

  19. Percutaneous techniques for tendon transfers in the foot and ankle.

    PubMed

    Panchbhavi, Vinod Kumar

    2014-03-01

    Tendon transfer procedures are useful for replacing a dysfunctional or diseased tendon or for restoring muscle imbalance. The tendon to be transferred is harvested as distal as is necessary to provide adequate length for rerouting and attachment at the different site. The harvesting of tendon itself can be attained using an open surgical approach or minimally invasive percutaneous techniques that limit surgical exposure. This article describes percutaneous techniques for tendon transfer procedures used to address foot and ankle disorders. PMID:24548514

  20. Chest Wall Dissemination of Nocardiosis after Percutaneous Transthoracic Needle Biopsy

    SciTech Connect

    Shimamoto, Hiroshi Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kamiya, Mika; Miyazaki, Masaya; Arai, Yasuaki; Horio, Yoshitsugu

    2007-07-15

    We described a case of chest wall dissemination after percutaneous transthoracic needle biopsy. A 65-year-old man had a lung nodule which was suspected to be lung carcinoma. He underwent percutaneous transthoracic needle biopsy using an 18G semiautomated biopsy needle and pathologic diagnosis showed organizing pneumonia. Two months after the biopsy, chest wall dissemination occurred. Implantation of carcinoma along the biopsy route was suspected, but the mass was actually due to pulmonary nocardiosis.

  1. Percutaneous absorption of chlorhexidine in neonatal cord care.

    PubMed Central

    Aggett, P J; Cooper, L V; Ellis, S H; McAinsh, J

    1981-01-01

    The percutaneous absorption of chlorhexidine during its routine use in topical antiseptic preparations used in umbilical cord care was investigated by determining plasma chlorhexidine concentrations at ages 5 and 9 days. These showed that percutaneous absorption of chlorhexidine occurred in preterm neonates treated with a 1% solution of chlorhexidine in ethanol, but not in term infants similarly treated, or in preterm infants treated only with a dusting powder containing 1% chlorhexidine and 3% zinc oxide. PMID:7305432

  2. Thermal Protection during Percutaneous Thermal Ablation of Renal Cell Carcinoma

    PubMed Central

    Kam, Anthony W.; Littrup, Peter J.; Walther, McClellan M.; Hvizda, Julia; Wood, Bradford J.

    2008-01-01

    Thermal injury to collateral structures is a known complication of thermal ablation of tumors. The authors present the use of CO2 dissection and inserted balloons to protect the bowel during percutaneous radiofrequency (RF) ablation and cryotherapy of primary and locally recurrent renal cell carcinoma. These techniques offer the potential to increase the number of tumors that can be treated with RF ablation or cryotherapy from a percutaneous approach. PMID:15231890

  3. Percutaneous cholecystolithotomy: is gall stone recurrence inevitable?

    PubMed Central

    Donald, J J; Cheslyn-Curtis, S; Gillams, A R; Russell, R C; Lees, W R

    1994-01-01

    Using radiological interventional techniques the gall bladder can be cleared of stones with a high success rate. As with any treatment option that leaves the gall bladder in situ there is an accompanying risk of stone recurrence, which is currently unknown for the radiological method. One hundred patients were studied prospectively to determine the recurrence rate of stones and clinical outcome after successful percutaneous cholecystolithotomy. Follow up included both clinical assessment and ultrasound examination at 3, 6, and 12 months and then annual intervals thereafter. The overall stone recurrence rate was 31% at a mean follow up of 26 months (range, 3-50 months). By actuarial life table analysis, the cumulative proportion of gall stone recurrence was 7, 19, 28, 35, and 44% at 6, 12, 24, 36, and 48 months respectively. Of the 31 patients with recurrent stones; 17 remain asymptomatic, seven have experienced biliary colic, two abdominal pain, three non-specific upper gastrointestinal symptoms, and two jaundice secondary to common duct stones. Thirteen of the stone free patients have remained symptomatic; six with abdominal pain and seven with nonspecific upper gastrointestinal symptoms. Eight patients have subsequently had a cholecystectomy. No significant difference was found between the sex of the patient or the number of stones before treatment and the stone recurrence rates. The cumulative stone recurrence rate was significantly less in the 56 patients who received adjuvant chemolitholysis (p < 0.05). These data show that stone recurrence after successful percutaneous cholecystolithotomy occurs in the minority, and is usually asymptomatic. It is concluded that the technique remains justified in the management of selected patients with gall stones. PMID:8200568

  4. Training the resident in percutaneous nephrolithotomy

    PubMed Central

    Ather, M. Hammad; Ng, Chi-Fai; Pourmand, Gholamraza; Osther, Palle J.

    2013-01-01

    Objective From the trainers’ perspective percutaneous nephrolithotomy (PCNL) is one of the most challenging endourological procedures. In this review we examine the problems arising when training residents in PCNL, and how to facilitate this process. Methods The recommendations are derived from discussions and consensus during the First European Urolithiasis Society (EULIS) meeting held in London in September 2011. In addition, we searched Medline for articles identified using the keywords ‘training’, ‘percutaneous surgery’, ‘renal calculi’, ‘PCNL’, ‘virtual reality’ and ‘simulators’. We also assessed the effect of modern technology, including the availability of virtual reality models vs. operating room training, and how international organisations like EULIS and European Urological Association can help. Results The difficulty of training residents in PCNL is partly due to the complexity of obtaining a safe access to the kidney for lithotripsy. The most common way of obtaining access is guided by imaging only, and usually only fluoroscopic imaging is available. This has the potential for injuring structures from the skin to the renal capsule. Minor vascular injuries are relatively common, although most are self-limiting. Visceral injuries that are particularly important are pleural and less commonly colonic injuries, but they are more complex and often require additional procedures. Conclusions Teaching the skills is more challenging than performing PCNL. In most urological training programmes it is difficult to incorporate teaching and training skills when performing PCNL. To train an academic stone doctor, proficiency in the safe conduct of PCNL is mandatory. PMID:26019923

  5. Renal Vein Injury During Percutaneous Nephrolithotomy Procedure

    PubMed Central

    Toffeq, Hewa Mahmood

    2016-01-01

    Abstract Background: Percutaneous nephrostolithotomy is an important approach for removing kidney stones. Puncturing and dilatation are two mandatory steps in percutaneous nephrolithotomy (PCNL). Uncommonly, during dilatation, the dilators can cause direct injury to the main renal vein or to their tributaries. Case Presentation: A 75-year-old female underwent PCNL for partial staghorn stone in the left kidney. During puncturing and dilatation, renal vein tributary was injured, and the nephroscope entered the renal vein and inferior vena cava, which was clearly recognized. Injection of contrast material through the nephroscope confirms the false pathway to the great veins (renal vein and inferior vena cava). Bleeding was controlled intraoperatively by applying Amplatz sheath over the abnormal tract, the procedure was continued and stones were removed. At the end of the procedure, a Foley catheter was used as a nephrostomy tube and its balloon was inflated inside the renal pelvis and pulled back with light pressure to the lower calix, which was the site of injury to the renal vein tributaries, then the nephrostomy tube was closed; by this we effectively controlled the bleeding. The patient remained hemodynamically stable; antegrade pyelography was done on the second postoperative day, there was distally patent ureter with no extravasation, neither contrast leak to renal vein, and was discharged home at third postoperative day. After 2 weeks, the nephrostomy tube was gradually removed in the operative room, without bleeding, on the next day, Double-J stent was removed. Conclusion: Direct injury and false tract to the renal vein tributaries during PCNL can result in massive hemorrhage, and can be treated conservatively in hemodynamically stable patients, using a nephrostomy catheter as a tamponade. PMID:27704054

  6. Percutaneous pulmonary and tricuspid valve implantations: An update

    PubMed Central

    Wagner, Robert; Daehnert, Ingo; Lurz, Philipp

    2015-01-01

    The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions. PMID:25914786

  7. Percutaneous Management of Biliary Strictures After Pediatric Liver Transplantation

    SciTech Connect

    Miraglia, Roberto Maruzzelli, Luigi; Caruso, Settimo; Riva, Silvia; Spada, Marco; Luca, Angelo; Gridelli, Bruno

    2008-09-15

    We analyze our experience with the management of biliary strictures (BSs) in 27 pediatric patients who underwent liver transplantation with the diagnosis of BS. Mean recipient age was 38 months (range, 2.5-182 months). In all patients percutaneous transhepatic cholangiography, biliary catheter placement, and bilioplasty were performed. In 20 patients the stenoses were judged resolved by percutaneous balloon dilatation and the catheters removed. Mean number of balloon dilatations performed was 4.1 (range, 3-6). No major complications occurred. All 20 patients are symptom-free with respect to BS at a mean follow-up of 13 months (range, 2-46 months). In 15 of 20 patients (75%) one course of percutaneous stenting and bilioplasty was performed, with no evidence of recurrence of BS at a mean follow-up of 15 months (range, 2-46 months). In 4 of 20 patients (20%) two courses of percutaneous stenting and bilioplasty were performed; the mean time to recurrence was 9.8 months (range, 2.4-24 months). There was no evidence of recurrence of BS at a mean follow-up of 12 months (range, 2-16 months). In 1 of 20 patients (5%) three courses of percutaneous stenting and bilioplasty were performed; there was no evidence of recurrence of BS at a mean follow-up of 10 months. In conclusion, BS is a major problem following pediatric liver transplantation. Radiological percutaneous treatment is safe and effective, avoiding, in most cases, surgical revision of the anastomosis.

  8. Percutaneous nephrostomy with extensions of the technique: step by step.

    PubMed

    Dyer, Raymond B; Regan, John D; Kavanagh, Peter V; Khatod, Elaine G; Chen, Michael Y; Zagoria, Ronald J

    2002-01-01

    Minimally invasive therapy in the urinary tract begins with renal access by means of percutaneous nephrostomy. Indications for percutaneous nephrostomy include urinary diversion, treatment of nephrolithiasis and complex urinary tract infections, ureteral intervention, and nephroscopy and ureteroscopy. Bleeding complications can be minimized by entering the kidney in a relatively avascular zone created by branching of the renal artery. The specific site of renal entry is dictated by the indication for access with consideration of the anatomic constraints. Successful percutaneous nephrostomy requires visualization of the collecting system for selection of an appropriate entry site. The definitive entry site is then selected; ideally, the entry site should be subcostal and lateral to the paraspinous musculature. Small-bore nephrostomy tracks can be created over a guide wire coiled in the renal pelvis. A large-diameter track may be necessary for percutaneous stone therapy, nephroscopy, or antegrade ureteroscopy. The most common extension of percutaneous nephrostomy is placement of a ureteral stent for treatment of obstruction. Transient hematuria occurs in virtually every patient after percutaneous nephrostomy, but severe bleeding that requires transfusion or intervention is uncommon. In patients with an obstructed urinary tract complicated by infection, extensive manipulations pose a risk of septic complications. PMID:12006684

  9. Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

    PubMed Central

    2016-01-01

    Aim. This report introduces extrapedicular infiltration anesthesia as an improved method of local anesthesia for unipedicular percutaneous vertebroplasty or percutaneous kyphoplasty. Method. From March 2015 to March 2016, 44 patients (11 males and 33 females) with osteoporotic vertebral compression fractures with a mean age of 71.4 ± 8.8 years (range: 60 to 89) received percutaneous vertebroplasty or percutaneous kyphoplasty. 24 patients were managed with conventional local infiltration anesthesia (CLIA) and 20 patients with both CLIA and extrapedicular infiltration anesthesia (EPIA). Patients evaluated intraoperative pain by means of the visual analogue score and were monitored during the procedure for additional sedative analgesia needs and for adverse nerve root effects. Results. VAS of CLIA + EPIA and CLIA group was 2.5 ± 0.7 and 4.3 ± 1.0, respectively, and there was significant difference (P = 0.001). In CLIA group, 1 patient required additional sedative analgesia, but in CLIA + EPIA group, no patients required that. In the two groups, no adverse nerve root effects were noted. Summary. Extrapedicular infiltration anesthesia provided good local anesthetic effects without significant complications. This method deserves further consideration for use in unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty. PMID:27766261

  10. A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy

    PubMed Central

    Javali, Tarun; Pathade, Amey; Nagaraj, H. K.

    2015-01-01

    ABSTRACT Objective: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. Materials and Methods: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. Results: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. Conclusions: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation. PMID:26689529

  11. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    SciTech Connect

    Mizandari, Malkhaz; Pai, Madhava Xi Feng; Valek, Vlastimil; Tomas, Andrasina; Quaretti, Pietro; Golfieri, Rita; Mosconi, Cristina; Ao Guokun; Kyriakides, Charis; Dickinson, Robert; Nicholls, Joanna; Habib, Nagy

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  12. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation.

    PubMed

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne; Wettergren, André; Hillingsø, Jens

    2015-06-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium-yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow-up time of 55 months. In all but 1 patient (17/18 or 94%), it was technically feasible to clear all BDSs with a mean of 1.3 sessions. PTCSL was unsuccessful in 1 patient because of multiple stones impacting the bile ducts bilaterally; 17% had early complications (Clavien II). All biliary casts were successfully cleared; 39% had total remission; 61% needed additional interventions in the form of percutaneous transhepatic cholangiography and dilation (17%), re-PTCSL (11%), self-expandable metallic stents (22%), or hepaticojejunostomy (6%); and 22% eventually underwent retransplantation. The overall liver graft survival rate was 78%. Two patients died during follow-up for reasons not related to their BDS. Nonanastomotic strictures (NASs) were significantly associated with treatment failure. We conclude that PTCSL in LT patients is safe and feasible. NASs significantly increased the risk of relapse. Repeated minimally invasive treatments, however, prevented graft failure in 78% of the cases. PMID:25821134

  13. Major Bleeding after Percutaneous Image-Guided Biopsies: Frequency, Predictors, and Periprocedural Management

    PubMed Central

    Kennedy, Sean A.; Milovanovic, Lazar; Midia, Mehran

    2015-01-01

    Major bleeding remains an uncommon yet potentially devastating complication following percutaneous image-guided biopsy. This article reviews two cases of major bleeding after percutaneous biopsy and discusses the frequency, predictors, and periprocedural management of major postprocedural bleeding. PMID:25762845

  14. [Retroperitoneal lymphocele occurring in a child after nephrectomy and treated by percutaneous drainage].

    PubMed

    Tlili-Graiess, K; Gharbi-Jemni, H; Kraiem, C; Harbi, A; Allegue, M; Jeddi, M

    1994-01-01

    Lymphocele is a rare complication of kidney surgery in pediatric practice. Recent treatment consists in long term percutaneous drainage. The case reported was diagnosed 9 years after nephrectomy and improved with 3 weeks percutaneous drainage.

  15. Percutaneous Image-guided Radiofrequency Ablation of Tumors in Inoperable Patients - Immediate Complications and Overall Safety

    PubMed Central

    Sahay, Anubha; Sahay, Nishant; Kapoor, Ashok; Kapoor, Jyoti; Chatterjee, Abhishek

    2016-01-01

    were likely to derive a direct benefit in the survival or as a palliative measure for relief in their symptoms and patients who were inoperable because of any of the following reasons: (1) Exhausted conventional treatment options, (2) technical and anatomical contraindications to conventional treatment, (3) medical comorbidities precluding surgery, (4) patient refusal, (5) recurrent tumors, and (6) advanced tumor stage. Conventional Treatment has been defined as surgical resection, radiotherapy, and/or chemotherapy, although the patient eligibility for each treatment may vary. Exclusion Criteria: Patients with the following were excluded: (1) Severe coagulopathy, (2) heart, renal, or liver failure, (3) lesions within 1 cm of gall bladder, hilum, bowel wall, and major blood vessels, (4) patient with any metal implant, (5) patients in sepsis, and (6) tumor adjacent to structures at risk (main bile ducts, pericardium, stomach, or bowel). Results: The duration of procedure as well as ablation of tumor free margin was significantly related to the size of the tumor. As the size of tumor increased, duration of procedure increased significantly. A good tumor-free margin also needs to be ablated for optimum results as it prevents residual tumors and recurrences in the future. We observed that tumors sized <3.1 cm were optimal in this regard. Most common adverse event in postprocedure period was pain in and around ablation site. Post-RFA syndrome is also a common and benign self-limiting side effect. Patient counseling and proper selection of patients in the early stages of malignancy can enhance the efficacy of the procedure and patient satisfaction. Conclusions: Percutaneous image-guided RFA is an option in patients where most other tumor management modalities have been exhausted or rejected. RFA may not be free from side effects such as postablation syndrome, pain, and there may be other serious complications such as bleeding, but based on our observations, percutaneous image

  16. Removal of a Trapped Endoscopic Catheter from the Gallbladder via Percutaneous Transhepatic Cholecystostomy: Technical Innovation

    SciTech Connect

    Stay, Rourke M.; Sonnenberg, Eric van Goodacre, Brian W.; Ozkan, Orhan S.; Wittich, Gerhard R.

    2006-12-15

    Background. Percutaneous cholecystostomy is used for a variety of clinical problems. Methods. Percutaneous cholecystostomy was utilized in a novel setting to resolve a problematic endoscopic situation. Observations. Percutaneous cholecystostomy permitted successful removal of a broken and trapped endoscopic biliary catheter, in addition to helping treat cholecystitis. Conclusion. Another valuable use of percutaneous cholecystostomy is demonstrated, as well as emphasizing the importance of the interplay between endoscopists and interventional radiologists.

  17. Parallel analysis of finite element model controlled trial and retrospective case control study on percutaneous internal fixation for vertical sacral fractures

    PubMed Central

    2013-01-01

    Background Although percutaneous posterior-ring tension-band metallic plate and percutaneous iliosacral screws are used to fix unstable posterior pelvic ring fractures, the biomechanical stability and compatibility of both internal fixation techniques for the treatment of Denis I, II and III type vertical sacral fractures remain unclear. Methods Using CT and MR images of the second generation of Chinese Digitized Human “male No. 23”, two groups of finite element models were developed for Denis I, II and III type vertical sacral fractures with ipsilateral superior and inferior pubic ramus fractures treated with either a percutaneous metallic plate or a percutaneous screw. Accordingly, two groups of clinical cases that were fixed using the above-mentioned two internal fixation techniques were retrospectively evaluated to compare postoperative effect and function. Parallel analysis was performed with a finite element model controlled trial and a case control study. Results The difference of the postoperative Majeed standards and outcome rates between two case groups was no statistically significant (P > 0.05). Accordingly, the high values of the maximum displacements/stresses of the plate-fixation model group approximated those of the screw-fixation model group. However, further simulation of Denis I, II and III type fractures in each group of models found that the biomechanics of the plate-fixation models became increasingly stable and compatible, whereas the biomechanics of the screw-fixation models maintained tiny fluctuations. When treating Denis III fractures, the biomechanical effects of the pelvic ring of the plate-fixation model were better than the screw-fixation model. Conclusions Percutaneous plate and screw fixations are both appropriate for the treatment of Denis I and II type vertical sacral fractures; whereas percutaneous plate fixation appears be superior to percutaneous screw fixation for Denis III type vertical sacral fracture. Biomechanical

  18. Percutaneous Endoscopic Gastrostomy: Mortality and Risk Factors for Survival

    PubMed Central

    Onder, Akin; Kapan, Murat; Arikanoglu, Zulfu; Gul, Mesut; Bestas, Remzi; Palanci, Yilmaz; Karaman, Haktan; Bac, Bilsel

    2012-01-01

    Background The present study evaluated long-term risk factors for survival in patients who have undergone Percutaneous endoscopic Gastrostomy, as well as morbidity and mortality rates. Methods The retrospective study included 44 patients who underwent placement of a percutaneous endoscopic gastrostomy tube at various departments at Dicle University Medical Faculty between April 2008-September 2010. Results The study evaluated 23 women (52.3%) and 21 men (47.7%), with a median age of 50 ± 20 (17 - 87) years. Median time for Percutaneous endoscopic Gastrostomy placement was 23 ± 8.3 (5 - 45) minutes per patient. Total morbidity was 15.9%, including wound infection (4), tube occlusion (1), peristomal leakage (1), and abdominal wall bleeding (1). Short-term complications were not associated with albumin level (P = 0.312).The median hospital stay was 49.34 ± 60.99 (1 - 314) days. The mean follow-up period was 13.07 ± 13.12 (1 - 41) months. The above-normal level of albumin was found to be effective on survival (P = 0.024). Mortality occurred in 18 (40.9%) patients during the follow-up. Conclusions Percutaneous endoscopic Gastrostomy is both safe and effective in that it does not require surgical operation and it can be performed under surface anesthesia. The serum albumin level with patients who have undergone percutaneous endoscopic gastrostomyis an effective factor for survival.

  19. Computer-assisted percutaneous scaphoid fixation: concepts and evolution.

    PubMed

    Smith, Erin J; Ellis, Randy E; Pichora, David R

    2013-11-01

    Background The treatment for undisplaced scaphoid waist fractures has evolved from conventional cast immobilization to percutaneous screw insertion. Percutaneous fixation reduces some of the risks of open surgery, but can be technically demanding and carries the risk of radiation exposure. Recently, computer-assisted percutaneous scaphoid fixation (CAPSF) has been gaining interest. Materials and Methods Conventional percutaneous scaphoid fixation is performed under fluoroscopic guidance and involves insertion of a guide wire along the length of the scaphoid to facilitate placement of a cannulated screw. Adapting computer-assisted techniques for scaphoid fixation poses several unique challenges including patient tracking and registration. Results To date, five groups have successfully implemented systems for CAPSF. These systems have implemented wrist immobilization strategies to resolve the issue of patient tracking and have developed unique guidance techniques incorporating 2D fluoroscope, cone-beam CT, and ultrasound, to circumvent patient-based registration. Conclusions Computer-aided percutaneous pinning of scaphoid waist fractures can significantly reduce radiation exposure and has the potential to improve the accuracy of this procedure. This article reviews the rationale for, and the evolution of, CAPSF and describes the key principles of computer-assisted technology.

  20. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy

    PubMed Central

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

    2016-01-01

    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac.

  1. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy

    PubMed Central

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

    2016-01-01

    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac. PMID:27695562

  2. [Local anesthesia after percutaneous administration. I].

    PubMed

    Ziegenmeyer, J; Meyer, F

    1976-11-01

    Local anesthesia of the intact skin is difficult because of the skin barrier to epicutaneous penetration. Using solutions of local anesthetics in organic agents, which have the ability of penetrating the skin without causing irreversible damage and enhancing the percutaneous absorption of all materials dissolved therein, topical anesthesia seems to be attainable. A satisfactory method for determining pain threshold in uninjured skin of animals has been set up. Measurments of the pricking pain threshold have been made by exposing the skin of guinea-pigs to defined mechanical and electrical stimuli. A nociceptive muscle reflex (twitch) has been taken as the index of pain sensation. The suppression of this twitch has been used as an indicator of anesthetic potency. Two methods have been applied with varying parameters: stimulation at a fixed intensity until the pain threshold was reached (duration of anesthetic effect) and stimulation with increasing stimulus strenght until the cutaneous reflex was elicited (intensity or "depth" of anesthesia). The local anesthetic effects of lidocaine, fomocaine and procaine bases were studied, after dissolving them in dimethyl sulfoxide (DMSO), a wellknown carrier for transmembranal application. The duration of local anesthesia measured by electrical stimuli was longer than that obtained with mechanical ones. Differences are discussed. All results indicate that fomocaine (5%) has a greater local anesthetic potency than procaine (5%) but both are less active than lidocaine (5%). No effect could be seen after application of DMSO alone. PMID:1037079

  3. Percutaneous nephrolithotomy--results and clinical experience.

    PubMed

    Li, M K; Wong, M Y; Toh, K L; Ho, G H; Foo, K T

    1996-09-01

    Percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) have largely replaced open surgical intervention for the management of upper urinary tract calculi. ESWL is the preferred treatment modality for calculi less than or equal to 2 cm in diameter as morbidity is lower than PCNL and success rates are comparable. However, the morbidity of ESWL rises substantially for stones greater than 2 cm in diameter while stone-free rate is less when compared to PCNL, suggesting that PCNL is the preferred treatment modality for most larger stones. PCNL was performed on 86 patients with 87 renal calculi. The indication for this approach was either high stone burden as in 72 patients (83%) or failed previous ESWL as in 15 patients (17%). The success rate was 74.7% and this was associated with minimal morbidity which included; symptomatic urinary tract infection (9.2%), pleural effusion (2.3%) and the formation of a pseudo-aneurysm (2.3%). Blood transfusion was required in one patient (1.1%) and we had one postoperative death due to massive pulmonary embolism (1.1%). PCNL is the preferred approach to patient with difficult renal calculi at our institution.

  4. Percutaneous Transluminal Angioplasty of Peripheral Bypass Stenoses

    SciTech Connect

    Hoksbergen, Arjan W.J.; Legemate, Dink A.; Reekers, Jim A.; Ubbink, Dirk T.; Jacobs, Michael J.H.M.

    1999-07-15

    Purpose: To assess the success of percutaneous transluminal angioplasty (PTA) in treating peripheral bypass stenoses. Methods: Patients who received a femoropopliteal or femorocrural bypass graft for limb ischemia were included in a duplex surveillance program. If duplex ultrasound revealed a short (<2 cm) severe (peak systolic velocity ratio {>=} 4.5) stenosis, patients were scheduled for arteriography and PTA. Fifty-eight peripheral bypass stenoses in 39 grafts in 37 patients were treated with PTA. The cumulative primary patency of treated stenoses was calculated. Results: During the first year after PTA 31 (53%) treated lesions remained patent, 15 (26%) lesions restenosed at a median interval of 5.0 (range 1-12) months and 4 (7%) bypasses occluded. The cumulative primary patency of 58 treated graft stenoses at 1 year was 60% [95% confidence interval (CI) 46%-74%] and 55% (95% CI 41%-70%) at 2 years. Graft body stenoses showed a better 2-year cumulative primary patency (86%; 95% CI 68%-100%) compared with juxta-anastomotic lesions (45%; 95% CI 29%-62%; p < 0.05). Conclusion: PTA is justifiable as the initial treatment of peripheral bypass stenoses. Nevertheless, the restenosis rate is rather high, especially in juxta-anastomotic lesions. Continuation of duplex surveillance after PTA and timely reintervention is recommended.

  5. Percutaneous nephrolithotomy through an intercostal approach.

    PubMed

    Narasimham, D L; Jacobsson, B; Vijayan, P; Bhuyan, B C; Nyman, U; Holmquist, B

    1991-03-01

    During a 5-year period percutaneous nephrolithotripsy through an intercostal space was performed in 56 of 231 procedures. Minimal thoracic complications were seen in 3 of 53 patients with 11th intercostal space tracts into a lower, middle, or upper pole calyx. A working sheath and a pyelostomy drainage catheter were used in all these cases. Hydro- and pneumothorax requiring treatment occurred in 2 of 3 patients with a 10th intercostal space approach into an upper pole calyx combined with improper use of the working sheath and/or the pyelostomy catheter. Review of the literature also indicates that an intercostal approach appears safe when performed via the 11th intercostal space into a lower or middle pole calyx. Thoracic complications occurred when punctures were made towards an upper pole calyx or above the 11th rib. The complications may be limited by identifying the posterior inferior lung border by fluoroscopy during puncture, and performing it under general anesthesia with controlled breath-holding. The use of a working sheath to seal the pleural opening during the procedure and an efficient pyelostomy drainage catheter to allow free drainage of urine and to tamponade the tract postoperatively are also recommended. PMID:2031802

  6. Minimizing radiation exposure during percutaneous nephrolithotomy.

    PubMed

    Chen, T T; Preminger, G M; Lipkin, M E

    2015-12-01

    Given the recent trends in growing per capita radiation dose from medical sources, there have been increasing concerns over patient radiation exposure. Patients with kidney stones undergoing percutaneous nephrolithotomy (PNL) are at particular risk for high radiation exposure. There exist several risk factors for increased radiation exposure during PNL which include high Body Mass Index, multiple access tracts, and increased stone burden. We herein review recent trends in radiation exposure, radiation exposure during PNL to both patients and urologists, and various approaches to reduce radiation exposure. We discuss incorporating the principles of As Low As reasonably Achievable (ALARA) into clinical practice and review imaging techniques such as ultrasound and air contrast to guide PNL access. Alternative surgical techniques and approaches to reducing radiation exposure, including retrograde intra-renal surgery, retrograde nephrostomy, endoscopic-guided PNL, and minimally invasive PNL, are also highlighted. It is important for urologists to be aware of these concepts and techniques when treating stone patients with PNL. The discussions outlined will assist urologists in providing patient counseling and high quality of care.

  7. Percutaneous vertebroplasty: current concepts and local experience.

    PubMed

    Hee, Hwan Tak

    2005-12-01

    With the aging population in our country, symptomatic osteoporotic compression fractures are increasingly common. Osteolytic compression fractures from spinal metastasis are also becoming more frequently seen because of the longer life expectancy from improvements in chemotherapy. Percutaneous vertebroplasty with PMMA has been shown to be an efficient procedure to treat pain due to these fractures. It is a minimally invasive procedure performed under local anesthesia and sedation. Injection of PMMA provides immediate stability when it hardens, and permits the patient to ambulate without pain. Appropriate patient selection is the key to clinical success. However, this procedure must be treated with respect, and has to be performed by physicians with the necessary training. Otherwise, increased pain, paralysis, and even death may occur from this seemingly innocuous procedure. In this article, I will deal with the background issues of osteoporotic and osteolytic vertebral compression fractures, patient selection, surgical technique, complications, and review of current literature on vertebroplasty. Key areas of development in this field include the use of kyphoplasty, defining the role of prophylactic augmentation, and improvements in biomaterials.

  8. Percutaneous coronary intervention in the elderly.

    PubMed

    Sandhu, Kully; Nadar, Sunil K

    2015-11-15

    Our population dynamics are changing. The number of octogenarians and older people in the general population is increasing and therefore the number of older patients presenting with acute coronary syndrome or stable angina is increasing. This group has a larger burden of coronary disease and also a greater number of concomitant comorbidities when compared to younger patients. Many of the studies assessing percutaneous coronary intervention (PCI) to date have actively excluded octogenarians. However, a number of studies, both retrospective and prospective, are now being undertaken to reflect the, "real" population. Despite being a higher risk group for both elective and emergency PCIs, octogenarians have the greatest to gain in terms of prognosis, symptomatic relief, and arguably more importantly, quality of life. Important future development will include assessment of patient frailty, encouraging early presentation, addressing gender differences on treatment strategies, identification of culprit lesion(s) and vascular access to minimise vascular complications. We are now appreciating that the new frontier is perhaps recognising and risk stratifying those elderly patients who have the most to gain from PCI. This review article summarises the most relevant trials and studies. PMID:26241641

  9. Minimizing radiation exposure during percutaneous nephrolithotomy.

    PubMed

    Chen, T T; Preminger, G M; Lipkin, M E

    2015-12-01

    Given the recent trends in growing per capita radiation dose from medical sources, there have been increasing concerns over patient radiation exposure. Patients with kidney stones undergoing percutaneous nephrolithotomy (PNL) are at particular risk for high radiation exposure. There exist several risk factors for increased radiation exposure during PNL which include high Body Mass Index, multiple access tracts, and increased stone burden. We herein review recent trends in radiation exposure, radiation exposure during PNL to both patients and urologists, and various approaches to reduce radiation exposure. We discuss incorporating the principles of As Low As reasonably Achievable (ALARA) into clinical practice and review imaging techniques such as ultrasound and air contrast to guide PNL access. Alternative surgical techniques and approaches to reducing radiation exposure, including retrograde intra-renal surgery, retrograde nephrostomy, endoscopic-guided PNL, and minimally invasive PNL, are also highlighted. It is important for urologists to be aware of these concepts and techniques when treating stone patients with PNL. The discussions outlined will assist urologists in providing patient counseling and high quality of care. PMID:26354615

  10. Sedation for Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    2016-01-01

    Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery. PMID:27738652

  11. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term intravascular catheter. (a) Identification. A percutaneous, implanted, long-term intravascular catheter is a device...

  12. Current status of percutaneous vertebroplasty and percutaneous kyphoplasty – a review

    PubMed Central

    Yimin, Yang; Zhiwei, Ren; Wei, Ma; Jha, Rajiv

    2013-01-01

    Percutaneous vertebroplasty (PV) and kyphoplasty (PK) are the 2 vertebral augmentation procedures that have emerged as minimally invasive surgical options to treat painful vertebral compression fractures (VCF) during the last 2 decades. VCF may either be osteoporotic or tumor-associated. Two hundred million women are affected by osteoporosis globally. Vertebral fracture may result in acute pain around the fracture site, loss of vertebral height due to vertebral collapse, spinal instability, and kyphotic deformity. The main goal of the PV and PK procedures is to give immediate pain relief to patients and restore the vertebral height lost due to fracture. In percutaneous vertebroplasty, bone cement is injected through a minimal incision into the fractured site. Kyphoplasty involves insertion of a balloon into the fractured site, followed by inflation-deflation to create a cavity into which the filler material is injected, and the balloon is taken out prior to cement injection. This literature review presents a qualitative overview on the current status of vertebral augmentation procedures, especially PV and PK, and compares the efficacy and safety of these 2 procedures. The review consists of a brief history of the development of these 2 techniques, a discussion on the current research on the bone cement, clinical outcome of the 2 procedures, and it also sheds light on ongoing and future research to maximize the efficacy and safety of vertebral augmentation procedures. PMID:24097261

  13. Percutaneous Aspiration Thrombectomy for the Treatment of Arterial Thromboembolic Occlusions Following Percutaneous Transluminal Angioplasty

    SciTech Connect

    Schleder, Stephan; Diekmann, Matthias; Manke, Christoph; Heiss, Peter

    2015-02-15

    PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diameter after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.

  14. Metal Preferences and Metallation*

    PubMed Central

    Foster, Andrew W.; Osman, Deenah; Robinson, Nigel J.

    2014-01-01

    The metal binding preferences of most metalloproteins do not match their metal requirements. Thus, metallation of an estimated 30% of metalloenzymes is aided by metal delivery systems, with ∼25% acquiring preassembled metal cofactors. The remaining ∼70% are presumed to compete for metals from buffered metal pools. Metallation is further aided by maintaining the relative concentrations of these pools as an inverse function of the stabilities of the respective metal complexes. For example, magnesium enzymes always prefer to bind zinc, and these metals dominate the metalloenzymes without metal delivery systems. Therefore, the buffered concentration of zinc is held at least a million-fold below magnesium inside most cells. PMID:25160626

  15. When is the indication of percutaneous chemolysis justified?

    PubMed

    Heimbach, D; Winter, P; Hesse, A

    1995-01-01

    Persistent residual stone fragments after extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with 'Suby G' solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone size could be observed. In 2 other brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.

  16. Prevention and Management of Infectious Complications of Percutaneous Interventions

    PubMed Central

    Huang, Steven Y.; Philip, Asher; Richter, Michael D.; Gupta, Sanjay; Lessne, Mark L.; Kim, Charles Y.

    2015-01-01

    Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications. PMID:26038616

  17. Percutaneous drainage of postoperative abdominal and pelvic lymphoceles.

    PubMed

    White, M; Mueller, P R; Ferrucci, J T; Butch, R J; Simeone, J F; Neff, C C; Yoder, I; Papanicolaou, N; Pfister, R C

    1985-11-01

    Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.

  18. [Percutaneous treatment of abscess of the kidney and retroperitoneum].

    PubMed

    Hélénon, O; Cornud, F; Di Stéfano, D; Chiche, J F; Chrétien, Y; Moreau, J F; Dufour, B

    1989-10-01

    Twenty eight abscesses or infected liquid collections located in the kidney or in the retroperitoneum were drained percutaneously. The abscesses were located in the renal parenchyma in most cases (14 cases), in the anterior pararenal space in 3 cases and in the iliopsoas muscle in 9 cases. In all cases, the drain was inserted under TV monitoring after needle puncture, which was most often guided by ultrasound. The percutaneous treatment was successful in 82% of all cases. Among the 5 unsuccessful attempts, 1 case of duodenal fistula required surgical treatment while the anterior pararenal abscess was effectively evacuated by the inserted drain, and 1 case of infected hydatid cyst was treated surgically immediately after the percutaneous needle puncture. Drainage is the first-line method for the treatment of abscesse of the kidney and retroperitoneum. It requires an appropriate technique and strict follow-up, which allow healing the lesion in most cases.

  19. Iatrogenic Subtotal Stenosis of the Right Subclavian Artery Treated With Percutaneous Transluminal Angioplasty

    SciTech Connect

    Smeenk, Robert M.; Kock, Mark C. J. M.; Elgersma, Otto E. H.; Schnater, Marco J.

    2011-02-15

    This report describes a rare vascular complication of surgical placement of a marking clip and a possible approach to problem solving. A 55-year-old patient presented with loss of sensation in the fingers and loss of peripheral pulsations in the right arm 4 days after right upper lobectomy for a pT2N1 moderately differentiated adenocarcinoma of the lung. Duplex examination and computed tomography were performed the same day and showed a subtotal stenosis of the right subclavian artery, which was caused by the surgical placement of a metal clip to mark the surgical boundary. Selective angiography was subsequently performed. Percutaneous transluminal angioplasty (PTA) successfully dilated the stenosis and pushed the clip off. Flow in the right subclavian artery (RSA) was completely restored as were neurology and peripheral pulses. In conclusion, arterial stenosis by a surgical (marking) clip may be feasibly treated with PTA.

  20. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    PubMed Central

    Pinheiro, Carlos Passos; Rezek, Daniele; Costa, Eduardo Paiva; de Carvalho, Edvagner Sergio Leite; Moscoso, Freddy Antonio Brito; Taborga, Percy Richard Chavez; Jeronimo, Andreia Dias; Abizaid, Alexandre Antonio Cunha; Ramos, Auristela Isabel de Oliveira

    2016-01-01

    Background Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Conclusion Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk. PMID:27305109

  1. Risk factors for pulmonary complications after percutaneous nephrolithotomy

    PubMed Central

    Yu, Jihion; Choi, Jae Moon; Lee, Joonho; Kwon, Koo; Kong, Yu-Gyeong; Seo, Hyungseok; Hwang, Jai-Hyun; Park, Hyung Keun; Kim, Young-Kug

    2016-01-01

    Abstract Although percutaneous nephrolithotomy is minimally invasive, it is associated with several complications, including extravasation of fluid and urine, the need for a blood transfusion, and septicemia. However, little is known about pulmonary complications after this procedure. Therefore, we aimed to evaluate the risk factors for and outcomes of pulmonary complications after percutaneous nephrolithotomy. All consecutive patients who underwent percutaneous nephrolithotomy between 2001 and 2014 were identified and divided into group A (no clinically significant pulmonary complications) and group B (clinically significant pulmonary complications). Preoperative and intraoperative variables and postoperative outcomes were evaluated. Independent risk factors for postoperative pulmonary complications were evaluated by univariate and multivariate logistic regression analyses. The study included 560 patients: 378 (67.5%) in group A and 182 (32.5%) in group B. Multivariate logistic regression analysis revealed that the independent risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index (odds ratio = 1.062, P = 0.026), intraoperative red blood cell transfusion (odds ratio = 2.984, P = 0.012), and an intercostal surgical approach (odds ratio = 3.046, P < 0.001). Furthermore, the duration of hospital stay was significantly longer (8.4 ± 4.3 days vs 7.6 ± 3.4 days, P = 0.010) and the intensive care unit admission rate was significantly higher [13 (7.1%) vs 1 (0.3%), P < 0.001] in group B than in group A. Risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index, intraoperative red blood cell transfusion, and an intercostal surgical approach. Postoperative pulmonary complications were associated with poor outcomes. These results may provide useful information for the perioperative management of pulmonary complications after

  2. [Pancreatic tail pseudoaneurysm: percutaneous treatment by thrombin injection].

    PubMed

    Pacheco Jiménez, M; Moreno Sánchez, T; Moreno Rodríguez, F; Guillén Rico, M

    2014-01-01

    Visceral artery pseudoaneurysms secondary to acute and/or chronic pancreatitis are a relatively common and potentially serious complication. Endovascular techniques are the most currently accepted techniques, given the higher morbidity-mortality of surgery. The thrombosis of the pseudoaneurysm using an ultrasound-guided percutaneous thrombin injection is emerging as a useful option in those cases in which endovascular embolisation is not possible. We present the case of a patient with a pseudoaneurysm of the transverse pancreatic artery secondary to chronic pancreatitis, and successfully treated by administering percutaneous thrombin.

  3. Embolization of Bleeding Stomal Varices by Direct Percutaneous Approach

    SciTech Connect

    Arulraj, Ramakrishnan; Mangat, Kamarjit S.; Tripathi, Dhiraj

    2011-02-15

    Stomal varices can occur in patients with stoma in the presence of portal hypertension. Suture ligation, sclerotherapy, angiographic embolization, stoma revision, beta blockade, portosystemic shunt, and liver transplantation have been described as therapeutic options for bleeding stomal varices. We report the case of a 21-year-old patient with primary sclerosing cholangitis and colectomy with ileostomy for ulcerative colitis, where stomal variceal bleeding was successfully treated by direct percutaneous embolization. We consider percutaneous embolization to be an effective way of treating acute stomal bleeding in decompensated patients while awaiting decisions regarding shunt procedures or liver transplantation.

  4. Percutaneous Ventricular Assist Devices: New Deus Ex Machina?

    PubMed Central

    Arroyo, Diego; Cook, Stéphane

    2011-01-01

    The development of ventricular assist devices has broadened the means with which one can treat acute heart failure. Percutaneous ventricular assist devices (pVAD) have risen from recent technological advances. They are smaller, easier, and faster to implant, all important qualities in the setting of acute heart failure. The present paper briefly describes the functioning and assets of the most common devices used today. It gives an overview of the current evidence and indications for left ventricular assist device use in cardiogenic shock and high-risk percutaneous coronary intervention. Finally, extracorporeal life support devices are dealt with in the setting of hemodynamic support. PMID:22091361

  5. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    PubMed

    Bhatty, Shaun; Ali, Asghar; Shetty, Ranjith; Sumption, Kevin F; Topaz, On; Jovin, Ion S

    2014-04-01

    The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions.

  6. Atlantoaxial Joint Synovial Cyst: Diagnosis and Percutaneous Treatment

    SciTech Connect

    Velan, Osvaldo; Rabadan, Alejandra; Paganini, Lisandro; Langhi, Luciano

    2008-11-15

    Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.

  7. Life-threatening paraspinal muscle hematoma after percutaneous vertebroplasty

    PubMed Central

    Jeon, Chang-Hoon; Chung, Nam-Su; Lee, Jae-Heon; Lee, Han-Dong

    2016-01-01

    Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain. PMID:27746502

  8. A case of micro-percutaneous nephrolithotomy with macro complication.

    PubMed

    Dede, Onur; Utangaç, Mazhar; Dağguli, Mansur; Hatipoğlu, Namık Kemal; Sancaktutar, Ahmet Ali; Bodakçı, Mehmet Nuri

    2015-06-01

    Percutaneous nephrolithotomy is accepted as the standard management approach for kidney stones that are either refractory to extracorporeal shock wave lithotripsy or are >2 cm in diameter. The recently developed micro-percutaneous nephrolithotomy (microperc) technique provides intrarenal access under full vision using an optic instrument with a smaller calibration. A lesser amount of bleeding has been reported with the use of this method. Here we present a case of a bleeding complication on postoperative day 15 after a microperc procedure used to treat a left kidney stone. The complication led to retention of bloody urine in the bladder and required transfusion of 5 units of whole blood.

  9. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    PubMed

    Bhatty, Shaun; Ali, Asghar; Shetty, Ranjith; Sumption, Kevin F; Topaz, On; Jovin, Ion S

    2014-04-01

    The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions. PMID:24506409

  10. A case of micro-percutaneous nephrolithotomy with macro complication.

    PubMed

    Dede, Onur; Utangaç, Mazhar; Dağguli, Mansur; Hatipoğlu, Namık Kemal; Sancaktutar, Ahmet Ali; Bodakçı, Mehmet Nuri

    2015-06-01

    Percutaneous nephrolithotomy is accepted as the standard management approach for kidney stones that are either refractory to extracorporeal shock wave lithotripsy or are >2 cm in diameter. The recently developed micro-percutaneous nephrolithotomy (microperc) technique provides intrarenal access under full vision using an optic instrument with a smaller calibration. A lesser amount of bleeding has been reported with the use of this method. Here we present a case of a bleeding complication on postoperative day 15 after a microperc procedure used to treat a left kidney stone. The complication led to retention of bloody urine in the bladder and required transfusion of 5 units of whole blood. PMID:26328211

  11. Angioscopy by a new percutaneous transluminal coronary angioscope

    NASA Astrophysics Data System (ADS)

    Sakurada, Masami; Mizuno, Kyoichi; Miyamoto, Akira; Arakawa, Koh; Satomura, Kimio; Shibuya, Toshio; Yanagida, Shigeki; Okamoto, Yasuyuki; Kurita, Akira; Nakamura, Haruo; Arai, Tsunenori; Suda, Akira; Kikuchi, Makoto; Utsumi, Atsushi; Takeuchi, Kiyoshi; Akai, Yoshiro

    1990-07-01

    We developed a new percutaneous transluminal coronary angioscopic catheter for visualization of coronary artery.This angioscopic catheter has an inflatable balloon at the distal tip and one - directional angulation mechanism.We performed percutaneous transluminal coronary angioscopy during cardiac catheterization cosecutively in 155 patients. With this angioscope , we could get good'-'fair visualization in 81%(131 of 162 lesions)without major complications.We could investigate the endothelial macropathology of ischemic heart disease such as unstable angina and acute myocardial infarction.

  12. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Oksar, Menekse; Gumus, Tulin; Kanbak, Orhan

    2016-01-01

    Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer's assessment of alertness/sedation score. PMID:27298743

  13. Third-generation percutaneous vertebral augmentation systems.

    PubMed

    Vanni, Daniele; Galzio, Renato; Kazakova, Anna; Pantalone, Andrea; Grillea, Giovanni; Bartolo, Marcello; Salini, Vincenzo; Magliani, Vincenzo

    2016-03-01

    Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting(®) (VBS), OsseoFix(®) and Spine Jack(®). VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix(®) and Spine Jack(®) are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix(®) has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting(®) and Spine Jack(®), the OsseoFix(®) has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack(®) is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors. PMID:27683690

  14. Third-generation percutaneous vertebral augmentation systems

    PubMed Central

    Galzio, Renato; Kazakova, Anna; Pantalone, Andrea; Grillea, Giovanni; Bartolo, Marcello; Salini, Vincenzo; Magliani, Vincenzo

    2016-01-01

    Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting® (VBS), OsseoFix® and Spine Jack®. VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix® and Spine Jack® are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix® has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting® and Spine Jack®, the OsseoFix® has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack® is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors.

  15. Supracostal percutaneous nephrolithotomy: A prospective comparative study

    PubMed Central

    Sinha, Maneesh; Krishnappa, Pramod; Subudhi, Santosh Kumar; Krishnamoorthy, Venkatesh

    2016-01-01

    Introduction: A widely prevalent fear of thoracic complications with the supracostal approach has led to its underutilization in percutaneous nephrolithotomy (PCNL). We frequently use the supracostal approach and compared the efficacy and thoracic complications of infracostal, supra 12th, and supra 11th punctures. Materials and Methods: This was a prospective study of patients who underwent PCNL between January 2005 and December 2012. The patients were divided into three groups based on the access: infracostal, supra 12th (between the 11th and 12th ribs) and supra 11th (between the 10th and 11th ribs). Clearance rates, fall in hemoglobin levels, transfusion rates, perioperative analgesic requirements, hospital stay and thoracic complications were compared. Results: Seven hundred patients were included for analysis. There were 179 (25.5%) patients in the supra 11th group, 187 (26.7%) patients in the supra 12th group and 334 (47.8%) patients in the infracostal group. The overall clearance rate was 78% with no difference in the three groups. The postoperative analgesic requirements were significantly higher in the supracostal groups and showed a graded increase from infracostal to supra 12th to supra 11th. During the study period, only 2 patients required angioembolization (0.3%) and none required open exploration. The number of patients requiring intercostal chest drain insertion was extremely low, at 1.6% and 2.2% in the supra 12th and supra 11th groups, respectively. Conclusions: Our results confirm the feasibility of the supracostal approach including punctures above the 11th rib, albeit at the cost of an increase in thoracic complications. Staying in the line of the calyx has helped us to minimize the most dreaded complication of bleeding requiring angioembolization. PMID:26941494

  16. Third-generation percutaneous vertebral augmentation systems

    PubMed Central

    Galzio, Renato; Kazakova, Anna; Pantalone, Andrea; Grillea, Giovanni; Bartolo, Marcello; Salini, Vincenzo; Magliani, Vincenzo

    2016-01-01

    Currently, there is no general consensus about the management of osteoporotic vertebral fractures (OVF). In the past, conservative treatment for at least one month was deemed appropriate for the majority of vertebral fractures. When pain persisted after conservative treatment, it was necessary to consider surgical interventions including: vertebroplasty for vertebral fractures with less than 30% loss of height of the affected vertebral body and kyphoplasty for vertebral fractures with greater than 30% loss of height. Currently, this type of treatment is not feasible. Herein we review the characteristics and methods of operation of three of the most common percutaneous vertebral augmentation systems (PVAS) for the treatment of OVF: Vertebral Body Stenting® (VBS), OsseoFix® and Spine Jack®. VBS is a titanium device accompanied by a hydraulic (as opposed to mechanical) working system which allows a partial and not immediate possibility to control the opening of the device. On the other hand, OsseoFix® and Spine Jack® are accompanied by a mechanical working system which allows a progressive and controlled reduction of the vertebral fracture. Another important aspect to consider is the vertebral body height recovery. OsseoFix® has an indirect mechanism of action: the compaction of the trabecular bone causes an increase in the vertebral body height. Unlike the Vertebral Body Stenting® and Spine Jack®, the OsseoFix® has no direct lift mechanism. Therefore, for these characteristics and for the force that this device is able to provide. In our opinion, Spine Jack® is the only device also suitable for the treatment OVF, traumatic fracture (recent, old or inveterate) and primary or secondary bone tumors. PMID:27683690

  17. Comparison Between Percutaneous Transhepatic Rigid Cholangioscopic Lithotripsy and Conventional Percutaneous Transhepatic Cholangioscopic Surgery for Hepatolithiasis Treatment

    PubMed Central

    Sun, Beiwang; Huang, Binyuan; Xie, Jiafen; Liu, Yanmin; Zhu, Canhua; Ye, Chen; Zhou, Zixuan

    2016-01-01

    Background: Percutaneous transhepatic cholangioscopy (PTCS) is one option for treating hepatolithiasis without surgical resection. This approach can use conventional biliary drainage methods over a long period, but a shorter procedure needs to be evolved. Objective: To evaluate the short-term and the long-term therapeutic outcomes of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in comparison with conventional PTCS. Methods: In this retrospective study, 118 patients with hepatolithiasis were enrolled who underwent treatment in our hospital between March 2007 and July 2014. About 67 of them received PTCSL and the remaining 51 patients received conventional PTCS. Preoperative data, surgical operation-related records, the postoperative therapeutic effect, and the long-term hepatolithiasis recurrence rate were collected for comparison between the 2 groups. Results: The age, sex, and surgical history were similar between the 2 groups, but there was a significant difference in the Child-Pugh score, with more grade 3 patients in the PTCS group (P=0.002). However, the operation time, intraoperative blood infusion, and the blood loss were similar between the 2 groups. The final clearance ratio of calculus in the PTCSL group was significantly better than in the PTCS group after multivariate analysis (P=0.021; OR=0.201; 95% CI, 0.051-0.785). Calculus recurrence was 9% (PTCSL) and 22% (PTCS). The postoperative hospital stay was significantly shorter in the PTCSL group (P=0.001; OR=1.337; 95% CI, 1.132-1.58). Conclusions: PTCSL was a satisfactory therapeutic option for hepatolithiasis treatment, with less operation time and a superior long-term therapeutic effect compared with conventional PTCS. PMID:26679679

  18. Primary Percutaneous Coronary Intervention in Chronic Type A Aortic Dissection

    PubMed Central

    Farag, Ahmed; Chauhan, Aneesha; Avinash, Sunita; Liew, Chee K; Eichhöfer, Jonas; Chauhan, Anoop

    2016-01-01

    This case illustrates the complexities of performing a primary percutaneous intervention in a patient with chronic Type A aortic aneurysm and dissection with contraindications for surgical management. We also discuss the significant risk that the patient had to overcome to survive an undiagnosed aortic dissection and an acute ST elevation myocardial infarction. PMID:27757405

  19. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    PubMed Central

    Teoh, Anthony Yuen Bun; Dhir, Vinay; Jin, Zhen-Dong; Kida, Mitsuhiro; Seo, Dong Wan; Ho, Khek Yu

    2016-01-01

    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage. METHODS: Comparative studies published between January 1980 and May 2014 were identified on PubMed, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities. RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound (EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies compared EUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits. CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities. PMID:27014427

  20. Percutaneous multiple electrode connector, design parameters and fabrication (biomedical)

    NASA Technical Reports Server (NTRS)

    Myers, L. A.

    1977-01-01

    A percutaneous multielectrode connector was designed which utilizes an ultrapure carbon collar to provide an infection free biocompatible passage through the skin. The device provides reliable electrical continuity, mates and demates readily with the implant, and is fabricated with processes and materials oriented to commercial production.

  1. Cardiac Perforation and Multiple Emboli After Percutaneous Vertebroplasty.

    PubMed

    Shen, Chong; Liu, Gang; Hu, Jun-Zu; Yang, Xi-Heng

    2015-10-01

    Percutaneous vertebroplasty is a minimally invasive technique for treating vertebral compression fractures and tumors. Although percutaneous vertebroplasty is considered a relatively safe and technically simple procedure, it is also associated with life-threatening complications as a result of cement leakage, including cardiac perforation and pulmonary embolism. A 63-year-old woman underwent percutaneous vertebroplasty for an L3 vertebral fracture and had cement leaks into the inferior vena cava, pulmonary arteries, and right heart chambers, with a free wall perforation. Surgical removal of the cement emboli was recommended as a result of apparent penetration of the ventricle and the fragile nature of polymethyl methacrylate. A cardiopulmonary bypass was immediately performed via a right atriotomy. A foreign body 10 cm in length was removed from the right atrium and ventricle. Arteriotomies were then performed, and 4 cement filaments were retrieved from the pulmonary arteries. The inferior vena cava was also surgically opened, allowing extraction of a cement fragment that was 12 cm long. The postoperative course was uneventful, and the patient fully recovered. This is the first report of the migration of a cement fragment larger than 10 cm that had migrated and embedded in the heart chamber. This report showed that imaging analysis is valuable when cement leakage is detected during percutaneous vertebroplasty and can be used to avoid serious complications and improve patient outcomes. PMID:26488794

  2. Percutaneous antegrade ureteric stent insertion in malignant disease.

    PubMed Central

    Harding, J R

    1993-01-01

    Untreated, progressive bilateral ureteric obstruction, or unilateral ureteric obstruction in patients with a solitary functioning kidney, will ultimately lead to uraemia, renal failure and death. This paper describes 34 successful percutaneous antegrade ureteric stent placements from 37 attempts, performed on 25 selected patients with a history of malignant disease, in whom retrograde ureteric stenting was impossible or difficult. PMID:8410885

  3. Complications in Percutaneous Vertebroplasty Associated with Puncture or Cement Leakage

    SciTech Connect

    Baumann, Clemens Fuchs, Heiko; Kiwit, Juergen; Westphalen, Kerstin; Hierholzer, Johannes

    2007-04-15

    Due to the minimally invasive character and excellent clinical outcome of percutaneous vertebroplasty (PVP), the procedure is being performed in greatly increasing numbers. While PVP has a low complication rate in general, severe complications can occur. We focus on the imaging appearance of complications of PVP associated with puncture or cement leakage-from harmless to life-threatening.

  4. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  5. Percutaneous Drainage of Suppurative Pylephlebitis Complicating Acute Pancreatitis

    SciTech Connect

    Nouira, Kais Bedioui, Haykel; Azaiez, Olfa; Belhiba, Hend; Messaoud, Monia Ben; Ksantini, Rachid; Jouini, Mohamed; Menif, Emna

    2007-11-15

    Suppurative pylephlebitis is a rare condition with a significant mortality rate, ranging from 50% to 80%. We report a case of suppurative pylephlebitis complicating acute pancreatitis treated by percutaneous drainage in a 40-year-old woman. The patient had an uneventful recovery.

  6. Direct Transoral Approach to C2 for Percutaneous Vertebroplasty

    SciTech Connect

    Martin, Jean-Baptiste; Gailloud, Philippe; Dietrich, Pierre-Yves; Luciani, Marc E.; Somon, Thierry; Sappino, Pascal-Andre; Ruefenach, Daniel A.

    2002-12-15

    Percutaneous vertebroplasty was performed via a transoral route in a 70-year-old woman with a C2 metastasis of thyroid origin involving anterior vertebral elements. Complete pain relief was obtained after an uncomplicated minimally invasive procedure. This preliminary experience demonstrates that a transoral approach under fluoroscopic control can provide safe access to the upper cervical spine at C2 level.

  7. Percutaneous approach to the upper thoracic spine: optimal patient positioning.

    PubMed

    Bayley, Edward; Clamp, Jonathan; Boszczyk, Bronek M

    2009-12-01

    Percutaneous access to the upper thoracic vertebrae under fluoroscopic guidance is challenging. We describe our positioning technique facilitating optimal visualisation of the high thoracic vertebrae in the prone position. This allows safe practice of kyphoplasty, vertebroplasty and biopsy throughout the upper thoracic spine.

  8. Successful Percutaneous Transluminal Angioplasty and Stenting in Acute Mesenteric Ischemia

    SciTech Connect

    Gartenschlaeger, Soeren Bender, Siegfried; Maeurer, Juergen; Schroeder, Ralf J.

    2008-03-15

    Acute mesenteric ischemia (AMI) is a life-threatening emergency. The complications are high by the time of diagnosis in most cases and therefore only few data on primary percutaneous intervention with percutaneous transluminal angioplasty (PTA) and stenting in AMI are available. We present the case of an 84-year-old woman who presented to our emergency department complaining of an acute worsening of pre-existing abdominal periumbilical pain, nausea, vomiting, and diarrhea. She had previously undergone percutaneous transluminal embolectomy for an acute occlusion of the left common femoral artery. Due to suspicion of intestinal infarction, conventional angiography of the aorta and the superior mesenteric artery (SMA) was performed and confirmed a proximal occlusion of the SMA. Percutaneous SMA recanalization with balloon dilation and subsequent stent implantation was carried out successfully. The abdominal symptoms subsided after this procedure. In AMI that is diagnosed early, endovascular stenting should be considered as an alternative treatment to the surgical approach that avoids the need for surgical bowel resection.

  9. Lateral rectus palsy following coronary angiography and percutaneous coronary intervention

    PubMed Central

    Nicholson, Luke; Jones, Ruth; Hughes, David S

    2014-01-01

    We present a rare case of unilateral lateral rectus palsy following an elective coronary angiography and percutaneous coronary intervention in a 78-year-oldwoman. Ophthalmoplegia following coronary angiography is extremely rare and this is the first case of a unilateral lateral rectus palsy following the procedure. PMID:24536054

  10. The Evolving Role of Percutaneous Mitral Valve Repair

    PubMed Central

    Stewart, Merrill H.; Jenkins, J. Stephen

    2016-01-01

    Background: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery. However, many questions are left unanswered about when to perform this procedure and whom to perform it on. Methods: We reviewed major published literature on the MitraClip from 2003-2016 to help guide clinical decision-making. A PubMed search was conducted using the phrase “mitraclip” or “percutaneous mitral valve repair” to identify relevant articles pertaining to the clip as well as surgical valve repair. Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the MitraClip but did not prove its superiority to surgical repair in the population studied. Numerous subsequent registries have suggested that the success of the MitraClip varies with the patient population studied. The currently enrolling Cardiovascular Outcomes for Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional MR (COAPT) trial hopes to answer some of these questions. Conclusion: The MitraClip is a new and exciting technology for percutaneously treating disease processes traditionally managed with surgery. The future of the clip and its patient population is dependent on further studies.

  11. Percutaneous Cystgastrostomy as a Single-Step Procedure

    SciTech Connect

    Curry, L. Sookur, P.; Low, D.; Bhattacharya, S.; Fotheringham, T.

    2009-03-15

    The purpose of this study was to evaluate the success of percutaneous transgastric cystgastrostomy as a single-step procedure. We performed a retrospective analysis of single-step percutaneous transgastric cystgastrostomy carried out in 12 patients (8 male, 4 female; mean age 44 years; range 21-70 years), between 2002 and 2007, with large symptomatic pancreatic pseudocysts for whom up to 1-year follow-up data (mean 10 months) were available. All pseudocysts were drained by single-step percutaneous cystgastrostomy with the placement of either one or two stents. The procedure was completed successfully in all 12 patients. The pseudocysts showed complete resolution on further imaging in 7 of 12 patients with either enteric passage of the stent or stent removal by endoscopy. In 2 of 12 patients, the pseudocysts showed complete resolution on imaging, with the stents still noted in situ. In 2 of 12 patients, the pseudocysts became infected after 1 month and required surgical intervention. In 1 of 12 patients, the pseudocyst showed partial resolution on imaging, but subsequently reaccumulated and later required external drainage. In our experience, percutaneous cystgastrostomy as a single-step procedure has a high success rate and good short-term outcomes over 1-year follow-up and should be considered in the treatment of large symptomatic cysts.

  12. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    Oh, Jung Suk Lee, Hae Giu Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-10-15

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

  13. The Evolving Role of Percutaneous Mitral Valve Repair

    PubMed Central

    Stewart, Merrill H.; Jenkins, J. Stephen

    2016-01-01

    Background: Mitral regurgitation (MR) is the second leading cause of valvular heart disease in the United States behind aortic stenosis. The percutaneous repair of the mitral valve (MitraClip, Abbott, Inc.) has been approved in the United States since 2013 as an alternative to traditional mitral valve surgery. However, many questions are left unanswered about when to perform this procedure and whom to perform it on. Methods: We reviewed major published literature on the MitraClip from 2003-2016 to help guide clinical decision-making. A PubMed search was conducted using the phrase “mitraclip” or “percutaneous mitral valve repair” to identify relevant articles pertaining to the clip as well as surgical valve repair. Results: The clinical trials EVEREST I and EVEREST II (Endovascular Valve Edge-to-Edge Repair Study) demonstrated the safety and efficacy of the MitraClip but did not prove its superiority to surgical repair in the population studied. Numerous subsequent registries have suggested that the success of the MitraClip varies with the patient population studied. The currently enrolling Cardiovascular Outcomes for Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional MR (COAPT) trial hopes to answer some of these questions. Conclusion: The MitraClip is a new and exciting technology for percutaneously treating disease processes traditionally managed with surgery. The future of the clip and its patient population is dependent on further studies. PMID:27660576

  14. Percutaneous techniques for cervical pain of discal origin.

    PubMed

    Gangi, Afshin; Tsoumakidou, Georgia; Buy, Xavier; Cabral, Jose Facundo; Garnon, Julien

    2011-04-01

    Cervical discogenic pain is an important cause of suffering and disability in the adult population. Pain management in cervical disc herniation relies initially on conservative care (rest, physiotherapy, and oral medications). Once conservative treatment has failed, different percutaneous minimally invasive radiological procedures can be applied to relief pain. This article offers a systematic review on the percutaneous minimally invasive techniques that can be advocated for the treatment of cervical pain of discal origin. Periradicular steroid injection under image guidance (computed tomography or magnetic resonance imaging) is the first technique to be considered. The steroid injection aims at reducing the periradicular inflammation and thus relieves the radicular pain. The steroid injections present satisfying short-term results, but pain can recur in the long term. Whenever the steroid injections fail to relieve pain from a contained cervical disc herniation, the more invasive percutaneous disc decompression techniques should be proposed. Percutaneous radiofrequency nucleoplasty is the most often applied technique on the cervical level with a low risk of thermal damage. When the indications and instructions are respected, radiofrequency nucleoplasty presents accepted safety and efficacy levels. PMID:21500138

  15. Outcomes of cancer patients undergoing percutaneous pericardiocentesis for pericardial effusion

    PubMed Central

    El Haddad, Danielle; Iliescu, Cezar; Yusuf, Syed Wamique; William, William Nassib; Khair, Tarif H.; Song, Juhee; Mouhayar, Elie N.

    2015-01-01

    BACKGROUND Pericardial effusion (PE) is common in cancer patients but the optimal therapeutic approach is not well defined. Percutaneous pericardiocentesis is less invasive than surgery, but its long-term effectiveness and safety are not well documented. OBJECTIVES We evaluated outcomes of cancer patients undergoing percutaneous pericardiocentesis for PE and assessed the procedure’s safety in patients with thrombocytopenia. METHODS Cancer patients who underwent percutaneous pericardiocentesis for PE between November 2009 and October 2014 at MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed. RESULTS Of 1,645 cancer patients referred for PE, 212 (13%) underwent percutaneous pericardiocentesis. The procedure was successful in 99% of the cases with no procedure-related deaths. Four patients had major procedure-related bleeding that did not vary by platelet count <50,000/µl or ≥50,000/µl (p = 0.1281). Patients with catheter drainage for 3 to 5 days had the lowest recurrence rate (10%). Median overall survival was 143 days with age >65 years, lung cancer, platelet count <20,000/µl, and malignant pericardial fluid independently associated with poor prognosis. Lung cancer patients with proven malignant effusions had a significantly shorter median 1-year survival compared to those with nonmalignant effusions (16.2% vs. 49.0%, respectively; log-rank test p value = 0.0101). A similar difference in 1-year survival was not observed in breast cancer patients (40.2% vs. 40.0%, respectively; log-rank test p = 0.4170). CONCLUSION Percutaneous pericardiocentesis with extended catheter drainage, as primary treatment for PE in cancer patients, is safe and effective, including in those with thrombocytopenia. Malignant PE significantly shortens the survival outcome of lung, but not breast, cancer patients. PMID:26337990

  16. Percutaneous Retrieval of Foreign Bodies Around Vital Vessels Aided with Vascular Intervention: A Technical Note

    SciTech Connect

    Yang, Xiu-Jun; Xing, Guang-Fu

    2015-10-15

    ObjectiveTo describe a new interventional technique to remove foreign bodies (FBs) embedded in soft tissues around vital vessels.MethodsUnder fluoroscopic guidance and using local anesthesia, percutaneous removal of FBs was performed using forceps in nine patients. All patients suffered from a metallic soft tissue FB located in close proximity to important vessels and one also had a small traumatic pseudoaneurysm adjacent to the FB. Prior to removal of the FB, the position of the nearest vessel was identified using a guide wire or catheter placed into the vessel. Balloon catheter was also simultaneously used to temporarily stop the blood flow of the nearest artery during the FB removal in three of the nine patients.ResultsAll of the nine FBs with 0–2 mm interval to the nearest vessel were successfully removed in the nine patients without any serious complications. The removed FBs measured 3–12 mm in length and 1–3 mm in width. The total fluoroscopic time of retrieval of each FB was 5–9 min (mean, 6.4 min). The volume of intraoperative bleeding ranged from 5 to 12 ml (mean, 7.5 ml). The length of hospital stay for each patient ranged from 4 to 8 days (mean, 5.5 days).ConclusionVascular intervention-aided percutaneous FB removal is minimally invasive and an effective method for removal of FBs around vital vessels.

  17. Predictors of excessive renal displacement during access in percutaneous nephrolithotomy: a randomized clinical trial.

    PubMed

    Aminsharifi, Alireza; Haghpanah, Reza; Haghpanah, Sezaneh

    2014-02-01

    To determine the magnitude of renal displacement (a major cause of access failure or loss) during the renal access steps in percutaneous nephrolithotomy (PCNL), investigate predictors of excessive renal displacement, and compare the effect of one-stage versus gradual dilation on renal displacement during access. Sixty-six adult patients undergoing PCNL were randomized into two groups containing 33 patients each: Group 1 underwent gradual tract dilation with Alken metal dilators, and Group 2 received one-stage tract dilation. In each patient, maximum renal displacement was measured in three planes (cephalocaudal, anteroposterior, and mediolateral) during the three access steps (needle puncture, Alken guide insertion, and dilator advancement). The patients' demographic data and intraoperative parameters were compared. In both groups, net renal displacement during the three access steps was in the cephalad, medial, and anterior directions. There were no significant differences in the magnitude of renal displacement in patients with gradual versus one-stage tract dilation. Renal displacement was significantly more pronounced in all planes and in all access steps in female patients and in those with no previous history of open stone surgery on the ipsilateral kidney. High body mass index (BMI) showed a significant negative correlation with cephalad and anterior renal displacement, but not with medial displacement. Three-dimensional movement of the kidney during percutaneous access in PCNL is similar when gradual versus one-stage tract dilation is used. Inherent patient characteristics, such as female sex, BMI, and a previous ipsilateral flank scar are major determinants of the magnitude of renal displacement during the PCNL access steps. PMID:23963103

  18. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for osteoporotic vertebral compression fracture: A metaanalysis

    PubMed Central

    Shi-Ming, Guo; Wen-Juan, Luo; Yun-Mei, Huang; Yin-Sheng, Wu; Mei-Ya, Huang; Yan-Ping, Lin

    2015-01-01

    Background: Osteoporotic vertebral compression fracture (OVCF) is the most common complication of osteoporosis, however, debate persists over which procedure of percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) is a better treatment. We performed a metaanalysis of prospective, randomized controlled and clinical controlled trials of PVP and BKP to determine the efficacy and safety for the treatment of OVCFs to reach a relatively conclusive answer. Materials and Methods: We searched computerized databases comparing efficacy and safety of PVP and BKP in osteoporotic vertebral compression fractures. These reports included pain relief, functional capacity (Oswestry disability index [ODI] score), anterior vertebral body height (AVBH), kyphotic angle and complications (i.e. cement leakage, incident fractures). Studies were assessed for methodological bias and potential reasons for heterogeneity were explored. Results: As of March 15, 2013, a PubMed search resulted in 761 articles, of which eleven studies encompassing 789 patients, met the inclusion criteria. The average length of followup is 17 months and 4.6% patients were lost to followup. Results of metaanalysis indicated that BKP is more effective for short term pain relief. In addition, BKP is more effective to restore the AVBH (anterior vertebral body height), ODI and kyphotic angle of OVCFs. Moreover, BKP need more polymethylmethacrylate amount. Conclusions: In terms of better effectiveness of BKP procedure, we believe BKP to be superior over PVP for the treatment of osteoporotic VCFs. PMID:26229156

  19. Percutaneous Dorsal Instrumentation of Vertebral Burst Fractures: Value of Additional Percutaneous Intravertebral Reposition—Cadaver Study

    PubMed Central

    Krüger, Antonio; Schmuck, Maya; Noriega, David C.; Ruchholtz, Steffen; Baroud, Gamal; Oberkircher, Ludwig

    2015-01-01

    Purpose. The treatment of vertebral burst fractures is still controversial. The aim of the study is to evaluate the purpose of additional percutaneous intravertebral reduction when combined with dorsal instrumentation. Methods. In this biomechanical cadaver study twenty-eight spine segments (T11-L3) were used (male donors, mean age 64.9 ± 6.5 years). Burst fractures of L1 were generated using a standardised protocol. After fracture all spines were allocated to four similar groups and randomised according to surgical techniques (posterior instrumentation; posterior instrumentation + intravertebral reduction device + cement augmentation; posterior instrumentation + intravertebral reduction device without cement; and intravertebral reduction device + cement augmentation). After treatment, 100000 cycles (100–600 N, 3 Hz) were applied using a servohydraulic loading frame. Results. Overall anatomical restoration was better in all groups where the intravertebral reduction device was used (p < 0.05). In particular, it was possible to restore central endplates (p > 0.05). All techniques decreased narrowing of the spinal canal. After loading, clearance could be maintained in all groups fitted with the intravertebral reduction device. Narrowing increased in the group treated with dorsal instrumentation. Conclusions. For height and anatomical restoration, the combination of an intravertebral reduction device with dorsal instrumentation showed significantly better results than sole dorsal instrumentation. PMID:26137481

  20. Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

    PubMed Central

    2012-01-01

    Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography. PMID:22452829

  1. Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol

    SciTech Connect

    Anon, Ramon Guijarro, Jorge; Amoros, Cirilo; Gil, Joaquin; Bosca, Marta M.; Palmero, Julio; Benages, Adolfo

    2006-08-15

    We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent. A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted and sent for microbiologic and pathologic studies to rule out an infectious or malignant origin. Immediately afterwards, complete drainage and local sclerotherapy with alcohol was performed. This therapy was repeated 8 days later, after having observed 60 ml of fluid in the drainage bag. One year after treatment the cyst has practically disappeared. We believe that treatment of splenic cyst with percutaneous puncture, ethanolization, and drainage is a valid option and it does not rule out surgery if the conservative treatment fails.

  2. Design and Testing of a Percutaneously Implantable Fetal Pacemaker

    PubMed Central

    Loeb, Gerald E.; Zhou, Li; Zheng, Kaihui; Nicholson, Adriana; Peck, Raymond A.; Krishnan, Anjana; Silka, Michael; Pruetz, Jay; Chmait, Ramen; Bar-Cohen, Yaniv

    2012-01-01

    We are developing a cardiac pacemaker with a small, cylindrical shape that permits percutaneous implantation into a fetus to treat complete heart block and consequent hydrops fetalis, which can otherwise be fatal. The device uses off-the-shelf components including a rechargeable lithium cell and a highly efficient relaxation oscillator encapsulated in epoxy and glass. A corkscrew electrode made from activated iridium can be screwed into the myocardium, followed by release of the pacemaker and a short, flexible lead entirely within the chest of the fetus to avoid dislodgement from fetal movement. Acute tests in adult rabbits demonstrated the range of electrical parameters required for successful pacing and the feasibility of successfully implanting the device percutaneously under ultrasonic imaging guidance. The lithium cell can be recharged inductively as needed, as indicated by a small decline in the pulsing rate. PMID:22855119

  3. [Results following percutaneous intramedullary pin fixation in distal radius fractures].

    PubMed

    Kirchner, R; Hüttl, T; Krüger-Franke, M; Rosemeyer, B

    1994-01-01

    42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures. PMID:7516105

  4. Evaluation and percutaneous management of atherosclerotic peripheral vascular disease

    SciTech Connect

    Widlus, D.M.; Osterman, F.A. Jr. )

    1989-06-02

    Atherosclerotic peripheral vascular disease (PVD) of the lower extremities deprives a person of the ability to exercise to their satisfaction, later of the ability to perform the activities of their daily life, and finally of their legs themselves. Peripheral vascular disease has long been managed by the vascular surgeon utilizing endarterectomy and peripheral arterial bypass. Patient acceptance of nonsurgical, percutaneous procedures such as percutaneous transluminal balloon angioplasty (PTA) is high. Increased utilization of these procedures has led to improved techniques and adjuncts to therapy, as well as more critical review of long-term results. This article will review the evaluation and nonoperative management of PVD, with an emphasis on the newer modalities of management presently being investigated.

  5. Percutaneous ventricular assist devices and extracorporeal life support: current applications.

    PubMed

    Blumenstein, Johannes; de Waha, Suzanne; Thiele, Holger

    2016-05-17

    Percutaneous mechanical circulatory support devices, such as intra-aortic balloon pump (IABP), active left ventricular assist devices (LVAD) or extracorporeal life support (ECLS), are treatment options for selected patients in cardiogenic shock, undergoing cardiopulmonary resuscitation, or high-risk percutaneous coronary intervention and coronary artery bypass grafting. Potential benefits include the maintenance of organ function and the reduction of intracardiac pressures, volumes, and oxygen consumption. On the other hand, they are invasive, resource intensive, and can be associated with serious complications. Thus, their potential benefits must be weighed against the inherent risks. Despite the lack of sufficient scientific evidence, the use of mechanical circulatory support devices has risen considerably in recent years. This educational article covers practical issues of IABP, LVAD, and ECLS with respect to patient and device selection, implantation technique, potential complications, and future perspectives.

  6. Spontaneous left main dissection treated by percutaneous coronary intervention.

    PubMed

    Sousa, Alexandra; Lopes, Ricardo; Silva, João Carlos; Maciel, M Júlia

    2013-06-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization. We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature.

  7. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    SciTech Connect

    Pabon-Ramos, Waleska M.; Niemeyer, Matthew M.; Dasika, Narasimham L.

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  8. Recent advancement or less invasive treatment of percutaneous nephrolithotomy

    PubMed Central

    2015-01-01

    Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL. PMID:26366273

  9. High-density percutaneous chronic connector for neural prosthetics

    SciTech Connect

    Shah, Kedar G.; Bennett, William J.; Pannu, Satinderpall S.

    2015-09-22

    A high density percutaneous chronic connector, having first and second connector structures each having an array of magnets surrounding a mounting cavity. A first electrical feedthrough array is seated in the mounting cavity of the first connector structure and a second electrical feedthrough array is seated in the mounting cavity of the second connector structure, with a feedthrough interconnect matrix positioned between a top side of the first electrical feedthrough array and a bottom side of the second electrical feedthrough array to electrically connect the first electrical feedthrough array to the second electrical feedthrough array. The two arrays of magnets are arranged to attract in a first angular position which connects the first and second connector structures together and electrically connects the percutaneously connected device to the external electronics, and to repel in a second angular position to facilitate removal of the second connector structure from the first connector structure.

  10. Outpatient percutaneous and endoscopic surgery in interventional pain management.

    PubMed

    McMillan, Marion R

    2011-12-01

    The evolution of interventional pain management from inception through the present is examined. Increasing demand from patients, referring physicians and third party payors for proven interventions which provide long-term functional relief of symptoms or primary correction of common spinal pain syndromes is discussed. The role of current palliative therapy as compared to the proven clinical validity of outpatient percutaneous and endoscopic spinal surgical techniques is reviewed. Practitioners are encouraged to transition from the use of spinal injections and narcotics of unproven benefit to percutaneous and endoscopic spinal intervention as primary therapy of herniated lumbar disc, discogenic spinal pain, and lumbar spinal stenosis in appropriately selected patients. SD, Expenditures and health status among adults with back and neck problems. PMID:23256229

  11. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation.

    PubMed

    Li, Chi-Hion; Arzamendi, Dabit; Carreras, Francesc

    2016-04-01

    Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures.

  12. Percutaneous ventricular assist devices and extracorporeal life support: current applications.

    PubMed

    Blumenstein, Johannes; de Waha, Suzanne; Thiele, Holger

    2016-05-17

    Percutaneous mechanical circulatory support devices, such as intra-aortic balloon pump (IABP), active left ventricular assist devices (LVAD) or extracorporeal life support (ECLS), are treatment options for selected patients in cardiogenic shock, undergoing cardiopulmonary resuscitation, or high-risk percutaneous coronary intervention and coronary artery bypass grafting. Potential benefits include the maintenance of organ function and the reduction of intracardiac pressures, volumes, and oxygen consumption. On the other hand, they are invasive, resource intensive, and can be associated with serious complications. Thus, their potential benefits must be weighed against the inherent risks. Despite the lack of sufficient scientific evidence, the use of mechanical circulatory support devices has risen considerably in recent years. This educational article covers practical issues of IABP, LVAD, and ECLS with respect to patient and device selection, implantation technique, potential complications, and future perspectives. PMID:27174115

  13. Simultaneous percutaneous nephrolithotomy and early endoscopic ureteric realignment for iatrogenic ureteropelvic junction avulsion during ureteroscopy

    PubMed Central

    Tayeb, Marawan El; Mellon, Matthew J.; Lingeman, James E.

    2015-01-01

    We present a case report of successful management of ureteropelvice junction avulsion during ureteroscopy successfully managed with simultaneous percutaneous nephrolithotomy and early endoscopic ureteral realignment. PMID:26834898

  14. Management of hemorrhagic complications associated with percutaneous nephrolithotomy.

    PubMed

    Rastinehad, Ardeshir R; Andonian, Sero; Smith, Arthur D; Siegel, David N

    2009-10-01

    Urologists have witnessed replacement of complex open surgical procedures with minimally invasive therapies over the past quarter century. Nothing personifies this more than an anatrophic nephrolithotomy in the management of kidney stones. The Boyce procedure, once the gold standard for staghorn calculi, is rarely performed. Percutaneous nephrolithotomy (PCNL) has become the gold standard procedure for large renal stones and staghorns. This article will review the hemorrhagic complications that are associated with PCNL and the necessary therapeutic interventions.

  15. Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi.

    PubMed

    Stening, S G; Bourne, S

    1998-08-01

    The incidence of upper pole calculi is 15% of all caliceal calculi. The management of such calculi has been simplified since the advent of extracorporeal shockwave lithotripsy (SWL). In our experience, however, there is a subset of upper pole caliceal calculi wherein certain features can render SWL less than adequate treatment, namely diameter >1.5 cm, narrowing of the caliceal infundibulum, either singly or combined, and morbid obesity. In such instances, percutaneous nephrolithotomy (PCNL) is indicated. Percutaneous access to an upper pole calix can be difficult by a subcostal track. The supracostal 12th rib approach provides direct and efficient access to an upper pole calix and is ideally suited for upper pole calculi. Twenty-one patients with large or complex upper pole calculi were treated by supracostal PCNL. The maximum diameter of the calculi ranged from 7 to 40 mm. Eight were branched (staghorn). There was one horseshoe kidney, and calculi were bilaterally represented in another patient. Two patients were morbidly obese. All procedures were performed in one stage under general anesthesia. Following cystoscopy and ureteral catheterization, the upper pole calix was accessed directly with the aid of C-arm fluoroscopy and retrograde ureteral contrast injection. The percutaneous tract was dilated to a maximum of 26 F, a working sheath was inserted, and the calculi were extracted after ultrasonic or pneumatic fragmentation. One patient required secondary SWL for residual fragments. There were no intrathoracic complications, and blood loss was minimal. Large or complex upper pole caliceal calculi, particularly in the morbidly obese, can be treated effectively by PCNL using supracostal percutaneous access.

  16. Pain Palliation by Percutaneous Acetabular Osteoplasty for Metastatic Hepatocellular Carcinoma

    SciTech Connect

    Hokotate, Hirofumi; Baba, Yasutaka; Churei, Hisahiko; Nakajo, Masayuki; Ohkubo, Kouichi; Hamada, Kenji

    2001-09-15

    A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

  17. Percutaneous Permeation of Topical Phtalocyanine Studied by Photoacoustic Measurements

    NASA Astrophysics Data System (ADS)

    Silva, E. P. O.; Beltrame, M.; Cardoso, L. E.; Barja, P. R.

    2012-11-01

    The purpose of this study was to evaluate the percutaneous permeation of topical hydroxy-(29 H,31 H-phthalocyaninato)aluminum (PcAlOH) on pig ear skin employing photoacoustic (PA) measurements. The PcAlOH was incorporated in an emulsion with assessed stability parameters of pH and short- and long-term stability tests. Pig skin was prepared through a heat separation technique, and the outer skin of the cartilage was removed with a scalpel. Skin samples were then cut and treated with sodium bromide 2 mol . L-1 for 6 h at 37 °C. The epidermis layer was washed with purified water, dried, and stored under reduced pressure until use. The skin permeation kinetics were determined by PA measurements as a function of time, performed with an open PA cell developed at Universidade do Vale do Paraíba. Short- and long-term stability tests showed no phase separation. A significant difference was found between the typical times for percutaneous permeation of the emulsion base and the emulsion + PcAlOH. The study showed two absorption transients due to the physical diffusion of molecules in the skin sample. The first is attributed to the penetration of molecules that promptly passed through the lipid barrier, while the second is related to the molecules that had greater difficulty of passing through. This slower component in the absorption curves is attributed to the penetration of PcAlOH, a planar molecule whose percutaneous penetration is more difficult. The study indicates that the formulations containing PcAlOH have stable characteristics and show promising results in absorption into the skin. The presence of the photosensitive agent in the formulation contributed significantly to the larger time constant observed. PA measurements allowed the evaluation of the penetration kinetics of PcAlOH in pig ear skin; the methodology employed may be used in the determination of the percutaneous permeation of phthalocyanines in further studies.

  18. Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replacement

    NASA Technical Reports Server (NTRS)

    Sitges, M.; Kapadia, S.; Rubin, D. N.; Thomas, J. D.; Tuzcu, M. E.; Lever, H. M.

    2001-01-01

    When left ventricular outflow tract obstruction develops after aortic valve replacement, few treatment choices have been available until now. We present a patient with prior aortic valve replacement who developed left ventricle outflow tract obstruction that was successfully treated with a percutaneous transcoronary myocardial septal alcohol ablation. This technique is a useful tool for the treatment of obstructive hypertrophic cardiomyopathy, especially in those patients with prior heart surgery. Copyright 2001 Wiley-Liss, Inc.

  19. Testing Percutaneous Arterial Closure Devices: An Animal Model

    SciTech Connect

    Ni Ruifang; Kranokpiraksa, Pawanrat; Pavcnik, Dusan Kakizawa, Hideaki; Uchida, Barry T.; Keller, Frederick S.; Roesch, Josef

    2009-03-15

    The ovine superficial femoral artery was used for testing the efficacy of percutaneous arterial closure devices (PACDs) in their developmental stage. Two topical devices containing chitostan, one staple-mediated PACD and a porcine small intestinal submucosa plug, were tested by follow-up angiography in 37 sheep. Absence or presence of bleeding and time to bleeding cessation were the main criteria for evaluation of PAVD efficacy. The results of these tests directed modification of individual PACDs and improved their efficacy.

  20. Percutaneous Renal Cyst Ablation and Review of the Current Literature.

    PubMed

    Desai, Devang; Modi, Sunny; Pavicic, Matthew; Thompson, Melissa; Pisko, John

    2016-01-01

    Renal cysts are common and most often are discovered incidentally, but may require intervention if associated with pain, hypertension, or hematuria. Minimally invasive treatment options are preferred with numerous modalities available, including renal cyst ablation. This case report of a 61-year-old female describes the effective percutaneous drainage and endoscopic ablation of a simple parapelvic renal cyst for management of symptomatic renal calculus. Current literature regarding this surgical intervention and alternative methods is discussed. PMID:27579403

  1. Haemophilic pseudotumours of the limbs and their percutaneous treatment.

    PubMed

    Caviglia, H A; FernAndez-Palazzi, F; Gilbert, M S

    2002-05-01

    The percutaneous treatment of limb pseudotumours is a nonaggressive method of treating haemophilic pseudotumours. However, efforts should be directed to the prevention of such pseudotumours by ensuring that all patients receive adequate treatment of their bleeding episodes through education and the elimination of geographical or social barriers that prevent access to such treatment. Prevention of pseudotumours by means of early substitution treatment of muscular bleeding episodes is the best treatment.

  2. Image-guided percutaneous internal fixation of sacral fracture.

    PubMed

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture.

  3. Image-guided percutaneous internal fixation of sacral fracture.

    PubMed

    Kinon, Merritt D; Desai, Rupen; Loriaux, Daniel; Houten, John K

    2016-01-01

    Percutaneous iliosacral screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. The use of stereotactic image guidance has been shown to provide superior accuracy in the placement of spinal instrumentation. Here, the authors describe a novel application of O-arm technology (Medtronic Sofamor Danek, Memphis, TN, USA) to help safely place iliosacral screws for the treatment of a traumatic sacral fracture. PMID:26433323

  4. Iatrogenic Percutaneous Vascular Injuries: Clinical Presentation, Imaging, and Management

    PubMed Central

    Ge, Benjamin H.; Copelan, Alexander; Scola, Dominic; Watts, Micah M.

    2015-01-01

    Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist. PMID:26038619

  5. Percutaneous aspiration of fluid for management of peritonitis in space

    NASA Technical Reports Server (NTRS)

    Kirkpatrick, A. W.; Nicolaou, S.; Campbell, M. R.; Sargsyan, A. E.; Dulchavsky, S. A.; Melton, S.; Beck, G.; Dawson, D. L.; Billica, R. D.; Johnston, S. L.; Hamilton, D. R.

    2002-01-01

    BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

  6. Ovarian vein thrombosis: A complication of percutaneous nephrolithotomy

    PubMed Central

    Ho, Louisa; Hall, Grayson; Thomas, Richard; Beiko, Darren

    2016-01-01

    The medical and surgical complications of percutaneous nephrolithotomy (PCNL) are well-known, including deep venous thrombosis. Ovarian vein thrombosis (OVT) is a rare, but potentially serious type of venous thrombosis that has not previously been reported as a complication of PCNL or ureteral stent placement. We report a case of OVT associated with ureteral stenting following a tubeless PCNL. This complication was successfully managed conservatively without any short- or long-term sequelae. PMID:27695586

  7. Ovarian vein thrombosis: A complication of percutaneous nephrolithotomy

    PubMed Central

    Ho, Louisa; Hall, Grayson; Thomas, Richard; Beiko, Darren

    2016-01-01

    The medical and surgical complications of percutaneous nephrolithotomy (PCNL) are well-known, including deep venous thrombosis. Ovarian vein thrombosis (OVT) is a rare, but potentially serious type of venous thrombosis that has not previously been reported as a complication of PCNL or ureteral stent placement. We report a case of OVT associated with ureteral stenting following a tubeless PCNL. This complication was successfully managed conservatively without any short- or long-term sequelae.

  8. BILATERAL PNEUMOTHORAX AS A COMPLICATION OF PERCUTANEOUS TRACHEOSTOMY: CASE REPORT.

    PubMed

    Klancir, Tino; Adam, Višnja Nesek; Mršić, Viviana; Marin, Damjan; Goranović, Tatjana

    2016-03-01

    Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

  9. Negative pressure wound therapy limits downgrowth in percutaneous devices

    PubMed Central

    Mitchell, Saranne J.; Jeyapalina, Sujee; Nichols, Francesca R.; Agarwal, Jayant; Bachus, Kent N.

    2016-01-01

    Maintenance of a soft tissue seal around percutaneous devices is challenged by the downgrowth of periprosthetic tissues—a gateway to potential infection. As negative pressure wound therapy (NPWT) is used clinically to facilitate healing of complex soft tissue pathologies, it was hypothesized that NPWT could limit downgrowth of periprosthetic tissues. To test this hypothesis, 20 hairless guinea pigs were randomly assigned into four groups (n = 5/group). Using a One-Stage (Groups 1 and 3) or a Two-Stage (Groups 2 and 4) surgical procedure, each animal was implanted with a titanium-alloy subdermal device porous-coated with commercially pure, medical grade titanium. Each subdermal device had a smooth titanium-alloy percutaneous post. The One-Stage procedure encompassed insertion of a fully assembled device during a single surgery. The Two-Stage procedure involved the implantation of a subdermal device during the first surgery, and then three weeks later, insertion of a percutaneous post. Groups 1 and 2 served as untreated controls and Groups 3 and 4 received NPWT. Four weeks postimplantation of the post, the devices and surrounding tissues were harvested, and histologically evaluated for downgrowth. Within the untreated control groups, the Two-Stage surgical procedure significantly decreased downgrowth (p = 0.027) when compared with the One-Stage procedure. Independent of the surgical procedures performed, NPWT significantly limited downgrowth (p ≤ 0.05) when compared with the untreated controls. PMID:26487170

  10. Enhancing percutaneous delivery of methotrexate using different types of surfactants.

    PubMed

    Javadzadeh, Yousef; Hamishehkar, Hamed

    2011-02-01

    Regarding the potential severe toxicity associated with systemic administration of methotrexate (MTX), a topical formulation might be of greater utility for the treatment of psoriasis and other hyperproliferative skin disorders. One of the presumed reasons for the lack of clinical activity of topical methotrexate in psoriasis is insufficient percutaneous penetration necessary to inhibit epidermal DNA synthesis. The present study was undertaken to prepare a formulation to enhance skin penetration of MTX. For this mean, topical gel formulations were prepared and evaluated for MTX percutaneous absorption using rat skin and standard Franz diffusion cells. For enhancing percutaneous absorption, three surfactants (anionic, cationic and nonionic) were incorporated into formulations with different concentrations. Finally salicylic acid as a keratolytic material was added for more enhancement effect. The results showed that SLS (sodium lauryl sulphate) and alkyl benzyl dimethyl chloride did not show significant enhancement effect on the penetration of MTX. Transcutol was able to enhance transdermal absorption of MTX and the higher enhancement ratio was obtained with 2% (w/w) concentration of transcutol. Addition of salicylic acid increased this ratio. Prepared formulation containing transcutol 2% (w/w) and salicylic acid 6% (w/w) showed higher enhancement property and could be used clinically for local treatment of psoriasis.

  11. Paravertebral block for surgical anesthesia of percutaneous nephrolithotomy

    PubMed Central

    Liu, Yong; Yu, Xiao; Sun, Xingxing; Ling, Qing; Wang, Shaogang; Liu, Jihong; Luo, Ailin; Tian, Yuke; Mei, Wei

    2016-01-01

    Abstract Background Paravertebral block is often used to provide postoperative analgesia after renal surgery. In this case-series report, we present our experience with 3 patients in whom percutaneous nephrolithotomy was performed successfully under ultrasound-guided 3-segment lumbar-thoracic paravertebral block. Case summary Three patients were scheduled for percutaneous nephrolithotomy. All 3 patients were high-risk cases for both general and neuraxial anesthesia. After due deliberation and with the consent of patient and his family, ultrasound-guided paravertebral block was performed. Seven to 10 mL of 0.5% ropivacaine was injected at T10/T11, T11/T12, and T12/L1 paravertebral place, respectively. Sensory loss to pinprick from T8 to L2 was achieved in all 3 patients 20 min after administration of block. Surgical procedures for all 3 patients were successful, and none of the patients complained of pain during the operation. Conclusions Ultrasound-guided multilevel paravertebral block may be an attractive option for anesthetic management of percutaneous nephrolithotomy in clinical practice. PMID:27428208

  12. Current perspectives in percutaneous atrial septal defect closure devices

    PubMed Central

    Bissessor, N

    2015-01-01

    In the last decade, percutaneous atrial septal defect (ASD) closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future. PMID:26203289

  13. Diagnosis and Percutaneous Treatment of Soft-Tissue Hydatid Cysts

    SciTech Connect

    Akhan, Okan Gumus, Burcak; Akinci, Devrim; Karcaaltincaba, Musturay; Ozmen, Mustafa

    2007-06-15

    The purpose of this study is to demonstrate and discuss the radiological features of four patients with muscular hydatid disease and to evaluate the results of percutaneous treatment in these patients. Four patients (three female and one male) with six muscular hydatid cysts underwent percutaneous treatment and were followed up. The mean age of patients was 35 years (range: 12-60 years). Type I (n = 2), type II (n = 1), and type III (n = 3) hydatid cysts were observed in the thigh (n = 3) and gluteal (n = 1) region on radiologic examination. All interventions were performed under sonographic and fluoroscopic guidance. According to the type of the cyst, the procedure was carried out by either a 'catheterization technique with hypertonic saline and alcohol' or a 'modified catheterization technique.' The mean cathaterization time was 13.7 days, ranging from 1 to 54 days. The dimensions of the residual cavity were noted at every sonographic control, and an average of 96.1% volume reduction was obtained in six cysts of four patients. No sign of viability was observed during the follow-up period. Cavity infection and cellulitis were observed as complications, which resolved after medical therapy. Percutaneous treatment is a safe and effective procedure in patients with soft-tissue hydatid cysts and should be considered as a serious alternative to surgery.

  14. Fluoroscopy guided percutaneous renal access in prone position

    PubMed Central

    Sharma, Gyanendra R; Maheshwari, Pankaj N; Sharma, Anshu G; Maheshwari, Reeta P; Heda, Ritwik S; Maheshwari, Sakshi P

    2015-01-01

    Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access. PMID:25789297

  15. Assessment of Neuromuscular Function Using Percutaneous Electrical Nerve Stimulation.

    PubMed

    Rozand, Vianney; Grosprêtre, Sidney; Stapley, Paul J; Lepers, Romuald

    2015-09-13

    Percutaneous electrical nerve stimulation is a non-invasive method commonly used to evaluate neuromuscular function from brain to muscle (supra-spinal, spinal and peripheral levels). The present protocol describes how this method can be used to stimulate the posterior tibial nerve that activates plantar flexor muscles. Percutaneous electrical nerve stimulation consists of inducing an electrical stimulus to a motor nerve to evoke a muscular response. Direct (M-wave) and/or indirect (H-reflex) electrophysiological responses can be recorded at rest using surface electromyography. Mechanical (twitch torque) responses can be quantified with a force/torque ergometer. M-wave and twitch torque reflect neuromuscular transmission and excitation-contraction coupling, whereas H-reflex provides an index of spinal excitability. EMG activity and mechanical (superimposed twitch) responses can also be recorded during maximal voluntary contractions to evaluate voluntary activation level. Percutaneous nerve stimulation provides an assessment of neuromuscular function in humans, and is highly beneficial especially for studies evaluating neuromuscular plasticity following acute (fatigue) or chronic (training/detraining) exercise.

  16. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    PubMed

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  17. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    PubMed

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success. PMID:26141983

  18. Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.

    PubMed

    Li, Jian; Yan, Deng-lu; Zhang, Zai-Heng

    2008-12-01

    Percutaneous disc decompression procedures have been performed in the past. Various percutaneous techniques such as percutaneous discectomy, laser discectomy, and nucleoplasty have been successful. Our prospective study was directly to evaluate the results of percutaneous cervical nucleoplasty (PCN) surgery for cervical disc herniation, and illustrate the effectiveness of PCN in symptomatic patients who had cervical herniated discs. From July of 2002 to June of 2005, 126 consecutive patients with contained cervical disc herniations have presented at the authors' clinic and treated by PCN. The patients' gender distribution for PCN was 65 male, 61 female. The age of patients ranged from 34 to 66 years (mean 51.9 +/- 10.2 years). The levels of involvement were 21 cases at C3-4, 30 cases at C4-5, 40 cases at C5-6, and 35 cases at C6-7. The clinical outcomes, pain reduction and the segment stability were all recorded during this study. A clinical outcome was quantified by the Macnab standard and using VAS. The angular displacement (AD) > or =11 degrees or horizontal displacement (HD) > or =3 mm was considered to be radiographically unstable. In the results of this study, puncture of the needle into the disc space was accurately performed under X-ray guidance in all cases. There was one case where the Perc-D Spine Wand had broken in the disc space during the procedure. The partial Perc-D Spine Wand, which had broken in the disc space could not be removed by the percutaneous cervical discectomy and thus remained there. There were no recurrent cases or complications in our series. Macnab standard results were excellent in 62 cases, good in 41 cases and fair in 23 cases. The rate of excellent and good was 83.73%. The VAS scores demonstrated statistically significant improvement in PCN at the 2-week, 1, 3, 6, and 12-month follow-up visits when compared to preoperational values (P < 0.01). There were no cases of instability following the PCN procedure. There was no

  19. Preliminary clinical trial in percutaneous nephrolithotomy using a real-time navigation system for percutaneous kidney access

    NASA Astrophysics Data System (ADS)

    Rodrigues, Pedro L.; Moreira, António H. J.; Rodrigues, Nuno F.; Pinho, A. C. M.; Fonseca, Jaime C.; Lima, Estevão.; Vilaça, João. L.

    2014-03-01

    Background: Precise needle puncture of renal calyces is a challenging and essential step for successful percutaneous nephrolithotomy. This work tests and evaluates, through a clinical trial, a real-time navigation system to plan and guide percutaneous kidney puncture. Methods: A novel system, entitled i3DPuncture, was developed to aid surgeons in establishing the desired puncture site and the best virtual puncture trajectory, by gathering and processing data from a tracked needle with optical passive markers. In order to navigate and superimpose the needle to a preoperative volume, the patient, 3D image data and tracker system were previously registered intraoperatively using seven points that were strategically chosen based on rigid bone structures and nearby kidney area. In addition, relevant anatomical structures for surgical navigation were automatically segmented using a multi-organ segmentation algorithm that clusters volumes based on statistical properties and minimum description length criterion. For each cluster, a rendering transfer function enhanced the visualization of different organs and surrounding tissues. Results: One puncture attempt was sufficient to achieve a successful kidney puncture. The puncture took 265 seconds, and 32 seconds were necessary to plan the puncture trajectory. The virtual puncture path was followed correctively until the needle tip reached the desired kidney calyceal. Conclusions: This new solution provided spatial information regarding the needle inside the body and the possibility to visualize surrounding organs. It may offer a promising and innovative solution for percutaneous punctures.

  20. Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

    SciTech Connect

    Pua, Uei; Chan, Stephen Yung-Wei

    2013-06-15

    Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.

  1. Kirschner wire pin tract infection rates: a randomized controlled trial between percutaneous and buried wires.

    PubMed

    Hargreaves, D G; Drew, S J; Eckersley, R

    2004-08-01

    This prospective, randomized trial compares the infection rates of Kirschner wires left percutaneously and those buried deep to the skin in a group of patients with isolated distal radial fractures. Percutaneous wires had a significantly greater infection rate than wires which were buried deep to the skin.

  2. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...: “Guidance on Premarket Notification Submission for Short-Term and Long-Term Intravascular Catheters.” ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term...

  3. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...: “Guidance on Premarket Notification Submission for Short-Term and Long-Term Intravascular Catheters.” ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term...

  4. 21 CFR 880.5970 - Percutaneous, implanted, long-term intravascular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...: “Guidance on Premarket Notification Submission for Short-Term and Long-Term Intravascular Catheters.” ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Percutaneous, implanted, long-term intravascular... and Personal Use Therapeutic Devices § 880.5970 Percutaneous, implanted, long-term...

  5. Isolated Spontaneous Dissection of the Common Iliac Artery: Percutaneous Stent Placement in Two Patients

    SciTech Connect

    Kwak, Hyo-Sung; Han, Young-Min Chung, Gyung-Ho; Yu, Hee Chul; Jeong, Yeon-Jun

    2006-10-15

    Isolated spontaneous dissection of the common iliac artery (CIA) is a rare entity. Two patients with this condition were successfully treated by percutaneous stent placement. We emphasize the feasibility of nonsurgical management by percutaneous stent placement for isolated spontaneous dissection of the CIA.

  6. Percutaneous placement of a suprapubic tube with peel away sheath introducer.

    PubMed

    O'Brien, W M

    1991-05-01

    A new technique for percutaneous placement of a suprapubic tube has been developed, which allows controlled entry into the bladder over a guide wire to avoid the potential hazards of blind trocar cystotomy. A Foley style catheter can be placed, which is less likely to become dislodged than other types of percutaneous suprapubic catheters currently available. PMID:2016781

  7. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed Central

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-01-01

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life. PMID:3083922

  8. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-03-29

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.

  9. Long-term outcomes after percutaneous patent foramen ovale closure.

    PubMed

    Nagpal, Sameer V; Lerakis, Stamatios; Flueckiger, Peter B; Halista, Michael; Willis, Patrick; Block, Peter C; Douglas, John S; Morris, Douglas C; Liff, David A; Stewart, James; Devireddy, Chethan; Veledar, Emir; Nahab, Fadi B; Babaliaros, Vasilis C

    2013-09-01

    Percutaneous patent foramen ovale (PFO) closure is a treatment for cryptogenic stroke and migraine headache. The goal of this study was to assess long-term outcomes of patients treated with percutaneous PFO closure. Records of patients with percutaneous PFO closure at Emory University Hospital from February 2002 to July 2009 were reviewed. Follow-up telephone questionnaire and chart review assessed recurrent stroke, migraine, and complications. Data was reviewed on 414 consecutive patients. Long-term follow-up was obtained in 207 of patients, and mean follow up was 4.6 ± 2.0 years. Cryptogenic stroke was the primary indication for intervention in 193 (93%) patients. Thirteen (7%) patients had a recurrent neurologic event post closure. In patients with multiple neurological events at baseline, 17% (n = 11) had a recurrent event, compared with 2% (n = 2) of patients with a single neurological event prior to PFO-closure (P < 0.002). Post closure, migraine frequency and severity declined from 4.5 to 1.1 migraine/month (P < 0.01) and 7.2 to 3.6 out of 10 (P < 0.01) in patients with history of migraine (n = 60). Thirty-day mortality was 1% (n = 2). One patient had device erosion 5 years post-procedure requiring emergent surgery. Atrial fibrillation was newly diagnosed in 8 (4%) patients within 6 months. In conclusion, the long-term rate of recurrent stroke after PFO closure is low in patients with a single neurological event at baseline. Serious long-term complications after PFO closure are rare. PFO closure may decrease the frequency and severity of migraine.

  10. Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques

    PubMed Central

    Añón, José M; Gómez, Vicente; Escuela, Mª Paz; De Paz, Vicente; Solana, Luis F; De La Casa, Rosa M; Pérez, Juan C; Zeballos , Eugenio; Navarro, Luis

    2000-01-01

    Background: Although the standard tracheostomy described in 1909 by Jackson has been extensively used in critical patients, a more simple procedure that can be performed at the bedside is needed. Since 1957 several different types of percutaneous tracheostomy technique have been described. The purpose of the present study was to compare two bedside percutaneous tracheostomy techniques: percutaneous dilatational tracheostomy (PDT) and the guidewire dilating forceps (GWDF). Materials and methods: A prospective study in two medical/surgical intensive care units (ICUs) was carried out. Sixty-three critically ill patients who required endotracheal intubation for longer than 15 days were consecutively selected to undergo PDT (25 patients) or GWDF (38 patients) technique. Intraoperative and postoperative complications were recorded. Results: Age (mean ± standard error) was 63 ± 1.1 years. The patients had been mechanically ventilated for an average of 19.8 ± 1.2 days. The GWDF technique was significantly faster than PDT technique (P = 0.02). Fifteen complications occurred in 10 out of 63 (15%) patients. They were as follows: tracheal tear (one patient in each group; in one case this was due to false passage); transient hypotension (one patient in the PDT group and two patients in the GWDF group); atelectasis (one patient in the PDT group); and haemorrhage (one patient in the PDT group and three patients in the GWDF group). In both patients with tracheal tear, reduced arterial oxygen saturation (SaO2) with concomitant subcutaneous emphysema ensued. Conclusion: We found no statistical differences between complications with both techniques. The surgical time required for the GWDF technique was less than that for PDT. PMID:11056749

  11. Percutaneous permeation measurement of topical phthalocyanine by photoacoustic technique

    NASA Astrophysics Data System (ADS)

    Silva, Emanoel P. O.; Barja, Paulo R.; Cardoso, Luiz E.; Beltrame, Milton

    2012-11-01

    This investigation have studied photoacoustic (PA) technique to percutaneous permeation of topical hydroxy-(29H,31H-phthalocyaninate) aluminum (PcAlOH) on pig ear skin. The PcAlOH was incorporated in an emulsion (O/W) (1 mg/dl) with assessed stability parameters of: pH, short and long term stability tests (in the several conditions). The skin was prepared through a heat separation technique, and with a scalpel, the outer skin of the cartilage was removed. The skins were then cut into 4 cm2 pieces and treated with sodium bromide 2 mol/L for 6 h at 37 °C. The epidermis layer was washed with purified water, dried, and stored under reduced pressure until use. The skin permeation kinetics was determined by photoacoustic technique in an open photoacoustic cell. Short (after preparation) and long-term stability tests showed no phase separation. The emulsion developed pH 7.6 and after incorporating the pH was unchanged. The typical times for percutaneous permeation of the emulsion base and emulsion + PcAlOH were 182 (±6) and 438 (±3) s, respectively. This study indicated that the formulations containing PcAlOH have stabile characteristics and show promising results in absorption into the skin. The presence of the photosensitive agent in the formulation contributed significantly to the greater absorption time than observed in the base formulation. The used photoacoustic technical to examine the penetration kinetics of PcAlOH in pig ear skin was adequate and may be employed in the determination of the percutaneous permeation of phthalocyanines.

  12. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    SciTech Connect

    Beardsley, Shannon L.; Shlansky-Goldberg, Richard D.; Patel, Aalpen; Freiman, David B.; Soulen, Michael C.; Stavropoulos, S. William; Clark, Timothy W.I.

    2005-04-15

    Purpose. Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. Methods. A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. Results. Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. Conclusion. No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis

  13. Anatomical bases of percutaneous surgery for calculi in horseshoe kidney.

    PubMed

    Cussenot, O; Desgrandchamps, F; Ollier, P; Teillac, P; Le Duc, A

    1992-01-01

    Horseshoe kidney is a renal fusion which combines three anatomic abnormalities: ectopia, malrotation and vascular changes. These anomalies can be recognised separately to varying degrees in unfused kidneys. Necessary modifications of the standard technique for percutaneous nephrolithotomy (PNL) are directly deducible from analysis of the anatomic data of the imaging of horseshoe kidneys. We report our experience with 5 patients (7 kidneys) who underwent PNL for calculi in horseshoe kidneys. The percutaneous approach was performed under ultrasound and fluoroscopic monitoring. In situ disintegration by ultrasonic lithotripsy and nephrostomy drainage were necessary in all cases. Modifications of the standard PNL procedure are related to the anatomic changes. The lower abdominal position of a horseshoe kidney necessitates upper or middle calyceal puncture, while the malrotation necessitates a more posterior puncture. Monitoring of the puncture needle by fluoroscopy as it is advanced postero-anteriorly is more difficult and the risk of the surgeon's hand entering the radiation path is increased. The renal pelvis is deep and a long endoscope may be required. Aberrant segmental vessels may create potential hazards. The majority of problems in location can be avoided by use of an ultrasonically guided needle. Percutaneous nephrolithotomy is the treatment of choice for calculi in horseshoe kidneys for the following reasons: the high incidence of recurrent lithiasis in horseshoe kidney and the complexity of repeated surgical approaches diminish the acceptable results of open surgery; difficulties in focussing on the calculi and drainage problems militate against the success of extracorporeal shock wave lithotripsy (ESWL); PNL has a good success rate and the least morbidity.

  14. Distal protection devices during percutaneous coronary and carotid interventions.

    PubMed

    Fasseas, Panayotis; Orford, James L; Denktas, Ali E; Berger, Peter B

    2001-01-01

    Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWiretrade mark is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilitate entrapment of particles and safe removal. The Parodi Anti-Emboli Systemtrade mark is an example of a catheter occlusion device that establishes protection by reversing blood flow in the target vessel.

  15. Primary percutaneous coronary intervention in a patient with dextrocardia.

    PubMed

    Khan, Naveed-Ullah; Farman, Muhammad Tariq; Ashraf, Tariq

    2012-08-01

    The case of a 40-year-old male with dextrocardia who presented with ST Elevated Myocardial Infarction (STEMI) is reported. Coronary angiogram was performed after due manipulation and then successful primary percutaneous coronary intervention (PCI) of Left anterior descending (LAD) coronary artery was done. His 9 months follow up primary PCI in a patient with angiogram revealed patent stent in proximal LAD. There are very few published case reports of this rare congenital anomaly addressing technical details of successful primary PCI with dextrocardia.

  16. Assessment of coronary bypass surgery and percutaneous transluminal coronary angioplasty.

    PubMed

    Preston, T A

    1989-01-01

    Coronary bypass surgery developed as another in a line of surgical procedures dating back more than 60 years. The medical profession at first assessed this procedure with time-honored anecdotal techniques. Gradually, for a variety of reasons, improved methods of comparisons worked their way into assessments of bypass surgery. Randomized controlled trials met resistance but have been very influential. Assessment of percutaneous transluminal coronary angioplasty has benefited from the knowledge generated during the last 25 years, but clinicians have been slower to apply the most advanced techniques.

  17. Temporary Percutaneous Mechanical Circulatory Support in Advanced Heart Failure.

    PubMed

    Brown, Jessica L; Estep, Jerry D

    2016-07-01

    Cardiogenic shock is severe, refractory heart failure caused by significant myocardial dysfunction in the setting of adequate preload that is accompanied by systemic hypoperfusion. Progressive end-organ dysfunction is a hallmark of persistent cardiogenic shock and necessitates intervention to overcome altered hemodynamics and restore end-organ perfusion. Temporary percutaneous mechanical circulatory support is an established modality in the treatment of cardiogenic shock and is increasingly used in patients with cardiogenic shock as a bridge to recovery or further definitive therapy. This article reviews the current devices, their effects on left ventricular hemodynamics, and the evidence supporting their continued use. PMID:27371515

  18. Percutaneous suprapubic endoscopy for treatment of bladder tamponade

    PubMed Central

    Powroźnik, Jan; Szostek, Przemysław; Chłosta, Piotr; Borówka, Andrzej

    2013-01-01

    Suprapubic catheterisation is generally considered a safe procedure. It can, however, be associated with complications including haematuria. It is usually self-limiting and easily treated with non-surgical measures but at times formal treatment in the operating room may be required. We present an endoscopic management of bladder tamponade through a percutaneous approach in a 21-year-old man with the fibrotic defect completely occluding his posterior urethra preventing cystoscopic clot evacuation. To our knowledge, this is the first reported case of minimally invasive treatment of bladder tamponade using a suprapubic access. We believe this challenging case will serve as an aid to management of similar episodes. PMID:24501610

  19. Imaging and Percutaneous Management of Acute Complicated Pancreatitis

    SciTech Connect

    Shankar, Sridhar; Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Banks, Peter A.

    2004-11-15

    Acute pancreatitis varies from a mild, self-limited disease to one with significant morbidity and mortality in its most severe forms. While clinical criteria abound, imaging has become indispensable to diagnose the extent of the disease and its complications, as well as to guide and monitor therapy. Percutaneous interventional techniques offer options that can be life-saving, surgery-sparing or important adjuncts to operation. Close cooperation and communication between the surgeon, gastroenterologist and interventional radiologist enhance the likelihood of successful patient care.

  20. Percutaneous endoscopic gastrostomy for postoperative rehabilitation after maxillofacial tumor surgery.

    PubMed

    Koehler, J; Buhl, K

    1991-02-01

    Despite the progress made in tumor and reconstructive surgery of the maxillofacial region, postoperative problems, such as malnutrition and dysfunction of the oral-oesophageal tract are still encountered. Nutrition via a nasogastric tube often complicates the rehabilitation process of these patients. Percutaneous endoscopic gastronomy (PEG), as opposed to nasogastral feeding, is presented. The technique, possible long-term complications, and the easy usage of the mechanical pump system, are presented. In our study of 40 patients, PEG, objectively, proved useful for functional, esthetic, practical, economical, and psychological reasons.

  1. Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi

    PubMed Central

    Kokorovic, Andrea; Wilson, James W.L.; Beiko, Darren

    2014-01-01

    Percutaneous nephrolithotomy (PCNL) is the surgical procedure of choice to treat staghorn calculi. Most centres perform PCNL as the traditional inpatient procedure. However, outpatient PCNL has been successfully attempted and represents a feasible method of reducing hospital costs. We report the case of a 35-year-old female who underwent outpatient simultaneous PCNL for bilateral renal staghorn calculi. The patient was discharged in stable condition less than 3 hours following the procedure with minimal discomfort. To the best of our knowledge, this case report is the first to describe a successfully completed outpatient bilateral supracostal tubeless PCNL for staghorn calculi. PMID:24839499

  2. Use of percutaneous nephrostomy in hydronephrosis of pregnancy.

    PubMed

    Peer, A; Strauss, S; Witz, E; Manor, H; Eidelman, A

    1992-10-01

    Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.

  3. Rupture of ectopic renal arterial pseudoaneurysm after percutaneous nephrolithotomy

    PubMed Central

    Wang, Mingshuai; Zhang, Junhui; Xing, Nianzeng

    2016-01-01

    ABSTRACT A 35-year-old female patient presented with swelling pain at left waist for 1 month. Left renal pelvis stones were found and standard percutaneous nephrolithotomy was successfully performed. Two weeks later, the patient suddenly suffered massive bleeding presented with gross hematuria. Rupture of ectopic renal artery pseudoaneurysm was identified by computed tomography and angiography of the renal artery. Emergency selective angioembolization of one branch of the artery was performed. To our knowledge, this is the first report of ruptured ectopic renal arterial pseudoaneurysm. PMID:27564300

  4. [Percutaneous stabilization of traumatic spondylolisthesis in a child].

    PubMed

    Vetter, S Y; Wendl, K; Grützner, P A; Matschke, S

    2015-02-01

    A 12-year-old boy suffered a rare occurrence of a traumatic spondylolisthesis (L5/S1) without neurological alterations after being partially buried underneath a collapsing brick wall. Additionally he sustained a third degree open fracture of the left distal fibula and epiphysiolysis of the left distal tibia. A closed reduction and percutanous dorsal instrumentation L5/S1 as well as an open reduction and osteosynthesis of the tibia and fibula were performed. After 6 months the instrumentation was completely removed and an unrestrained range of motion of the lumbar spine and the upper ankle joint was regained.

  5. [Percutaneous closure of the left atrial appendage for stroke prevention].

    PubMed

    Loupis, Anastasia M; Backer, Ole De; Ihlemann, Nikolaj; Rosenberg, Tine S; Franzen, Olaf W; Søndergaard, Lars

    2014-09-15

    In patients with atrial fibrillation (AF) and increased risk of stroke, oral anticoagulation (OAC) is the standard treatment for stroke prevention - however, this therapy also carries a high risk of bleeding. Percutaneous closure of the left atrial appendage (LAA) has been suggested to be an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment. In this paper, we discuss the rationale for LAA closure, the importance of a proper patient selection, as well as some pre- and post-procedural issues.

  6. Biliary peritonitis due to gall bladder perforation after percutaneous nephrolithotomy.

    PubMed

    Ranjan, Nikhil; Singh, Rana Pratap; Tiwary, Rajesh

    2015-01-01

    A 19-year-old male patient underwent right percutaneous nephrolithotomy (PNL) for right renal 1.5 × 1.5 cm lower pole stone. The procedure was completed uneventfully with complete stone clearance. The patient developed peritonitis and shock 48 h after the procedure. Exploratory laparotomy revealed a large amount of bile in the abdomen along with three small perforations in the gall bladder (GB) and one perforation in the caudate lobe of the liver. Retrograde cholecystectomy was performed but the patient did not recover and expired post-operatively. This case exemplifies the high mortality of GB perforation after PNL and the lack of early clinical signs. PMID:26166971

  7. Heart transplant coronary artery disease: Multimodality approach in percutaneous intervention.

    PubMed

    Leite, Luís; Matos, Vítor; Gonçalves, Lino; Silva Marques, João; Jorge, Elisabete; Calisto, João; Antunes, Manuel; Pego, Mariano

    2016-06-01

    Coronary artery disease is the most important cause of late morbidity and mortality after heart transplantation. It is usually an immunologic phenomenon termed cardiac allograft vasculopathy, but can also be the result of donor-transmitted atherosclerosis. Routine surveillance by coronary angiography should be complemented by intracoronary imaging, in order to determine the nature of the coronary lesions, and also by assessment of their functional significance to guide the decision whether to perform percutaneous coronary intervention. We report a case of coronary angiography at five-year follow-up after transplantation, using optical coherence tomography and fractional flow reserve to assess and optimize treatment of coronary disease in this challenging population.

  8. Percutaneous Endoluminal Bypass of Iliac Aneurysms with a Covered Stent

    SciTech Connect

    Ruebben, Alexander; Tettoni, Serena; Muratore, Pierluigi; Rossato, Dennis; Savio, Daniele; Rabbia, Claudio

    1998-07-15

    To evaluate the feasibility of percutaneous treatment of iliac aneurysms, a covered stent was inserted in nine men suffering from common iliac artery aneurysms (six cases), external iliac aneurysms (one case), or pseudoaneurysms (two cases). Placement of the stent was successful in all patients. In one patient, an endoprosthesis thrombosed after 15 days, but was successfully treated by thrombolysis and additional stent placement. At the follow-up examinations (mean period 22 months) all stent-grafts had remained patent. No late leakage or stenosis was observed.

  9. [Immediate complications of feeding percutaneous gastrostomy: a 10-year experience].

    PubMed

    Chicharro, L; Puiggrós, C; Cots, I; Pérez-Portabella, C; Planas, M

    2009-01-01

    Percutaneous gastrostomy feeding tube (PG) may be beneficial in some patients, in others such as advanced dementia or rapidly progressive diseases its value is being questioned. Patient selection is important to identify those who will benefit from PG. This study aims to identify patients factors that may help in patient selection for PG. To analyse the characteristics of this patient's cohort and to describe the immediate complications of the procedure that we have defined as the ones happened in the first 30 days. To compare the two patient's group -with and without- immediate complications, non-parametric tests were used.

  10. [In vitro percutaneous absorption of chromium powder and the effect of skin cleanser].

    PubMed

    D'Agostin, F; Crosera, M; Adami, G; Malvestio, A; Rosani, R; Bovenzi, M; Maina, G; Filon, F Larese

    2007-01-01

    Occupational chromium dermatitis occurs frequently among cement and metal workers, workers dealing with leather tanning and employees in the ceramic industry. The present study, using an in-vitro system, evaluated percutaneous absorption of chromium powder and the effect of rapid skin decontamination with a common detergent. Experiments were performed using the Franz diffusion cell method with human skin. Physiological solution was used as receiving phase and a suspension of chromium powder in synthetic sweat was used as donor phase. The tests were performed without or with decontamination using the cleanser 30 minutes after the start of exposure. The amount of chromium permeated through the skin was analysed by Inductively Coupled Plasma Atomic Emission Spectroscopy and Electro Thermal Atomic Absorption Spectroscopy. Speciation analysis and measurements of chromium skin content were also performed. We calculated a permeation flux of 0.843 +/- 0.25 ng cm(-2) h(-1) and a lag time of 1.1 +/- 0.7 h. The cleaning procedure significantly increased chromium skin content, whereas skin passage was not increased. These results showed that chromium powder can pass through the skin and that skin decontamination did not decrease skin absorption. Therefore, it is necessary to prevent skin contamination when using toxic agents.

  11. Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty.

    PubMed

    Sanborn, T A; Greenfield, A J; Guben, J K; Menzoian, J O; LoGerfo, F W

    1987-01-01

    In this study, the safety and efficacy of percutaneous laser thermal angioplasty as an adjunct to balloon angioplasty were investigated in 13 patients with severe peripheral vascular disease. By means of a novel fiberoptic laser delivery system (Laserprobe) in which argon laser energy is converted to heat in a metallic tip at the end of the fiberoptic fiber, improvement in the angiographic luminal diameter was noted in 14 of 15 femoropopliteal vessels (93%) by delivering 8 to 13 watts of continuous argon laser energy as the Laserprobe was advanced through the lesion. Initial clinical success (indicated by relief of symptoms and increase in Doppler index) for the combined laser and balloon angioplasty procedures was obtained in 12 of 15 vessels (80%), with inadequate balloon dilatation being the limiting factor in three patients. No significant complications of vessel perforation, dissection, pain, spasm, or embolization of debris occurred. Of the 12 patients who had procedures with initial angiographic and clinical success, 10 (83%) were asymptomatic in the initial follow-up period of 1 to 9 months (mean 6 months). Thus, laser thermal angioplasty with a Laserprobe is a safe and effective adjunct to peripheral balloon angioplasty. This technique has the potential to increase the initial success rate of angioplasty for lesions that are difficult or impossible to treat by conventional means. By removing most of the obstructing lesion, this technique may also reduce recurrent stenosis.

  12. [Percutaneous cementoplasty for malignant osteolysis of the acetabulum].

    PubMed

    Cotten, A; Duquesnoy, B

    1995-09-30

    The development of malignant lesions in the acetabulum can lead to painful and disabling bone destruction. In carefully selected patients where the cortical still provides a sufficient barrier protecting the joint, percutaneous injection of ciment (10-15 cc) can be a successful mean of countering both pain and functional impairment. This easy-to-perform technique requires only local anaesthesia and can be highly cost-effective. The antalgic effect is rapid. Most patients are able to walk again within 1 to 5 days (an effect which is particularly spectacular in bedridden subjects) probably due to the reduced pain and to better distribution of the mechanical forces. Hospitalization is usually shortened. In our experience with 18 patients, clinical improvement has been maintained for up to 18 months (mean follow-up 7 months) if the osteolytic process remains under control. Secondary effects are not rare but usually temporary. Recurrent pain, fever and/or inflammatory processes have been observed and usually resolve within 1 to 4 days. Intra-articular leakage can be avoided by careful patient selection. In association with radiotherapy, percutaneous injection of ciment appears to be an useful alternative to surgery for patients with destructive malignant lesions of the acetabulum, particularly in those with a poor clinical status and a short life expectancy. This technique has already been shown to be effective in lesions of the vertebral bodies. Several teams have made further attempts in other localizations. PMID:7501624

  13. Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

    PubMed

    Yanbin, Xu; Haikun, Chu; Xiaofeng, Ji; Wanshan, Yang; Shuangping, Liu

    2015-01-01

    Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis.

  14. Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study.

    PubMed

    Ahlawat, R; Banerjee, G K; Dalela, D

    1995-01-01

    A prospective study was undertaken to assess the feasibility and safety of bilateral simultaneous percutaneous nephrolithotomy (BPNL) under single anesthesia. BPNL was attempted in 16 consecutive patients with upper tract urolithiasis suitable for percutaneous treatment bilaterally. Bilateral simultaneous PNL could be accomplished in 14 of 16 cases; the opposite side was abandoned in 2 due to technical reasons. The operating sides could be switched within a short period (15 min) by rotating the patient table by 180 degrees. The average total operating time and irrigation time was 83 and 43 min, respectively. A total of 29 tracts and 18 sessions were required for endourologic treatment of 28 units in 14 patients. There was no significant morbidity. Complete clearance was achieved in 11 of 14 patients; there was insignificant residue in 1, while 2 with major residue required adjunct JJ stenting and extra-corporeal shockwave lithotripsy. The average hospital stay was 5.4 days. After initial proficiency with endourology, preparedness for BPNL is advisable in all such cases.

  15. Preventing percutaneous absorption of industrial chemicals: the skin denotation

    SciTech Connect

    Grandjean, P.; Berlin, A.; Gilbert, M.; Penning, W.

    1988-01-01

    Percutaneous absorption has received comparatively little attention in occupational health, although this route of entry has repeatedly caused occupation-related intoxications. In practice, the evaluation of skin penetration rates is far from simple. Much evidence has been obtained from studies of chemicals used for cosmetics and topical therapeutics, but the information available on compounds encountered in occupational health is limited. The data obtained from experimental studies have confirmed that the concentration, type of vehicle, skin area, skin condition, and extent of occlusion are important factors in determining the degree of percutaneous absorption, but no general model has been developed. Also, too little is known about the basic chemical properties governing the rate of penetration. Thus, prediction is difficult and bound to be rather inaccurate. Current preventive practice follows the procedure used by ACGIH and is mainly based on a skin denotation in official listings of chemicals to which exposure limits have been allocated. The number of substances and groups of chemicals which have received skin denotation in 17 selected countries varies between 24 and 179 and a total of 275 are listed as a skin hazard in one or more countries; ACGIH lists 143. Thus, the denotation practice varies. As an unfortunate result of these discrepancies and the dichotomy of skin denotation, the absence of skin denotation may erroneously indicate that efforts to protect the skin are unnecessary. Thus, an evaluation of skin penetration potentials should be incorporated in occupational health practice as a supplement to the official denotations. 23 references.

  16. Positions for percutaneous nephrolithotomy: Thirty-five years of evolution

    PubMed Central

    Karaolides, Theocharis; Moraitis, Konstantinos; Bach, Christian; Masood, Junaid; Buchholz, Noor

    2012-01-01

    Objectives To present the chronological development of the different positions described for percutaneous nephrolithotomy (PCNL), in an attempt to identify the reasons for their development and to highlight their specific advantages and disadvantages. Methods Previous reports were identified by a non-systematic search of Medline and Scopus. Results The classic prone position for PCNL was first described in 1976. The technique was gradually standardised and PCNL with the patient prone became the generally accepted standard approach. In the next 35 years many other positions were described, with the patient placed prone, lateral or supine in various modifications. Modifications of the classic prone position in the early 1990s aimed to provide the option of a simultaneous retrograde approach during the procedure. As PCNL became more popular the lateral position was first described in 1994, to allow the application of PCNL to patients who were unable to tolerate being prone because of their body habitus. The supine position for percutaneous access was originally described even before 1990, but become more popular after 2007 when the Galdakao modification was reported. Several other modifications of the supine position have been described, with the latest being the flank-free modified supine position, which allows the best exposure of the flank among the supine positions. Each position has its specific advantages and disadvantages. Conclusion Urologists who perform PCNL should be familiar with the differences in the positions and be able to use the method appropriate to each case. PMID:26558042

  17. Angioscopic assessment of various percutaneous treatments for arteriosclerosis obliterance

    NASA Astrophysics Data System (ADS)

    Kusaba, Hiroyasu; Watanabe, Kazuo; Shiraishi, Shohzo; Sato, Takashi; Koga, Nobuhiko

    1993-06-01

    We have evaluated the angioscopic findings before and after various percutaneous techniques to treat 39 lesions in 32 cases of arteriosclerosis obliterans (ASO). We applied a laser (CL50: SLT, Japan), percutaneous transluminal angioplasty (PTA), and atherectomy -- either singly or in combination, with angioscopic luminal observation (angioscope: PF14L & PF18L Olympus, Japan) recorded before and after the treatments. In the case of a complete obstruction, we employed PTA as the first choice. We used a laser prior to PTA when the PTA guide-wire failed to penetrate the lumen. For eccentric and calcified lesions atherectomy was applied. A sufficient enlargement was obtained initially in 37 of the 39 lesions. The angioscopic observations after treatment revealed carbonization (3/5) and attachment of small thrombi (3/5) after using the laser, intimal rupture (3/8), dissection (2/8), flap formation (2/8), and attachment of small thrombi (4/8) after PTA, and attachment of small thrombi (9/19), flap formation (6/19), and dissection (2/19) after atherectomy. We established the efficacy of angioscopic assessment demonstrating beneficial clinical results. The angioscopic findings suggest that attachment of small thrombi may be responsible for a poor prognosis. Additional angioscopic observations with angiography are recommended for improved understanding of the luminal changes.

  18. Bleeding risk with clopidogrel and percutaneous endoscopic gastrostomy

    PubMed Central

    Sohail, Umair; Harleen, Chela; Mahdi, Amin O; Arif, Murtaza; Nguyen, Douglas L; Bechtold, Matthew L

    2016-01-01

    AIM To compare bleeding within 48 h in patients undergoing percutaneous endoscopic gastrostomy (PEG) with or without clopidogrel. METHODS After institutional review board approval, a retrospective study involving a single center was conducted on adult patients having PEG (1/08-1/14). Patients were divided into two groups: Clopidogrel group consisting of those patients taking clopidogrel within 5 d of PEG and the non-clopidogrel group including those patients not taking clopidogrel within 5 d of the PEG. RESULTS Three hundred and nineteen PEG patients were found. One hundred and sixty-eight males and 151 females with mean body mass index 28.47 ± 9.75 kg/m2 and mean age 65.03 ± 16.11 years were identified. Thirty-three patients were on clopidogrel prior to PEG with 286 patients not on clopidogrel. No patients in either group developed hematochezia, melena, or hematemesis within 48 h of percutaneous endoscopic gastrostomy (PEG). No statistical differences were observed between the two groups with 48 h for hemoglobin decrease of > 2 g/dL (2 vs 5 patients; P = 0.16), blood transfusions (2 vs 7 patients; P = 0.24), and repeat endoscopy for possible gastrointestinal bleeding (no patients in either group). CONCLUSION Based on the results, no significant post-procedure bleeding was observed in patients undergoing PEG with recent use of clopidogrel. PMID:27621767

  19. Development of a Double Lumen Cannula for a Percutaneous RVAD

    PubMed Central

    Wang, Dongfang; Jones, Cameron; Ballard-Croft, Cherry; Zhao, Ju; Zhao, Guangfeng; Topaz, Stephen; Zwischenberger, Joseph B.

    2016-01-01

    The objectives were to design/fabricate a double lumen cannula (DLC) for a percutaneous RVAD (pRVAD), and to test the feasibility/performance of this pRVAD system. A 27 Fr DLC prototype was made and tested in 6 adult sheep. The pRVAD DLC was inserted into the right jugular vein, advanced through the superior vena cava (SVC)-right atrium (RA)-right ventricle (RV), and ended in the pulmonary artery (PA). A CentriMag pump and optional gas exchanger were connected to the DLC. Blood was withdrawn from RA, pumped through gas exchanger, and perfused PA. Maximal pumping flow was maintained for 2 hours. The pRVAD DLC was successfully deployed in all 6 sheep. In first 3 sheep, maximal average pumping flow was below 3 l/min because the DLC was advanced too far with drainage opening against RA side wall. In last 3 sheep with well positioned DLC, average maximal flow was above 3.5 l/min. The gas exchanger provided up to 230 ml/min CO2 removal and 174 ml/min O2 transfer. Our DLC-based pRVAD system is feasible for percutaneous right heart and respiratory assistance through a single cannulation. The pRVAD DLC can easily be placed prophylactically during LVAD implantation and removed as needed without additional open chest procedures. PMID:25851314

  20. [Percutaneous coronary intervention in myocardial infarction. Current concepts].

    PubMed

    García, Eulogio

    2005-05-01

    Percutaneous mechanical reperfusion during acute myocardial infarction with ST-segment elevation has proved to be the most effective way of quickly restoring adequate flow in the affected coronary artery. Randomized clinical trials have shown that percutaneous coronary intervention (PCI) is superior to thrombolysis. Initial fears about the use of stents in primary angioplasty vanished when clinical studies demonstrated that they gave better results than those obtained under optimal conditions with balloon angioplasty. The need to transfer patients to a cardiac catheterization laboratory for primary PCI does not decrease the efficacy of this form of treatment, which remains superior to immediate thrombolysis at the admitting hospital. Distal embolization can alter the situation by preventing myocardial reperfusion. Although there are many therapeutic strategies for managing thrombotic lesions, only early administration of glycoprotein IIb/IIIa inhibitors, direct stenting, and use of an X-Sizer device followed by stent implantation have been shown in randomized studies to lead to significant improvements in clinical or angiographic parameters. No technique has been shown to prevent damage due to myocardial reperfusion. However, it would be difficult to improve upon the good results achieved with PCI in the majority of patients. Rescue PCI is indicated when thrombolysis appears to have failed, especially when a catheterization laboratory is close by or when patients can be transferred early to a center with angioplasty facilities. For most cases of cardiogenic shock, PCI is the only therapeutic modality currently recommended.

  1. Preoperative trajectory planning for percutaneous procedures in deformable environments.

    PubMed

    Hamzé, Noura; Peterlík, Igor; Cotin, Stéphane; Essert, Caroline

    2016-01-01

    In image-guided percutaneous interventions, a precise planning of the needle path is a key factor to a successful intervention. In this paper we propose a novel method for computing a patient-specific optimal path for such interventions, accounting for both the deformation of the needle and soft tissues due to the insertion of the needle in the body. To achieve this objective, we propose an optimization method for estimating preoperatively a curved trajectory allowing to reach a target even in the case of tissue motion and needle bending. Needle insertions are simulated and regarded as evaluations of the objective function by the iterative planning process. In order to test the planning algorithm, it is coupled with a fast needle insertion simulation involving a flexible needle model and soft tissue finite element modeling, and experimented on the use-case of thermal ablation of liver tumors. Our algorithm has been successfully tested on twelve datasets of patient-specific geometries. Fast convergence to the actual optimal solution has been shown. This method is designed to be adapted to a wide range of percutaneous interventions. PMID:26629592

  2. Outpatient percutaneous screw fixation of the acute Jones fracture.

    PubMed

    Mindrebo, N; Shelbourne, K D; Van Meter, C D; Rettig, A C

    1993-01-01

    Nine patients (8 men and 1 woman, ranging in age from 17 to 22 years) who sustained a Jones fracture were treated with percutaneous intramedullary screw fixation as outpatients. All of the patients were varsity athletes. Seven were Division I scholarship athletes. Beginning at 7 to 10 days after surgery, all patients were allowed weightbearing as tolerated with a CAM walker. Stationary bicycling, swimming, and Stairmaster were allowed at 2 to 3 weeks. The average return to running was 5.5 weeks (range, 3 to 10). The average return to full competition was 8.5 weeks (range, 7 to 12). No perioperative or postoperative complications occurred. Average followup was 2.5 years. All fractures attained clinical and radiographic union. We believe that outpatient percutaneous intramedullary screw fixation of the acute Jones fracture is a reasonable alternative for those active patients who would have difficulty with a non-weightbearing cast and crutches or who desire an expeditious return to activities. Time restraints are particularly critical for in-season or preseason athletes. With the outpatient screw fixation method, our patient population had predictable healing, and they returned to full sports participation within 12 weeks.

  3. Single-Institution Results of Image-Guided Nonplugged Percutaneous Versus Transjugular Liver Biopsy

    SciTech Connect

    Hardman, Rulon L.; Perrich, Kiley D.; Silas, Anne M.

    2011-04-15

    Purpose: To retrospectively review patients who underwent transjugular and image-guided percutaneous biopsy and compare the relative risk of ascites, thrombocytopenia, and coagulopathy. Materials and Methods: From August 2001 through February 2006, a total of 238 liver biopsies were performed. The radiologist reviewed all patient referrals for transjugular biopsy. These patients either underwent transjugular biopsy or were reassigned to percutaneous biopsy (crossover group). Patients referred to percutaneous image-guided liver biopsy underwent this same procedure. Biopsies were considered successful if a tissue diagnosis could be made from the samples obtained. Results: A total of 36 transjugular biopsies were performed with 3 total (8.3%) and 1 major (2.8%) complications. A total of 171 percutaneous biopsies were performed with 10 (5.8%) total and 3 (1.8%) major complications. The crossover group showed a total of 4 (12.9%) complications with 1 (3.2%) major complication. Sample adequacy was 91.9% for transjugular and 99.5% for percutaneous biopsy. Conclusion: Both transjugular and percutaneous liver biopsy techniques are efficacious and safe. Contraindications such as thrombocytopenia, coagulopathy, and ascites are indicators of greater complications but are not necessarily prevented by transjugular biopsy. Percutaneous biopsy more frequently yields a diagnostic specimen than transjugular biopsy.

  4. Acute oral and percutaneous toxicity of pesticides to mallards: Correlations with mammalian toxicity data

    USGS Publications Warehouse

    Hudson, R.H.; Haegele, M.A.; Tucker, R.K.

    1979-01-01

    Acute oral (po) and 24-hr percutaneous (perc) LD50 values for 21 common pesticides (19 anticholinesterases, of which 18 were organophosphates, and one was a carbamate; one was an organochlorine central nervous system stimulant; and one was an organonitrogen pneumotoxicant) were determined in mallards (Anas platyrhynchos). Three of the pesticides tested were more toxic percutaneously than orally. An index to the percutaneous hazard of a pesticide, the dermal toxicity index (DTI = po LD50/perc LD50 ? 100), was also calculated for each pesticide. These toxicity values in mallards were compared with toxicity data for rats from the literature. Significant positive correlations were found between log po and log percutaneous LD50 values in mallards (r = 0.65, p 0.10). Variations in percutaneous methodologies are discussed with reference to interspecies variation in toxicity values. It is recommended that a mammalian DTI value approaching 30 be used as a guideline for the initiation of percutaneous toxicity studies in birds, when the po LD50 and/or projected percutaneous LD50 are less than expected field exposure levels.

  5. Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

    SciTech Connect

    Kelekis, Alexis D. Filippiadis, Dimitris K.; Martin, Jean-Baptiste; Brountzos, Elias

    2010-10-15

    Percutaneous treatments are used in the therapy of small- to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy- and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

  6. Percutaneous Transosseous Embolization of Internal Iliac Artery Aneurysm Type II Endoleak: Report of Two Cases

    SciTech Connect

    Gemmete, Joseph J. Arabi, Mohammad; Cwikiel, Wojciech B.

    2011-02-15

    This report describes two cases of successful treatment of an internal iliac artery aneurysm (IIAA) type II endoleak utilizing a percutaneous transosseous access that could not be treated using an endovascular or standard percutaneous approach. A direct percutaneous approach through bone was chosen to avoid vital structures and the surrounding bowel. The procedure was successful and required minimal fluoroscopy time compared with other treatment options. We believe this procedure is an alternative to some of the more complex and technically challenging means of treating this lesion.

  7. Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

    SciTech Connect

    Ierardi, Anna Maria; Mangini, Monica; Vaghi, Massimo; Cazzulani, Alberto; Mattassi, Raul; Carrafiello, Gianpaolo

    2011-02-15

    Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

  8. Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism.

    PubMed

    Tokue, Hiroyuki; Shibuya, Kei; Ueno, Hiroyuki; Tokue, Azusa; Tsushima, Yoshito

    2016-09-01

    There are many treatment options in high-flow priapism. Those mentioned most often are watchful waiting, Doppler-guided compression, endovascular highly selective embolization, and surgery. We present a case of high-flow priapism in a 57-year-old man treated by percutaneous direct puncture embolization of a post-traumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate. Erectile function was preserved during a 12-month follow-up. No patients with percutaneous direct puncture embolization for high-flow priapism have been reported previously. Percutaneous direct puncture embolization is a potentially useful and safe method for management of high-flow priapism.

  9. A Kinect™ camera based navigation system for percutaneous abdominal puncture

    NASA Astrophysics Data System (ADS)

    Xiao, Deqiang; Luo, Huoling; Jia, Fucang; Zhang, Yanfang; Li, Yong; Guo, Xuejun; Cai, Wei; Fang, Chihua; Fan, Yingfang; Zheng, Huimin; Hu, Qingmao

    2016-08-01

    Percutaneous abdominal puncture is a popular interventional method for the management of abdominal tumors. Image-guided puncture can help interventional radiologists improve targeting accuracy. The second generation of Kinect™ was released recently, we developed an optical navigation system to investigate its feasibility for guiding percutaneous abdominal puncture, and compare its performance on needle insertion guidance with that of the first-generation Kinect™. For physical-to-image registration in this system, two surfaces extracted from preoperative CT and intraoperative Kinect™ depth images were matched using an iterative closest point (ICP) algorithm. A 2D shape image-based correspondence searching algorithm was proposed for generating a close initial position before ICP matching. Evaluation experiments were conducted on an abdominal phantom and six beagles in vivo. For phantom study, a two-factor experiment was designed to evaluate the effect of the operator’s skill and trajectory on target positioning error (TPE). A total of 36 needle punctures were tested on a Kinect™ for Windows version 2 (Kinect™ V2). The target registration error (TRE), user error, and TPE are 4.26  ±  1.94 mm, 2.92  ±  1.67 mm, and 5.23  ±  2.29 mm, respectively. No statistically significant differences in TPE regarding operator’s skill and trajectory are observed. Additionally, a Kinect™ for Windows version 1 (Kinect™ V1) was tested with 12 insertions, and the TRE evaluated with the Kinect™ V1 is statistically significantly larger than that with the Kinect™ V2. For the animal experiment, fifteen artificial liver tumors were inserted guided by the navigation system. The TPE was evaluated as 6.40  ±  2.72 mm, and its lateral and longitudinal component were 4.30  ±  2.51 mm and 3.80  ±  3.11 mm, respectively. This study demonstrates that the navigation accuracy of the proposed system is acceptable

  10. Percutaneous isolated limb perfusion with thrombolytics for severe limb ischemia.

    PubMed

    Ali, Ahsan T; Kalapatapu, Venkat R; Bledsoe, Shelly; Moursi, Mohammed M; Eidt, John F

    2005-01-01

    Patients with severe tibioperoneal disease are poor candidates for a distal bypass. Absence of a distal target, lack of conduit, or multiple medical problems can make these patients a prohibitive risk for revascularization. Acute on chronic ischemia in this group poses a greater challenge. Thrombolytic therapy for acute ischemia can be prolonged and carries a significant risk of bleeding if continued beyond 24 hours. However, if the ischemic limbs can be isolated from the systemic circulation, a higher dose of the lytic agent can be given with lower risk. These are the initial results of a series of 10 patients who underwent percutaneous isolated limb perfusion with a high dose of thrombolytics for severe ischemia. Ten patients (lower extremity 8 and upper extremity 2) presented with severe limb-threatening ischemia. Mean ankle/brachial index (ABI) was 0.15 for the lower extremity, and there were no recordable digital pressures in patients with upper extremity ischemia. No distal target was visible on the initial arteriogram. These patients were then taken to the operating room, and under anesthesia, catheters were placed in an antegrade fashion via femoral approach in the popliteal artery and vein percutaneously. For upper extremity, the catheters were placed in the brachial artery and vein. A proximal tourniquet was then applied. This isolated the limb from the systemic circulation. Heparinized saline was infused through the arterial catheter while the venous catheter was left open. A closed loop or an isolated limb perfusion was confirmed when effluent became clear coming out of the venous port. A high dose of thrombolytic agent (urokinase 500,000 to 1,000,000 U) was infused into the isolated limb via the arterial catheter and drained out of the venous catheter. After 45 minutes, arterial flow was reestablished. In 4 patients, Reopro((R)) was used in addition to thrombolytics. Postprocedure angiograms showed minimal changes, but patients exhibited marked

  11. Impact of previous open renal surgery on the outcomes of subsequent percutaneous nephrolithotomy: a meta-analysis

    PubMed Central

    Hu, Henglong; Lu, Yuchao; Cui, Lei; Zhang, Jiaqiao; Zhao, Zhenyu; Qin, Baolong; Wang, Yufeng; Wang, Qing; Wang, Shaogang

    2016-01-01

    Objective The aim of this study was to systematically compare the perioperative outcomes of percutaneous nephrolithotomy in patients with or without previous ipsilateral open renal surgery (POS). Design Systematic searches of the PubMed, Web of Science and Cochrane Library databases were used to identify relevant studies, and, following literature screening and data extraction, a meta-analysis was performed. Results 17 retrospective cohort studies involving 4833 procedures (4784 patients) were included. No statistically significant differences were observed between patients with or without POS in terms of supracostal access; single/multiple tracts; metal dilator need; time required to access the collecting system; fluoroscopic duration; demand for analgesics; hospital stay; final stone-free rate; and risk of developing certain complications (eg, fever, haemorrhage, haemo/hydro/pneumothorax, blood transfusion, urinary tract infection and sepsis) as well as regarding the risk of total complications. Patients with POS, however, had a greater drop in haemoglobin (weighted mean difference (WMD), 1.78 g/L; 95% CI 1.09 to 2.47; p<0.00001) and higher risk of bleeding that required angiographic embolisation (relative risk (RR), 3.73; 95% CI 1.36 to 10.21; p=0.01). In addition, patients with POS also had a lower initial stone-free rate (RR, 0.96; 95% CI 0.92 to 0.99; p=0.007) and more secondary treatment (RR, 1.61; 95% CI 1.09 to 2.37; p=0.02). Sensitivity analysis produced comparable results except for differences in operative time and initial stone-free rate, which did, however, prove to be statistically insignificant (p=0.16 and 0.69, respectively). Conclusions Current evidence suggests that percutaneous nephrolithotomy in patients with POS is associated with a significantly greater drop in haemoglobin, higher risk of requiring angiographic embolisation and auxiliary procedures, potentially longer operative time, and lower initial stone-free rate than percutaneous

  12. Percutaneous cementoplasty for painful osteolytic distal femur metastases: a case report

    PubMed Central

    Lei, Mingxing; Liu, Yaosheng; Yang, Shaoxing; Jiang, Weigang; Cao, Yuncen; Liu, Shubin

    2016-01-01

    Percutaneous cementoplasty has been shown to immediately restore the mechanical stability of affected bones, prevent further risk of bone fractures, and allow immediate weight bearing. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. This study aimed at describing the procedure, indications, and benefits of percutaneous cementoplasty for painful osteolytic distal femur metastases. We report the case of a painful metastatic lesion in the left distal femur secondary to non-small-cell lung cancer in a 58-year-old woman. The patient underwent percutaneous cementoplasty and experienced effective pain relief and recovery of knee function postoperatively. In addition, no perioperative complication was observed. Percutaneous cementoplasty for osteolytic distal femur metastases offers effective pain relief and restores impaired knee function. Although this method may be a safe option, larger samples of retrospective or prospective confirmation are warranted. PMID:27799817

  13. Case report: perinephric-splenic fistula--a complication of percutaneous perinephric abscess drainage.

    PubMed

    Stewart, I E; Borland, C

    1994-09-01

    A case of acute perinephric abscess due to chronic parenchymal disease and calculi is presented. During percutaneous drainage a reno-splenic vein communication developed acutely. The aetiology and treatment complications of perinephric abscesses are reviewed.

  14. Persistent high fever and systemic inflammation induced by percutaneous coronary intervention-related periaortitis

    PubMed Central

    Kakino, Takamori; Nakayama, Tomohiro; Yamamoto, Hideo

    2009-01-01

    After coronary catheterization, fever sometimes occurs, usually transiently. We report a very rare case that suggests persistent high fever and systemic inflammation might be caused by periaortitis induced by coronary catheterization including percutaneous coronary intervention. PMID:20057898

  15. Percutaneous Pediculoplasty for Vertebral Hemangioma Involving the Neural Arch: A Case Report

    SciTech Connect

    Fuwa, Sokun Numaguchi, Yuji; Kobayashi, Nobuo; Saida, Yukihisa

    2008-01-15

    Vertebral hemangiomas occasionally involve the neural arch and they can be symptomatic. We report a case of symptomatic vertebral hemangioma mainly involving the unilateral neural arch which was successfully treated with percutaneous pediculoplasty using a single-needle technique.

  16. Pulmonary artery catheter entrapment in cardiac surgery: a simple percutaneous solution.

    PubMed

    Divakaran, Vijay; Caldera, Angel; Stephens, Jack; Gonzalez, Rafael

    2015-10-01

    Pulmonary artery catheter entrapment is a reported complication after cardiac surgery from inadvertent suturing of the catheter to the vena-caval wall during surgery. This article reports a simple percutaneous technique to retrieve the trapped catheter.

  17. Percutaneous Sclerotherapy Using Acetic Acid After Failure of Alcohol Ablation in an Intra-abdominal Lymphangioma

    SciTech Connect

    Park, Sang Woo Cha, In Ho; Kim, Kyeong Ah; Hong, Suk Joo; Park, Cheol Min; Chung, Hwan Hoon

    2004-09-15

    We report a case of percutaneous sclerotherapy using acetic acid in a 22-year-old woman with an intra-abdominal cystic lymphangioma who was not successfully treated with ethanol despite multiple trials.

  18. Pseudoaneurysm After Spontaneous Rupture of Renal Angiomyolipoma in Tuberous Sclerosis: Successful Treatment with Percutaneous Thrombin Injection

    SciTech Connect

    Corso, Rocco Carrafiello, Gianpaolo; Rampoldi, Antonio; Leni, Davide; Ticca, Cristiana; Vercelli, Ruggero; Vanzulli, Angelo

    2005-04-15

    We report a case of a large perinephric pseudoaneurysm due to spontaneous rupture of renal angiomyolipoma, occluded by percutaneous thrombin injection under ultrasound guidance in a young woman affected by tuberous sclerosis.

  19. Percutaneous ventricular septal defect closure with Amplatzer devices resulting in severe tricuspid regurgitation.

    PubMed

    Matyal, Robina; Wang, Angela; Mahmood, Feroze

    2013-11-15

    While percutaneous intervention is an alternative for patients who are not surgical candidates, the rate of morbidity and mortality is comparable to open repair. Appending the reported complications associated with percutaneous intervention (device mal-positioning, dislodgement, and entrapment in the sub-valvular apparatus), we report mechanical damage to the tricuspid valve (TV). Percutaneous closure with an Amplatzer septal occluder device was attempted on three patients who developed a ventricular septal defects (VSD) after myocardial infarction. In all three cases, damage to the tricuspid leaflet was noted post-procedure. The accompanying severe tricuspid regurgitation led to right ventricular failure, even in the patients where the VSD was considered successfully occluded. Despite successful deployment of the Amplatzer device, complications with catheter manipulation may still arise. Damage to the TV can occur during percutaneous VSD closure with Amplatzer device. Periprocedure TEE monitoring can detect damage to the tricuspid leaflets. PMID:23553968

  20. [Clinical experiences in 210 percutaneous removal of kidney and ureteral calculi].

    PubMed

    Brien, G; Schöpke, W; Althaus, P; Kirschner, P; Fahlenkamp, D; Gliech, V

    1988-05-01

    The introduction of percutaneous nephrolithotomy and ureterolithotomy has greatly widened the therapeutical spectrum of urolithiasis. In this paper indications and contraindications of percutaneous stone removal will be discussed as well as techniques of this procedure. 210 percutaneous stone operations were performed after an initial training period primarily using local anesthesia (neuroleptanalgesia). This operative procedure allowed stone removal in patients otherwise inoperable because of increased operation risk or of advanced age. With increasing experience the success rate has been improved, though the stage of difficulties in nephrolithotomy and ureterolithotomy has increased too. Percutaneous operation primarily in connection with extracorporal shock wave lithotripsy is the first treatment modality for patients with staghorn stones. Possible complications (bleeding, perforation, injury to neighbouring organs) and their treatment are discussed.

  1. Percutaneous Ablation of the Small Renal Mass—Techniques and Outcomes

    PubMed Central

    Gunn, Andrew J.; Gervais, Debra A.

    2014-01-01

    An increasing number of T1a renal cell carcinomas are being diagnosed in recent years, in part due to incidental detection from the increased use of cross-sectional imaging. Although partial nephrectomy is still considered the primary treatment for these small renal masses, percutaneous ablation is now being performed as a standard therapeutic, nephron-sparing approach in patients who are poor surgical candidates. Clinical studies to date have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical settings. This article will review various clinical aspects regarding the percutaneous ablation of small renal masses, including patient selection, preprocedural preparations, and the procedural considerations of commonly employed ablative technologies. Specific techniques such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, and high-intensity focused ultrasound will be addressed in detail. In addition, the technical and oncologic outcomes of percutaneous ablation will be discussed and referenced to that of partial nephrectomy. PMID:24596438

  2. Day care percutaneous renal surgery--is this viable?

    PubMed

    Chong, W L; Murali, S; Sahabudin, R M; Khairullah, A

    2002-03-01

    Pros and cons of Percutaneous Nephrolithotripsy (PCNL) versus Extracorporeal Shockwave Lithotripsy (ESWL) have often been highlighted when one discusses on the management of renal stones. An oft quoted point is that PCNL entails a prolonged hospital stay whereas ESWL sessions are day surgical in nature. However, PCNL has superior stone clearance rate as compared to ESWL especially for lower pole stones. In addition, PCNL is more suitable for large bulk stones and when ancillary procedures are required e.g. endopyelotomy. The first 50 cases of successful tubeless PCNL were reported by Bellman et al in 1997. The remarkable recovery of patients in their series encouraged them to employ this technique as their technique of choice for the majority of their cases. A similar technique was employed on endopyelotomy by Liang et al and they concluded that this was a safe, less morbid and effective technique. We report our first case of tubeless PCNL.

  3. Preoperative percutaneous stone surgery in patients receiving anticoagulant therapy.

    PubMed

    Gross, Andreas J; Bach, T

    2009-10-01

    Percutaneous nephrostolithotomy (PCNL) is an essential component in the management of large volume renal calculi. Either in combination with shockwave lithotripsy but especially as monotherapy, PCNL is recommended as the most effective treatment option for patients with staghorn calculi or large volume stone disease. Multiple tracts allow successful management of nearly every stone burden in a single surgical session. Furthermore, patients with anatomic variations (eg, horseshoe kidney) can be treated by PCNL successfully. Overall stone-free rates of above 78% are described. With the rising age of the overall patient population, another problem occurs. Increasing age frequently leads to an increase in comorbidities; for example, patients receiving anticoagulation may need treatment for stones, which can pose a dilemma. The aim of this review was to provide an overview of thrombotic risk, depending on the underlying disease, and to propose a clinical pathway on how to deal with this selected group of patients.

  4. Statins and percutaneous coronary intervention: a complementary synergy.

    PubMed

    Echeverri, Darío; Cabrales, Jaime

    2013-01-01

    The inclusion of statins and stents in coronary disease management during the 1980s has marked a dramatic change in the natural history of the disease. Separately, each of these therapies have progressed rapidly and have achieved a prime position in the current armamentarium. The simultaneous use of statins in patients undergoing percutaneous coronary revascularization procedures with stent implantation has shown a significant beneficial synergistic effect by reducing ischemia and necrosis, and improving coronary blood flow in patients with stable coronary disease, as well as in acute coronary syndromes. The use of high dose statins in conjunction with coronary angioplasty with stent implantation has shown great efficacy and safety in patients with severe coronary disease. PMID:24079365

  5. Coronary artery stents: evaluating new designs for contemporary percutaneous intervention.

    PubMed

    Kandzari, David E; Tcheng, James E; Zidar, James P

    2002-08-01

    Intracoronary stents have markedly improved the short- and long-term safety and efficacy of percutaneous coronary intervention by improving acute gains in luminal dimensions, decreasing abrupt vessel occlusion, and reducing restenosis. At present, nearly 90% of all coronary interventions involve stenting. A variety of advances in stent technology and design have expanded the clinical application of stenting to include complex coronary lesions, multivessel disease, and small-diameter vessels. In addition, the development of stents as drug delivery systems for antithrombotic or antiproliferative agents has the potential to expand the role of coronary stenting, and early clinical experience appears promising. The purpose of this review is to describe recent developments in stent design, examine the results of clinical trials of contemporary stents, and present future directions for investigation of new stent technologies. PMID:12124974

  6. Degenerative Mitral Stenosis: Unmet Need for Percutaneous Interventions.

    PubMed

    Sud, Karan; Agarwal, Shikhar; Parashar, Akhil; Raza, Mohammad Q; Patel, Kunal; Min, David; Rodriguez, Leonardo L; Krishnaswamy, Amar; Mick, Stephanie L; Gillinov, A Marc; Tuzcu, E Murat; Kapadia, Samir R

    2016-04-19

    Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients. PMID:27142604

  7. Palmar hyperhidrosis CT guided chemical percutaneous thoracic sympathectomy.

    PubMed

    Adler, O B; Engel, A; Rosenberger, A; Dondelinger, R

    1990-10-01

    Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathetic chain of the autonomous nervous system. The center of sympathetic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathetic ganglion. Besides the surgical procedure as such, and its complications, there are complications inherent to the excision of the ganglion. These are Horner's syndrome, compensatory sweating in other parts of the body, and recurrence of sweating. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed.

  8. Percutaneous Technique for Sclerotherapy of Vertebral Hemangioma Compressing Spinal Cord

    SciTech Connect

    Gabal, Abdelwahab M.

    2002-12-15

    Purpose: In this study we report a percutaneous technique to achieve sclerosis of vertebral hemangioma and decompression of the spinal cord and nerve roots. Methods: Under CT guidance the affected vertebral body is punctured by a biopsy needle and sclerosant is injected directly into the tumor. In the case of large paravertebral extension, additional injection is given in the paravertebral soft tissue component to induce shrinkage of the whole tumor mass and release of the compressed spinal cord. Results: Using this technique we treated five patients in whom vertebral hemangioma gave rise to neurologic symptoms.In three patients, sclerotherapy was the only treatment given. In the other two patients, sclerotherapy was preceded by transcatheter embolization. Neither decompressive surgery, radiation therapy nor stabilization was required with this technique. Conclusion: Our experience with CT-guided intraosseous sclerotherapy has proved highly satisfactory.

  9. Ultrasound-Guided Percutaneous Management of Splenic Ectopic Pregnancy.

    PubMed

    Python, Johanne L; Wakefield, Brian W; Kondo, Kimi L; Bang, Tami J; Stamm, Elizabeth R; Hurt, K Joseph

    2016-01-01

    Splenic ectopic pregnancies are a rare cause of abdominal pain in reproductive-age women. A 21-year-old woman with worsening abdominal pain and a positive pregnancy test presented with hemoperitoneum and no intrauterine pregnancy on transvaginal ultrasound. After 2 nondiagnostic laparoscopies, a splenic pregnancy was diagnosed by computed tomography scan and abdominal ultrasound. Currently, diagnosis and treatment of splenic pregnancies involve exploratory surgery and splenectomy. We report the successful treatment of this splenic ectopic pregnancy with combined intramuscular plus ultrasound-guided percutaneous methotrexate injection, with preservation of the patient's spleen. Abdominal implantation must be considered in patients with pregnancy of unknown location, and in carefully selected patients splenic ectopic pregnancy can be successfully managed by minimally invasive methods. PMID:27221066

  10. Percutaneous coronary intervention for acute myocardial infarction with mitral regurgitation

    PubMed Central

    Tu, Yan; Zeng, Qing-Chun; Huang, Ying; Li, Jian-Yong

    2016-01-01

    Ischemic mitral regurgitation (IMR) is a common complication of acute myocardial infarction (AMI). Current evidences suggest that revascularization of the culprit vessels with percutaneous coronary artery intervention (PCI) or coronary artery bypass grafting can be beneficial for relieving IMR. A 2.5-year follow-up data of a 61-year-old male patient with ST-segment elevation AMI complicated with IMR showed that mitral regurgitation area increased five days after PCI, and decreased to lower steady level three months after PCI. This finding suggest that three months after PCI might be a suitable time point for evaluating the possibility of IMR recovery and the necessity of surgical intervention of the mitral valve for AMI patient. PMID:27582769

  11. Percutaneous needle biopsy of the transplanted kidney: technique and complications.

    PubMed

    Huraib, S; Goldberg, H; Katz, A; Cardella, C J; deVeber, G A; Cook, G T; Uldall, P R

    1989-07-01

    Over 11 1/2 years, 420 percutaneous needle biopsies were obtained from the transplanted kidneys of 205 patients at one institution. The procedure was performed by one nephrologist and 55 nephrology trainees. No limit was placed on the number of biopsies performed on one kidney, and the highest number was seven. The complications were macroscopic hematuria in 28 biopsies, prolonged hematuria (greater than 24 hours) in eight, transient anuria in five, and prolonged anuria requiring surgical intervention in one. Perinephric hematoma occurred in three patients; retroperitoneal hematoma led to compression of the iliac vein in one. None of these complications led to loss of the transplant. It is suggested that the freedom from serious complication is related to the safety of the technique and the precautions applied to preparation of the patient. These are described in detail.

  12. Cement Leakage into Adjacent Vertebral Body Following Percutaneous Vertebroplasty

    PubMed Central

    Park, Jae Hoo; Kim, Hyeun Sung

    2016-01-01

    Percutaneous vertebroplasty (PV) is a minimally invasive procedure for osteoporotic vertebral compression fractures that fail to respond to conventional conservative treatment. It significantly improves intolerable back pain within hours, and has a low complication rate. Although rare, PV is not free of complications, most of which are directly related to cement leakage. Because of its association with new adjacent fracture, the importance of cement leakage into the adjacent disc space is paramount. Here, we report an interesting case of cement leakage into the adjacent upper vertebral body as well as disc space following PV. To the best of our knowledge, there has been no report of cement leakage into the adjacent vertebral body following PV. This rare case is presented along with a review of the literature. PMID:27437018

  13. Percutaneous ultrasound-guided insertion of ventriculo-atrial shunts.

    PubMed

    McCracken, James Albert; Bahl, Anuj; McMullan, John

    2016-08-01

    Ventriculo-atrial (VA) shunts have been in use for >60 years but less frequently so of late. This is due to a combination of the risk of cardiac complications, lack of expertise and a lengthy operation. We present our consecutive prospective series of 10 VA shunts inserted using a percutaneous method employing the Sonowand Invite™ neuronavigation system for both the distal and proximal catheters, over a 13-month period. We had two complications of cases needing revision, but our series highlights a safe and reproducible method of inserting a VA shunt. About 30% of the procedures were carried out by a trainee as the primary surgeon. This technique does not necessarily require the expertise of a complex hydrocephalus surgeon and is thus able to be in the armoury of any neurosurgeon needing to do a VA shunt procedure. The indications, operative data and outcomes of our patients are discussed.

  14. Quality of life after percutaneous coronary intervention: part 1.

    PubMed

    Cassar, Stephen; R Baldacchino, Donia

    Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part 1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory (Maslow, 1999) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL. PMID:23123651

  15. Gastrostomy Placement in Children: Percutaneous Endoscopic Gastrostomy or Laparoscopic Gastrostomy?

    PubMed Central

    De Marco, Erika A.; Fedele, Camilla; Mason, Elena J.; Taddei, Alessandra; Paradiso, Filomena V.; Catania, Vincenzo D.; Nanni, Lorenzo

    2016-01-01

    The aim of this study is to compare the outcomes and the complications between the 2 most adopted procedures for gastrostomy placement: percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) in children. We present our study on 69 patients (male: 46/female: 23): group 1 (37 patients, 54%) undergoing PEG, group 2 (32 patients, 46%) undergoing LG. A total of 5 major complications were observed all in the PEG group (13.5%), no major complication was observed in the LG group (P-value<0.05). A total of 12 minor complications were observed: 4 occurred in the PEG group (10.8%) and 8 (25%) in the laparoscopic gastrostmoy group, not statistically relevant. We suggest that the LG should be considered the preferred technique for gastrostomy placement in pediatric patients, particularly in newborns, children with significant skeletal malformations, and patients who underwent previous abdominal surgery. PMID:27661204

  16. [Nursing care for children undergoing percutaneous endoscopic gastrostomy].

    PubMed

    Huang, Mei-Jung; Lin, Chieh-Chung; Cheng, Shue-Lin

    2004-06-01

    Ever since percutaneous endoscopic gastronomy (PEG) was used for the first time in 1980 by Gauderer, Ponsky, Izant et al., It has been widely used in patients incapable of oral feeding. It is a safe and effective technique for long-term nutritional support in children, and easy to perform, as only local anesthesia or heavy sedation is required PEG can prevent children from suffering from nasopharyngeal and esophageal erosions due to repeated insertion of nasogastric tubes and the complication of aspiration pneumonia. It is therefore an alternative for children who need long-term feeding. In this article we review the literature on PEG and give a full description of its indications, complications, as well as advice on when to change gastrostomy tubes, and on nursing care, in the hope that this will be useful reference material for medical staff.

  17. Brachial Artery Access for Percutaneous Renal Artery Interventions

    SciTech Connect

    Kaukanen, Erkki T.; Manninen, Hannu I.; Matsi, Pekka J.; Soeder, Heini K.

    1997-09-15

    Purpose: To evaluate the suitability of transbrachial access for endovascular renal artery interventions. Methods: During 37 consecutive endovascular renal artery interventions, the transbrachial approach was used on nine patients (mean age 63 years; range 41-76 years) for 11 renal artery procedures on native kidneys and one percutaneous transluminal angioplasty (PTA) on a transplanted kidney. The reason for using transbrachial access was a steep aorta-renal angle in five, and severe aorta-iliac atherosclerosis in the remaining patients. In addition to the intervention catheter in the left brachial artery, an additional nonselective catheter for controlling the procedure was inserted transfemorally (six patients) or via the contralateral brachial artery. Results: Eleven interventions (six PTAs, five stents) were successfully completed. The one failure resulted from impenetrable subclavian artery stenosis. The only major complication was a brachial artery pseudoaneurysm requiring surgical treatment. Conclusion: Transbrachial access is an effective and relatively safe technique for renal artery interventions when transfemoral access is not possible.

  18. Nephrolithometric Scoring Systems to Predict Outcomes of Percutaneous Nephrolithotomy

    PubMed Central

    Vernez, Simone L; Okhunov, Zhamshid; Motamedinia, Piruz; Bird, Vincent; Okeke, Zeph; Smith, Arthur

    2016-01-01

    Currently, there is no single agreement upon an ideal predictive model that characterizes the complexity of renal stones and predicts surgical outcomes following percutaneous nephrolithotomy (PCNL). New predictive tools have recently emerged to systematically and quantitatively assess kidney stone complexity to predict outcomes following PCNL: the Guy’s Stone Score, the CROES nomogram, S.T.O.N.E. nephrolithometry, and S-ReSC score. An ideal scoring system should include variables that both influence surgical planning and are predictive of postoperative outcomes. This review discusses the strengths, weaknesses, and commonalities of each of the above scoring systems. Additionally, we propose future directions for the development and analysis of surgical treatment for stone disease, namely, the importance of assessing radiation exposure and patient quality of life when counseling patients on treatment options. PMID:27162508

  19. [Percutaneous Nephrolithotripsy for Renal Transplant Lithiasis: A Case Report].

    PubMed

    Oida, Takeshi; Kanemitsu, Toshiyuki; Hayashi, Tetsuya; Fujimoto, Nobumasa; Koide, Takuo

    2016-02-01

    A 54-year-old man was introduced to our hospital for follow-up examinations after renal transplantation. At the initial visit, a 25 mm renal transplant stone was noted, which had enlarged to 32 mm at an examination 1 year later. We first attempted transurethral lithotripsy (TUL), but failed due to ureteral stricture. However, we could completely remove the stone in 2 sessions of percutaneous nephrolithotripsy (PNL). The incidence of urinary lithiasis after renal transplantation ranges from 0.17-1.8%, for which PNL and TUL are frequently used. Although considered to be accompanied with risks of bleeding, bowel injury, and renal dysfunction, PNL is effective for urinary lithiasis after renal transplantation. TUL is less invasive, but access may be difficult when the ureter has an unusual course or ureteral stricture exists, as in our patient. PMID:27018408

  20. Percutaneous Radiofrequency Ablation for Treatment of Recurrent Retroperitoneal Liposarcoma

    SciTech Connect

    Keil, Sebastian Bruners, Philipp; Brehmer, Bernhard; Mahnken, Andreas Horst

    2008-07-15

    Percutaneous CT-guided radiofrequency ablation (RFA) is becoming more and more established in the treatment of various neoplasms, including retroperitoneal tumors of the kidneys and the adrenal glands. We report the case of RFA in a patient suffering from the third relapse of a retroperitoneal liposarcoma in the left psoas muscle. After repeated surgical resection and supportive radiation therapy of a primary retroperitoneal liposarcoma and two surgically treated recurrences, including replacement of the ureter by a fraction of the ileum, there was no option for further surgery. Thus, we considered RFA as the most suitable treatment option. Monopolar RFA was performed in a single session with a 2-cm umbrella-shaped LeVeen probe. During a 27-month follow-up period the patient remained free of tumor.

  1. Quality of life after percutaneous coronary intervention: part 1.

    PubMed

    Cassar, Stephen; R Baldacchino, Donia

    Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part 1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory (Maslow, 1999) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL.

  2. Percutaneous thermal ablation: how to protect the surrounding organs.

    PubMed

    Tsoumakidou, Georgia; Buy, Xavier; Garnon, Julien; Enescu, Julian; Gangi, Afshin

    2011-09-01

    A variety of thermal ablation techniques have been advocated for percutaneous tumor management. Although the above techniques are considered safe, they can be complicated with unintended thermal injury to the surrounding structures, with disastrous results. In the present article we report a number of different insulation techniques (hydrodissection, gas dissection and balloon interposition, warming/cooling systems) that can be applied. Emphasis is given to the procedure-related details, and we present the advantages and drawbacks of the insulation techniques. We also provide tips on avoiding painful skin burns when treating superficial lesions. Finally, we point out the interest of temperature monitoring and how it can be achieved (use of thermocouples, fiberoptic thermosensors, or direct magnetic resonance imaging temperature mapping). The above thermal insulation and temperature monitoring techniques can be applied alone or in combination. Familiarity with these techniques is essential to avoid major complications and to increase the indications of thermal ablation procedures.

  3. Subchronic percutaneous toxicity testing of two liquid hand dishwashing detergents.

    PubMed

    Petersen, D W

    1988-09-01

    Subchronic percutaneous toxicity studies were conducted on two liquid dishwashing detergents containing anionic surfactants (C12-14 alkylethoxylate sulphate) to assess the safety of these materials for human exposure. The detergents were administered dermally to the shaved backs of rabbits (dose volume of 2 ml/kg body weight) at concentrations of 0, 0.5, 1.0 and 2.5% in distilled water for 91 days. No adverse systemic effects were demonstrated by assessment of haematological parameters or by gross or microscopic tissue examination. Transient slight to moderate dermal irritation at the detergent application site was observed with detergent A. Slight to moderate dermal irritation confined to the detergent application site was noted in the detergent B study.

  4. Percutaneous coronary intervention for acute myocardial infarction with mitral regurgitation.

    PubMed

    Tu, Yan; Zeng, Qing-Chun; Huang, Ying; Li, Jian-Yong

    2016-09-01

    Ischemic mitral regurgitation (IMR) is a common complication of acute myocardial infarction (AMI). Current evidences suggest that revascularization of the culprit vessels with percutaneous coronary artery intervention (PCI) or coronary artery bypass grafting can be beneficial for relieving IMR. A 2.5-year follow-up data of a 61-year-old male patient with ST-segment elevation AMI complicated with IMR showed that mitral regurgitation area increased five days after PCI, and decreased to lower steady level three months after PCI. This finding suggest that three months after PCI might be a suitable time point for evaluating the possibility of IMR recovery and the necessity of surgical intervention of the mitral valve for AMI patient. PMID:27582769

  5. Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors.

    PubMed

    Meloni, Maria Franca; Smolock, Amanda; Cantisani, Vito; Bezzi, Mario; D'Ambrosio, Ferdinando; Proiti, Maria; Lee, Fred; Aiani, Luca; Calliada, Fabrizio; Ferraioli, Giovanna

    2015-09-01

    Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney. Contrast enhanced ultrasound (CEUS) is a real-time dynamic imaging technique that plays an important role in the pre-, intra-, and post-procedural management of these patients. This review will focus on the role of CEUS in the evaluation of patients undergoing treatment with percutaneous ablation for hepatic or renal tumors.

  6. Acute Shunt Malfunction Caused by Percutaneous Endoscopic Gastrostomy without Shunt Infection

    PubMed Central

    Choi, Jingyu; Ki, Seung Seog

    2014-01-01

    Percutaneous endoscopic gastrostomy tube placement is often performed in patients with a ventriculoperitoneal shunt and it has been accepted as a safe procedure. The authors report a case of a 50-year-old male who developed acute exacerbation of the hydrocephalus immediately after the percutaneous endoscopic gastrostomy tube placement without any signs of shunt infection, which has not been reported until now. After revision of the intraperitoneal shunt catheter, the sizes of the intracranial ventricles were normalized. PMID:25371790

  7. Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy.

    PubMed

    Mafeld, Sebastian; McNeill, Michael; Haslam, Philip

    2016-01-01

    Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies.

  8. Percutaneous Pancreatic Stent Placement for Postoperative Pancreaticojejunostomy Stenosis: A Case Report

    PubMed Central

    Yang, Seung Koo

    2016-01-01

    Stenosis of the pancreatico-enteric anastomosis is one of the major complications of pancreaticoduodenectomy (PD). Endoscopic stent placement, has limited success rate as a nonsurgical treatment due to altered gastrointestinal anatomy. Percutaneous treatment is rarely attempted due to the technical difficulty in accessing the pancreatic duct. We reported a case of pancreaticojejunostomy stenosis after PD, in which a pancreatic stent was successfully placed using a rendezvous technique with a dual percutaneous approach. PMID:27587970

  9. Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy

    PubMed Central

    Mafeld, Sebastian; McNeill, Michael; Haslam, Philip

    2016-01-01

    Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies. PMID:26809832

  10. Relief of Buttock Claudication by Percutaneous Recanalization of an Occluded Superior Gluteal Artery

    SciTech Connect

    Senechal, Quentin; Auguste, Mario C.; Louail, Bertrand; Lagneau, Pierre; Pernes, Jean Marc

    2000-03-15

    We report a case of a woman presenting with right severe buttock claudication and normal neurological and osteoarticular examination, in whom a guidewire recanalization and percutaneous transluminal angioplasty (PTA) of an occluded right superior gluteal artery (SGA) has provided relief of her symptoms. To our knowledge, this is the first report of percutaneous recanalization of the SGA. PTA can be considered the treatment of choice for buttock claudication caused by SGA stenosis or occlusion.

  11. Image-Guided Percutaneous Ablation of Bone and Soft Tissue Tumors

    PubMed Central

    Kurup, A. Nicholas; Callstrom, Matthew R.

    2010-01-01

    Image-guided percutaneous ablation of bone and soft tissue tumors is an effective minimally invasive alternative to conventional therapies, such as surgery and external beam radiotherapy. Proven applications include treatment of benign primary bone tumors, particularly osteoid osteoma, as well as palliation of painful bone metastases. Use of percutaneous ablation in combination with cementoplasty can provide stabilization of metastases at risk for fracture. Local control of oligometastatic disease and treatment of desmoid tumors are emerging applications. PMID:22550367

  12. Efficacy of Percutaneous Adhesiolysis in the Treatment of Lumbar Post Surgery Syndrome

    PubMed Central

    Manchikanti, Laxmaiah; Manchikanti, Kavita N.; Gharibo, Christopher G.; Kaye, Alan D.

    2016-01-01

    Context Lumbar post-surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis is often contemplated in managing lumbar post surgery syndrome. Recent guidelines and systematic reviews have reached different conclusions about the level of evidence for the efficacy of epidural injections and percutaneous adhesiolysis in managing lumbar post surgery syndrome. The objective of this systematic review was to determine the efficacy of all 3 percutaneous adhesiolysis anatomical approaches (caudal, interlaminar, and transforaminal) in treating lumbar post-surgery syndrome. Evidence Acquisition Data Sources: A literature search was performed from 1966 through October 2014 utilizing multiple databases. Study Selection: A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and percutaneous adhesiolysis in managing lumbar post-surgery syndrome was performed including methodological quality assessment utilizing Cochrane review criteria, Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment (IPM–QRB), and grading of evidence using 5 levels of evidence ranging from Level I to Level V. Data Extraction: The search strategy emphasized post-surgery syndrome and related pathologies treated with percutaneous adhesiolysis procedures. Results The search criteria yielded 16 manuscripts on percutaneous adhesiolysis assessing post-surgery syndrome. Of these, only 4 randomized trials met inclusion criteria for methodological quality assessment, 3 of them were of high quality; and the fourth manuscript was of low quality. Based on these 3 randomized controlled trials, 2 of them with one-day procedure and one with a 3-day procedure, the level of

  13. Percutaneous Pancreatic Stent Placement for Postoperative Pancreaticojejunostomy Stenosis: A Case Report.

    PubMed

    Yang, Seung Koo; Yoon, Chang Jin

    2016-01-01

    Stenosis of the pancreatico-enteric anastomosis is one of the major complications of pancreaticoduodenectomy (PD). Endoscopic stent placement, has limited success rate as a nonsurgical treatment due to altered gastrointestinal anatomy. Percutaneous treatment is rarely attempted due to the technical difficulty in accessing the pancreatic duct. We reported a case of pancreaticojejunostomy stenosis after PD, in which a pancreatic stent was successfully placed using a rendezvous technique with a dual percutaneous approach. PMID:27587970

  14. Salvage of Immature Arteriovenous Fistulas with Percutaneous Transluminal Angioplasty

    SciTech Connect

    Shin, Sung Wook; Do, Young Soo Choo, Sung Wook; Lieu, Wei Chiang; Choo, In-Wook

    2005-05-15

    The purpose of this study was to assess the value of percutaneous transluminal angioplasty (PTA) for the salvage of arteriovenous fistulas (AVFs) that fail to mature. From November 1998 to February 2003, 19 patients who were treated with PTA due to immature forearm AVFs were selected. Fistulography and PTA were performed via a retrograde transvenous approach after direct puncture of the fistular vein. Technical success was defined as less than a 30% residual stenosis, whereas clinical success was defined as the ability to perform at least one session of normal hemodialysis after PTA. Findings of fistulograms, success rates of PTA, and patency rates were evaluated. On initial fistulograms, stenoses were observed in all cases and 68% (13/19) of the stenoses were located in the perianastomotic area of these immature AVFs. The initial technical success rate was 84% (16/19). Technical failures comprised two patients with diffuse narrowing and segmental thrombosis of the cephalic veins and one case of elastic recoil of the anastomotic site stenosis after PTA. Two patients were immediately lost on follow-up. The remaining 14 cases underwent successful hemodialysis 0 to 33 (mean = 15) days after PTA, showing 74% (14/19) clinical success. Although accessory branch veins were noted in most cases (74%, 14/19), leaving them alone did not affect the maturation of AVFs following PTA. There was no significant procedural or late complication. Primary and secondary patency rates at 1 year were 61 and 82%, respectively. For those AVFs that failed to mature, there were stenoses along their vascular courses as underlying causes. For the percutaneous procedure, the retrograde transvenous approach was a reasonable one. As PTA is effective and quick for the salvation of immature AVFs, it can be considered a primary method for salvaging these immature AVFs.

  15. Percutaneous endoscopic gastrostomy: indications, technique, complications and management.

    PubMed

    Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T

    2014-06-28

    Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the "pull" technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues

  16. Safety of Early Discharge After Primary Percutaneous Coronary Intervention.

    PubMed

    Satılmısoglu, M Hulusi; Gorgulu, Sevket; Aksu, Hale Unal; Aksu, Huseyin; Ertaş, Gokhan; Tasbulak, Omer; Buturak, Ali; Kalkan, Ali Kemal; Degirmencioglu, Aleks; Koroglu, Bayram; Tusun, Eyyup; Murat, Ahmet; Oz, Ahmet

    2016-06-15

    In contrast to ST-elevation myocardial infarction treatment, there is no clear definition for when and which patient to discharge. Our study's main goal was to test the hypothesis that an early discharge strategy (within 48 to 56 hours) in patients with successful primary percutaneous coronary intervention (PPCI) is as safe as in patients who stay longer. The Early Discharge after Primary Percutaneous Coronary Intervention trial was designed in a prospective, randomized, multicenter fashion and registered with http://clinicaltrials.gov (NCT01860079). Of 900 patients with ST-elevation myocardial infarction, the study randomized 769 eligible patients to the early or the standard discharge group. The study's primary outcomes were all-cause mortality and readmission at 30 days. We considered assessment of functional status and health-related quality of life to be secondary outcomes. The early discharge group had significantly shorter length of hospital stay compared with the standard discharge group (45.99 ± 9.12 vs 114.87 ± 63.53 hours; p <0.0001). Neither all-cause mortality nor readmissions were different between the 2 study groups (p = 0.684 and p = 0.061, respectively). Quality-of-life measures were not statistically different between the 2 study groups. Our study reveals that discharge within 48 to 56 hours after successful PPCI is feasible, safe, and does not increase the 30-day readmission rate. Moreover, the patients perceived health status at 30 days did not differ with early discharge. PMID:27156829

  17. Percutaneous Balloon Mitral Valvulotomy and Coexisting Left Atrial Hemangioma

    PubMed Central

    van Buuren, Frank; Langer, Christoph; Faber, Lothar; Butz, Thomas; Schmidt, Henning Karl; Esdorn, Hermann; Bogunovic, Nikola; Mellwig, Klaus Peter; Scholtz, Werner; Horstkotte, Dieter

    2010-01-01

    Hemangiomas of the heart are extremely rare. The prognosis is quite variable, because this benign tumor may grow, involute, or stop growing; therefore, resection is usually the treatment of choice. In patients with tumors of the left atrium, percutaneous balloon mitral valvulotomy is generally contraindicated. Yet for patients with moderate-to-severe mitral valve stenosis, balloon valvulotomy is an established therapy. Herein, we present the case of a 73-year-old woman who was referred to our department in 1995 with severe mitral valve stenosis. Echocardiography showed a valve orifice area of 0.9 cm2, according to Gorlin's formula, and a mean pressure gradient of 11 mmHg. Surgical therapy was declined by the patient. There were no signs of coronary artery disease. The injection of contrast medium into the left coronary artery showed a hemangioma at the posterior wall of the left atrium. Magnetic resonance imaging and transesophageal echocardiography confirmed the diagnosis. Despite the increased risk posed by the hemangioma, we performed successful percutaneous balloon mitral valvulotomy with an Inoue balloon. We saw the patient in 2001, and again in 2008 when she was 86 years of age. She was in excellent condition, with no signs of relevant dyspnea. Magnetic resonance imaging showed the size of the hemangioma to be stable. By use of echocardiography, we were able to confirm a good long-term result of the balloon valvulotomy. In this patient, a nonsurgical approach was adequate because of the lack of growth of the hemangioma in the left atrium. PMID:20200640

  18. [Percutaneous repair of achilles tendon rupture--a technical note].

    PubMed

    Alexa, O; Veliceasa, B; Puha, C; Popia, I

    2008-01-01

    The treatment of the acute ruptures of the achillean tendon remains controversial. For the time being, there is no consent regarding the ideal therapeutic approach. The therapeutical procedure for the recent achilean tendon tears varies between two possible solutions, one conservative and the other surgical. The choice between these is made based on the type of rupture and the experience of the surgeon. The conservative techniques can have good results in selected cases, but they produce a degree of elongation of the tendon, which may lead to improper functional results. The classical surgical treatment (the open technique) has the handicap of a relatively large, longitudinal incision, which is made in an area with relatively poor skin vascular supply. Also, the vascular supply of the tendon itself is based mainly on perforant, subfascial vessels, which are intercepted during the approach. Taking these facts into consideration, some new, minimally invasive (percutaneous) techniques, were imagined. The principles of the standard percutaneous technique consist of: 1) union of the ruptured ends without using a large surgical approach, thus also avoiding the drainage of the local hematoma and rushing the repair; 2) avoiding damaging of the tendon's vascular supply. This techique leads to a rapid transformation of the collagen fibers into elastic fibers, which are mechanically effective. We present in this paper the method which uses the TENOLIG kit. This kit consists of two wires with anchors at one end and needles at the other end; two washers and two poliethylene disks for securing the distal end of the wire. We obtained good morphological (proven by MRI scan) and functional results with this technique. The postoperative protocol includes immobilization with the foot initially in equinous, then in normal position, with isometric muscle contractions and non-weight-bearing, then removal of the cast and wires at 45 days postoperatively and continuing the recovery by

  19. Cone-Beam Computed Tomography-Guided Percutaneous Radiologic Gastrostomy

    SciTech Connect

    Moehlenbruch, Markus; Nelles, Michael; Thomas, Daniel; Willinek, Winfried; Gerstner, Andreas; Schild, Hans H.; Wilhelm, Kai

    2010-04-15

    The purpose of this study was to investigate the feasibility of a flat-detector C-arm-guided radiographic technique (cone-beam computed tomography [CBCT]) for percutaneous radiologic gastrostomy (PRG) insertion. Eighteen patients (13 men and 5 women; mean age 62 years) in whom percutaneous endoscopic gastrostomy (PEG) had failed underwent CBCT-guided PRG insertion. PEG failure or unsuitability was caused by upper gastrointestinal tract obstruction in all cases. Indications for gastrostomy were esophageal and head and neck malignancies, respectively. Before the PRG procedure, initial C-arm CBCT scans were acquired. Three- and 2-dimensional soft-tissue reconstructions of the epigastrium region were generated on a dedicated workstation. Subsequently, gastropexy was performed with T-fasteners after CBCT-guided puncture of the stomach bubble, followed by insertion of an 14F balloon-retained catheter through a peel-away introducer. Puncture of the stomach bubble and PRG insertion was technically successful in all patients without alteration of the epigastric region. There was no malpositioning of the tube or other major periprocedural complications. In 2 patients, minor complications occurred during the first 30 days of follow-up (PRG malfunction: n = 1; slight infection: n = 1). Late complications, which were mainly tube disturbances, were observed in 2 patients. The mean follow-up time was 212 days. CBCT-guided PRG is a safe, well-tolerated, and successful method of gastrostomy insertion in patients in whom endoscopic gastrostomy is not feasible. CBCT provides detailed imaging of the soft tissue and surrounding structures of the epigastric region in one diagnostic tour and thus significantly improves the planning of PRG procedures.

  20. Percutaneous endoscopic gastrostomy: Indications, technique, complications and management

    PubMed Central

    Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T

    2014-01-01

    Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues

  1. Percutaneous coronary intervention: recommendations for good practice and training

    PubMed Central

    Dawkins, K; Gershlick, T; de Belder, M; Chauhan, A; Venn, G; Schofield, P; Smith, D; Watkins, J; Gray, H; Joint, W

    2005-01-01

    Cardiologists undertaking percutaneous coronary intervention (PCI) are excited by the combination of patient and physician satisfaction and technological advance occurring on the background of the necessary manual dexterity. Progress and applicability of percutaneous techniques since their inception in 1977 have been remarkable; a sound evidence base coupled with the enthusiasm and ingenuity of the medical device industry has resulted in a sea change in the treatment of coronary heart disease (CHD), which continues to evolve at breakneck speed. This is the third set of guidelines produced by the British Cardiovascular Intervention Society and the British Cardiac Society.1,2 Following the last set of guidelines published in 2000, we have seen PCI activity in the UK increase from 33 652 to 62 780 (87% in four years) such that the PCI to coronary artery bypass grafting ratio has increased to 2.5:1. The impact of drug eluting stents has been profound, and the Department of Health is investigating the feasibility of primary PCI for acute myocardial infarction. Nevertheless, the changes in the structure of National Health Service funding are likely to focus our attention on cost effective treatments and will require physician engagement and sensitive handling if we are to continue the rapid and appropriate growth in our chosen field.3 It is important with this burgeoning development now occurring on a broad front (in both regional centres and district general hospitals) that we maintain our vigilance on audit and outcome measures so that standards are maintained for both operators and institutions alike. This set of guidelines includes new sections on training, informed consent, and a core evidence base, which we hope you will find useful and informative. Keith D Dawkins: President, British Cardiovascular Intervention Society (2000–2004) Huon H Gray: President, British Cardiac Society (2003–2005) PMID:16365340

  2. [Percutaneous treatment of calculosis in caliceal diverticulosis: 13-year experience].

    PubMed

    Lancini, V; Liatsikos, E N; Bernardo, N O; Dinlenc, C Z; Kapoor, R; Smith, A D

    2000-06-01

    We report our experience with the composition and management of caliceal diverticular stones for the past 13 years at our institution. Fourty patients with caliceal diverticular stones were treated percutaneously at Long Island Jewish Medical Center. The size of the diverticula ranged from 1 to 4.8 cm, with a mean size of 2.27 cm. The stone size ranged from 0.2 to 4.5 cm in diameter with an average of 1.7 cm. Twenty patients underwent a metabolic evaluation. Follow-up ranged from 8 months to 140 months with a mean of 72.5 months. We achieved a stone free rate of 95%. All 40 patients were free of pain and infection. The chemical composition of stones was identified in 38 patients. Twelve patients were found to have mainly calcium phosphate stones, 16 mainly calcium oxalate stones, 7 mainly uric acid stones and 3 were found with milk of calcium in their diverticulum. Thirty-five patients had complete resolution of their diverticula with normal urograms. The remaining 5 patients had at least 50% diminution of the diverticulum size. No one of the latter patients was found to have stone recurrence. Metabolic evaluation of the 40 patients showed in the 75% of the cases any metabolic abnormality, an absorptive hypercalciuria type II in two patients (10%), hyperuricosuric hypercalciuria in two cases (10%) and hyperoxaluria in one (5%). Percutaneous management of caliceal diverticular stones is a safe and effective modality compared to the existing alternative procedures reported in the literature.

  3. Percutaneous ultrasound-guided thermal ablation for intrahepatic cholangiocarcinoma

    PubMed Central

    Xu, H-X; Wang, Y; Lu, M-D; Liu, L-N

    2012-01-01

    Objective The objective of this study was to evaluate the treatment efficacy and overall survival (OS) of percutaneous ultrasound-guided thermal ablation by means of microwave ablation or radiofrequency ablation for intrahepatic cholangiocarcinoma (ICC). Methods 18 patients with 25 ICC nodules underwent ultrasound-guided thermal ablation with curative intention. 8 patients were primary cases and 10 were recurrent cases after curative resection. The local treatment response, complications and survivals were analysed. Results Complete ablation was achieved in 23 (92.0%, 23/25) nodules (diameter, 0.7–4.3 cm; mean, 2.5±0.9 cm) and incomplete ablation was found in 2 (8.0%, 2/25) larger tumours (6.4 and 6.9 cm in diameter). No death associated with the treatment was found. The major complication rate was 5.5% (1/18). The follow-up periods ranged from 1.3 to 86.2 months (mean, 20.5±26.3 months; median, 8.7 months). OS rates for all patients at 6, 12, 36 and 60 months were 66.7%, 36.3%, 30.3% and 30.3%, respectively. By univariate analysis, the patient source (primary or recurrent case) was found to be a significant prognostic factor for OS rates (p=0.001). The patient source (p=0.001) and the number of nodules (p=0.038) were found to be significant prognostic factors for recurrence-free survival. OS rates for the primary ICC at 6, 12, 36 and 60 months were 87.5%, 75.0%, 62.5% and 62.5%, respectively. Conclusion Percutaneous ultrasound-guided thermal ablation is a safe and effective therapeutic technique for ICC. Acceptable survival can be achieved in primary ICCs, whereas the prognosis of recurrent ICCs is relatively poor. PMID:22374282

  4. Percutaneous absorption of [14C]chlordane from soil.

    PubMed

    Wester, R C; Maibach, H I; Sedik, L; Melendres, J; Liao, C L; DiZio, S

    1992-04-01

    The objective was to determine percutaneous absorption of chlordane in vitro and in vivo from soil into and through skin. The data are needed to calculate the absorbed dose of chlordane from soil, which is then used to assess the toxicity risk. Chlordane, an insecticide for which residues exist in soil, is restricted currently to use for termite control. Chlordane is highly lipophilic with little or no movement out of soil. Soil (Yolo County 65-California-57-8; 26% sand, 26% clay, 48% silt, 0.9% organic) was passed through 10-, 20-, and 48-mesh sieves. Soil then retained by 80-mesh was mixed with 14C-labeled chemical at 67 ppm. Acetone solutions were prepared for comparative analysis. Human cadaver skin was dermatomed to 500 microns and used in glass diffusion cells with human plasma as the receptor fluid (3 ml/h flow rate) for a 24-h skin application time. Chlordane concentration within skin from in vitro studies was 0.34 +/- 0.31% from soil and 10.8 +/- 8.2% from acetone vehicle (p less than .01). Individual variation from human skin sources was evident (p less than .008). Chlordane accumulation in human plasma receptor fluid was the same for soil (0.04 +/- 0.05%) and acetone (0.07% +/- 0.06%) formulations. Most of the remaining chlordane was recovered in the soap and water skin surface wash. In contrast, in vivo percutaneous absorption of chlordane in the rhesus monkey was the same for soil (4.2 +/- 1.8%) and acetone (6.0 +/- 2.8%) formulations (p = .29, nonsignificant). Multiple soap and water washings were necessary to remove chlordane from skin, suggesting that a single wash may not adequately remove all the chlordane. PMID:1578510

  5. Percutaneous absorption of [14C]chlordane from soil.

    PubMed

    Wester, R C; Maibach, H I; Sedik, L; Melendres, J; Liao, C L; DiZio, S

    1992-04-01

    The objective was to determine percutaneous absorption of chlordane in vitro and in vivo from soil into and through skin. The data are needed to calculate the absorbed dose of chlordane from soil, which is then used to assess the toxicity risk. Chlordane, an insecticide for which residues exist in soil, is restricted currently to use for termite control. Chlordane is highly lipophilic with little or no movement out of soil. Soil (Yolo County 65-California-57-8; 26% sand, 26% clay, 48% silt, 0.9% organic) was passed through 10-, 20-, and 48-mesh sieves. Soil then retained by 80-mesh was mixed with 14C-labeled chemical at 67 ppm. Acetone solutions were prepared for comparative analysis. Human cadaver skin was dermatomed to 500 microns and used in glass diffusion cells with human plasma as the receptor fluid (3 ml/h flow rate) for a 24-h skin application time. Chlordane concentration within skin from in vitro studies was 0.34 +/- 0.31% from soil and 10.8 +/- 8.2% from acetone vehicle (p less than .01). Individual variation from human skin sources was evident (p less than .008). Chlordane accumulation in human plasma receptor fluid was the same for soil (0.04 +/- 0.05%) and acetone (0.07% +/- 0.06%) formulations. Most of the remaining chlordane was recovered in the soap and water skin surface wash. In contrast, in vivo percutaneous absorption of chlordane in the rhesus monkey was the same for soil (4.2 +/- 1.8%) and acetone (6.0 +/- 2.8%) formulations (p = .29, nonsignificant). Multiple soap and water washings were necessary to remove chlordane from skin, suggesting that a single wash may not adequately remove all the chlordane.

  6. Clinical Validation of Percutaneous Cochlear Implant Surgery: Initial Report

    PubMed Central

    Labadie, Robert F.; Noble, Jack H.; Dawant, Benoit M.; Balachandran, Ramya; Majdani, Omid; Fitzpatrick, J. Michael

    2015-01-01

    Objective Percutaneous cochlear implant surgery consists of a single drill path from the lateral mastoid cortex to the cochlea via the facial recess. We sought to clinically validate this technique in patients undergoing traditional cochlear implant surgery. Study Design Prospective clinical trial. Methods After institutional regulatory board approved protocols, five ears were studied via the following steps. 1) In the clinic under local anesthesia, bone-implanted anchors were placed surrounding each mastoid. 2) Temporal-bone computed tomography (CT) scans were obtained. 3) On the CT scans, paths were planned from the lateral mastoid cortex, through the facial recess, to the basal turn of the cochlea both “manually” and “automatically” using computer software. 4) Customized microstereotactic frames were rapid-prototyped to serve as drill guides constraining the drill to follow the appropriate path. 5) During cochlear implant surgery, after drilling of the facial recess, drill guides were mounted on the bone-implanted anchors. 6) Accuracy of paths was assessed via intraoperative photodocumentation. Results All surgical paths successfully traversed the facial recess and hit the basal turn of the cochlea. Distance in millimeters (average SD) from the midpoint of the drill to the facial nerve was 1.18 ± 0.68 for the “manual” path and 1.24 ± 0.44 mm for the “automatic” path and for the chorda tympani 0.986 ± 0.48 for the “manual” path and 1.22 ± 0.62 for the “automatic” path. Conclusions Percutaneous cochlear implant access using customized drill guides based on preoperative CT scans and image-guided surgery technology can be safely accomplished. PMID:18401279

  7. Comparison of percutaneous and endoscopic retrograde removal of postoperatively retained bile duct stones.

    PubMed

    Becker, C D; Eigenmann, F; Scheurer, U; Halter, F

    1993-01-01

    Forty-one patients underwent nonsurgical removal of postoperatively retained bile duct stones in two nonrandomized groups. The endoscopic-retrograde technique was used in 21 patients, and succeeded in 19. The percutaneous approach through the T-tube tract was used in 22 patients, including the two in whom endoscopic stone removal had failed, and was successful in 21 patients. Individual preferences and prior history introduced a selection bias against the percutaneous technique. Auxiliary extracorporeal shockwave lithotripsy (ESWL) was used in 2 patients whose stones could not be fragmented mechanically by the percutaneous basket technique. ESWL was successful in one patient but failed in the second. Because endoscopy had also failed in this case, the patient subsequently underwent repeat surgery. Procedure-related complications were minor with both techniques and were readily treated by conservative measures. We conclude that both the retrograde and the percutaneous approaches are effective and safe. The endoscopic approach appears convenient because there is no need to await maturation of the percutaneous tract, but sphincterotomy carries a small but distinctive risk. Because the percutaneous approach uses an existing tract, is only minimally invasive and leaves the sphincter of Oddi intact, it is preferable in those patients who have T-tubes of appropriate size and position in place.

  8. Percutaneous Transpedicular Fixation: Technical tips and Pitfalls of Sextant and Pathfinder Systems

    PubMed Central

    Hassan, Ahmed Salah Aldin

    2016-01-01

    Study Design The efficacy of the operative techniques, possible benefits as well as pitfalls and limitations of the techniques are discussed. Potential drawbacks are also detected. Purpose This study aims to report indications, techniques, and our experience with the use of the Sextant and PathFinder percutaneous transpedicular screw fixation systems. Overview of Literature Percutaneous pedicle screw insertion is a novel technique. Successful percutaneous placement of pedicle screws requires surgical skill and experience because of lack of anatomic surface landmarks. Fluoroscopy-guided percutaneous placement of pedicle screws is effective. Many systems are now available. Methods We conducted a prospective operative and postoperative analysis of 40 patients with absolute indication for thoracic or lumbar instability between January 2009 and June 2013. All procedures were performed with the Sextant (group A) and PathFinder (group B) systems under fluoroscopic guidance. Operative techniques are discussed and the results compared. Results Percutaneous transpedicular screw fixation minimizes the morbidity associated with open techniques without compromising the quality of fixation. A total of 190 screws were inserted. There was no additional morbidity. Postoperative computed tomography images and plain X-rays were analyzed. Reduction of visual analog scale scores of back pain was evident. Conclusions Fluoroscopy-guided percutaneous pedicular screws are feasible and can be safely done. Current systems allow multi-segmental fixation with significantly less difficulties. The described techniques have acceptable intra- and postoperative complication rates, and overall sufficient pain control with early mobilization of patients. PMID:26949466

  9. Comparison Of Percutaneous Laser Discectomy With Other Modalities For The Treatment Of Herniated Lumbar Discs And Cadaveric Studies Of Percutaneous Laser Discectomy

    NASA Astrophysics Data System (ADS)

    Johansen, W. E.; Smith, Chadwick F.; Vangsness, Thomas; McEleney, Emmett T.; Yamaguchi, Ken; Bales, Peter

    1987-03-01

    Current modalities for treating a herniated lumbar disc include standard open discectomy, microsurgical discectomy, chemonucleoysis and percutaneous discectomy. The Food and Drug Administration has not yet approved percutaneous laser discectomy for clinical investigation. The investigators believe that percutaneous laser discectomy combines the efficacy of both chemonucleoysis and percutaneous discectomy with the safety of both open standard discectomy and microsurgical discectomy. The investigators removed two lumbar discs from a cadaveric spine and weighed each of them. The two lumbar discs weighed in the range of 13.654 grams and 15.713 grams, respectively. The investigators initiated several series of 10 firing cycles from a surgical carbon dioxide laser system. In each firing cycle the surgical carbon dioxide laser system delivered a beam of light energy having an output power of 18.0 watts at pulse duration of 0.045 second at the rate of 15 pulses per second for a period of 6 seconds and vaporized approximately 325 milligrams of disc material. Based on the findings of other investigators reported in the literature relating to percutaneous discectomy the investigators postulated that 10 to 20 firing cycles are required to vaporize 30 to 40% (2.4 to 6.4 grams) of the disc material. The investigators initiated two series of 10 firing cycles in order to perform laser discectomy in a third lumbar disc of the cadaveric spine in situ. The investigators harvested and then bisected the laser-treated third lumbar disc for gross review. Their gross findings indicated a high probability of success For percutaneous laser discectomy.

  10. Percutaneous treatment of symptomatic aneurysmal bone cyst of L5 by percutaneous injection of osteoconductive material (Cerament)

    PubMed Central

    Guarnieri, Gianluigi; Vassallo, Pasquale; Muto, Massimo; Muto, Mario

    2013-01-01

    We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous injection of osteoconductive cement (Cerament) to induce sclerosis and bone remodeling of the bone cyst lesion with an analgesic effect. Before treatment, spinal angiography was performed to exclude arterial afferents. No bone biopsy was done. Under general anesthesia and fluoroscopic guidance, a first vertebroplasty was performed by a bilateral transpedicular approach using the osteoconductive cement followed 2 months later by a second treatment with CT-fluoro-guided direct injection of Cerament. No complications occurred during the procedure. At 4 and 6 months follow-up the MRI/CT showed sclerotic bone remodeling of the walls of the aneurysmal cyst with clinical improvement. PMID:24186854

  11. The use of percutaneous left ventricular assist device in high-risk percutaneous coronary intervention and cardiogenic shock.

    PubMed

    Akhondi, Andre Babak; Lee, Michael S

    2013-01-01

    Patients with high-risk coronary lesions may be denied coronary artery bypass grafting due to excessive comorbidities. Percutaneous coronary intervention (PCI) may be a feasible revascularization strategy in high-risk patients who present with ST-elevation myocardial infarction and cardiogenic shock. Historically, the use if intra-aortic balloon pump (IABP) has been used in high-risk PCI and cardiogenic shock. However, recent data has shown that elective IABP insertion did not reduce the incidence of major cardiovascular events following PCI. The use of a left ventricular assist device is a reasonable and safe alternative compared with IABP counterpulsation, giving greater cardiac output and hemodynamic support in patients undergoing high-risk PCI and in those with severe cardiogenic shock. This review outlines a case of severe cardiogenic shock and hemodynamic instability where high-risk PCI is a reasonable option.

  12. A Prospective Randomized Study Comparing Mini-surgical Percutaneous Dilatational Tracheostomy With Surgical and Classical Percutaneous Tracheostomy

    PubMed Central

    Hashemian, Seyed Mohammad-Reza; Digaleh, Hadi

    2015-01-01

    Abstract Although percutaneous dilatational tracheostomy (PDT) is more accessible and less time-demanding compared with surgical tracheostomy (ST), it has its own limitations. We introduced a modified PDT technique and brought some surgical knowledge to the bedside to overcome some standard percutaneous dilatational tracheostomy relative contraindications. PDT uses a blind route of tracheal access that usually requires perioperational imaging guidance to protect accidental injuries. Moreover, there are contraindications in certain cases, limiting widespread PDT application. Different PDT modifications and devices have been represented to address the problem; however, these approaches are not generally popular among professionals due to limited accessibility and/or other reasons. We prospectively analyzed the double-blinded trial, patient and nurse head evaluating the complications, and collected data from 360 patients who underwent PDT, ST, or our modified mini-surgical PDT (msPDT, Hashemian method). These patients were divided into 2 groups—contraindicated to PDT—and randomization was done for msPDT or PDT in PDT-indicated group and msPDT or ST for PDT-contraindicated patients. The cases were compared in terms of pre and postoperational complications. Data analysis demonstrated that the mean value of procedural time was significantly lower in the msPDT group, either compared with the standard PDT or the ST group. Paratracheal insertion, intraprocedural hypoxemia, and bleeding were also significantly lower in the msPDT group compared with the standard PDT group. Other complications were not significantly different between msPDT and ST patients. The introduced msPDT represented a semiopen incision, other than blinded PDT route of tracheal access that allowed proceduralist to withdraw bronchoscopy and reduced the total time of procedure. Interestingly, the most important improvement was performing msPDT on PDT-contraindicated patients with the complication rate

  13. Comparison of percutaneous vertebroplasty and percutaneous kyphoplasty for the management of Kümmell's disease: A retrospective study

    PubMed Central

    Zhang, Guang-Quan; Gao, Yan-Zheng; Chen, Shu-Lian; Ding, Shuai; Gao, Kun; Wang, Hong-Qiang

    2015-01-01

    Background: Post traumatic osteonecrosis of a vertebral body occurring in a delayed fashion was first described by the German doctor Kümmell in 1895. Several studies have reported percutaneous vertebroplasty (PVP), or percutaneous kyphoplasty (PKP) for Kümmell's disease achieves good outcomes. However, it is unknown whether a technique is superior for the treatment of this disease. The objective of the study is to compare the efficacy of PVP and PKP for the treatment of Kümmell's disease. Materials and Methods: A retrospective review was conducted for 73 patients with Kümmell's disease. PVP was performed in 38 patients and PKP in 35 patients. Visual analogue score (VAS) was used to evaluate pain. The anterior vertebral height was measured. The operative time, the incidence of cement leakage and the costs were recorded. Results: In both PVP group and PKP group, the VAS and anterior vertebral height significantly improved at 1-day postoperatively (P < 0.05), and the improvement sustained at the final followup (P > 0.05). Between the PVP and PKP groups, there were no significant differences in VAS and the anterior vertebral height at 1-day postoperatively and at the final followup (P > 0.05). The operating time and expense in the PKP group were higher than the PVP group (P < 0.001). Cement leakages in the PKP group were fewer than PVP group (P < 0.05). Conclusions: PVP is a faster, less expensive option that still provides a comparable pain relief and restoration of vertebral height to PKP for the treatment of Kümmell's disease. PKP has a significant advantage over PVP in term of the fewer cement leakages. PMID:26806962

  14. Metal aminoboranes

    DOEpatents

    Burrell, Anthony K.; Davis, Benjamin J.; Thorn, David L.; Gordon, John C.; Baker, R. Thomas; Semelsberger, Troy Allen; Tumas, William; Diyabalanage, Himashinie Vichalya Kaviraj; Shrestha, Roshan P.

    2010-05-11

    Metal aminoboranes of the formula M(NH.sub.2BH.sub.3).sub.n have been synthesized. Metal aminoboranes are hydrogen storage materials. Metal aminoboranes are also precursors for synthesizing other metal aminoboranes. Metal aminoboranes can be dehydrogenated to form hydrogen and a reaction product. The reaction product can react with hydrogen to form a hydrogen storage material. Metal aminoboranes can be included in a kit.

  15. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms

    SciTech Connect

    Dohan, Anthony; Eveno, Clarisse; Dautry, Raphael Guerrache, Youcef; Camus, Marine; Boudiaf, Mourad; Gayat, Etienne; Dref, Olivier Le Sirol, Marc Soyer, Philippe

    2015-08-15

    PurposeTo assess the role and effectiveness of percutaneous arterial embolization (TAE) in patients with hemodynamic instability due to hypovolemic shock secondary to ruptured splanchnic artery pseudoaneurysms (SAPA).Materials and MethodsSeventeen patients (11 men, 6 women; mean age, 53 years) with hemodynamic instability (systolic blood pressure <90 mmHg) due to hypovolemic shock secondary to ruptured SAPA were treated by TAE. Clinical files, multidetector row computed tomography angiography, and angiographic examinations along with procedure details were reviewed.ResultsSeventeen SAPAs were present, predominantly located on gastroduodenal or pancreatic arteries (9/17; 53 %). Angiography showed extravasation of contrast medium from SAPA in 15/17 patients (88 %). Technical success rate of TAE was 100 %. TAE was performed using metallic coils in all patients (100 %), in association with gelatin sponge in 5/17 patients (29 %). TAE allowed controlling the bleeding and returning to normal hemodynamic status in 16/17 patients (94 %). In 1/17 patient (6 %), surgery was needed to definitively control the bleeding. The mortality and morbidity rate of TAE at 30 days were 0 and 12 %, respectively. Morbidity consisted in coil migration in 1/17 patient (6 %) and transient serum liver enzyme elevation in 1/17 patient (6 %).ConclusionTAE is an effective and safe treatment option for ruptured SAPA in hemodynamically unstable patients, with a success rate of 94 %. Our results suggest that TAE should be the favored option in patients with hemodynamic instability due to ruptured SAPA.

  16. Percutaneous Transcatheter Ethanol Sclerotherapy and Catheter Drainage of Postoperative Pelvic Lymphoceles

    SciTech Connect

    Akhan, Okan Karcaaltincaba, Musturay; Ozmen, Mustafa N.; Akinci, Devrim; Karcaaltincaba, Deniz; Ayhan, Ali

    2007-04-15

    The aim of this study is to investigate the efficacy and long-term results of percutaneous transcatheter ethanol sclerotherapy (PTES) for postoperative pelvic lymphocele treatment. Fifty-two patients who were referred for lymphocele treatment were included in this study. Sixty lymphoceles of 52 patients were treated by percutaneous treatment with or without ethanol sclerotherapy. Lymphoceles developed in 47 and 5 patients, who underwent gynecologic malignancy operation (31 ovarian cancer, 6 cervix cancer, 10 endometrial cancer) and renal transplantation, respectively. Lymphoceles were catheterized by ultrasonography and fluoroscopy guidance using the Seldinger technique. Lymphoceles smaller than 150 mL underwent single-session ethanol sclerotherapy and the others were treated by multiple-session ethanol scleortherapy. In 10 patients, percutaneous ethanol sclerotherapy could not be performed and they were treated only by percutaneous catheter drainage. The mean lymphocele volume was 329 mL (15-2900 mL). The mean catheterization duration was 11.8 days (1-60 days). The mean follow up time was 25.8 months (2-64 months). The initial treatment was successful in 46 out of 50 (91%) lymphoceles treated with PTES and 7 out of 10 (70%) lymphoceles treated with percutaneous catheter drainage. Minor complications (secondary infection and catheter dislodgement) were noted in seven (11.6%) patients. Recurrence developed in four and three patients who were treated by PTES and percutaneous catheter drainage, respectively. Five of these patients were treated with PTES without further recurrence. Percutaneous transcatheter ethanol sclerotherapy is an effective and reliable method for the treatment of postoperative lymphoceles.

  17. Rapamycin inhibits re-endothelialization after percutaneous coronary intervention by impeding the proliferation and migration of endothelial cells and inducing apoptosis of endothelial progenitor cells.

    PubMed

    Liu, Hai-Tao; Li, Fei; Wang, Wen-Yong; Li, Xiao-Jing; Liu, Yi-Meng; Wang, Rui-An; Guo, Wen-Yi; Wang, Hai-Chang

    2010-01-01

    Endothelial-cell function is important in the healing of damaged endothelium after percutaneous coronary artery damage. In 3 different animal models, we sought to determine whether rapamycin (sirolimus) affects the proliferation and migration of endothelial cells and endothelial progenitor cells. First, after we implanted stents in dogs, we found that re-endothelialization was impeded more by drug-eluting stents than by bare-metal stents, 30 days after percutaneous coronary intervention. Second, in vitro in rats, we found that 1-100 ng/mL of rapamycin time- and dose-dependently inhibited proliferation over 72 hr (with effects evident as early as 24 hr) and also dose-dependently induced endothelial progenitor-cell apoptosis. Finally, in vivo in rats, we observed that vascular endothelial growth factor expression was decreased after 5 days of rapamycin treatment. We conclude that rapamycin impedes re-endothelialization after drug-eluting stent implantation by inhibiting the proliferation and migration of coronary endothelial cells, inducing endothelial progenitor-cell apoptosis, and decreasing vascular endothelial growth factor expression in the circulation. PMID:20401293

  18. Results of arthrospine assisted percutaneous technique for lumbar discectomy

    PubMed Central

    Kaushal, Mohinder

    2016-01-01

    Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive “Arthrospine assisted percutaneous technique for lumbar discectomy” is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments. Materials and Methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years). The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3), L2-L3 (n = 2), L3-L4 (n = 8), L4-L5 (n = 90), and L5-S1 (n = 47). Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments. Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90%) patients had excellent to good, 12 (8%) had fair, and 2 patients (1.3%) had poor results. The complications observed were discitis in 3 patients (2%), dural tear in 4 patients (2.6%), and nerve root injury in 2 patients (1.3%). About 90% patients were able

  19. Percutaneous Embolization of Transhepatic Tracks for Biliary Intervention

    SciTech Connect

    Lyon, Stuart M.; Terhaar, Olaf; Given, Mark F.; O'Dwyer, Helena M.; McGrath, Frank P.; Lee, Michael J.

    2006-12-15

    Significant pain can occur after removing transhepatic catheters from biliary access tracks, after percutaneous biliary drainage (PBD) or stenting. We undertook a randomized prospective study to ascertain whether track embolization decreases the amount of pain or analgesic requirement after PBD. Fifty consecutive patients (M:F, 22:28; age range:29-85 years; mean age: 66.3 years) undergoing PBD were randomized to receive track embolization or no track embolization after removal of biliary drainage catheters. A combination of Lipoidol and n-butyl cyanoacrylate were used to embolize transhepatic tracks using an 8F dilator. The patients who did not have track embolization performed had biliary drainage catheters removed over a guide wire. A visual analog scoring (VAS) system was used to grade pain associated with catheter removal, 24 h afterward. A required analgesic score (RAS) was devised to tabulate the analgesia required. No analgesia had a score of 0, oral or rectal nonopiate analgesics had a score of 1, oral opiates had a score of 2, and parenteral opiates had a score of 3. The average VAS and RAS for both groups were calculated and compared.Seven patients were excluded for various reasons, leaving 43 patients in the study group. Twenty-one patients comprised the embolization group and 22 patients comprised the nonembolization group. The mean biliary catheter dwell time was not significantly different (p > 0.05) between the embolization group and nonembolization (mean: 5.4 days vs 6.9 days, respectively). In the nonembolization group, the mean VAS was 3.4. Eight patients required parenteral opiates, three patients required oral opiates, and five patients required oral or rectal analgesics, yielding a mean RAS of 1.6. In the embolization group, the mean VAS was 0.9. No patient required parenteral opiates, six patients required oral opiates, and two patients had oral analgesia. The average RAS was 0.6. Both the VAS and the RAS were significantly lower in the

  20. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

    PubMed Central

    Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  1. [Diverticular calculi of the kidney calices--extracorporeal shockwave lithotripsy, percutaneous extraction or open surgery].

    PubMed

    Kriegmair, M; Schüller, J; Schmeller, N; Knipper, A; Muschter, R; Hofstetter, A G

    1990-07-01

    The incidence of caliceal diverticula, mostly found on routine excretory urography, is very low. The indications for treatment include chronic or recurrent pyelonephritis, pain, gross hematuria and renal damage. There is controversy as to which treatment is best: extracorporeal shock-wave lithotripsy (ESWL), percutaneous techniques, or traditional open surgery. Since 1984, 27 patients with 28 caliceal diverticula calculi have been treated. Ten patients underwent ESWL, 13 patients percutaneous treatment, and 4 patients open surgery. The success rates as far as a stone-free status is concerned were: 1 patient (ESWL), 10 (percutaneous), and 4 (open surgery). There were no complications due to ESWL or open surgical treatment. Direct traumata such as severe bleeding in two and hydrothorax in one patient occurred during the training phase of the percutaneous techniques. Due to the low complication rate, non-invasive ESWL treatment should be tried first. The indications for percutaneous removal of calculi in caliceal diverticula depend on two aspects: it should be possible to puncture the caliceal diverticula via by a short parenchymal route coaxial to the axis of the calix and, if the intercostal approach is used, a pleural lesion must be excluded. If these requirements cannot be fulfilled, open surgical treatment should be performed, especially if the diverticula are located in the upper and anterior part of the kidney.

  2. The current role of percutaneous chemolysis in the management of urolithiasis: review and results.

    PubMed

    Kachrilas, Stefanos; Papatsoris, Athanasios; Bach, Christian; Bourdoumis, Andreas; Zaman, Faruquz; Masood, Junaid; Buchholz, Noor

    2013-08-01

    The treatment of urolithiasis has changed dramatically over the past several decades. Novel technologies have led to new management protocols. Percutaneous chemolysis as a primary or adjuvant treatment for urinary tract stones has widely been neglected. We present our own experience with it and discuss it in the light of an extensive literature review. From a MEDLINE search on percutaneous chemolysis we evaluated the most important studies, a total of 58 articles, 43 case series and 15 review articles. In our unit between 2001 and 2011, 29 patients (mean age 62 years) with infectious staghorn calculi were treated with adjuvant percutaneous chemolysis post-percutaneous nephrolithotripsy. There were 17 women, with 10 complete and 14 partial staghorn stones (mean size 32 mm). Patients were generally deemed at high risk to undergo another procedure in the future. Suby G solution was used following an established protocol. Sixteen patients (55.1 %) were stone free after chemolysis, eight stones showed partial dissolution, half of them with so-called "insignificant" residual fragments <4 mm. Patients with residual stones underwent SWL. Mean follow-up was 5.25 years (1-11). One stone-free patient (6 %) and three of eight patients (37.5 %) with residual fragments post local chemolysis, developed new stones during follow-up. The often neglected percutaneous chemolysis represents a significant and effective.

  3. A retrospective comparison of percutaneous plantar fasciotomy and open plantar fasciotomy with heel spur resection.

    PubMed

    Fallat, Lawrence M; Cox, J Todd; Chahal, Ruby; Morrison, Pamela; Kish, John

    2013-01-01

    Minimally invasive surgery for the treatment of recalcitrant heel pain is a relatively new approach. To compare the 2 approaches, a retrospective chart review was conducted of 53 patients (55 feet) who had undergone surgical treatment of plantar fasciitis by either open fasciotomy with heel spur resection or percutaneous medial fascial release. The outcomes measures included perioperative pain and the interval to return to full activity. Pain was measured on a subjective 10-point visual analog scale. Of the 55 fasciotomies performed, 23 were percutaneous and 32 were open, with adjunctive heel spur resection. The percutaneous group experienced a mean pain reduction of 5.69 points at the first postoperative visit, whereas open fasciotomy group experienced a mean pain reduction of 3.53 points. At 12 months postoperatively, no statistically significant difference was found in the pain levels between the 2 groups. The results also showed that the percutaneous group returned to normal activity an average of 2.82 weeks (p < .001) faster than the open group. In the patient cohorts studied, percutaneous medial fascial release was as effective at resolving recalcitrant plantar fasciitis pain as the open procedure and involved less postoperative pain and a faster return to full activity.

  4. Minimally Invasive Treatment of the Thoracic Spine Disease: Completely Percutaneous and Hybrid Approaches

    PubMed Central

    Francesco Ciro, Tamburrelli; Laura, Scaramuzzo; Maurizio, Genitiempo; Luca, Proietti

    2013-01-01

    The aim of the study was to evaluate the feasibility of a limited invasive approach for the treatment of upper thoracic spine disease. Seven patients with type-A thoracic fractures and three with tumors underwent long thoracic stabilization through a minimally invasive approach. Four patients underwent a completely percutaneous approach while the other three underwent a modified hybrid technique, a combination of percutaneous and open approach. The hybrid constructs were realized using a percutaneous approach to the spine distally to the spinal lesion and by open approach proximally. In two patients, the stabilization was extended proximally up to the cervical spine. Clinical and radiographic assessment was performed during the first year after the operation at 3, 6, and 12 months. No technically related complications were seen. The postoperative recovery was rapid even in the tumor patients with neurologic impairment. Blood loss was irrelevant. At one-year follow-up there was no loosening or breakage of the screws or failure of the implants. When technically feasible a completely percutaneous approach has to be taken in consideration; otherwise, a combined open-percutaneous approach could be planned to minimize the invasivity of a completely open approach to the thoracic spine. PMID:24455233

  5. Minimally invasive treatment of the thoracic spine disease: completely percutaneous and hybrid approaches.

    PubMed

    Tamburrelli, Francesco Ciro; Francesco Ciro, Tamburrelli; Scaramuzzo, Laura; Laura, Scaramuzzo; Genitiempo, Maurizio; Maurizio, Genitiempo; Proietti, Luca; Luca, Proietti

    2013-01-01

    The aim of the study was to evaluate the feasibility of a limited invasive approach for the treatment of upper thoracic spine disease. Seven patients with type-A thoracic fractures and three with tumors underwent long thoracic stabilization through a minimally invasive approach. Four patients underwent a completely percutaneous approach while the other three underwent a modified hybrid technique, a combination of percutaneous and open approach. The hybrid constructs were realized using a percutaneous approach to the spine distally to the spinal lesion and by open approach proximally. In two patients, the stabilization was extended proximally up to the cervical spine. Clinical and radiographic assessment was performed during the first year after the operation at 3, 6, and 12 months. No technically related complications were seen. The postoperative recovery was rapid even in the tumor patients with neurologic impairment. Blood loss was irrelevant. At one-year follow-up there was no loosening or breakage of the screws or failure of the implants. When technically feasible a completely percutaneous approach has to be taken in consideration; otherwise, a combined open-percutaneous approach could be planned to minimize the invasivity of a completely open approach to the thoracic spine.

  6. Percutaneous Retrieval of Misplaced Intravascular Foreign Objects with the Dormia Basket: An Effective Solution

    SciTech Connect

    Sheth, Rahul Someshwar, Vimal; Warawdekar, Gireesh

    2007-02-15

    Purpose. We report our experience of the retrieval of intravascular foreign body objects by the percutaneous use of the Gemini Dormia basket. Methods. Over a period of 2 years we attempted the percutaneous removal of intravascular foreign bodies in 26 patients. Twenty-six foreign bodies were removed: 8 intravascular stents, 4 embolization coils, 9 guidewires, 1 pacemaker lead, and 4 catheter fragments. The percutaneous retrieval was achieved with a combination of guide catheters and the Gemini Dormia basket. Results. Percutaneous retrieval was successful in 25 of 26 patients (96.2%). It was possible to remove all the intravascular foreign bodies with a combination of guide catheters and the Dormia basket. No complication occurred during the procedure, and no long-term complications were registered during the follow-up period, which ranged from 6 months to 32 months (mean 22.4 months overall). Conclusion. Percutaneous retrieval is an effective and safe technique that should be the first choice for removal of an intravascular foreign body.

  7. Influence of acute uraemia on percutaneous absorption of nonsteroidal anti-inflammatory drugs.

    PubMed

    Príborský, J; Takayama, K; Nagai, T

    1998-01-01

    The influence of uraemia on percutaneous absorption of three model drugs (diclofenac, ibuprofen and indomethacin) which are eliminated entirely via nonrenal route was investigated in the rats. Following day after bilateral nephrectomy (BUN levels were between 30-50 mmol/l), gel ointment containing drugs under test was applied on the abdominal site of the skin. Comparing with the sham operated controls the percutaneous absorption significantly decreased in all three challenged substances. Influence on percutaneous absorption of indomethacin was investigated more in depth as this compound can serve as a model for other nonsteroid anti-inflammatory drugs. The 50 mmol/l concentration of urea (equal to uraemia) added to the gel ointment did not influence percutaneous absorption while 10% concentration of urea decreased percutaneous absorption of indomethacin approximately 5 times. Solubility of indomethacin increased in the presence of 10% urea in the gel more than two times. Elimination ratios Q0 were estimated to find if there is any effect on pharmacokinetics linked directly to the renal elimination. None of such changes were observed.

  8. Percutaneous absorption of several chemicals, some pesticides included, in the red-winged blackbird

    USGS Publications Warehouse

    Rogers, J.G.; Cagan, R.H.; Kare, M.R.

    1974-01-01

    Percutaneous absorption in vivo through the skin of the feet of the red-winged blackbird (Agelaius phoeniceus) has been investigated. Absorption after 18-24 hours exposure to 0.01 M solutions of salicylic acid, caffeine, urea, 2,4-D, dieldrin, diethylstilbesterol, and DDT was measured. Of these, only DDT and diethylstilbesterol were not absorbed to a measurable degree. The solvents ethanol, dimethylsulfoxide (DMSO), and vegetable oil were compared with water in their effects on the absorption ofcaffeine, urea, and salicylic acid. Ethanol, DMSO,and oil each decreased percutaneous absorption of salicylic acid. DMSO increased absorption of caffeine, and ethanol had no effect on it. Neither DMSO nor ethanol affected penetration of urea. Partition coefficients (K) (epidermis/water) were determined for all seven penetrants. Compounds with higher values of K showed lower percutaneous absorption. These findings suggest that K may be useful to predict percutaneous absorption in vivo. It appears unlikely that percutaneous absorption contributes greatly to the body burden of 2,4-D and dieldrin in A. phoeniceus.

  9. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    PubMed

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

  10. Percutaneous biphasic electrical stimulation for treatment of obstructive sleep apnea syndrome.

    PubMed

    Hu, Lianggang; Xu, Xiaomei; Gong, Yongsheng; Fan, Xiaofang; Wang, Liangxing; Zhang, Jianhua; Zeng, Yanjun

    2008-01-01

    In this paper, we study the effect of stimulation of the genioglossus with percutaneous biphasic electrical pulses on patients with the obstructive sleep apnea syndrome (OSAS). The experiment was conducted in 22 patients clinically diagnosed with OSAS. The patients were monitored with polysomnography (PSG) in the trial. When the sleep apnea was detected, the genioglossus was stimulated with percutaneous biphasic electrical pulses that were automatically regulated by a microcontroller to achieve the optimal effect. The percutaneous biphasic electrical stimulation caused contraction of the genioglossus, forward movement of the tongue, and relieving of the glossopharyngeal airway obstruction. The SaO2, apnea time, hypoxemia time, and change of respiratory disturbance index (RDI) were compared in patients with treatment and without treatment. With percutaneous biphasic electrical stimulation of the genioglossus, the OSAS patients showed apnea time decreased (P < 0.01), RDI decreased (P < 0.01), and SaO2 increased (P < 0.01). No tissue injury or major discomfort was noticed during the trial. The stimulation of genioglossus with percutaneous biphasic electrical current pulse is an effective method for treating OSAS. PMID:18232360

  11. Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial.

    PubMed

    Arias-Buría, José L; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A; Fernández-de-Las-Peñas, César

    2015-01-01

    Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention.

  12. A novel vacuum assisted closure therapy model for use with percutaneous devices

    PubMed Central

    Cook, Saranne J.; Nichols, Francesca R.; Brunker, Lucille B.; Bachus, Kent N.

    2016-01-01

    Long-term maintenance of a dermal barrier around a percutaneous prosthetic device remains a common clinical problem. A technique known as Negative Pressure Wound Therapy (NPWT) uses negative pressure to facilitate healing of impaired and complex soft tissue wounds. However, the combination of using negative pressure with percutaneous prosthetic devices has not been investigated. The goal of this study was to develop a methodology to apply negative pressure to the tissues surrounding a percutaneous device in an animal model; no tissue healing outcomes are presented. Specifically, four hairless rats received percutaneous porous coated titanium devices implanted on the dorsum and were bandaged with a semi occlusive film dressing. Two of these animals received NPWT; two animals received no NPWT and served as baseline controls. Over a 28-day period, both the number of dressing changes required between the two groups as well as the pressures were monitored. Negative pressures were successfully applied to the periprosthetic tissues in a clinically relevant range with a manageable number of dressing changes. This study provides a method for establishing, maintaining, and quantifying controlled negative pressures to the tissues surrounding percutaneous devices using a small animal model. PMID:24685323

  13. A novel vacuum assisted closure therapy model for use with percutaneous devices.

    PubMed

    Cook, Saranne J; Nichols, Francesca R; Brunker, Lucille B; Bachus, Kent N

    2014-06-01

    Long-term maintenance of a dermal barrier around a percutaneous prosthetic device remains a common clinical problem. A technique known as Negative Pressure Wound Therapy (NPWT) uses negative pressure to facilitate healing of impaired and complex soft tissue wounds. However, the combination of using negative pressure with percutaneous prosthetic devices has not been investigated. The goal of this study was to develop a methodology to apply negative pressure to the tissues surrounding a percutaneous device in an animal model; no tissue healing outcomes are presented. Specifically, four hairless rats received percutaneous porous coated titanium devices implanted on the dorsum and were bandaged with a semi occlusive film dressing. Two of these animals received NPWT; two animals received no NPWT and served as baseline controls. Over a 28-day period, both the number of dressing changes required between the two groups as well as the pressures were monitored. Negative pressures were successfully applied to the periprosthetic tissues in a clinically relevant range with a manageable number of dressing changes. This study provides a method for establishing, maintaining, and quantifying controlled negative pressures to the tissues surrounding percutaneous devices using a small animal model.

  14. Percutaneous Cholecystostomy for Patients with Acute Cholecystitis and an Increased Surgical Risk

    SciTech Connect

    Overhagen, Hans van; Meyers, Hjalmar; Tilanus, Hugo W.; Jeekel, Johannes; Lameris, Johan S.

    1996-03-15

    Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n= 22; acalculous, n= 11) underwent percutaneous cholecystostomy by means of a transhepatic (n= 21) or transperitoneal (n= 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n= 13), normalization of the white blood cell count (n= 3), or both (n= 6). There were 6 (18%) minor/moderate complications (transhepatic access, n= 3; transperitoneal access, n= 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n= 9) and percutaneous and endoscopic stone removal (n= 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n= 2) and gallbladder ablation (n= 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.

  15. Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases.

    PubMed

    vanSonnenberg, E; Wittich, G R; Casola, G; Brannigan, T C; Karnel, F; Stabile, B E; Varney, R R; Christensen, R R

    1989-03-01

    Percutaneous drainage of 101 pancreatic pseudocysts (51 infected, 50 noninfected) in 77 patients is described. In this group of patients, 91 of 101 pseudocysts were cured by means of catheter drainage (90.1%) (noninfected, 43 of 50 [86%]; infected, 48 of 51 [94.1%]). Six patients underwent operation after percutaneous treatment due to persistent drainage. In patients with infected pseudocysts, the infection was eradicated by percutaneous drainage before operation. Four pseudocysts recurred and were redrained percutaneously. The mean duration of drainage was 19.6 days (infected pseudocysts, 16.7 days; noninfected, 21.2 days). Various access routes were used for catheter drainage: transperitoneal, retroperitoneal, transhepatic, transgastric, transduodenal, and transsplenic (inadvertent). Four major (superinfections) and six minor complications occurred. An unexpected finding in seven patients was spontaneous fistulization of the pseudocyst into the gastrointestinal tract. Percutaneous drainage is an effective front-line treatment for most pancreatic pseudocysts; cure is likely if fluid collections are drained adequately and if sufficient time is allowed for closure of fistulas from the pancreatic duct.

  16. Percutaneous biphasic electrical stimulation for treatment of obstructive sleep apnea syndrome.

    PubMed

    Hu, Lianggang; Xu, Xiaomei; Gong, Yongsheng; Fan, Xiaofang; Wang, Liangxing; Zhang, Jianhua; Zeng, Yanjun

    2008-01-01

    In this paper, we study the effect of stimulation of the genioglossus with percutaneous biphasic electrical pulses on patients with the obstructive sleep apnea syndrome (OSAS). The experiment was conducted in 22 patients clinically diagnosed with OSAS. The patients were monitored with polysomnography (PSG) in the trial. When the sleep apnea was detected, the genioglossus was stimulated with percutaneous biphasic electrical pulses that were automatically regulated by a microcontroller to achieve the optimal effect. The percutaneous biphasic electrical stimulation caused contraction of the genioglossus, forward movement of the tongue, and relieving of the glossopharyngeal airway obstruction. The SaO2, apnea time, hypoxemia time, and change of respiratory disturbance index (RDI) were compared in patients with treatment and without treatment. With percutaneous biphasic electrical stimulation of the genioglossus, the OSAS patients showed apnea time decreased (P < 0.01), RDI decreased (P < 0.01), and SaO2 increased (P < 0.01). No tissue injury or major discomfort was noticed during the trial. The stimulation of genioglossus with percutaneous biphasic electrical current pulse is an effective method for treating OSAS.

  17. Tracheal trauma from percutaneous tracheostomy using the Griggs method.

    PubMed

    Watters, M; Thorne, G; Cox, C; Monk, C

    2002-03-01

    In a safety evaluation study, relative force and distance measurements during percutaneous tracheostomy were recorded using specially monitored Griggs guidewire dilating tracheostomy forceps on 12 cadavers scheduled to undergo postmortem examination the same day. All measurements were recorded in millivolts and were converted to force and distance via appropriate calibration tables. Markedly more force was required for tracheal destruction than for therapeutic tracheal dilation (87.7 N +/- 19 N vs. 31.6 N +/- 17.1 N, p <0.001). Also relatively less force was required for therapeutic tracheal dilation than for dilation of the pretracheal tissues (44.4 N +/- 17.1 N vs. 31.6 N +/- 17.1 N, p <0.05). These results suggest that the Griggs tracheostomy forceps have a reasonable margin of safety in that tracheal destruction is unlikely to occur inadvertently during therapeutic dilation. Second, the dilation of pretracheal tissues can act as useful guide in knowing how much force to apply in a therapeutic dilation.

  18. Percutaneous cryodenervation of lumbar facet joints: a prospective clinical trial

    PubMed Central

    Veihelmann, A.; Trouillier, H.; Hausdorf, J.; Devens, C.; Wegener, B.; Jansson, V.; von Schulze Pellengahr, C.

    2006-01-01

    Facet joint pain is an important aspect of degenerative lumbar spine disease, and radiofrequency medial branch neurotomy remains an established therapy, while cryodenervation has still been poorly examined. This study was undertaken to examine the effects of medial branch cryodenervation in the treatment of lumbar facet joint pain. This was a prospective clinical case series. Patient selection was based on the history, physical examination and positive medial branch blocks. Percutaneous medial branch cryodenervation was performed using a Lloyd Neurostat 2000. Target parameters were low back pain (VAS), limitation of activity (McNab) and overall satisfaction. Fifty patients were recruited, and 46 completed the study. The follow-up time was 1 year. At 6 weeks, 33 patients (72%) were pain free or had major improvement of low back pain; 13 (28%) had no or little improvement. Including failures, mean low back pain decreased significantly from 7.7 preoperatively to 3.2 at 6 weeks, 3.3 at 3 months, 3.0 at 6 months and 4.2 at 12 months (P<0.0001). Limitation of the activities of daily living improved parallel to reduced pain. Our results suggest that medial branch cryodenervation is a safe and effective treatment for lumbar facet joint pain. PMID:16927087

  19. Percutaneous Cryoablation of Pulmonary Metastases from Colorectal Cancer

    PubMed Central

    Yamauchi, Yoshikane; Izumi, Yotaro; Kawamura, Masafumi; Nakatsuka, Seishi; Yashiro, Hideki; Tsukada, Norimasa; Inoue, Masanori; Asakura, Keisuke; Nomori, Hiroaki

    2011-01-01

    Objective To evaluate the safety and efficacy of cryoablation for metastatic lung tumors from colorectal cancer. Methods The procedures were performed on 24 patients (36–82 years of age, with a median age of 62; 17 male patients, 7 female patients) for 55 metastatic tumors in the lung, during 30 sessions. The procedural safety, local progression free interval, and overall survival were assessed by follow-up computed tomographic scanning performed every 3–4 months. Results The major complications were pneumothorax, 19 sessions (63%), pleural effusion, 21 sessions (70%), transient and self-limiting hemoptysis, 13 sessions (43%) and tract seeding, 1 session (3%). The 1- and 3-year local progression free intervals were 90.8% and 59%, respectively. The 3-years local progression free intervals of tumors ≤15 mm in diameter was 79.8% and that of tumors >15 mm was 28.6% (p = 0.001; log-rank test). The 1- and 3-year overall survival rates were 91% and 59.6%, respectively. Conclusion The results indicated that percutaneous cryoablation is a feasible treatment option. The local progression free interval was satisfactory at least for tumors that were ≤15 mm in diameter. PMID:22096520

  20. Extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy for lower pole nephrolithiasis?

    PubMed

    Cass, A S

    1996-02-01

    A controversy has arisen as to whether the initial form of therapy for lower pole nephrolithiasis should be extracorporeal shockwave lithotripsy (SWL) or percutaneous nephrolithotomy (PCNL). We reviewed our results with 968 single lower pole stones treated by SWL and reviewed publications comparing SWL and PCNL for lower pole nephrolithiasis. In our cases, the stone-free rate was 71.2%, the rate of repeat treatment and post-treatment secondary procedures was 6.4%, the complication rate was 0.5%, and the hospital stay was less than 24 hours in 99.3% of patients. In published series of PCNL for lower pole nephrolithiasis, the stone free rate was 70.5% to 100%, repeat treatment rates were 4% to 62.5%, the complication rates were 13% to 38%, and the hospital stay was 3.1 to 6.1 days. The rates of recurrent stone disease with PCNL were 11% to 22%, similar to the rates after SWL. The percentage of renal urolithiasis patients with lower pole calculi since we started our unit in late 1986 has remained essentially constant at 38%. Although the stone-free rate with PCNL is higher than with SWL, the lower complication rate, lower repeat treatment/secondary procedure rate, the shorter hospital stay, and the similar recurrent stone rate with SWL make SWL more clinically effective as the primary therapy for lower pole calculi less than 2 cm in diameter.

  1. Effects of solvent on percutaneous absorption of nonvolatile lipophilic solute.

    PubMed

    Intarakumhaeng, Rattikorn; Li, S Kevin

    2014-12-10

    Understanding the effects of solvents upon percutaneous absorption can improve drug delivery across skin and allow better risk assessment of toxic compound exposure. The objective of the present study was to examine the effects of solvents upon the deposition of a moderately lipophilic solute at a low dose in the stratum corneum (SC) that could influence skin absorption of the solute after topical application. Skin permeation experiments were performed using Franz diffusion cells and human epidermal membrane (HEM). Radiolabeled corticosterone ((3)H-CS) was the model permeant. The solvents used had different evaporation and skin penetration properties that were expected to impact skin deposition of CS and its absorption across skin. The results show no correlation between the rate of absorption of the permeant and the rate of solvent evaporation/penetration with ethanol, hexane, isopropanol, and butanol as the solvent; all of these solvents have fast evaporation rates (complete evaporation in <30 min after application). This suggests no differences in solvent-induced deposition of CS in the SC for the fast-evaporating solvents. The results of these fast-evaporating solvents were different from those of water, propylene glycol, and polyethylene glycol 400, that a relationship between permeant absorption and the rate of solvent evaporation was observed. PMID:25261711

  2. Percutaneous needling of Morton’s complex: a technical note

    PubMed Central

    Atilano, Leire; Martin, Jose Ignacio; Iglesias, Gotzon; Andia, Isabel

    2015-01-01

    Summary Background the Morton’s complex, i.e. fibrotic mass enfolding the medial plantar nerve, the bursa and the interdigital transverse ligament in the web space, is a common cause of pain and functional disability. Conservative and operative treatments are investigated but currently the best approach to treat the Morton’s complex is unknown. Methods we describe a non-invasive, straight forward intervention consisting on multiple percutaneous punctures, shearing the fibrotic tissue in lateromedial and anteroposterior directions. The goal is to break up fibrosis occupying the intermetatarsal space thus releasing the affected nerve from the adjacent structures, there by stimulating tissue remodelling. Results slow tissue remodelling occurs following sequential fibrosis cleavage through multiple needling. Needling of the intermetatarsal fibrosis is performed every eight weeks until pain resolution. Echographic changes are associated to pain reduction as measured by Visual Analogue Score (VAS). Conclusion we present an original idea that may improve Morton’s management. Upcoming prospective clinical studies have to demonstrate the symptomatic benefits and the usefulness of this novel echographic intervention. PMID:26958536

  3. Percutaneous Nephrolithotomy: Current Clinical Opinions and Anesthesiologists Perspective

    PubMed Central

    Malik, Indira; Wadhwa, Rachna

    2016-01-01

    Percutaneous nephrolithotomy (PCNL), a minimally invasive method for removal of renal calculi, was initially started in the 1950s but gained popularity about two decades later and has now become standard practice for management. There has been an immense improvement in technique and various guidelines have been established for treatment of renal stones. However, it has its own share of complications which can be attributed to surgical technique as well as anesthesia related complications. PubMed and Google search yielded more than 30 articles describing the different complications seen in this procedure, out of which 15 major articles were selected for writing this review. The aim of this review article is to describe the implications of the complications associated with PCNL related to the anesthesiologist. The anesthesiologist is as much responsible for the management of the patient perioperatively as the surgeon. Therefore, it is mandatory to be familiar with the various complications, some of which may be life threatening and he should be able to manage them efficiently. The paper also analyses the advantages and drawbacks of the available options in anesthesia, that is, general and regional, both of which are employed for PCNL. PMID:27110239

  4. Percutaneous Endoscopic Gastrostomy: Technical Problems, Complications, and Management.

    PubMed

    Yuruker, Savas; Koca, Bulent; Karabicak, Ilhan; Kuru, Bekir; Ozen, Necati

    2015-12-01

    Percutaneous endoscopic gastrostomy (PEG) is an important technique for the provision of nutrition. The present study presents data from our analysis of the PEG procedure. Patients administered with PEG at the endoscopy unit of the 19 Mayıs University General Surgery Department between 2007 and 2013 were analyzed retrospectively, and technical problems, indications, and complications related to the PEG procedure in 221 patients were evaluated. Of the patients, 60 % were male and the median age was 61 years (18-92 years). The most frequent indication was admittance to the intensive care unit, accounting for 46 % of the total, followed by neurological disease, with 41 %. The success rate of the procedure was 98 %, and the overall rate of complications was 22 %. No mortalities were reported as resulting from the procedure. The most common complication was the development of granulomas around the tube (8 %). PEG is a safe method of long-term feeding but is associated with a high rate of morbidity that can be treated easily using conservative treatment methods. PMID:27011529

  5. Percutaneous vertebroplasty: the radiologist’s point of view

    PubMed Central

    Masala, Salvatore; Mammucari, Matteo; Fucci, Francesco Paolo Maria; Massari, Francesco; Simonetti, Giovanni

    2010-01-01

    Introduction: Vertebral compression fractures (VCFs), usually caused by osteoporosis, is a disabling pathology associated with back pain, low quality of life and high costs. We report a retrospective study of 852 patients who underwent Percutaneous Vertebroplasty (PVP) in our department, for treatment of refractory back pain caused by osteoporotic vertebral fractures. Objectives: To evaluate the safety and the helpfulness of the PVP in vertebral osteoporotic fractures treatment and, particularly on durable pain reduction, mobility improvement and analgesic drugs need. Materials and Methods: Follow-up analysis was made through a questionnaire filled by the patients before and after PVP (1-6 months), designed to measure pain, ambulation capacity, ability to perform activities of daily living (ADL) and analgesic drugs administration. Results: A statistically significant difference between visual analogue scale (VAS) values before and after treatment has been observed. No difference between VAS values were observed at 1 and 6 months post-treatment period. The treated vertebrae number did not influence post-treatment VAS values during all the follow-up. Ambulation capacity and the ability to perform ADL have been improved following PVP. Patients also reported significant reduction in administration of medications after PVP. Conclusions: PVP is a safe and useful procedure in painful osteoporotic VCFs treatment, able to reduce pain, improve patients mobility and decrease analgesic drugs need. PMID:22461290

  6. Percutaneous iliosacral screw placement using image guided techniques.

    PubMed

    Tonetti, J; Carrat, L; Lavalleé, S; Pittet, L; Merloz, P; Chirossel, J P

    1998-09-01

    A computer assisted technique of iliosacral screw placement that is applicable to unstable pelvic ring fractures is proposed. The goals are to operate noninvasively with a percutaneous procedure to decrease the complications of surgical exposure and to provide greater accuracy in locating the close neurovascular structures. Preoperative computed tomographic images of the pelvis are provided and a computed tomography three-dimensional model is built. In this model, the optimal trajectories for the drilling are planned. An ultrasound based registration is performed intraoperatively. This registration is the most original part of this work. After performing the passive drilling guidance step, the surgeon places the screws. The accuracy of the ultrasound based registration is checked by comparison with a standard surface based registration at the end of the test experiment. Each screw position is verified by a computed tomographic examination. Four human anatomic specimen pelves were tested with three screw insertions for each pelvis (12 screws). All of the screws were considered to be placed correctly. The method is safe and encourages the start of clinical application. PMID:9755769

  7. [Elective percutaneous coronary intervention after acute coronary syndrome].

    PubMed

    Sebetić, Drazen; Raguz, Miroslav; Sakić, Ivana; Lazić, Jelenko; Puksić, Silva; Bergovec, Mijo

    2009-02-01

    Elective percutaneous coronary intervention (PCI) after acute coronary syndrome (ACS), according to guidelines issued by the European Society of Cardiology (ESC) and American Heart Association/American College of Cardiology (AHA/ACC), is a therapeutic method that is indicated in patients with ACS with ST segment elevation in case of persistent signs of myocardial ischemia and with significant stenosis of coronary artery verified by coronary angiography, suitable for PCI according to the guidelines. It is also indicated for non-culprit significant stenosis of other coronary arteries which have been seen during primary PCI for ST segment elevation myocardial infarction (STEMI). After non ST segment myocardial infarction (NSTEMI) or after non-ST elevation ACS, elective coronary artery angiography is indicated in low risk patients if they have positive signs of ischemia on noninvasive tests. Depending on the results of coronary angiography, elective PCI is indicated according to ESC or AHA/ACC guidelines. The method success is assessed at three levels, i.e. by angiography, clinically and periprocedurally. PCI enables earlier and more efficient resolution of symptoms, better effort tolerance and lower rate of residual ischemia on noninvasive tests. PMID:19681465

  8. Percutaneous mitral heart valve repair--MitraClip.

    PubMed

    Doshi, Jay V; Agrawal, Sahil; Garg, Jalaj; Paudel, Rajiv; Palaniswamy, Chandrasekar; Doshi, Tina V; Gotsis, William; Frishman, William H

    2014-01-01

    Mitral regurgitation (MR) is the most common cardiac valvular disease in the United States. Approximately 4 million people have severe MR and roughly 250,000 new diagnoses of MR are made each year. Mitral valve surgery is the only treatment that prevents progression of heart failure and provides sustained symptomatic relief. Mitral valve repair is preferred over replacement for the treatment of MR because of freedom from anticoagulation, reduced long-term morbidity, reduced perioperative mortality, improved survival, and better preservation of left ventricular function compared with valve replacement. A large proportion of patients in need of valve repair or replacement do not undergo such procedures because of a perceived unacceptable perioperative risk. Percutaneous catheter-based methods for valvular pathology that parallel surgical principles for valve repair have been developed over the last few years and have been proposed as an alternate measure in high-risk patients. The MitraClip (Abbott Labs) device is one such therapy and is the subject of this review.

  9. In vitro percutaneous absorption of the fragrance ingredient musk xylol.

    PubMed

    Hood, H L; Wickett, R R; Bronaugh, R L

    1996-05-01

    The percutaneous absorption of the fragrance fixative musk xylol was measured in vitro in human and hairless guinea pig skin. For comparison, musk xylol was applied to skin in an oil-in-water emulsion or the volatile solvent, methanol. After 24 hr, total absorption of musk xylol in hairless guinea pig skin was 55% from the emulsion vehicle and 45% from the methanol vehicle. With human skin, permeation of musk xylol from both vehicles decreased to 22% of the applied dose. When human studies were continued for an additional 6 days after skin surface washing, only 6% of the applied dose remained in skin. The data suggest that most of the absorbed musk xylol in skin at 24 hr will be systemically absorbed in vivo within 1 wk. Throughout the 24-hr absorption study, absorbed musk xylol was not metabolized. A permeability constant for musk xylol permeation through hairless guinea pig skin was determined by a modified procedure for the lipophilic compound. At each time point, some diffusion cells were terminated so that skin and receptor fluid levels could be determined. Under steady-state absorption the permeability constant was 6.86 x 10(-5) cm/hr. The amount of musk xylol penetrating skin from three types of cosmetic products was also calculated on the basis of actual conditions of use. Products that are applied to large areas of the body and remain on the skin for long periods will result in the greatest absorption of musk xylol.

  10. Sperm retrieval and fertilization in repeated percutaneous epididymal sperm aspiration.

    PubMed

    Rosenlund, B; Westlander, G; Wood, M; Lundin, K; Reismer, E; Hillensjö, T

    1998-10-01

    Percutaneous epididymal sperm aspiration (PESA) for retrieval of spermatozoa for intracytoplasmic sperm injection (ICSI) is a new simplified technique in the treatment of men with obstructive azoospermia. There has been a fear that the PESA procedure, being blind, could cause damage to the epididymal duct system and make it impossible to retrieve spermatozoa if a repeated procedure is required. We report here on repeated PESA procedures from the same unilateral epididymis. Twenty-seven men with obstructive azoospermia were investigated retrospectively regarding sufficiency of the number of motile spermatozoa for ICSI, fertilization rate (FR) and possibility of collecting spermatozoa for cryopreservation in repeated PESA procedures. Sufficient motile spermatozoa for ICSI were found in a similar proportion of men at the first two attempts: 91 and 89% respectively. Fertilization rate and the possibility of collecting spermatozoa for cryopreservation were also similar at the first two PESA procedures: 62 versus 67% and 33 versus 33% respectively. At the third procedure, motile spermatozoa for ICSI were retrieved in 86% (6/7), FR was 47% and spermatozoa were cryopreserved in one case. Two men underwent a fourth PESA. In both cases, a sufficient number of motile spermatozoa for ICSI was found and FR was 62%. This study shows that in men with obstructive azoospermia, PESA can be repeated on the same unilateral epididymis up to three times, with good opportunity of retrieving sufficient motile spermatozoa for ICSI.

  11. Renal calculi with retrocaval ureter: is percutaneous nephrolithotomy sufficient?

    PubMed

    Prakash, Jai; Raj, Anubhav; Sankhwar, Satyanarayan; Singh, Vishwajeet

    2013-01-01

    A 60-year-old woman presented with complaints of intermittent right flank pain which had begun one year ago. Ultrasonography and intravenous urogram showed right pelvic (15 mm) and inferior calyceal (6 mm) calculi along with suspected retrocaval course of right ureter, which was confirmed by contrast CT scan. Tc-99m diethylene-triamine-penta-acetic acid (DTPA) scan showed normal function and normal drainage of right kidney. Percutaneous nephrolithotomy (PCNL) was performed for right renal calculi. Because of curved ureteric course, negotiation of ureteric catheter in pelvis was anticipated to be troublesome, so intraoperative retrograde pyelogram (RGP) was performed to delineate the anatomy. Puncture was performed safely after air contrast pyelography. No complications occurred intraoperatively and postoperatively. On follow-up of up to 1 year patient was asymptomatic and renal scan showed normal function and drainage. So in the presence of retrocaval ureter and associated renal calculi, PCNL is a safe and optimal procedure and in condition of non-obstructive drainage, management of calculi only is adequate.

  12. Delayed Acute Subdural Hematoma Associated With Percutaneous Coronary Intervention

    PubMed Central

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2016-01-01

    Background: Delayed acute subdural hematoma (DASH) is a subdural hematoma which is detected later. An initial computed tomography (CT) does not reveal any intracranial hemorrhage at all. Few patients of DASH after mild traumatic brain injury associated with percutaneous coronary intervention (PCI) have been published. Patient Presentation: A 63-year-old woman presented with cardiac pulmonary arrest due to acute myocardial infarction and lethal arrhythmia. She had hit her head on the road. The initial CT did not reveal any hemorrhage in the intra-cranium. She fully recovered after PCI. However, 1 hour after PCI, she lost consciousness and immediate CT showed acute subdural hematoma and subarachnoid hemorrhage. The period from losing consciousness to brain herniation presenting as anisocoria was very short—only 30 minutes in our patient. Although emergent evacuation of hematoma and external decompression were performed, the patient died 1 day after the operation. Conclusion: The authors encountered a patient of DASH after PCI that resulted in death. Clinicians should be aware that subdural hemorrhage can occur after PCI if no hemorrhage is noted in the initial head CT, and the operation should be performed as soon as possible when the consciousness level decreases. PMID:27526240

  13. Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

    PubMed

    Gedik, Abdullah; Tutus, Ali; Kayan, Devrim; Yılmaz, Yakup; Bircan, Kamuran

    2011-02-01

    The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

  14. Tracheal trauma from percutaneous tracheostomy using the Griggs method.

    PubMed

    Watters, M; Thorne, G; Cox, C; Monk, C

    2002-03-01

    In a safety evaluation study, relative force and distance measurements during percutaneous tracheostomy were recorded using specially monitored Griggs guidewire dilating tracheostomy forceps on 12 cadavers scheduled to undergo postmortem examination the same day. All measurements were recorded in millivolts and were converted to force and distance via appropriate calibration tables. Markedly more force was required for tracheal destruction than for therapeutic tracheal dilation (87.7 N +/- 19 N vs. 31.6 N +/- 17.1 N, p <0.001). Also relatively less force was required for therapeutic tracheal dilation than for dilation of the pretracheal tissues (44.4 N +/- 17.1 N vs. 31.6 N +/- 17.1 N, p <0.05). These results suggest that the Griggs tracheostomy forceps have a reasonable margin of safety in that tracheal destruction is unlikely to occur inadvertently during therapeutic dilation. Second, the dilation of pretracheal tissues can act as useful guide in knowing how much force to apply in a therapeutic dilation. PMID:11879214

  15. The Challenging Buried Bumper Syndrome after Percutaneous Endoscopic Gastrostomy

    PubMed Central

    Afifi, Ibrahim; Zarour, Ahmad; Al-Hassani, Ammar; Peralta, Ruben; El-Menyar, Ayman; Al-Thani, Hassan

    2016-01-01

    Buried bumper syndrome (BBS) is a rare complication developed after percutaneous endoscopic gastrostomy (PEG). We report a case of a 38-year-old male patient who sustained severe traumatic brain injury that was complicated with early BBS after PEG tube insertion. On admission, bedside PEG was performed, and 7 days later the patient developed signs of sepsis with rapid progression to septic shock and acute kidney injury. Abdominal CT scan revealed no collection or leakage of the contrast, but showed malpositioning of the tube bumper at the edge of the stomach and not inside of it. Diagnostic endoscopy revealed that the bumper was hidden in the posterolateral part of the stomach wall forming a tract inside of it, which confirmed the diagnosis of BBS. The patient underwent laparotomy with a repair of the stomach wall perforation, and the early postoperative course was uneventful. Acute BBS is a rare complication of PEG tube insertion which could be manifested with severe complications such as pressure necrosis, peritonitis and septic shock. Early identification is the mainstay to prevent such complications. Treatment selection is primarily guided by the presenting complications, ranging from simple endoscopic replacement to surgical laparotomy. PMID:27462190

  16. The Challenging Buried Bumper Syndrome after Percutaneous Endoscopic Gastrostomy.

    PubMed

    Afifi, Ibrahim; Zarour, Ahmad; Al-Hassani, Ammar; Peralta, Ruben; El-Menyar, Ayman; Al-Thani, Hassan

    2016-01-01

    Buried bumper syndrome (BBS) is a rare complication developed after percutaneous endoscopic gastrostomy (PEG). We report a case of a 38-year-old male patient who sustained severe traumatic brain injury that was complicated with early BBS after PEG tube insertion. On admission, bedside PEG was performed, and 7 days later the patient developed signs of sepsis with rapid progression to septic shock and acute kidney injury. Abdominal CT scan revealed no collection or leakage of the contrast, but showed malpositioning of the tube bumper at the edge of the stomach and not inside of it. Diagnostic endoscopy revealed that the bumper was hidden in the posterolateral part of the stomach wall forming a tract inside of it, which confirmed the diagnosis of BBS. The patient underwent laparotomy with a repair of the stomach wall perforation, and the early postoperative course was uneventful. Acute BBS is a rare complication of PEG tube insertion which could be manifested with severe complications such as pressure necrosis, peritonitis and septic shock. Early identification is the mainstay to prevent such complications. Treatment selection is primarily guided by the presenting complications, ranging from simple endoscopic replacement to surgical laparotomy.

  17. Perk Station – Percutaneous Surgery Training and Performance Measurement Platform

    PubMed Central

    Vikal, Siddharth; U-Thainual, Paweena; Carrino, John A.; Iordachita, Iulian; Fischer, Gregory S.; Fichtinger, Gabor

    2009-01-01

    Motivation Image-guided percutaneous (through the skin) needle-based surgery has become part of routine clinical practice in performing procedures such as biopsies, injections and therapeutic implants. A novice physician typically performs needle interventions under the supervision of a senior physician; a slow and inherently subjective training process that lacks objective, quantitative assessment of the surgical skill and performance[S1]. Shortening the learning curve and increasing procedural consistency are important factors in assuring high-quality medical care. Methods This paper describes a laboratory validation system, called Perk Station, for standardized training and performance measurement under different assistance techniques for needle-based surgical guidance systems. The initial goal of the Perk Station is to assess and compare different techniques: 2D image overlay, biplane laser guide, laser protractor and conventional freehand. The main focus of this manuscript is the planning and guidance software system developed on the 3D Slicer platform, a free, open source software package designed for visualization and analysis of medical image data. Results The prototype Perk Station has been successfully developed, the associated needle insertion phantoms were built, and the graphical user interface was fully implemented. The system was inaugurated in undergraduate teaching and a wide array of outreach activities. Initial results, experiences, ongoing activities and future plans are reported. PMID:19539446

  18. PBNR: Percutaneous Blunt Needle Reduction of Bony Mallet Injuries.

    PubMed

    Miranda, Benjamin H; Murugesan, Logendra; Grobbelaar, Adriaan O; Jemec, Barbara

    2015-06-01

    Mallet finger injuries are common; treatment goals include achieving joint stability, preventing extensor lag, and subsequent swan-neck deformity. We describe a simple technique for improving intraoperative bony mallet reduction, which may avoid the requirement for closed Ishiguro extension blocking wires or open fixation, and present a prospective case series (n=12). Intraoperative percutaneous blunt needle reduction (PBNR) is achieved under image intensifier guidance. Using artery forceps, a blunt fill needle tip is manipulated onto the proximal avulsed fragment; this is then guided into a reduced position and maintained using a well-formed Zimmer splint across the distal interphalangeal joint in 15- to 30-degree extension. There were 5 injuries involving >1/3 of the articular surface (Doyle's classification IVb) and 7 injuries involving >1/2 of the articular surface (Doyle's classification IVc). Mean hand therapy follow-up was 10.6±1.0 weeks, extensor lag was 4.6±1.7 degrees, and all patients achieved full functional recovery with return to normal daily activity. No complications were reported. Closed techniques, for example, Ishiguro extension blocking wires, may reduce the risks associated with open reduction, but do not avoid further articular surface damage. PBNR offers the surgeon a useful adjunct to the treatment options for bony mallet injuries, without excluding progression to surgical fixation if required. PBNR represents a less-invasive management option for bony mallet injures where surgical fixation may also be indicated. PMID:25989396

  19. Colon perforation related to percutaneous nephrolithotomy: from diagnosis to treatment.

    PubMed

    Akbulut, Fatih; Tok, Adem; Penbegul, Necmettin; Daggulli, Mansur; Eryildirim, Bilal; Adanur, Senol; Gurbuz, Gokhan; Celik, Huseyin; Utangac, Mehmet Mazhar; Dede, Onur; Bodakcı, Mehmet Nuri; Tepeler, Abdulkadir; Sarica, Kemal

    2015-11-01

    We present our experience with the largest series of colon perforation (CP) as complication of percutaneous nephrolithotomy (PNL). From January 1998 to August 2014, 22 cases that presented with PNL-related CP from seven referral centers were retrospectively reviewed. The patients with CP were evaluated in terms of probable risk factors. Peri-operative and postoperative findings, timing of diagnosis, and treatment modalities of the CP were reviewed. Of the 22 patients, previous ipsilateral renal surgery (n:2) and retrorenal colon (n:5) were the risk factors for CP. The CP was directly visualized via nephroscopy during the surgery in 3 (13.6%) and with nephrostography at the end of the procedure in 4 patients (18.2%). In two patients, perforation was realized via the passage of contrast into the colon with nephrostography on the postoperative second day. Postoperative passage of feces through the nephrostomy tube was seen in six patients. The clinical signs in 13 cases directed CP diagnosis. The confirmation of the CP was achieved with a CT scan in all the patients. The patients with extraperitoneal perforation were primarily managed conservatively. Open surgical treatment was performed in cases with intraperitoneal perforation (n:5) and those with extraperitoneal perforation resistant to conservative treatment (n:5). Meticulous evaluation of the risk factors preoperatively is the initial step in the prevention of CP. Timely diagnosis plays essential role in the management of this PNL complication. Although extraperitoneal CP may be managed conservatively, surgery is required for intraperitoneal CPs. PMID:26033042

  20. Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture

    PubMed Central

    Omidi-Kashani, Farzad; Hasankhani, Ebrahim G; Akhlaghi, Saeed; Golhasani-Keshtan, Farideh; Toosi, Katayoun Z

    2013-01-01

    Background: Percutaneous vertebroplasty (PVP) is more commonly used for osteoporotic compression fractures (OCFs) and osteolytic vertebral body tumors. This study aimed to study the differences between OCFs and vertebral hemangiomas (VHs) treated with PVP. Materials and Methods: Between September 2007 and January 2010, we prospectively treated 28 consecutive patients of OCFs (43 recently symptomatic OCFs) and 24 cases of VHs (26 VHs). We used visual analogue scale (VAS) pain and Oswestry Disability Index (ODI) to evaluate the patients. The followup period in group 1 and 2 were 25.1 months (range 12 - 31 months) and 21.3 months (range 14 - 28 months), respectively. Comparison of means was carried out with the Chi Square Tests, t-test, and N Par-Test for multiple comparisons, whenever appropriate. The level of statistical significance was set at P < 0.05. Results: Following PVP the VAS score decreased to 4.57 and 4.17 in group 1 and 2, respectively. The ODI scores were 32.5% and 30%, respectively. This decrease in ODI scores lasted throughout the followup period. Conclusions: Although the preoperative scores were significantly different between group 1 and 2, there was no significant difference between two groups following the PVP. PMID:23798752

  1. Percutaneous Endoscopic Discectomy via Transforaminal Route for Discal Cyst.

    PubMed

    Jha, Subash C; Higashino, Kosaku; Sakai, Toshinori; Takata, Yoichiro; Abe, Mitsunobu; Nagamachi, Akihiro; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Background. Discal cyst has been identified as a rare cause of low back pain and radiating leg pain. The pathogenesis and management of this condition are still debated. The largest number of reported cases had undergone microsurgery while very few cases have been treated with percutaneous endoscopic discectomy (PED). Methods. An 18-year-old boy complained of low back pain radiating to right leg after a minor road traffic accident. Diagnosis of a discal cyst at L4-L5 level was made based on magnetic resonance imaging (MRI). Despite conservative management for 6 months, the low back pain and radiating leg pain persisted so surgical treatment by PED was performed under local anesthesia. As the patient was a very active baseball player, his physician recommended a minimally invasive procedure to avoid damage to the back muscles. Results. The patient's low back pain and leg pain disappeared immediately after surgery and he made a rapid recovery. He resumed mild exercise and sports practice 4 weeks after surgery. Complete regression of the cystic lesion was demonstrated on the 2-month postoperative MRI. Conclusion. A minimal invasive procedure like PED can be an effective surgical treatment for discal cyst, especially in active individuals who play sports.

  2. Percutaneous mechanical thrombectomy for treatment of acute femoropopliteal bypass occlusion

    PubMed Central

    Lichtenberg, Michael; Käunicke, Matthias; Hailer, Birgit

    2012-01-01

    Acute and subacute ischemia of the legs in acute and subacute femoropopliteal bypass occlusion is a dramatic situation that endangers the survival of the limbs, depending on the severity of the ischemia. Different therapy options like percutaneous mechanical thrombectomy procedures, which include rotational thrombectomy, have become available in recent years, in addition to local lysis and surgical thrombectomy. Surgical thrombectomy using the Fogarty catheter technique, in particular, shows an increased incidence of perioperative complications but only small technical success rates in randomized trials. On the other hand, local lysis is associated with increased costs due to resource-consuming measures, such as intensive monitoring and repeat angiographies, in addition to bleeding complications. In the past, further development of the Straub Rotarex® system as an endovascular therapy option has demonstrated good success leading to amputation-free survival in multiple studies. At the same time, a low rate of complications with use has been documented. Most examinations have been conducted in the thigh. To date, there are little investigational data on its use in acutely and subacutely occluded femoropopliteal bypasses. In this paper, the current study-based significance of the Rotarex system for this indication is analyzed based on the existing literature and the authors’ own experiences with 22 patients. PMID:22661895

  3. Percutaneous penetration of 2-phenoxyethanol through rat and human skin.

    PubMed

    Roper, C S; Howes, D; Blain, P G; Williams, F M

    1997-01-01

    2-Phenoxyethanol applied in methanol was absorbed (64 +/- 4.4% at 24 hr) through unoccluded rat skin in vitro in the static diffusion cell with ethanol/water as receptor fluid. By comparison (43 +/- 3.7% in 24 hr) was absorbed in the flow-through diffusion system with tissue culture medium as receptor fluid. 2-Phenoxyethanol applied in methanol was absorbed (59.3 +/- 7.0% at 6 hr) through unoccluded human skin in vitro in the flow-through diffusion cell with tissue culture medium. With both unoccluded cells, 2-phenoxyethanol was lost by evaporation but occlusion of the static cell reduced evaporation and increased total absorption to 98.8 +/- 7.0%. Skin, post mitochondrial fraction, metabolized phenoxyethanol to phenoxyacetic acid at 5% of the rate for liver. Metabolism was inhibited by 1 mM pyrazole, suggesting involvement of alcohol dehydrogenase. However, first-pass metabolism of phenoxyethanol to phenoxyacetic acid was not detected during percutaneous penetration through viable rat skin in the flow-through system. First-pass metabolism in the skin does not therefore have an influence on systemic availability of dermally absorbed phenoxyethanol. These measures of phenoxyethanol absorption through rat and human skin in vitro agree well with those obtained previously in vivo.

  4. Preliminary study on HA coating percutaneously implanted in bone.

    PubMed

    Yang, B C; Weng, J; Li, X D; Yang, Z J; Feng, J M; Chen, J Y; Zhang, X D

    1999-10-01

    A comparative investigation on the possibility of hydroxyapatite (HA) coating and pure Ti column to form biological sealing with skin tissue was completed in this study. HA coating and pure Ti column were percutaneously implanted in the tibia of rabbits. Compared with titanium (Ti) implant, HA coating forms epithelial sealing with skin tissue at 6 weeks postoperatively, while the Ti implant may loosen from the implanted site and be lost. The Ti column loosing rate at this time was 50%. However, once the Ti implant becomes fixed with the bone tissue, it can form epithelial sealing with skin tissue just like the HA coating, at 8 weeks postoperatively. At 8 weeks postoperatively, the epithelial sealing is not destroyed in spite of the fact that the HA coating is biodegraded. Our results show that the HA coating can become fixed with the bone faster than the Ti, which is beneficial for epithelial sealing formation. The main role of HA coating for epithelial sealing is beneficial for sealing at the initial period after it is implanted.

  5. Ischemic hepatitis after percutaneous nephrolitotomy: A case report

    PubMed Central

    Temiz, Mustafa Zafer; Yuruk, Emrah; Teberik, Kutlu; Akbas, Burcu Kadriye; Piroglu, Mustafa Devrim; Oztorun, Hande Selvi; Kandirali, Engin

    2014-01-01

    INTRODUCTION Ischemic hepatitis (IH) is the necrosis of the centrilobular hepatocytes of liver and is secondary to liver hypoperfusion in most of the cases. The diagnosis is usually based on biochemical findings due to the absence of symptoms and signs. Although the disease course is often mild, and sometimes is even not diagnosed, the outcome is poor if the etiology of hypotension and liver anoxia is not promptly corrected. PRESENTATION OF CASE A 64-year-old patient who underwent percutaneous nephrolithotomy (PNL) for right renal pelvic stone developed acute IH at first postoperative day as a result of hemorrhage related severe hypotension. After restoring hemodynamic parameters, she completely recovered 2 weeks after the operation. DISCUSSION IH is a frequent cause of marked serum aminotransferase elevation and most commonly occurs as a result of arterial hypoxemia and insufficient hepatic perfusion. Although no specific treatment of IH exists, stabilizing the hemodynamic parameters of the patient resolves the problem in most of the cases. CONCLUSION This case is presented to demonstrate that ischemic hepatitis should be kept in mind if severe hemorrhage occurs during PNL. PMID:25437690

  6. Robotic systems for percutaneous needle-guided interventions.

    PubMed

    Kettenbach, Joachim; Kronreif, Gernot

    2015-02-01

    Several groups have developed robotic systems for invasive medical procedures. In this article we will focus on selected robotic systems for percutaneous needle-guided interventions using CT or MR imaging. We present six interventional robotic systems designed to work with imaging modalities such as CT, Cone-beam CT and MRI. The details of each system are given along with any phantom, animal, or human trials performed with each particular robot. Although each of these systems has specific features, they are all of great clinical value since they provide very stable needle guidance -- even for angulated approaches, they may allow access to lesions when the width of the CT- or MR- gantry would limit the access for a biopsy needle or other interventional tools such as thermal ablation probes. Then, such a robot may be able to guide the needle into the most promising region of the lesion without the need for a second contrast injection. Thus, more efficacious characterization and treatment, particularly for lesions that are difficult to target, can be anticipated. Although more research and clinical trials are certainly needed, it is, however, our belief that robotic systems will be an important part of future interventions.

  7. Application of a New Guiding System in Percutaneous Biopsies

    SciTech Connect

    Petsas, Theodore Tsota, Irene; Kalogeropoulou, Christina P.; Liatsikos, Evangelos N.

    2007-04-15

    We herein describe the application of a new guiding system designed for percutaneous biopsies. The guiding system set is composed of a 0.41 mm (27G) stainless steel guide stylet and a 22G Chiba needle. Following the initial insertion of the Chiba needle, the stylet is advanced via the needle toward the lesion. The stylet serves either as a guide for the Chiba needle or as an exchange wire for the introduction of larger or cutting biopsy needles. The stylet can also be curved prior to its insertion to facilitate access to lesions which require needle redirection. The technique was applied to 117 cases (54 thoracic, 31 abdominal, 21 pelvic, and 11 vertebral lesions.) The main advantage of the stylet is its small diameter, rendering it atraumatic and permitting multiple punctures for the successful final targeting of the lesion. With this guiding set we achieved targeting of difficult lesions. Furthermore, larger needles were more easily introduced in locations that posed technical difficulties. No major complications were observed. The complication rate was comparable to that of the conventional biopsy technique. The technique using the guide stylet was easily performed and could be applied to almost all organs.

  8. Percutaneous transfemoral closure of a pseudoaneurysm at the left ventricular apical access site for transcatheter aortic valve implantation.

    PubMed

    Karimi, Ashkan; Beaver, Thomas M; Fudge, James C

    2015-02-01

    This case report illustrates a left ventricular pseudoaneurysm that developed at the transapical access site for transcatheter aortic valve implantation and was successfully excluded percutaneously through a femoral approach using an Amplatzer muscular VSD occluder (St. Jude Medical). We also discuss various currently available devices and technical pearls for percutaneous closure of left ventricular pseudoaneurysms. PMID:25661768

  9. An Audit to Evaluate the Safety and Efficacy of Percutaneous Endoscopic Gastrostomy Placement in Patients with Learning Disabilities

    ERIC Educational Resources Information Center

    Ayres, Lachlan; Black, Chris; Scheepers, Mark; Shaw, Ian

    2015-01-01

    Percutaneous endoscopic gastrostomy insertion is an effective method of providing enteral nutrition to patients with neurologically unsafe swallowing or failure of feeding. Patients with severe learning disabilities may develop unsafe swallowing and benefit from percutaneous endoscopic gastrostomy placement. It is unclear whether this intervention…

  10. Metal inks

    DOEpatents

    Ginley, David S; Curtis, Calvin J; Miedaner, Alex; van Hest, Marinus Franciscus Antonius Maria; Kaydanova, Tatiana

    2014-02-04

    Self-reducing metal inks and systems and methods for producing and using the same are disclosed. In an exemplary embodiment, a method may comprise selecting metal-organic (MO) precursor, selecting a reducing agent, and dissolving the MO precursor and the reducing agent in an organic solvent to produce a metal ink that remains in a liquid phase at room temperature. Metal inks, including self-reducing and fire-through metal inks, are also disclosed, as are various applications of the metal inks.

  11. Percutaneous Access: Acute Effects on Renal Function and Structure in a Porcine Model

    NASA Astrophysics Data System (ADS)

    Handa, Rajash K.; Willis, Lynn R.; Evan, Andrew P.; Connors, Bret A.; Ying, Jun; Fat-Anthony, William; Wind, Kelli R.; Johnson, Cynthia D.; Blomgren, Philip M.; Estrada, Mark C.; Paterson, Ryan F.; Kuo, Ramsay L.; Kim, Samuel C.; Matlaga, Brian R.; Miller, Nicole L.; Watkins, Stephanie L.; Handa, Shelly E.; Lingeman, James E.

    2007-04-01

    Percutaneous nephrolithotomy (PCNL) involves gaining access into the urinary collecting system to remove kidney stones. Animal studies demonstrated that a reduction in renal filtration and perfusion in both kidneys, and a decline in tubular organic anion transport in the treated kidney characterizes the acute (hours) functional response to unilateral percutaneous access. The acute morphologic and histological changes in the treated kidney were consistent with blunt trauma and ischemia. Only tubular organic anion transport remained depressed during the late (3-day) response to the access procedure. Human studies revealed an acute decline in glomerular function and bilateral renal vasoconstriction following unilateral PCNL. Therefore, percutaneous access is not a benign procedure, but is associated with acute functional and structural derangements.

  12. Percutaneous debulking of staghorn stones combined with extracorporeal shockwave lithotripsy: results and complications.

    PubMed

    Puppo, P; Bottino, P; Germinale, F; Caviglia, C; Ricciotti, G; Giuliani, L

    1988-01-01

    The results and complications of 122 percutaneous debulking of staghorn stones are carefully reviewed, discriminating between dilated and not dilated kidneys. Percutaneous debulking can be defined as satisfactory in about 70% of the cases. In the remaining 30% of the cases (mostly not dilated kidneys) it has got little or no results. The overall complication rate is quite low and most of the common complications can be prevented. Percutaneous procedures in nondilated kidneys have an overall complication rate highly superior to that in dilated kidneys. It should be preferable to treat as many staghorn stones as possible in nondilated kidneys with staged extracorporeal shockwave lithotripsy (ESWL) monotherapy, stenting the ureter and monitoring the urinary infection. Struvite stones are best suitable for stented ESWL because of their fragility. In case of cystine or oxalate monohydrate staghorn stone open surgery might be preferable in virgin patients, but it is often refused by the patients.

  13. Percutaneous endoscopic management of intrahepatic stones in patients with altered biliary anatomy: A case series.

    PubMed

    Bhandari, Suryaprakash; Bathini, Rajesh; Sharma, Atul; Maydeo, Amit

    2016-03-01

    Incidence of primary intrahepatic stones (IHS) in India is very less as compared to the Far East. However patients with altered biliary anatomy are prone for IHS formation secondary to anastomotic stricture formation. Indian data on percutaneous endoscopic management of IHS is scare. Five patients with IHS were managed percutaneously. All patients had undergone Roux-en-Y hepaticojejunostomy and were not suitable for direct endoscopic intervention. All patients underwent percutaneous biliary drainage followed by cholangioscopy-guided laser lithotripsy. Crushed stones were pushed across the anastomotic site using basket/balloon and ductal clearance was achieved. Good stone pulverization could be achieved in five patients (100 %). Complete ductal clearance could be achieved in all patients (100 %). Cholangioscopy-guided treatment of IHS can be valuable alternative to surgery in select group of patients especially those having dilated biliary tree with absence of intrahepatic strictures. However long-term follow up studies are required to see for recurrence of stone formation.

  14. Technique tip: percutaneous fixation of partial incongruous Lisfranc injuries in athletes.

    PubMed

    Bleazey, Scott T; Brigido, Stephen A; Protzman, Nicole M

    2013-06-01

    Open reduction with screw fixation is considered the standard surgical approach for injuries of the Lisfranc complex in athletes. However, multiple incisions are required, which increase the risk for postoperative complications. We present a novel percutaneous reduction and solid screw fixation technique that may be a viable option to address partial incongruous injuries of the Lisfranc complex in athletes. At our institution, no intraoperative or postoperative complications have been encountered. Screw breakage did not occur. Reduction of the second metatarsal was considered anatomic across all patients. All patients have returned to their respective sport without limitation. The percutaneous approach appears to decrease complications while the targeting-reduction guide appears to precisely reduce the injury. Consequently, outcomes have been more consistent and predictable. The authors note that this percutaneous approach is specific to partial incongruous injuries of the Lisfranc complex. When presented with more extensive injuries, the authors advocate an open approach.

  15. Percutaneous valved stent repair of a failed homograft: implications for the Ross procedure.

    PubMed

    Pretorius, Victor; Jones, Alan; Taylor, Dylan; Coe, Yashu; Ross, David B

    2008-08-01

    A case of percutaneous pulmonary valve implantation following a failed homograft in the pulmonary position is reported. A 16-year-old boy developed infective endocarditis of his pulmonary homograft, which was implanted four years earlier during a Ross procedure for congenital aortic stenosis. Following successful medical therapy, the boy was symptomatic due to pulmonary stenosis and regurgitation. A 22 mm Melody valve (Medtronic, USA) was successfully implanted percutaneously. His symptoms resolved and he was discharged home one day after the procedure. Echocardiography at the six-month follow-up demonstrated a normally functioning pulmonary valve. Percutaneous pulmonary valve replacement may make the Ross procedure a more attractive option for patients with aortic stenosis, particularly in the pediatric population.

  16. Perforated Duodenal Ulcer in High Risk Patients: Is Percutaneous Drainage Justified?

    PubMed Central

    Saber, Aly; Gad, Mohammad A; Ellabban, Gouda M

    2012-01-01

    Background: Conservative treatment was recommended as the treatment of choice in perforated acute peptic ulcer. Here, we adjunct percutaneous peritoneal drainage with nonoperative conservative treatment in high risk elderly patients with perforated duodenal ulcer. Aim: The work was to study the efficacy of percutaneous peritoneal drainage under local anesthesia supported by conservative measures in high risk elderly patients, according to the American Society of Anesthesiologists grading, with perforated duodenal ulcer. Patients and Methods: Twenty four high risk patients with age >65 years having associated medical illness with evidence of perforated duodenal ulcer. Results: The overall morbidity and mortality were comparable with those treated by conservative measures alone. Conclusion: In high risk patients with perforated peptic ulcer and established peritonitis, percutaneous peritoneal drainage under local anesthesia seems to be effective with least operative trauma and mortality rate. PMID:22393546

  17. Open versus percutaneous release of the A1-pulley for stenosing tendovaginitis: a prospective randomized trial.

    PubMed

    Dierks, Ulf; Hoffmann, Reimer; Meek, Marcel F

    2008-09-01

    A prospective randomized trial for release of the first annular pulley (A-1 pulley) in trigger fingers with a percutaneous technique versus the open surgical technique is presented. Thirty-six patients were randomized to either open (n = 16) or percutaneous (#15 blade; n = 20) release of the A-1 pulley. All patients were evaluated for grip strength, active range of motion of the proximal interphalangeal joint, and residual pain at 1 and 12 weeks after release. Furthermore, the operation time was assessed, and the costs were calculated. Overall, 100% success in terms of grip strength, active range of motion of the proximal interphalangeal joint, and residual pain was obtained in both groups. Mean operation time was significantly longer with the open technique. Because of lower costs and quicker procedure with equal functional outcome when compared with open surgery, we recommend the percutaneous technique using a #15 blade for trigger finger release. PMID:18776782

  18. Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures.

    PubMed

    Ruatti, S; Kerschbaumer, G; Gay, E; Milaire, M; Merloz, P; Tonetti, J

    2013-09-01

    We describe an early reduction and percutaneous fixation technique for isolated sacral fractures. Strong manual traction combined with manual counter-traction on the torso is used to disimpact the fracture. Transcondylar traction is then applied bilaterally and two ilio-sacral screws are inserted percutaneously on each side. Open reduction and fixation, with sacral laminectomy in patients with neurological abnormalities, remains the reference standard. Early reduction and percutaneous fixation ensures restoration of the pelvic parameters while minimising soft-tissue damage and the risk of infection. Decompression procedures can be performed either during the same surgical procedure after changing the installation or after a few days. These complex fractures warrant patient referral to specialised reference centres.

  19. Fluoroscopically guided percutaneous suprapubic cystostomy for long-term bladder drainage: an alternative to surgical cystostomy.

    PubMed

    Lee, M J; Papanicolaou, N; Nocks, B N; Valdez, J A; Yoder, I C

    1993-09-01

    Percutaneous large-bore suprapubic cystostomy catheters were placed under fluoroscopic guidance in 60 patients as an alternative to surgical cystostomy. Foley catheters (16-20 F) were placed in 57 of the patients in a one-stage procedure. Ten-French catheters were initially placed in three patients because of difficulty in dilating percutaneous tracks because of obesity (one patient) or dense scar tissue (two patients). Three weeks later, 18-F Foley catheters were placed in these three patients when mature tracks had developed, making dilation easier. Minor complications occurred in three patients, including superficial track bleeding in two and urosepsis in one. Fifteen patients were lost to follow-up. Suprapubic catheters provided excellent long-term drainage (range, 0.5-36 months; mean, 16 months; median, 18 months) in the remaining 45 patients. The authors conclude that percutaneous suprapubic catheter placement is a safe and effective procedure that provides excellent long-term bladder drainage. PMID:8351348

  20. Retrospective comparison of percutaneous fixation and volar internal fixation of distal radius fractures.

    PubMed

    Lozano-Calderón, Santiago A; Doornberg, Job N; Ring, David

    2008-06-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius.

  1. Retroperitoneal laparoscopic pyelolithotomy: how does it compare with percutaneous nephrolithotomy for larger stones?

    PubMed

    2001-03-01

    Our 10-year experience of retroperitoneal laparoscopic pyelolithotomy, a rarely performed minimally invasive operative procedure, is presented. The results are compared with our own experience of percutaneous nephrolithotomy for larger renal stones. Forty-two patients with a mean age of 39.12 years underwent 43 retroperitoneal laparoscopic pyelolithotomies using Gaur's balloon technique. The total number of stones was 65 (44 pelvic and 21 calyceal) and they ranged in size between 5 and 48 mm. Two patients had chronic renal failure due to bilateral impacted renal calculi. Forty-eight percutaneous nephrolithotomies performed in the same unit during the last 2 years in patients with non-staghorn calculi > 2 cm were included for a comparative study. The open conversion rate and the drainage period for retroperitoneal laparoscopic pyelolithotomy were much higher. However, the operative time, blood loss, analgesic intake, hospital stay, residual stone rate, re-treatment rate and major complication rates were lower, compared with percutaneous nephrolithotomy. PMID:16753999

  2. Percutaneous Release of Trigger Fingers: Comparing Multiple Digits with Single Digit Involvement

    PubMed Central

    Saremi, Hossein; Hakhamaneshi, Elham; Rabiei, Mohamad Ali Seif

    2016-01-01

    Background: To evaluate safety and efficacy of percutaneous release of trigger finger in multiple digits involvement in comparison with single digit involvement. Method: A number of 100 patients (131 fingers) were treated by percutaneous release and divided into two groups: single digit (group A) and multiple digits (group B). They were followed up for one year. Success rate, pain, complications and duration of analgesic use were studied and then compared in both groups. Results: All patients in both groups were treated successfully without any recurrence in a one-year follow-up. No complication was observed, but postoperative duration of pain was significantly different between the two groups. Period of painkiller use was also different between the two groups. Conclusion: Percutaneous release is a safe and effective treatment for trigger fingers even if multiple digits are involved. It is also safe in thumb and index finger involvement and diabetic patients. PMID:27517066

  3. Risk factors for pulmonary complications after percutaneous nephrolithotomy: A retrospective observational analysis.

    PubMed

    Yu, Jihion; Choi, Jae Moon; Lee, Joonho; Kwon, Koo; Kong, Yu-Gyeong; Seo, Hyungseok; Hwang, Jai-Hyun; Park, Hyung Keun; Kim, Young-Kug

    2016-08-01

    Although percutaneous nephrolithotomy is minimally invasive, it is associated with several complications, including extravasation of fluid and urine, the need for a blood transfusion, and septicemia. However, little is known about pulmonary complications after this procedure. Therefore, we aimed to evaluate the risk factors for and outcomes of pulmonary complications after percutaneous nephrolithotomy.All consecutive patients who underwent percutaneous nephrolithotomy between 2001 and 2014 were identified and divided into group A (no clinically significant pulmonary complications) and group B (clinically significant pulmonary complications). Preoperative and intraoperative variables and postoperative outcomes were evaluated. Independent risk factors for postoperative pulmonary complications were evaluated by univariate and multivariate logistic regression analyses.The study included 560 patients: 378 (67.5%) in group A and 182 (32.5%) in group B. Multivariate logistic regression analysis revealed that the independent risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index (odds ratio = 1.062, P = 0.026), intraoperative red blood cell transfusion (odds ratio = 2.984, P = 0.012), and an intercostal surgical approach (odds ratio = 3.046, P < 0.001). Furthermore, the duration of hospital stay was significantly longer (8.4 ± 4.3 days vs 7.6 ± 3.4 days, P = 0.010) and the intensive care unit admission rate was significantly higher [13 (7.1%) vs 1 (0.3%), P < 0.001] in group B than in group A.Risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index, intraoperative red blood cell transfusion, and an intercostal surgical approach. Postoperative pulmonary complications were associated with poor outcomes. These results may provide useful information for the perioperative management of pulmonary complications after percutaneous

  4. METAL PHTHALOCYANINES

    DOEpatents

    Frigerio, N.A.

    1962-03-27

    A process is given for preparing heavy metal phthalocyanines, sulfonated or not. The process comprises mixing an inorganic metal salt with dimethyl formamide or methyl sulfoxide; separating the metal complex formed from the solution; mixing the complex with an equimolar amount of sodium, potassium, lithium, magnesium, or beryllium sulfonated or unsulfonated phthalocyanine whereby heavy-metal phthalocyanine crystals are formed; and separating the crystals from the solution. Uranyl, thorium, lead, hafnium, and lanthanide rare earth phthalocyanines can be produced by the process. (AEC)

  5. Intraoperative ultrasound assistance for percutaneous repair of the acute Achilles tendon rupture.

    PubMed

    Giannetti, Silvio; Patricola, Alessandro Antonio; Stancati, Andrea; Santucci, Attillio

    2014-12-01

    Various methods have been used to treat the acute Achilles tendon rupture. Traditional open repair is associated with a higher rate of complications. Percutaneous methods avoid most of the disadvantages of open surgical treatment, but the degree of tendon regeneration cannot be ensured. The authors prospectively followed 40 patients with acute Achilles tendon rupture who underwent percutaneous repair with intraoperative ultrasound assistance an average of 13 months after the injury. No surgery-related complications, such as wounds or deep infections, sural nerve injury, or re-rupture, were detected at follow-up. This technique avoids injury to the sural nerve, minimizes wound complications, and provides a strong repair.

  6. Percutaneous Salvage of Crushed Bilateral Aorto-Iliac Stents: Case Report

    SciTech Connect

    Soares, Gregory M.; Coiner, Leonard G.; Gunlock, Michael G.; Hagino, Ryan T.

    2002-12-15

    There are multiple reports of externally deformed or crimped intravascular stents. Percutaneous salvage has been described in multiple anatomic locations including the carotid artery,coronary artery bypass grafts, and hemodialysis conduits. We report successful percutaneous salvage of severely crushed aortoiliac stents in a patient status post low anterior resection, chemotherapy, and radiation therapy for rectal carcinoma. A review of the literature describing approaches to externally deformed stents in other anatomic regions, the limited experience with crushed iliac stents, and our technique is presented.

  7. Percutaneous Vertebroplasty in a Broken Vertebral Titanium Implant (Titanium Mesh Cage)

    SciTech Connect

    Bierry, G.; Buy, X.; Mohan, P. Chandra; Cupelli, J.; Steib, J.P.; Gangi, A.

    2006-08-15

    We report the case of a percutaneous consolidation of a broken vertebral implant (Surgical Titanium Mesh Implants; DePuy Spine, Raynham, MA, USA) by vertebroplasty. Four years after anterior spondylectomy with cage implantation and stabilization with posterior instrumentation, the patient was admitted for excruciating back pain. Radiographs showed fracture of the cage, screw, and rod. An anterior surgical approach was deemed difficult and a percutaneous injection of polymethyl methacrylate into the cage was performed following posterior instrumentation replacement. This seems to be an interesting alternative to the classical anterior surgical approach, which is often difficult in postoperative conditions.

  8. Successful transradial percutaneous coronary intervention in a patient with dextrocardia and situs inversus.

    PubMed

    Sinha, Ramanand P; Agarwal, Deepesh; Sarang, Arohi Mehul; Thakkar, Ashok Suryakant

    2015-01-01

    Dextrocardia with situs inversus is a rare clinical entity with an estimated incidence ranges from 1 in 8000 to 1 in10,000. Percutaneous intervention in patient with dextrocardia and situs inversus is clinically challenging due to abnormal orientation of coronary geometry and the intervention requires appropriate use of guiding catheters, engagement technique, appropriate radiological angles as well as views. In this case-report, we describe percutaneous intervention with stenting in 48-year-old male patient with dextrocardia and situs inversus. We successfully deployed drug-eluting stents in right coronary artery and left circumflex artery.

  9. Extracorporeal shockwave lithotripsy and percutaneous renal surgery. Comparisons, combinations and conclusions.

    PubMed

    Webb, D R; Payne, S R; Wickham, J E

    1986-02-01

    Although percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) were introduced clinically at approximately the same time (1980-1981), their clinical progress appeared to progress along separate paths and to compete with each other. After 5 years it has become apparent that for optimal removal of nearly all renal stones by minimal or noninvasive techniques, PCNL and ESWL are required either separately or as combined procedures. This review traces the development, introduction and progress of these procedures and defines the current indications for extracorporeal, percutaneous and open renal stone surgery.

  10. Hemobilia and other complications caused by percutaneous ultrasound-guided liver biopsy

    PubMed Central

    Zhou, Hai-Bo

    2014-01-01

    Hemobilia accounts for approximately 3% of all major percutaneous liver biopsy complications, and rarely results from arterioportal fistula. We report a patient who suffered from four complications over 11 d after ultrasound-guided percutaneous liver biopsy: hemobilia, acute pancreatitis, acute cholecystitis, and multiple stomach ulcers. Digital subtraction angiography was done after consultation with doctors, and showed obvious arteriovenous fistula of the right liver. The hepatic artery was selected and embolized by spring orbs. The active bleeding was stopped after embolization of the hepatic artery. The patient was discharged home on day 12 after embolization and remained well. PMID:24707158

  11. Percutaneous Endovascular Recanalization of a Thrombosed Aortic Graft Limb with Stent Placement

    PubMed Central

    Georgakarakos, Efstratios; Kapoulas, Konstantinos

    2014-01-01

    Common practice in recanalization of a thrombosed prosthetic graft limb in an aortoiliac bypass focuses on balloon-catheter thrombectomy and angiographic exploration followed either by open surgical revision or endovascular management. This report describes the technique of percutaneous endovascular recanalization of an early thrombosed aortic graft limb with stent placement and subsequent restoration of patency and adequate limb perfusion, which remains patent after one year. Percutaneous intervention with stent placement and angioplasty for early graft limb recanalization avoids femoral incisions, and complications or morbidity associated with open surgery, while permitting rapid mobilization of the patient. PMID:26798727

  12. Percutaneous Endovascular Recanalization of a Thrombosed Aortic Graft Limb with Stent Placement.

    PubMed

    Georgakarakos, Efstratios; Kapoulas, Konstantinos

    2014-06-01

    Common practice in recanalization of a thrombosed prosthetic graft limb in an aortoiliac bypass focuses on balloon-catheter thrombectomy and angiographic exploration followed either by open surgical revision or endovascular management. This report describes the technique of percutaneous endovascular recanalization of an early thrombosed aortic graft limb with stent placement and subsequent restoration of patency and adequate limb perfusion, which remains patent after one year. Percutaneous intervention with stent placement and angioplasty for early graft limb recanalization avoids femoral incisions, and complications or morbidity associated with open surgery, while permitting rapid mobilization of the patient. PMID:26798727

  13. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction

    PubMed Central

    Gao, Lei; Hu, Xin; Liu, Yu-Qi; Xue, Qiao; Feng, Quan-Zhou

    2014-01-01

    As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes. PMID:25114518

  14. Percutaneous mechanical assist for severe cardiogenic shock due to acute right ventricular failure.

    PubMed

    Kipp, Ryan; Raval, Amish N

    2015-05-01

    Acute right ventricular failure can lead to severe cardiogenic shock and death. Recovery may be achieved with early supportive measures. In many patients, intravenous fluid and inotropic resuscitation is inadequate to improve cardiac output. In these cases, percutaneous mechanical assist may provide a non-surgical bridge to recovery. Herein, we describe a case series of patients with severe, refractory cardiogenic shock due to acute right ventricular failure who received a continuous flow percutaneous ventricular device primarily utilizing the right internal jugular vein for out flow cannula placement.

  15. The Role of Percutaneous Endoscopic Transgastric Jejunostomy in the Management of Enteral Tube Feeding

    PubMed Central

    Toh Yoon, Ezekiel Wong

    2016-01-01

    Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia can impede the use of PEG. Percutaneous endoscopic transgastric jejunostomy (PEG-J) using large-bore jejunal tubes with gastric decompression function may improve outcomes by circumventing gastric passage during enteral nutrition and improving drainage of excessive gastric secretions. This report describes a case where PEG-J was successful in maintaining enteral tube feeding in a 72-year-old man when PEG feeding was not tolerated. Patients with unsuccessful PEG feeding can be offered the option of jejunal feeding before terminating enteral nutrition.

  16. Treatment of Residual Facial Arteriovenous Malformations after Embolization with Percutaneous Cryotherapy.

    PubMed

    Woolen, Sean; Gemmete, Joseph J

    2016-10-01

    This report presents 4 patients (mean age, 22 y; range, 17-26 y) with facial arteriovenous malformations (AVMs) who underwent arterial ethanol and N-butyl cyanoacrylate embolization followed by percutaneous cryoablation of residual inaccessible AVMs. After the procedure, minor complications classified as type B according to the Society of Interventional Radiology (SIR) classification system occurred in 75% (3/4) of patients. One patient achieved 90% obliteration of AVM, and 3 patients had complete obliteration of AVM at 1-year follow-up. This reports shows that percutaneous ablation may be a viable treatment option for residual facial AVMs after ethanol and glue embolization. PMID:27670993

  17. Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

    PubMed Central

    Gupta, Arun Kumar; Rajan, Jayadevan E; Thomas, Bejoy

    2007-01-01

    A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck. PMID:17554195

  18. Percutaneous Thrombin Injection to Complete SMA Pseudoaneurysm Exclusion After Failing of Endograft Placement

    SciTech Connect

    Szopinski, Piotr Ciostek, Piotr; Pleban, Eliza; Iwanowski, Jaroslaw; Krol, Malgorzata Serafin-; Marianowska, Agnieszka; Noszczyk, Wojciech

    2005-05-15

    Visceral aneurysms are potentially life-threatening vascular lesions. Superior mesenteric artery (SMA) pseudoaneurysms are a rare but well-recognized complication of chronic pancreatitis. Open surgical repair of such an aneurysm, especially in patients after previous surgical treatment, might be dangerous and risky. Stent graft implantation makes SMA pseudoaneurysm exclusion possible and therefore avoids a major abdominal operation. Percutaneous direct thrombin injection is also one of the methods of treating aneurysms in this area. We report a first case of percutaneous ultrasound-guided thrombin injection to complete SMA pseudoaneurysm exclusion after an unsuccessful endograft placement. Six-month follow-up did not demonstrate any signs of aneurysm recurrence.

  19. Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

    PubMed Central

    Liang, Ping; Yu, Jie; Lu, Ming-De; Dong, Bao-Wei; Yu, Xiao-Ling; Zhou, Xiao-Dong; Hu, Bing; Xie, Ming-Xing; Cheng, Wen; He, Wen; Jia, Jian-Wen; Lu, Guo-Rong

    2013-01-01

    Primary liver cancer and liver metastases are among the most frequent malignancies worldwide, with an increasing number of new cases and deaths every year. Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy. This synopsis outlines the first clinical practice guidelines for ultrasound-guided percutaneous microwave ablation therapy for hepatic malignancy, which was created by a joint task force of the Society of Chinese Interventional Ultrasound. The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment, as well as proposing the criteria for the treatment candidates. PMID:24023485

  20. Percutaneous Transhepatic Cutting Balloon Papillotomy for Removal of Common Bile Duct Stones

    SciTech Connect

    Oguzkurt, Levent Ozkan, Ugur; Gumus, Burcak

    2009-09-15

    We report the case of a 66-year-old female who presented with jaundice secondary to recurrent adenocarcinoma of the gallbladder and several common bile duct stones. Percutaneous papillary dilatation was planned to remove the common bile duct stones. Papilla was dilated through the percutaneous approach with an 8-mm peripheral cutting balloon instead of a standard balloon. All the stones were pushed successfully into the duodenum with a saline flush. No complications were encountered. Use of a peripheral cutting balloon for dilatation of the papilla seems to be safe and effective because it has the advantage of controlled incision and dilatation of the target at low pressures.

  1. Stroke from delayed embolization of polymerized glue following percutaneous direct injection of a carotid body tumor.

    PubMed

    Krishnamoorthy, Thamburaj; Gupta, Arun Kumar; Rajan, Jayadevan E; Thomas, Bejoy

    2007-01-01

    A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.

  2. Cost-effectiveness of percutaneous vertebroplasty in osteoporotic vertebral fractures

    PubMed Central

    Masala, Salvatore; Ciarrapico, Anna Micaela; Vinicola, Vincenzo; Mammucari, Matteo; Simonetti, Giovanni

    2008-01-01

    A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age: 72.0 ± 8.59 years; range: 51–93) with single symptomatic acute amyelic osteoporotic vertebral fracture presenting between September 2004 and September 2005 to the Santa Lucia Foundation in Rome, Italy. Vertebral fractures usually become manifest due to pain which can be debilitating. Treatment depends on the presence or absence of spinal cord involvement. In the first case, surgical stabilization is mandatory. In the second case, treatment may be performed either by conservative medical therapy (CMT) or percutaneous vertebroplasty (PVT). The aim of this study was to evaluate the effectiveness, costs and cost-effectiveness of percutaneous vertebroplasty. After 2 weeks of analgesic therapy, 153 patients presented refractory pain and were offered treatment by PVT. A total of 58 patients accepted and underwent PVT (PVT group), while 95 refused and underwent conservative medical therapy (CMT group). Follow-up was performed by specialist consults, spine radiography and MRI and a self-assessment questionnaire evaluating pain using a Visual Analogue Scale (VAS) and function using an ambulation and an Activities of Daily Living (ADL) scale. A 12-month follow-up was obtained in 86 of 95 (90.5%) CMT group patients and 54 of 58 (93.1%) PVT group patients. Significant reduction of VAS and improvement of ambulation and ADL was observed in both groups at 1 week and 3 and 12 months (P < 0.05; Wilcoxon signed rank test), however, these results were significantly superior in the PVT group at 1 week and 3 months (P < 0.05; Mann–Whitney U test). Average cost per patient at 1 week and 3 and 12 months were respectively 755.49 ± 661.96, 3791.95 ± 3341.97 and 4299.55 ± 3211.53 € (CMT group) and 3311.35 ± 0.32, 3745.30 ± 3.59 and 4101.05 ± 755.41 € (PVT group). PVT resulted significantly more cost-effective than CMT with regards to the three scales at

  3. Silicone metalization

    DOEpatents

    Maghribi, Mariam N.; Krulevitch, Peter; Hamilton, Julie

    2008-12-09

    A system for providing metal features on silicone comprising providing a silicone layer on a matrix and providing a metal layer on the silicone layer. An electronic apparatus can be produced by the system. The electronic apparatus comprises a silicone body and metal features on the silicone body that provide an electronic device.

  4. Silicone metalization

    DOEpatents

    Maghribi, Mariam N.; Krulevitch, Peter; Hamilton, Julie

    2006-12-05

    A system for providing metal features on silicone comprising providing a silicone layer on a matrix and providing a metal layer on the silicone layer. An electronic apparatus can be produced by the system. The electronic apparatus comprises a silicone body and metal features on the silicone body that provide an electronic device.

  5. Metallic glasses.

    PubMed

    Greer, A L

    1995-03-31

    Amorphous metallic alloys, relative newcomers to the world of glasses, have properties that are unusual for solid metals. The metallic glasses, which exist in a very wide variety of compositions, combine fundamental interest with practical applications. They also serve as precursors for exciting new nanocrystalline materials. Their magnetic (soft and hard) and mechanical properties are of particular interest.

  6. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    SciTech Connect

    Breault, Stéphane; Glauser, Frédéric; Babaker, Malik Doenz, Francesco Qanadli, Salah Dine

    2015-06-15

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

  7. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy

    PubMed Central

    Cyrany, Jiri; Rejchrt, Stanislav; Kopacova, Marcela; Bures, Jan

    2016-01-01

    Percutaneous endoscopic gastrostomy (PEG) is a widely used method of nutrition delivery for patients with long-term insufficiency of oral intake. The PEG complication rate varies from 0.4% to 22.5% of cases, with minor complications being three times more frequent. Buried bumper syndrome (BBS) is a severe complication of this method, in which the internal fixation device migrates alongside the tract of the stoma outside the stomach. Excessive compression of tissue between the external and internal fixation device of the gastrostomy tube is considered the main etiological factor leading to BBS. Incidence of BBS is estimated at around 1% (0.3%-2.4%). Inability to insert, loss of patency and leakage around the PEG tube are considered to be a typical symptomatic triad. Gastroscopy is indicated in all cases in which BBS is suspected. The depth of disc migration in relation to the lamina muscularis propria of the stomach is critical for further therapy and can be estimated by endoscopic or transabdominal ultrasound. BBS can be complicated by gastrointestinal bleeding, perforation, peritonitis, intra-abdominal and abdominal wall abscesses, or phlegmon, and these complications can lead to fatal outcomes. The most important preventive measure is adequate positioning of the external bolster. A conservative approach should be applied only in patients with high operative risk and dismal prognosis. Choice of the method of release is based on the type of the PEG set and depth of disc migration. A disc retained inside the stomach and completely covered by the overgrowing tissue can be released using some type of endoscopic dissection technique (needle knife, argon plasma coagulation, or papillotome through the cannula). Proper patient selection and dissection of the overgrowing tissue are the major determinants for successful endoscopic therapy. A disc localized out of the stomach (lamina muscularis propria) should be treated by a surgeon. PMID:26811611

  8. [Patients facing with the decision to undergo percutaneous coronary intervention].

    PubMed

    Bobbio, Marco

    2015-03-01

    Percutaneous coronary intervention (PCI) is a common procedure to treat coronary artery stenoses. Several studies had demonstrated that PCI does not reduce the risk of death or myocardial infarction when performed to patients with stable angina. However it has been observed that most patients believe that PCI will reduce their risk for death and myocardial infarction. On the other hand, cardiologists generally acknowledge the limitation of PCI according to the current literature.Cardiologists' decision to refer a patient to PCI is based on factors other then perceived benefits such as fear of missing a needed procedure, defensive medicine, desire of demonstrating their professional competence, vested professional and economic interests, accomplish patient expectation, the so called oculo-stenotic reflex, when a lesion is dilated regardless the clinical indication. Patients' misleading perception of harm and benefits of a procedure is mainly related to the cognitive dissonance, when individuals tend to reduce the conflict of an uncomfortable decision adopting information, which are likely to reduce their discomfort. Furthermore, patients believe that doing more means doing better, that technologic intervention are better than pharmacological treatment that in turn are better than doing nothing. Finally, they assume that a procedure is really effective since their physician suggested it.It should be emphasized that physicians and patients do not communicate successfully about key decision and how little we know about patient understanding of the factors that influence important medical care decisions. Although considerable attention is given to facilitating informed consent, patients' perceived benefits of elective PCI do not match existing evidence, as they overestimated both the benefits and urgency of their procedures. These findings suggest that an even greater effort at patient education is needed prior to elective PCI to facilitate fully informed decision-making.

  9. [Artificial circulation in high-risk percutaneous coronary interventions].

    PubMed

    Bazylev, V V; Evdokimov, M E; Pantiukhina, M A; Morozov, Z A

    2016-01-01

    In their everyday practical clinical work cardiovascular surgeons sometimes have to deal with patients at extremely high risk of both percutaneous coronary interventions (PCIs) and direct myocardial revascularization. A method of choice in such situations may become a PCI supported by artificial circulation (AC), for which foreign and Russian authors propose using systems of prolonged extracorporeal membrane oxygenation (ECMO). The present work was aimed at sharing our experience with using standard systems of AC and their modifications (mini-circuit systems) for performing high-risk PCIs. Between October 2011 and November 2014, PCIs supported by artificial circulation were performed in a total of ten patients. All had extremely high risk of PCI due to coronary artery lesions [subocclusion of the trunk of the left coronary artery (LCA) combined with occlusion or significant stenosis of the right coronary artery (RCA)], concomitant pathology (obesity, diabetes mellitus, age, etc.) or critical state (circulatory arrest, resuscitating measures). Three patients during PCI developed ventricular fibrillation and one patient suffered an episode of asystole. All cardiac arrhythmias after restoration of the coronary blood flow disappeared spontaneously on the background of extracorporeal support. The only lethal outcome was registered during emergency PCI in a female patient admitted to the roentgen-operating room in the state of clinical death, on the background of continuing resuscitation measures. The presented methods of assisted circulation based on the standard AC systems and modification thereof (mini-circuit system) proved efficient. They make it possible to perform high-risk PCIs, including in clinics having neither appropriate equipment nor experience in ECMO. PMID:27626258

  10. Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur

    SciTech Connect

    Deschamps, Frederic Farouil, Geoffroy Hakime, Antoine Teriitehau, Christophe Barah, Ali Baere, Thierry de

    2012-12-15

    Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score {>=}8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels' score was 9.8 {+-} 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 {+-} 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 {+-} 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.

  11. Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis

    PubMed Central

    Malla, Rabi; Rajbhandari, Rajib; Shakya, Urmila; Sharma, Poonam; Shrestha, Nagma; KC, Bishal; Limbu, Deepak; KC, Man Bahadur

    2016-01-01

    Background Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. Methods It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. Results During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm2 to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm2 in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. Conclusions PTMC in JMS is safe and effective. PMID:26885488

  12. Comparison of percutaneous absorption of fragrances by humans and monkeys.

    PubMed

    Bronaugh, R L; Stewart, R F; Wester, R C; Bucks, D; Mailbach, H I; Anderson, J

    1985-01-01

    The percutaneous absorption of two cosmetic fragrance materials, safrole and cinnamyl anthranilate, as well as of cinnamic alcohol and cinnamic acid, has been measured at occluded and non-occluded application sites. Absorption values were determined in the rhesus monkey in vivo. Absorption through human skin was measured by using excised skin in diffusion cells. Because of the insolubility in water of safrole and cinnamyl anthranilate, a nonionic surfactant solution (6% oleth 20) was used in the receptor chamber of the diffusion cell in order to facilitate the partitioning of the compounds from the skin into the receptor fluid. The relative volatility of the compounds was determined in order to aid in the interpretation of the absorption results. The greatest difference between in vivo and in vitro absorption values occurred with safrole, which was the least well absorbed and the most volatile compound. Cinnamic acid absorption through non-occluded human skin (17.8 +/- 4.9%, mean +/- SEM) was significantly lower than through monkey skin (38.6 +/- 8.3%). The values for absorption through human and monkey skin did not differ significantly for cinnamyl anthranilate (24.0 +/- 5.1% v. 26.1 +/- 2.3%) or cinnamic alcohol (33.9 +/- 7.3% v. 25.4 +/- 4.4%). Occlusion of the skin resulted in greater permeation of all of the compounds; a significant difference in permeability between the two types of skin occurred only with safrole. The fragrances were absorbed well, but their volatility must be considered in a toxicity evaluation. There was reasonable agreement between the values obtained from the studies of the human skin in vitro and the monkey skin in vivo.

  13. Percutaneous nephrolithotomy in prone position in patients with spinal deformities

    PubMed Central

    Izol, Volkan; Aridogan, Ibrahim Atilla; Borekoglu, Ali; Gokalp, Fatih; Hatipoglu, Zehra; Bayazit, Yildirim; Zeren, Sinan

    2015-01-01

    Introduction: The feasibility, safety and efficacy of percutaneous nephrolithotomy (PCNL) in patients with spinal deformities were evaluated and the results of a single centre experience were reported. Patients and methods: Between July 1999 and December 2014, 16 patients with spinal deformities underwent PCNL. The anomalies included 5 cases with kyphoscoliosis, 4 with post-polio syndrome, 3 with osteogenesis imperfecta, 3 with myotonic dystrophy, and 1 with ankylosing spondylitis. All patients were preoperatively evaluated by an intravenous urogram and computerized tomography to assess the anatomy and appropriate access. The operative details, stone clearance rates, and complications were retrospectivelyanalyzed. Results: A total of 16 standard PCNL procedures were performed on 16 renal-units. The mean age of the patients was 30.7 ± 17.2 (5-62) years, and the mean stone burden was 609.6 ± 526.9 (100-1800) mm2. The mean operative and fluoroscopy times were 76.6 ± 35.1 (35-150) minutes and 12.5 ± 8.5 (3-34) minutes, respectively. At the end of the surgery, 13 (81.2%) of the patients were stone free. The overall success rate was 93.7% with the inclusion of 2 patients with clinically insignificant residual fragments (<3 mm). Complications (31.2%) included haemorrhage requiring a transfusion in 2 patients, prolonged urine leakage requiring double J catheter insertion in 1, infection in 1, and nephrectomy due to bleeding in 1. Mean hospitalization time was 4.6 ± 2.4 (3-13) days. Conclusion: PCNL is an effective, safe and minimally invasive procedure for the treatment of kidney stones in patients with spinal deformities, and it can be performed with low morbidity and high success rates. To achieve better results and minimizing the risk factors, systematic and anatomic evaluations for anaesthesia and operative planning are crucial before surgery. PMID:26885036

  14. Percutaneous ultrasound-guided renal biopsy: A Libyan experience

    PubMed Central

    Mishra, A.; Tarsin, R.; ElHabbash, B.; Zagan, N.; Markus, R.; Drebeka, S.; AbdElmola, K.; Shawish, T.; Shebani, A.; AbdElmola, T.; ElUsta, A.; Ehtuish, E. F.

    2010-01-01

    This study was done to assess the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB), to ascertain the risk factors for complications and determine the optimal period of observation. The radiologist (A.M.) at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya, performed 86 PRBs between February 1, 2006, and January 31, 2008, using an automated biopsy gun with 16-gauge needle. Coagulation profile was done in all the patients. All patients were kept on strict bed rest for six hours post-procedure. Eighty six renal biopsies were performed on 78 patients referred from rheumatology department and eight post-kidney transplant recipients; 23 were males with age range 15 – 56 years and 63 females with age range 16 – 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in four biopsies. Class I lupus nephritis (LN) was seen in 1 patient, class II lupus nephritis in 7 patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as acute tubular necrosis or acute interstitial rejection. The risk of post-biopsy bleeding was higher in women, older patients and higher PTT. The overall complication rate was 5.8%. Three complications were observed within six hours of biopsy. No late complication was seen. PRB under real-time ultrasound-guidance is a safe and efficacious procedure to establish the histological diagnosis and should be done as out-patient procedure. Observation time of six hours post-biopsy is optimal. PMID:20835320

  15. Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

    PubMed Central

    Lantz, Andrea G.; O’Malley, Padraic; Ordon, Michael; Lee, Jason Y.

    2014-01-01

    Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopy time, effective dose) and investigates variables that may predict increased exposure. Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure. Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose. Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI. PMID:25408802

  16. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

    PubMed Central

    2012-01-01

    Introduction The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients. Methods Fifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m2. The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage). Results The median BMIs were 34 kg/m2 (32-38) in the obese patient group and 25 kg/m2 (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths. Conclusions This study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site. Trial registration ClinicalTrials.gov: NCT01502657. PMID:22390815

  17. Patient and Hospital Characteristics Associated with Inappropriate Percutaneous Coronary Interventions

    PubMed Central

    Chan, Paul S.; Rao, Sunil V.; Bhatt, Deepak L.; Rumsfeld, John S.; Gurm, Hitinder S.; Nallamothu, Brahmajee K.; Cavender, Matthew A.; Kennedy, Kevin; Spertus, John A.

    2013-01-01

    Objective To examine whether rates of inappropriate PCI differ by demographic characteristics and insurance status. Background Prior studies have found that blacks, women and those with public or no health insurance are less likely to undergo percutaneous coronary intervention (PCI). Whether this reflects potential overuse in whites, men, and privately insured patients, in addition to underuse in disadvantaged populations, is unknown. Methods Within the NCDR® CathPCI Registry®, we identified 221,254 non-acute PCIs performed between July 2009 and March 2011. PCI appropriateness was determined using Appropriate Use Criteria (AUC) for coronary revascularization. Multivariable hierarchical regression models evaluated the association between patient demographics and insurance status with AUC-defined inappropriate PCI. Results Of 211,254 non-acute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted OR, 1.08 [95% CI: 1.05–1.11]; P<0.001) and whites (adjusted OR, 1.09 [1.05–1.14]; P<0.001) were more likely to undergo an inappropriate PCI, compared with women and non-whites. Compared with privately insured patients, those with Medicare (adjusted OR, 0.85 [0.83–0.88]), other public insurance (adjusted OR, 0.78 [0.73–0.83]) and no insurance (adjusted OR, 0.56 [0.50–0.61]) were less likely to undergo an inappropriate PCI (P<0.001). Additionally, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely. Conclusion For non-acute indications, PCIs categorized as inappropriate were more commonly performed in men, patients of white race, and those with private insurance. Higher rates of PCI in these patient populations may be, in part, due to procedural overuse. PMID:24055743

  18. Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model

    PubMed Central

    Shi, Hong; Chen, Su-Yu; Wang, Yong-Guang; Jiang, Sheng-Jun; Cai, He-Li; Lin, Kai; Xie, Zhao-Fei; Dong, Fen-Fang

    2016-01-01

    AIM To introduce natural orifice transgastric endoscopic surgery (NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy. METHODS Six live pigs (three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cm transversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation. RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min (range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy. CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement. PMID:27729743

  19. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    SciTech Connect

    Hierholzer, Johannes Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-11-15

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  20. Stone culture retrieved during percutaneous nephrolithotomy: is it clinically relevant?

    PubMed

    Osman, Yasser; Elshal, Ahmed M; Elawdy, Mohamed M; Omar, Helmy; Gaber, Asaad; Elsawy, Essam; El-Nahas, Ahmed R

    2016-08-01

    Stone culture has been frequently investigated following percutaneous nephrolithotomy (PNL) in the last decade. We aimed to crucially define the clinical role of stone culture in modifying the treatment plan in patients with postoperative sepsis. Between June 2012 and April 2013, a total of 79 consecutive PNL procedures were included. Perioperative data were prospectively maintained. Preoperative urine sample, retrieved stone fragments and postoperative nephrostomy tube urine sample were cultured and antibiotic sensitivity tests were performed. The occurrence of at least two of the systemic inflammatory response syndrome (SIRS) events during their inpatient stay was diagnostic of SIRS. The antibiotic regimen utilized and its modifications were reported. The preoperative culture was positive in 26 patients (32.9 %). The culture of stone fragments showed significant bacterial growth in 23 (29.1 %) cases. Significant growth on stone culture was significantly associated with the presence of preoperative urinary catheters and positive preoperative urine culture (P = 0.001, 0.006 respectively). Postoperative culture was positive in only six patients (7.6 %). SIRS was diagnosed in the first postoperative day in 12 patients (15.2 %). Leukocytosis was the only predictor of SIRS. Neither preoperative culture, stone culture nor postoperative culture was predictor of SIRS. Stone culture was positive in four patients with SIRS. Stone culture changed the treatment plan in only one patient. Our data do not support the routine implementation of stone culture in the PNL workup, as it did not indicate a change of antibiotic regimen in most of the cases. PMID:26781741

  1. Cardiac magnetic resonance imaging safety following percutaneous coronary intervention.

    PubMed

    Curtis, Jason W; Lesniak, Donna C; Wible, James H; Woodard, Pamela K

    2013-10-01

    In the first 8 weeks after percutaneous coronary intervention (PCI), possible negative interactions exist between the cardiac magnetic resonance (CMR) imaging environment and the weakly ferromagnetic material in coronary stents. There are circumstances when CMR would be indicated shortly following PCI, such as acute myocardial infarction (AMI). The purpose of this study is to demonstrate CMR safety shortly following stent PCI in AMI patients. We performed a retrospective analysis of safety data in AMI patients with recently placed coronary artery stents enrolled in a multi-center phase II trial for gadoversetamide. Patients underwent 1.5 T CMR within 16 days of PCI. Vital signs (blood pressure, heart rate, respiratory rate, and body temperature) and ECGs were taken pre-CMR, 1, 2, and 24 h post-CMR. Any major adverse cardiac event (MACE) or other serious adverse events in the first 24 h after MRI were recorded. There were 258 stents in 211 AMI patients. The mean delay to CMR following PCI was 6.5 ± 4 days, with 62 patients (29 %) receiving CMR within 3 days and 132 patients (63 %) within 1 week. Patients showed no significant vital sign changes following CMR. Ten patients (4.7 %) showed mild, transient ECG changes. Within the 24-h follow-up group, 4 patients (1.9 %) had moderate to severe events, including chest pain (1) and elevated cardiac enzymes (1), resolving in 24 h; heart failure (1) and ischemic stroke (1). There were no deaths. This study demonstrates fewer MACE in AMI patients undergoing 1.5 T CMR within 16 days of stent placement in comparison to post-stent event rate reported in the literature. This study adds to the CMR after stent PCI safety profile suggested by previous studies and is the largest and first study that uses multicenter data to assess stent safety following CMR examination.

  2. Devascularization of Head and Neck Paragangliomas by Direct Percutaneous Embolization

    SciTech Connect

    Ozyer, Umut Harman, Ali; Yildirim, Erkan; Aytekin, Cuneyt; Akay, Tankut Hakki; Boyvat, Fatih

    2010-10-15

    Preoperative transarterial embolization of head and neck paragangliomas using particulate agents has proven beneficial for decreasing intraoperative blood loss. However, the procedure is often incomplete owing to extensive vascular structure and arteriovenous shunts. We report our experience with embolization of these lesions by means of direct puncture and intratumoral injection of n-butyl cyanoacrylate (NBCA) or Onyx. Ten patients aged 32-82 years who were referred for preoperative embolization of seven carotid body tumors and three jugular paragangliomas were retrospectively analyzed. Intratumoral injections were primarily performed in four cases with multiple small-caliber arterial feeders and adjunctive to transarterial embolization in six cases with incomplete devascularization. Punctures were performed under ultrasound and injections were performed under roadmap fluoroscopic guidance. Detailed angiographies were performed before and after embolization procedures. Control angiograms showed complete or near-complete devascularization in all tumors. Three tumors with multiple small-caliber arterial feeders were treated with primary NBCA injections. One tumor necessitated transarterial embolization after primary injection of Onyx. Six tumors showed regional vascularization from the vasa vasorum or small-caliber branches of the external carotid artery following the transarterial approach. These regions were embolized with NBCA injections. No technical or clinical complications related to embolization procedures occurred. All except one of the tumors were surgically removed following embolization. In conclusion, preoperative devascularization with percutaneous direct injection of NBCA or Onyx is feasible, safe, and effective in head and neck paragangliomas with multiple small-caliber arterial feeders and in cases of incomplete devascularization following transarterial embolization.

  3. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    PubMed

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms.

  4. Nefopam Reduces Dysesthesia after Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Ok, Young Min; Cheon, Ji Hyun; Choi, Eun Ji; Chang, Eun Jung; Lee, Ho Myung

    2016-01-01

    Background Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. Methods Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. Results The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. Conclusions NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia. PMID:26839670

  5. Percutaneous stent placement in children weighing less than 10 kilograms.

    PubMed

    Ashwath, Ravi; Gruenstein, Daniel; Siwik, Ernest

    2008-05-01

    The objectives of this study were to evaluate the safety, efficacy, and outcomes of palliative percutaneous stent placement in infants with congenital heart disease (CHD). There is interest in improving outcomes of infants with CHD through interventional/surgical collaboration. Small, high-risk patients may benefit from delayed open operations, and endovascular stents may provide a means to defer surgery to more advantageous times in select infants. Patients weighing < or =10 kg in whom stent placement was attempted during 2003-2006 were identified. Diagnoses, indications, angiographic and hemodynamic data, complications, and outcomes were reviewed. Seventeen stents were successfully placed in 15 patients. The mean age was 10.21 months; the mean weight was 6.08 kg. Indications were branch pulmonary artery stenosis, coarctation, total anomalous pulmonary venous return with obstructed venous egress, right ventricle-pulmonary artery conduit, and shunt stenosis. Premounted Palmaz Genesis and Driver Mx stents were used. Average vessel diameter increased from 3.65 to 6.72 mm (p < 0.001). The pressure gradient fell from 24 to 15 mm Hg (p < 0.01). Two stents migrated. One was recaptured and implanted at the target site and one implanted away from the target site. None needed surgical intervention. Mean follow-up was 270 days. Five patients have had additional surgery; seven patients underwent 10 additional stent dilations. There was no procedural-related mortality. Five patients (33%) died during the follow-up period, none attributable to the stent placement. We conclude that stent placement can be successfully accomplished in select, small, high-risk patients. A collaborative interventional/surgical paradigm is important to ensure that the risk-benefit ratio is properly evaluated during the patient selection. PMID:18046599

  6. Interventional Optical Molecular Imaging Guidance during Percutaneous Biopsy

    PubMed Central

    Sheth, Rahul A.; Heidari, Pedram; Esfahani, Shadi A.; Wood, Bradford J.

    2014-01-01

    Purpose To investigate indocyanine green (ICG) as a molecular beacon for malignant lesions within the liver and evaluate the ability of a developed handheld imaging system to allow measurement of ICG fluorescence within focal hepatic lesions with high target-to-background ratios in a mouse model. Materials and Methods All animal experiments were approved by the institutional animal care committee. A handheld optical molecular imaging device was constructed to pass through the introducer needle of a standard percutaneous biopsy kit. An ex vivo phantom system was constructed to quantify tissue attenuation properties of ICG in liver parenchyma. Subsequently, intrahepatic colorectal cancer metastases were generated in nude mice, and epifluorescence imaging of ICG, as well as histologic analysis of the explanted livers, was performed at 3 weeks after implantation (n = 6). Epifluorescence imaging with the handheld imaging device was then performed on intrahepatic colorectal metastases after the administration of ICG (n = 15) at 3, 6, and 24 hours after injection. Target-to-background ratios were calculated for each time point. Subsequently, a core biopsy of intrahepatic colorectal metastases was performed by using a standard clinical 18-gauge biopsy needle. Results There was avid localization of ICG to the focal lesions at all time points. Similarly, fluorescence within the tumors was greater than that within normal liver, as detected with the handheld imaging system (mean target-to-background ratio ± standard deviation, 3.9 ± 0.2 at 24 hours). A core biopsy of tumor and normal adjacent liver by using a standard biopsy needle demonstrated a sharp margin of fluorescence intensity at the tumor-liver interface. Conclusion The custom-designed molecular imaging device, in combination with ICG, readily allowed differentiation between normal and malignant tissue in a murine model of intrahepatic colorectal metastasis. © RSNA, 2014 PMID:24520946

  7. A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis.

    PubMed

    Dehong, Cao; Liangren, Liu; Huawei, Liu; Qiang, Wei

    2013-11-01

    The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.

  8. Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry).

    PubMed

    Bauer, Timm; Boeder, Niklas; Nef, Holger M; Möllmann, Helge; Hochadel, Matthias; Marco, Jean; Weidinger, Franz; Zeymer, Uwe; Gitt, Anselm K; Hamm, Christian W

    2015-11-01

    Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality. PMID:26341189

  9. Fate of Patients With Coronary Perforation Complicating Percutaneous Coronary Intervention (from the Euro Heart Survey Percutaneous Coronary Intervention Registry).

    PubMed

    Bauer, Timm; Boeder, Niklas; Nef, Holger M; Möllmann, Helge; Hochadel, Matthias; Marco, Jean; Weidinger, Franz; Zeymer, Uwe; Gitt, Anselm K; Hamm, Christian W

    2015-11-01

    Coronary perforation (CP) is a life-threatening complication that can occur during percutaneous coronary intervention (PCI). Little is known, however, about the incidence and clinical outcome of CP. We sought to investigate the occurrence of CP and its determinants and risk profile in a large-scale, prospective registry. From 2005 to 2008, unselected patients (n = 42,068) from 175 centers in 33 countries who underwent a PCI procedure were prospectively enrolled in the PCI registry of the Euro Heart Survey program. For the present analysis, patients experiencing CP during PCI (n = 124, 0.3%) were compared with those who underwent PCI without CP. Patients with CP were older, more often women, had more severe coronary disease, and underwent more complex types of coronary intervention. Independent factors associated with CP were the use of rotablation, intravascular ultrasound-guided PCI, bypass PCI, a totally occluded vessel, a type C lesion, peripheral arterial disease, and body mass index <25. More than 10% of the patients developed cardiac tamponade. In a small minority (3.3%), emergency bypass surgery had to be performed. The inhospital death rate was markedly elevated in patients with CP (7.3% vs 1.5%, p <0.001). After adjustment for the EuroHeart score, CP remained a strong predictor of hospital mortality (odds ratio 5.21, 95% confidence interval 2.34 to 11.60). In conclusion, in this real world, all-comers registry, the incidence of CP was low, occurred more often in patients who underwent more complex coronary interventions, and was associated with a fivefold higher hospital mortality.

  10. (F)Utility of invasive haemodynamic measurements to guide percutaneous intervention in chronic coronary artery disease.

    PubMed

    Seiler, Christian

    2015-01-01

    Percutaneous coronary intervention (PCI) in chronic stable coronary artery disease has not been shown to reduce the incidence of myocardial infarction or death. There is, however, evidence that the outcome from PCI is dependent on the amount of myocardial ischaemia. This review provides an overview of coronary circulatory pathophysiology and focuses on fractional flow reserve from a semantical, conceptual and practical point of view.

  11. Retrograde approach for percutaneous closure in a patient with ruptured sinus of Valsalva.

    PubMed

    İlkay, Erdoğan; Çelebi, Özlem Özcan; Kaçmaz, Fehmi; Pampal, Kutluk

    2014-12-01

    In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach. PMID:25620339

  12. Percutaneous closure of atrial septal defect with situs solitus and dextrocardia.

    PubMed

    Galal, Mohammed Omar; Khan, Muhammad Arif; El-Segaier, Milad

    2015-02-01

    Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.

  13. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  14. Comparison of laparoscopic and percutaneous cryoablation of renal tumors: a cost analysis.

    PubMed

    Badwan, Khalid; Maxwell, Keegan; Venkatesh, Ramakrishna; Figenshau, Robert S; Brown, Dan; Chen, Cathy; Bhayani, Sam B

    2008-06-01

    Cryoablation of renal masses is an evolving in situ ablative technique for the management of localized renal masses and can be performed in a laparoscopic or percutaneous manner. Its usefulness is increasing and correlates with the increasing frequency of incidentally diagnosed renal lesions. At present, this technique has been applied to patients deemed to be poor surgical candidates for extirpative therapy or those with a strong desire to avoid surgery, at least until long-term data become available to fully evaluate its cancer-control effectiveness. In addition, as costs become an ever more critical factor in healthcare, the costs of various management options for clinically localized kidney cancer will become as important as clinical outcomes in deciding appropriate treatment. We compare laparoscopic and percutaneous renal cryoablation from a cost perspective. Our findings indicate that percutaneous renal cryoablation may have distinct cost advantages over its laparoscopic counterpart. It remains to be seen whether these differences will translate into an overall increase in reliance on the percutaneous approach for renal cryoablation. PMID:18578660

  15. Magnetic Resonance-Guided Percutaneous Cryoablation of Uterine Fibroids: Early Clinical Experiences

    SciTech Connect

    Sakuhara, Yusuke Shimizu, Tadashi; Kodama, Yoshihisa; Sawada, Akihiro; Endo, Hideho; Abo, Daisuke; Hasegawa, Tenshu; Miyasaka, Kazuo

    2006-08-15

    Purpose. Uterine fibroids (leiomyomas) are the most common tumors of the uterus. The present study evaluated the feasibility and effectiveness of magnetic resonance (MR)-guided percutaneous cryoablation for uterine fibroids as a minimally invasive treatment alternative. Methods. From August 2001 to June 2002, MR-guided percutaneous cryoablation was performed on seven uterine fibroids in 6 patients who displayed clinical symptoms related to tumors. Using a horizontal-type open MR system, cryoablation probes were percutaneously placed in fibroids. Fibroids were ablated, and the site and size of ice balls were monitored on MR imaging. Postoperatively, patients completed a questionnaire to assess changes in presenting clinical symptoms, and MR images were obtained for all patients at follow-up. Changes in clinical symptoms and tumor volume were evaluated in each patient. Results. All treated patients showed reductions in tumor size. Mean volume reduction rate was 40.3% at 6 weeks postoperatively, and 79.4% at 9-12 months. All patients reported fever after treatment. Surgical drainage was required for abscess in the probe channel in one patient, and transient liver damage occurred in another. Subjective symptoms improved in all patients except one who had multiple tumors, and no patient complained of new symptoms after cryoablation during follow-up. Conclusion. MR-guided percutaneous cryoablation represents a feasible and effective treatment for uterine fibroids.

  16. Percutaneous Ultrasound-Guided Thrombin Injection as First-Line Treatment of Pancreatic Pseudoaneurysm

    SciTech Connect

    McErlean, Aoife; Looby, Seamus; Lee, Michael J.

    2007-06-15

    Pancreatic pseudoaneurysms are a rare but potentially fatal complication of pancreatitis. Surgical intervention and transcatheter embolization are not always feasible therapeutic options. In this report we present a case of a pseudoaneurysm secondary to pancreatitis which, despite being angiographically invisible, was successfully embolized with a single ultrasound-guided percutaneous injection of thrombin.

  17. Subcutaneous Marcaine Infiltration and Post-Operative Pain Perception after Percutaneous Nephrolithotomy

    NASA Astrophysics Data System (ADS)

    Haleblian, George E.; Leitao, Victor A.; Robinson, Marnie R.; Pierre, Sean A.; Sur, Roger L.; Preminger, Glenn M.

    2007-04-01

    Recent studies have shown a significant decrease in patient reported pain scores when operative incisions are infiltrated with subcutaneous local anesthetic. We hypothesize that patient reported pain and narcotic use could be further decreased for patients with post-percutaneous nephrolithotomy nephrostomy tubes if the nephrostomy tract and incision are infiltrated with local anesthetic.

  18. Thermal Protection During Percutaneous Thermal Ablation Procedures: Interest of Carbon Dioxide Dissection and Temperature Monitoring

    SciTech Connect

    Buy, Xavier; Tok, Chung-Hong; Szwarc, Daniel; Bierry, Guillaume; Gangi, Afshin

    2009-05-15

    Percutaneous image-guided thermal ablation of tumor is widely used, and thermal injury to collateral structures is a known complication of this technique. To avoid thermal damage to surrounding structures, several protection techniques have been reported. We report the use of a simple and effective protective technique combining carbon dioxide dissection and thermocouple: CO{sub 2} displaces the nontarget structures, and its low thermal conductivity provides excellent insulation; insertion of a thermocouple in contact with vulnerable structures achieves continuous thermal monitoring. We performed percutaneous thermal ablation of 37 tumors in 35 patients (4 laser, 10 radiofrequency, and 23 cryoablations) with protection of adjacent vulnerable structures by using CO{sub 2} dissection combined with continuous thermal monitoring with thermocouple. Tumor locations were various (19 intra-abdominal tumors including 4 livers and 9 kidneys, 18 musculoskeletal tumors including 11 spinal tumors). CO{sub 2} volume ranged from 10 ml (epidural space) to 1500 ml (abdominal). Repeated insufflations were performed if necessary, depending on the information given by the thermocouple and imaging control. Dissection with optimal thermal protection was achieved in all cases except two patients where adherences (one postoperative, one arachnoiditis) blocked proper gaseous distribution. No complication referred to this technique was noted. This safe, cost-effective, and simple method increases the safety and the success rate of percutaneous thermal ablation procedures. It also offers the potential to increase the number of tumors that can be treated via a percutaneous approach.

  19. [Ultrasonically-guided percutaneous needle biopsy in the diagnosis of malignant abdominal diseases].

    PubMed

    Pesić, V; Lisanin, Lj; Lukac, S; Zica, D; Kupresanin, S; Spasić, V

    1998-01-01

    In 3-year period 340 percutaneous ultrasonographically guided needle biopsies of abdominal organs and tissues were performed in suspected neoprocesses. Positive cytologic results were obtained in 77.6% and histological in 74.8% of patients. These results were obtained thanks to good choice of a bioptic needle and the technique of performing percutaneous needle biopsy under ultrasonographic control and sometimes in combination with radioscopy, too. Experience of both a biopsy performer and a cytologist or histologist with this kind of material is of great importance. Thanks to early histologic diagnosis, made in this way, percutaneous biopsy is classified as a high sensitive method and as such it forces on to be one of the first methods in algorithm of diagnostic procedures. Even the aim of this paper is to point out not only the authors ultrasonographic experience but also reliability, simplicity and safety of percutaneous guided needle biopsies, what excludes the necessity for more difficult and more expensive diagnostic procedures significantly reducing the examination.

  20. Sclerotic Vertebral Metastases: Pain Palliation Using Percutaneous Image-Guided Cryoablation

    SciTech Connect

    Costa de Freitas, Ricardo Miguel Menezes, Marcos Roberto de; Cerri, Giovanni Guido; Gangi, Afshin

    2011-02-15

    Cryoablative therapies have been proposed to palliate pain from soft-tissue or osteolytic bone tumors. A case of a patient with painful thoracic and sacral spine sclerotic metastases successfully treated by image-guided percutaneous cryoablation with the aid of insulation techniques and thermosensors is reported in this case report.