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Sample records for percutaneous transgastric computed

  1. 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

  2. Percutaneous Transgastric Snaring for Repositioning of a Dislocated Internal Drain from a Pancreatic Pseudocyst

    SciTech Connect

    Mahnken, Andreas H. Guenther, Rolf W.; Winograd, Ron

    2008-07-15

    Pancreatic pseudocysts may occur in up to 10% of patients with acute or chronic pancreatitis. Symptomatic, persistent, and infected pancreatic pseudocysts require interventional therapy. We present the case of a patient with complete dislocation of a double pigtail catheter into an infected pseudocyst and the repositioning of the drainage catheter using a transgastric snaring technique. The combination of CT-guided percutaneous puncture and fluoroscopic snaring permitted minimally invasive management of this rare complication.

  3. 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. PMID:27785325

  4. Transgastric long tube placement following percutaneous endoscopic gastrostomy for severe chronic intestinal pseudo-obstruction related to systemic sclerosis.

    PubMed

    Nunokawa, Takahiro; Yokogawa, Naoto; Ohtsuka, Hideo; Shimada, Kota; Sugii, Shoji

    2015-01-01

    Medical management of systemic sclerosis (SSc)-associated chronic intestinal pseudo- obstruction (CIPO) has often proved inadequate. Percutaneous endoscopic colostomy (PEC) has been proposed as a method of treatment, but it is associated with a relatively high incidence of serious complications. We report herein a very severe case of SSc-associated CIPO in which complications were successfully controlled by long tube placement via a gastrostomy. Transgastric long tube placement may offer a relatively safe alternative to PEC in treating severe SSc-associated CIPO.

  5. Percutaneous transgastric traction-assisted esophageal endoscopic submucosal dissection: a randomized controlled trial in a porcine model.

    PubMed

    Chen, Peng-Jen; Huang, Wen-Chien; Wang, Hsiu-Po; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Shih, Shou-Chuan; Wang, Horng-Yuan; Liu, Chia-Yuan

    2012-11-01

    Endoscopic submucosal dissection (ESD) is a technically difficult, hazardous, and time-consuming treatment option for superficial neoplasms of the esophagus. The aim of this pilot study was to determine the effectiveness and safety of percutaneous transgastric traction (PTT)-assisted ESD, a method that overcomes the drawbacks of conventional ESD, in a porcine model. Six domestic pigs (25-30 kg) were used in the study. In each animal, two 5-cm-long esophageal areas were assigned randomly for resection by conventional ESD or PTT-assisted ESD. The PTT method was designed to offer esophageal mucosal traction directed toward the stomach. The wire was introduced into the stomach through a percutaneous transgastric cannula and was fixed on the resected esophageal mucosa. Submucosal dissection in the traction group required only half the time of that in the non-traction group (mean dissection time 596.0 vs. 1127.3 s, respectively; p = 0.01). At necropsy, no differences in the incidence of perforation or bleeding were found between two groups. The PTT method can enhance the speed of submucosal dissection for esophageal ESD to completely remove large areas of resected mucosa.

  6. Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis.

    PubMed

    Tyng, Chiang J; Almeida, Maria Fernanda A; Barbosa, Paula N V; Bitencourt, Almir G V; Berg, José Augusto A G; Maciel, Macello S; Coimbra, Felipe J F; Schiavon, Luiz Henrique O; Begnami, Maria Dirlei; Guimarães, Marcos D; Zurstrassen, Charles E; Chojniak, Rubens

    2015-03-28

    To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions. CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant. CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally invasive diagnosis.

  7. Computed tomography-guided percutaneous core needle biopsy in pancreatic tumor diagnosis

    PubMed Central

    Tyng, Chiang J; Almeida, Maria Fernanda A; Barbosa, Paula NV; Bitencourt, Almir GV; Berg, José Augusto AG; Maciel, Macello S; Coimbra, Felipe JF; Schiavon, Luiz Henrique O; Begnami, Maria Dirlei; Guimarães, Marcos D; Zurstrassen, Charles E; Chojniak, Rubens

    2015-01-01

    AIM: To evaluate the techniques, results, and complications related to computed tomography (CT)-guided percutaneous core needle biopsies of solid pancreatic lesions. METHODS: CT-guided percutaneous biopsies of solid pancreatic lesions performed at a cancer reference center between January 2012 and September 2013 were retrospectively analyzed. Biopsy material was collected with a 16-20 G Tru-Core needle (10-15 cm; Angiotech, Vancouver, CA) using a coaxial system and automatic biopsy gun. When direct access to the lesion was not possible, indirect (transgastric or transhepatic) access or hydrodissection and/or pneumodissection maneuvers were used. Characteristics of the patients, lesions, procedures, and histologic results were recorded using a standardized form. RESULTS: A total of 103 procedures included in the study were performed on patients with a mean age of 64.8 year (range: 39-94 year). The mean size of the pancreatic lesions was 45.5 mm (range: 15-195 mm). Most (75/103, 72.8%) procedures were performed via direct access, though hydrodissection and/or pneumodissection were used in 22.2% (23/103) of cases and indirect transhepatic or transgastric access was used in 4.8% (5/103) of cases. Histologic analysis was performed on all biopsies, and diagnoses were conclusive in 98.1% (101/103) of cases, confirming 3.9% (4/103) of tumors were benign and 94.2% (97/103) were malignant; results were atypical in 1.9% (2/103) of cases, requiring a repeat biopsy to diagnose a neuroendocrine tumor, and surgical resection to confirm a primary adenocarcinoma. Only mild/moderate complications were observed in 9/103 patients (8.7%), and they were more commonly associated with biopsies of lesions located in the head/uncinate process (n = 8), than of those located in the body/tail (n = 1) of the pancreas, but this difference was not significant. CONCLUSION: CT-guided biopsy of a pancreatic lesion is a safe procedure with a high success rate, and is an excellent option for minimally

  8. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass.

    PubMed

    Peters, M; Papasavas, P K; Caushaj, P F; Kania, R J; Gagné, D J

    2002-07-01

    Access to the gastric remnant and duodenum is lost after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Traditionally, a percutaneous transhepatic access to the common bile duct has been used to manage choledocholithiasis and duct strictures. We present a novel method of laparoscopic transgastric endoscopic retrograde cholangiopancreatography for managing a benign biliary stricture after a Roux-en-Y gastric bypass.

  9. Laparoscopic Gastroscopic Transgastric Cystogastrostomy and Cholecystectomy for Pseudopancreatic Cyst after Gallstone Pancreatitis in Children

    PubMed Central

    Slater, Bethany J.; Pimpalwar, Ashwin

    2013-01-01

    A 15-year-old girl presented with gallstone pancreatitis. Subsequently, a pseudopancreatic cyst developed that was diagnosed on computed tomographic scan. She underwent a laparoscopic and gastroscopic transgastric cystogastrostomy. In the following report, we describe our novel approach and technique for the above condition. PMID:25755959

  10. Laparoscopic gastroscopic transgastric cystogastrostomy and cholecystectomy for pseudopancreatic cyst after gallstone pancreatitis in children.

    PubMed

    Slater, Bethany J; Pimpalwar, Ashwin

    2014-06-01

    A 15-year-old girl presented with gallstone pancreatitis. Subsequently, a pseudopancreatic cyst developed that was diagnosed on computed tomographic scan. She underwent a laparoscopic and gastroscopic transgastric cystogastrostomy. In the following report, we describe our novel approach and technique for the above condition.

  11. An Assessment of Radiologically Inserted Transoral and Transgastric Gastroduodenal Stents to Treat Malignant Gastric Outlet Obstruction

    SciTech Connect

    Miller, Bethany H. T.; Griffiths, Ewen A.; Pursnani, Kishore G. Ward, Jeremy B.; Stockwell, Robert C.

    2013-12-15

    IntroductionSelf-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist. Methods: Patients were identified from a prospectively collected database held by one consultant radiologist. Data were retrieved from radiological reports, multidisciplinary team meetings, and the patients' case notes. Univariate survival analysis was performed. Results: Between December 2000 and January 2011, 100 patients (63 males, 37 females) had 110 gastroduodenal stenting procedures. Median age was 73 (range 39-89) years. SEMS were inserted transorally (n = 66) or transgastrically (n = 44). Site of obstruction was the stomach (n = 37), duodenum (n = 50), gastric pull-up (n = 10), or gastroenterostomy (n = 13). Seven patients required biliary stents. Technical success was 86.4 %: 83.3 % for transoral insertion, 90.9 % for transgastric insertion. Eleven patients developed complications. Median GOO severity score: 1 pre-stenting, 2 post-stenting (p = 0.0001). Median survival was 54 (range 1-624) days. Post-stenting GOO severity score was predictive of survival (p = 0.0001). Conclusions: The technical success rate for insertion of palliative SEMS is high. Insertional technique can be tailored to the individual depending on the location of the tumor and whether it is possible to access the stomach percutaneously. Patients who have successful stenting and return to eating a soft/normal diet have a statistically significant increase in survival.

  12. Multimedia article. The fear of transgastric cholecystectomy: misinterpretation of the biliary anatomy.

    PubMed

    Perretta, Silvana; Dallemagne, Bernard; Donatelli, Gianfranco; Mutter, Didier; Marescaux, Jacques

    2011-02-01

    Prevention of injury during cholecystectomy relies on accurate dissection of the cystic duct and artery and avoidance of major biliary and vascular structures. The advent of natural orifice translumenal surgery (NOTES) has led to a new look into the biliary anatomy, especially Calot's triangle. Here we show the clinical case of a NOTES transgastric cholecystectomy for uncomplicated cholelithiasis, in which misinterpretation of the biliary anatomy occurred. A 5-mm port was introduced at the umbilicus to ascertain the feasibility of transgastric cholecystectomy and to ensure safe gastrotomy creation and closure. Transgastric access was obtained using a percutaneous endoscopic gastrostomy (PEG)-like technique on the anterior mid body of the stomach to pass a 12-mm gastroscope (Karl Storz, Tuttlingen, Germany). The laparoscope was switched to a grasper for gallbladder retraction. Dissection was started close to the gallbladder using the endoscope at the junction between the infundibulum and what was thought to be the cystic duct. During dissection, the size and the orientation of the cystic duct appeared to be unclear. The decision was made to switch to a laparoscopic view to reorient the dissection plane and clarify the anatomy. At laparoscopy, dissection of the triangle of Calot, although started close to the gallbladder, appeared far too low. The common bile duct had been mistaken for the cystic duct. Once the biliary anatomy was clarified, the vision was switched back to the endoscope, but an additional 2-mm grasper was introduced to improve exposure while cholecystectomy was performed in a standard fashion. Specific anatomic distortions due to NOTES technique together with the lack of exposure provided by current methods of retraction tend to distort Calot's triangle by flattening it rather than opening it out. At this stage, whenever the anatomy of the biliary tract is unclear, a temporary "conversion" to a laparoscopic view, more familiar to the surgeon's eye

  13. Mobile augmented reality for computer-assisted percutaneous nephrolithotomy.

    PubMed

    Müller, Michael; Rassweiler, Marie-Claire; Klein, Jan; Seitel, Alexander; Gondan, Matthias; Baumhauer, Matthias; Teber, Dogu; Rassweiler, Jens J; Meinzer, Hans-Peter; Maier-Hein, Lena

    2013-07-01

    Percutaneous nephrolithotomy (PCNL) plays an integral role in treatment of renal stones. Creating percutaneous renal access is the most important and challenging step in the procedure. To facilitate this step, we evaluated our novel mobile augmented reality (AR) system for its feasibility of use for PCNL. A tablet computer, such as an iPad[Formula: see text], is positioned above the patient with its camera pointing toward the field of intervention. The images of the tablet camera are registered with the CT image by means of fiducial markers. Structures of interest can be superimposed semi-transparently on the video images. We present a systematic evaluation by means of a phantom study. An urological trainee and two experts conducted 53 punctures on kidney phantoms. The trainee performed best with the proposed AR system in terms of puncturing time (mean: 99 s), whereas the experts performed best with fluoroscopy (mean: 59 s). iPad assistance lowered radiation exposure by a factor of 3 for the inexperienced physician and by a factor of 1.8 for the experts in comparison with fluoroscopy usage. We achieve a mean visualization accuracy of 2.5 mm. The proposed tablet computer-based AR system has proven helpful in assisting percutaneous interventions such as PCNL and shows benefits compared to other state-of-the-art assistance systems. A drawback of the system in its current state is the lack of depth information. Despite that, the simple integration into the clinical workflow highlights the potential impact of this approach to such interventions.

  14. [Transesophageal paracoronal transgastric imaging. Use and indications in pediatric cardiology].

    PubMed

    Pinto, C A; Horowitz, E S; Rigby, M

    1995-05-01

    To evaluate the contribution and comparative value of paracoronal transgastric view compared with conventional transesophageal examination for morpho-functional assessment of different types of congenital heart disease in a pediatric group. Fifteen patients with clinical and echocardiographic diagnosis of congenital heart disease were selected for single plane transesophageal examination. After routine evaluation, the probe was positioned to obtain a paracoronal transgastric view, and images that result from this technique were recorded and compared with those obtained in the conventional way. Eleven procedures were carried out in the cathlab and four in pediatric intensive care unit, under general anesthesia or heavy sedation. The age and weight were 32.0 months and 11.6 kg respectively. No adverse reactions were observed with this method. In comparison with conventional transesophageal study, the paracoronal transgastric view permitted better morpho-functional assessment of the outlets of the right and left ventricles, as well as additional informations about the left pulmonary artery. Morphological and hemodynamic informations obtained from paracoronal transgastric view is a safe method which can be used either as an alternative or a complement to conventional examination to assess the outlets of both ventricles, as well as to evaluate the subvalvar, valvar and supravalvar region in different types of congenital heart disease.

  15. 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.

  16. Transgastric cholecystectomy: From the laboratory to clinical implementation

    PubMed Central

    Dallemagne, Bernard; Perretta, Silvana; Allemann, Pierre; Donatelli, Gianfranco; Asakuma, Mitsuhiro; Mutter, Didier; Marescaux, Jacques

    2010-01-01

    After the first report by Kalloo et al on transgastric peritoneoscopy in pigs, it rapidly became apparent that there was no room for an under-evaluated concept and blind adoption of an appealing (r)evolution in minimal access surgery. Systematic experimental work became mandatory before any translation to the clinical setting. Choice and management of the access site, techniques of dissection, exposure, retraction and tissue approximation-sealing were the basics that needed to be evaluated before considering any surgical procedure or study of the relevance of natural orifice transluminal endoscopic surgery (NOTES). After several years of testing in experimental labs, the revolutionary concept of NOTES, is now progressively being experimented on in clinical settings. In this paper the authors analyse the challenges, limitations and solutions to assess how to move from the lab to clinical implementation of transgastric endoscopic cholecystectomy. PMID:21160872

  17. Comparison of Inflammatory Response to Transgastric and Transcolonic NOTES

    PubMed Central

    Hucl, Tomas; Benes, Marek; Kocik, Matej; Splichalova, Alla; Maluskova, Jana; Krak, Martin; Lanska, Vera; Heczkova, Marie; Kieslichova, Eva; Oliverius, Martin; Spicak, Julius

    2016-01-01

    Aims. The aim of our study was to determine the physiologic impact of NOTES and to compare the transgastric and transcolonic approaches. Methods. Thirty pigs were randomized to transgastric, transcolonic, or laparoscopic peritoneoscopy. Blood was drawn and analyzed for C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin- (IL-) 1β, IL-6, WBCs, and platelets. Results. Endoscopic closure with an OTSC was successful in all 20 animals. The postoperative course was uneventful in all animals. CRP values rose on day 1 in all animals and slowly declined to baseline levels on day 14 with no differences between the groups (P > 0.05, NS). The levels of TNF-α were significantly increased in the transcolonic group (P < 0.01); however this difference was already present prior to the procedure and remained unchanged. No differences were observed in IL1-β and IL-6 values. There was a temporary rise of WBC on day 1 and of platelets on day 7 in all groups (P > 0.05, NS). Conclusions. Transgastric, transcolonic, and laparoscopic peritoneoscopy resulted in similar changes in systemic inflammatory markers. Our findings do not support the assumption that NOTES is less invasive than laparoscopy. PMID:27403157

  18. Percutaneous vertebroplasty guided by preoperative computed tomography measurements

    PubMed Central

    Tan, Zhongbao; Di, Zhenhai; Mao, Xuequn; Zhang, Jian; Zou, Rong; Wang, Qingqing

    2016-01-01

    Background: Percutaneous vertebroplasty (PVP) is now widely performed to treat painful vertebral compression fractures. Previous researches have reported numerous advantages. However, it rarely reported that how to determine the feasibility of the unilateral or bilateral approach and how to decide the puncture angle, the skin insertion site before the procedure. The aim of this study was to discuss the feasibility of PVP using unilateral pedicular approach by the three-dimensional positioning of computed tomography (CT) image. Materials and Methods: Under fluoroscopic guidance, 108 patients with 115 diseased vertebral bodies underwent PVP. The study was divided in two groups. Group A, fifty patients with 52 vertebrae received PVP without using preoperative CT measurements and puncture simulation. Group B, 58 patients with 63 vertebrae received PVP using preoperative CT measurements and puncture simulation. The skin needle entry point and puncture angle of the transverse plane and sagittal plane were determined by the software of PACS on preoperative CT image. The choice of unilateral or bilateral pedicular approach was decided based on the CT image before the procedure. PVP was carried out according to the measurement result above. The average time for a single vertebra operation, the success rate of single puncture and complications was evaluated and compared between Group A and Group B. Results: In Group A, technical success of unilateral PVP was 63.5% (33/52 vertebrae), and 92% (58/63 vertebrae) in Group B. The average time of operation in Groups A and B were (37.5 ± 5.5) and (28.5 ± 5.5) min, respectively. There was a significant difference in the time of single-vertebra operation and the success rates of unilateral PVP between Groups A and B. No serious complications developed during the followup period. Conclusions: The CT three-dimensional positioning measurement for PVP can increase the success rate of unilateral PVP. PMID:27904217

  19. Transgastrically placed endoscopic vacuum-assisted closure system as an addition to transgastric necrosectomy in necrotizing pancreatitis (with video).

    PubMed

    Wedemeyer, Jochen; Kubicka, Stefan; Lankisch, Tim O; Wirth, Thomas; Patecki, Margret; Hiss, Marcus; Manns, Michael P; Schneider, Andrea S

    2012-12-01

    Endoscopic transluminal débridement of infected pancreatic necrosis has been proved to be an important alternative to surgical débridement. Recently, endoscopic vacuum-assisted closure (EVAC) has been described as a new effective treatment option in upper intestinal anastomotic leaks. To test whether the EVAC can be applied to transgastrically accessible infected cavities. Single-center case study. Academic medical center. Two patients with necrotizing pancreatitis. Successful closure of leak. We successfully applied EVAC to treat transgastrically accessible necrotic cavities. Small case number. EVAC might be an important additional endoscopic treatment option for infected pancreatic necrosis, especially if established endoscopic treatment options fail. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  20. Early experience in human hybrid transgastric and transvaginal endoscopic cholecystectomy.

    PubMed

    Salinas, Gustavo; Saavedra, Lil; Agurto, Hellen; Quispe, Rosa; Ramírez, Edwin; Grande, José; Tamayo, Juan; Sánchez, Victoria; Málaga, Daniel; Marks, Jeffrey M

    2010-05-01

    Abdominal procedures have been performed for a long time through the anterior abdominal wall. Since the first reports in the 1980s, laparoscopy has become the standard for cholecystectomy, with many advantages over open procedures. Now a natural-orifice approach to the peritoneal cavity may further reduce the invasiveness of surgery by either diminishing or avoiding abdominal incisions. Several orifice routes to the abdominal cavity have been described: transgastric, transvaginal, transvesical, and transcolonic. Although most experiences with the porcine model showed the possibility of these approaches, few surgeons reported experiences with humans. The authors present their complete early experience with transgastric (TG) and transvaginal (TV) cholecystectomies in human beings. Thirty-nine patients (4 males and 35 females) underwent hybrid NOTES procedures from January 2007 to January 2009. The mean age was 46 years (range = 19-83). The body mass index ranged from 20 to 41 and ASA was I-II. Transgastric (TG) cholecystectomy was performed in 27 patients and 12 patients had a transvaginal (TV) cholecystectomy. The mean operative time was 140 min. Although operative times were slightly shorter in the TG group 005B137 +/- 34.6 min (range = 75-195)] compared to the TV route [147 +/- 31.5 min (range = 95-220)], there were no significant differences between the two groups (p = 0.5, Mann-Whitney U test). Patients were started on liquids within 1 h and discharged 2 h later, except the last 11 TG patients, who went home 24 h later because of enrollment in a separate protocol. An overall 20% morbidity rate and no mortality were found. The complication rates for the TG and TV groups were 18% (5/27) and 25% (3/12), respectively, which was not statistically significant (p = 0.6, chi(2) test). Seventy-five percent of complications (6/8) occurred the first year and 25% (2/8) during the second year of our experience. Transgastric and transvaginal cholecystectomies are feasible

  1. Percutaneous Transthoracic Computed Tomography-Guided AICD Insertion in a Patient with Extracardiac Fontan Conduit

    SciTech Connect

    Murphy, Darra T. Moynagh, Michael R.; Walsh, Kevin P.; Noelke, Lars; Murray, John G.

    2011-02-15

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  2. Endoscopic transgastric debridement and drainage for splenic necrosis following an acute episode in chronic alcoholic pancreatitis.

    PubMed

    Binek, J; Fretz, C; Meyenberger, C

    2006-06-01

    Management of the complications and sequelae of acute and chronic pancreatitis is a clinical challenge. We report a case of successful transgastric drainage of splenic necrosis after occlusion of the splenic vessels during an acute episode in chronic pancreatitis.

  3. Percutaneous computed tomography-guided aspiration and biopsy of intrathoracic lesions: Results of 265 procedures

    PubMed Central

    Neyaz, Zafar; Lal, Hira; Thakral, Anuj; Nath, Alok; Rao, Ram Naval; Verma, Ritu

    2016-01-01

    Context: Percutaneous computed tomography (CT)-guided needle aspiration and biopsy technique have developed over time as a method for obtaining tissue specimen. Although this is a minimally invasive procedure, complications do occasionally occur. Aims: The aim of the study was to evaluate the diagnostic yield and complications of 265 percutaneous CT-guided aspiration and biopsy procedures performed on various intrathoracic lesions. Settings and Design: Data of percutaneous CT-guided aspiration and biopsy procedures of intrathoracic lesions performed over a 4 year period were retrospectively analyzed. Subjects and Methods: Procedure details, radiological images, and pathological and microbiological reports were retrieved from radiology records and hospital information system. Technical success, diagnostic yield, and complication rates were calculated. Results: Total 265 procedures were performed for lung (n = 179), mediastinum (n = 73), and pleural lesions (n = 13). Diagnostic yield for lung, mediastinal, and pleural lesions was 80.7%, 74.2, and 75%, respectively, for core biopsy specimens. Major complication was noted in only one procedure (0.4%). Minor complications were noted in 13.6% procedures which could be managed conservatively. Conclusions: Percutaneous CT-guided aspiration and biopsy procedures for intrathoracic lesions are reasonably safe with good diagnostic yield. Complications are infrequent and conservatively managed in most of the cases. PMID:27890990

  4. Multiple large splenic abscesses managed with computed tomography-guided percutaneous catheter drainage in children.

    PubMed

    Yeom, Jung Sook; Park, Ji Sook; Seo, Ji-Hyun; Park, Eun Sil; Lim, Jae-Young; Park, Chan Hoo; Woo, Hyang Ok; Park, Jung Je; Cho, Jae Min; Youn, Hee-Shang

    2013-12-01

    Splenic abscess is a rare finding in children. Splenectomy combined with broad-spectrum antibiotics has been the treatment of choice for multiple splenic abscesses. Herein, we report the case of a 14-year-old girl with multiple large splenic abscesses that were successfully managed after two image-guided percutaneous drainage procedures and administration of intravenous antibiotics. Initially, an abscess located at the periphery in the lower pole of the spleen was aspirated under ultrasound guidance. Finally, another abscess located near the hilum of the spleen was drained under computed tomography guidance. To the best of our knowledge, this is the first report of multiple large splenic abscesses treated with computed tomography-guided percutaneous drainage.

  5. Percutaneous Computed Tomography-Guided Thermal Ablation of Pulmonary Osteosarcoma Metastases in Children.

    PubMed

    Yevich, Steven; Gaspar, Natalie; Tselikas, Lambros; Brugières, Laurence; Pacquement, Hélène; Schleiermacher, Gudren; Tabone, Marie-Dominique; Pearson, Ernesto; Canale, Sandra; Muret, Jane; de Baere, Thierry; Deschamps, Frederic

    2016-04-01

    The role of percutaneous thermal ablation as a minimally-invasive treatment has not been evaluated in children under 18 years of age with pulmonary osteosarcoma metastases. This was a retrospective review of children treated with percutaneous thermal ablation for pulmonary osteosarcoma metastasis after prior surgical metastasectomy and chemotherapy. Selection criteria included number of pulmonary nodules <5 and nodule size smaller than 2 cm. Indications were discussed at multidisciplinary meetings. The goal was to achieve complete remission using percutaneous thermal ablation, thereby avoiding additional thoracotomies. A total of 26 pulmonary nodules (mean size 6.7 mm, range 2-16 mm) were successfully treated by percutaneous computed tomography (CT)-guided thermal ablation in 11 children with osteosarcoma between the ages of 7 and 17 years (median 12.5). Patients denied post-procedure pain. Complications were limited to three pneumothoraxes (two minor, one major), and median hospitalization duration was 2.0 days. One patient died of rapidly progressive lumbar metastasis discovered 20 days post-ablation. Of the remaining 10 patients, local control at the ablation site was achieved, with median follow up of 16.7 months (range 4.1-41.8). Five patients remained in complete remission after median follow-up of 37.5 months, and five patients developed new metastases (one osseous, four pulmonary), of which two are in remission after subsequent treatment. Percutaneous thermal ablation is a safe and effective minimally-invasive curative local treatment alternative for children with oligometastatic pulmonary osteosarcoma in whom surgical intervention is clinically contraindicated or unappealing.

  6. Predicting calyceal access for percutaneous nephrolithotomy with computed tomography multiplanar reconstruction.

    PubMed

    Guglielmetti, Giuliano B; Danilovic, Alexandre; Torricelli, Fabio C M; Coelho, Rafael F; Mazzucchi, Eduardo; Srougi, Miguel

    2013-06-01

    Objective parameters in computed tomography (CT) scans that could predict calyceal access during percutaneous nephrolithotomy have not been evaluated. These parameters could improve access planning for percutaneous nephrolithotomy. We aimed to determine which parameters extracted from a preoperative multiplanar reconstructed CT could predict renal calyceal access during a percutaneous nephrolithotomy. From January 2009 through April 2011, 230 patients underwent 284 percutaneous nephrolithotomies at our institution. Sixteen patients presented with complete staghorn calculi, and 11 patients (13 renal units) were analyzed. Five parameters were extracted from a preoperative reconstructed CT and compared with the surgical results of percutaneous nephrolithotomy. Fifty-eight calyces were studied, with an average of 4.4 calyces per procedure. A rigid nephroscope was used to access a particular calyx, and a univariate analysis showed that the entrance calyx had a smaller length (2.7 vs. 3.98 cm, p=0.018). The particular calyx to be accessed should have a smaller length (2.22 vs. 3.19 cm, p=0.012), larger angles (117.6 vs. 67.96, p<0.001) and larger infundibula (0.86 vs. 0.61 cm, p=0.002). In the multivariate analysis, the only independent predictive factor for accessing a particular calyx was the angle between the entrance calyx and the calyx to be reached (OR 1.15, 95% confidence interval [CI], 1.053-1.256, p=0.002). The angle between calyces obtained by multiplanar CT reconstruction is the only predictor of calyx access.

  7. Right adrenal gland prospective evaluation through transgastric endoscopic ultrasound: an alternative approach

    PubMed Central

    Figueiredo, Pedro C.; Pinto-Marques, Pedro; Almeida, Ines; Gomes, Pedro C.; Serra, David

    2016-01-01

    Background and aims: Endoscopic ultrasound (EUS) guided right adrenal gland (RAG) evaluation is frequently unsuccessful and, when feasible, requires a cumbersome maneuver through the duodenum. In our experience, the use of a recent ultrasound platform has enabled transgastric detection of the RAG with a simple maneuver. The aim of this study was to determine the RAG transgastric EUS detection rate and identify predictive factors for failure. Methods: Consecutive patients referred to EUS in a single center were prospectively included over a 6-month period. Success was defined as RAG transgastric EUS detection within 180 seconds. Logistic regression analysis was used to assess factors associated with failure. Results: Among 100 patients, the success rate for RAG transgastric EUS detection was 75 %, with a median maneuver duration of 45 seconds [interquartile range, 25 – 70 seconds]. Two incidental RAG lesions were detected. Of possible demographic and anthropometric predictive factors for failure, only age (OR 1.04; P = 0.04) was statistically significant on multivariate analysis. Conclusions: The transgastric EUS approach for RAG detection is simple, fast and effective. PMID:27853745

  8. Characterization of Force and Torque Interactions during a Simulated Transgastric Appendectomy Procedure

    PubMed Central

    Dargar, Saurabh; Brino, Cecilia; Matthes, Kai; Sankaranarayanan, Ganesh; De, Suvranu

    2015-01-01

    We have developed an instrumented endoscope grip handle equipped with a 6-axis load cell and measured forces and torques during a simulated transgastric NOTES appendectomy procedure performed in an EASIE-R© ex vivo simulator. The data were collected from 10 participating surgeons of varying degrees of expertise which was analyzed to compute a set of 6 force and torque parameters for each coordinate axis for each of the nine tasks of the appendectomy procedure. The mean push/pull force was found to be 3.64 N (σ=3.54 N) in the push direction and the mean torque was 3.3 N-mm (σ=38.6 N-mm) in the counter-clockwise direction about the push/pull axis. Most interestingly, the force and torque data about the non-dominant×and z axes showed a statistically significant difference (p<0.05) between the expert and novice groups for five of the nine tasks. This data may be useful in developing surgical platforms especially new haptic devices and simulation systems for emerging natural orifice procedures. PMID:25398173

  9. Coronal Acetabular Fractures: The Anterior Approach in Computed Tomography-Navigated Minimally Invasive Percutaneous Fixation

    SciTech Connect

    Jacob, Augustinus Ludwig; Suhm, Norbert; Kaim, Achim; Regazzoni, Pietro; Steinbrich, Wolfgang; Messmer, Peter

    2000-09-15

    Purpose: To demonstrate the technical feasibility of the anterior approach to the coronal roof component of carefully selected acetabular fractures in computed tomography (CT)-navigated closed reduction and percutaneous fixation (CRPF).Methods: Four patients with nondisplaced or slightly displaced coronal fractures of the acetabular roof were treated with percutaneous screw fixation. Screws were implanted over guidepins placed under CT navigation. Mean clinical and radiological follow-up was 16 months.Results: All screws could be placed as intended. There were no peri- or postoperative complications. Radiological follow-up showed primary osseous union. Clinical results were excellent according to a median Merle-d'Aubigne score of 18.Conclusion: Nondisplaced or slightly displaced coronally oriented fractures of the acetabular roof can be treated by minimally invasive percutaneous CT-navigated fixation through an anterior approach that does not endanger the sciatic nerve. Early clinical results are encouraging. Close cooperation between trauma surgeons and radiologists and careful selection of cases is mandatory.

  10. Results from percutaneous drainage of Hinchey stage II diverticulitis guided by computed tomography scan.

    PubMed

    Durmishi, Y; Gervaz, P; Brandt, D; Bucher, P; Platon, A; Morel, P; Poletti, P A

    2006-07-01

    Percutaneous abscess drainage guided by computed tomography scan is considered the initial step in the management of patients presenting with Hinchey II diverticulitis. The rationale behind this approach is to manage the septic complication conservatively and to follow this later using elective sigmoidectomy with primary anastomosis. The clinical outcomes for Hinchey II patients who underwent percutaneous abscess drainage in our institution were reviewed. Drainage was considered a failure when signs of continuing sepsis developed, abscess or fistula recurred within 4 weeks of drainage, and emergency surgical resection with or without a colostomy had to be performed. A total of 34 patients (17 men and 17 women; median age, 71 years; range, 34-90 years) were considered for analysis. The median abscess size was 6 cm (range, 3-18 cm), and the median duration of drainage was 8 days (range, 1-18 days). Drainage was considered successful for 23 patients (67%). The causes of failure for the remaining 11 patients included continuing sepsis (n = 5), abscess recurrence (n = 5), and fistula formation (n = 1). Ten patients who failed percutaneous abscess drainage underwent an emergency Hartmann procedure, with a median delay of 14 days (range, 1-65 days) between drainage and surgery. Three patients in this group (33%) died in the immediate postoperative period. Among the 23 patients successfully drained, 12 underwent elective sigmoid resection with a primary anastomosis. The median delay between drainage and surgery was 101 days (range, 40-420 days). In this group, there were no anastomotic leaks and no mortality. Drainage of Hinchey II diverticulitis guided by computed scan was successful in two-thirds of the cases, and 35% of the patients eventually underwent a safe elective sigmoid resection with primary anastomosis. By contrast, failure of percutaneous abscess drainage to control sepsis is associated with a high mortality rate when an emergency resection is performed. The

  11. Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans.

    PubMed

    Narula, Vimal K; Happel, Lynn C; Volt, Kevin; Bergman, Simon; Roland, Jason C; Dettorre, Rebecca; Renton, David B; Reavis, Kevin M; Needleman, Bradley J; Mikami, Dean J; Ellison, E Christopher; Melvin, W Scott; Hazey, Jeffrey W

    2009-06-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a rapidly evolving field that provides endoscopic access to the peritoneum via a natural orifice. One important requirement of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in ten patients who underwent diagnostic transgastric endoscopic peritoneoscopy. Patients participating in this trial were scheduled to undergo diagnostic laparoscopy for evaluation of presumed pancreatic cancer. Findings at diagnostic laparoscopy were compared with those of diagnostic transgastric endoscopic peritoneoscopy, using an orally placed gastroscope, blinding the endoscopist to the laparoscopic findings. We performed no gastric decontamination. Diagnostic findings, operative times, and clinical course were recorded. Gastroscope and peritoneal fluid aspirates were obtained prior to and after the gastrotomy. Each sample was sent for bacterial colony counts, culture, and identification of species. Ten patients, with an average age of 63.7 years, have completed the protocol. All patients underwent diagnostic laparoscopy followed by successful transgastric access and diagnostic peritoneoscopy. The average time for laparoscopy was 7.2 min, compared with 18 min for transgastric instrumentation. Bacterial sampling was obtained in all ten patients. The average number of colony-forming units (CFU) in the gastroscope aspirate was 132.1 CFU/ml, peritoneal aspirates prior to creation of a gastrotomy showed 160.4 CFU/ml, and peritoneal sampling after gastrotomy had an average of 642.1 CFU/ml. There was no contamination of the peritoneal cavity with species isolated from the gastroscope aspirate. No infectious complications or leaks were noted at 30-day follow-up. There was no clinically significant contamination of the peritoneal cavity from the gastroscope after transgastric endoscopic instrumentation in humans

  12. Treatment of abdominal abscesses: comparative evaluation of operative drainage versus percutaneous catheter drainage guided by computed tomography or ultrasound.

    PubMed Central

    Johnson, W C; Gerzof, S G; Robbins, A H; Nabseth, D C

    1981-01-01

    Computed tomography and, to a lesser extent, ultrasonography provide detailed anatomic localization of intra-abdominal abscesses that permit precise percutaneous placement of catheters large enough to effect drainage. Using routes similar to surgical approaches, the authors have used this technique as definitive therapy for intra-abdominal abscesses. To assess its efficacy, the results in the 27 patients treated percutaneously over the last five years have been compared with the results in the 43 patients treated by operative intervention over the past ten years. In the percutaneous group, complications (4%), inadequate drainage (11%), and duration of drainage (17 days) were less than in the operative group (16%, 21% and 29 days respectively). These results indicate that percutaneous drainage is at least as efficacious as operative drainage and avoids the risks of a major operative procedure. Images Fig. 2. Fig. 4. PMID:7283510

  13. Transhepatic Approach for Percutaneous Computed-Tomography-Guided Radiofrequency Ablation of Renal Cell Carcinoma

    SciTech Connect

    Iguchi, Toshihiro Hiraki, Takao; Gobara, Hideo; Mukai, Takashi; Hase, Soichiro; Fujiwara, Hiroyasu; Tajiri, Nobuhisa; Sakurai, Jun; Mimura, Hidefumi; Saika, Takashi; Kumon, Hiromi; Kanazawa, Susumu

    2007-07-15

    We performed percutaneously radiofrequency (RF) ablation of 5 renal cell carcinomas (mean diameter 26 {+-} 15 mm) with computed-tomography (CT) fluoroscopic guidance using the transhepatic route. The RF electrode was successfully advanced into all tumors. RF ablation caused one minor complication (small asymptomatic perirenal hematoma); no major complications occurred. The follow-up contrast-enhanced CT images showed no local tumor progression of any tumors in a median period of 10 months (range 3-14 months). In conclusion, it seems that this transhepatic approach is safe and can be an alternative method for electrode insertion during RF ablation of selected renal tumors.

  14. Evaluation of endoscopy in localizing transgastric access for natural orifice transluminal endoscopic surgery in humans.

    PubMed

    Linke, Georg R; Zerz, Andreas; Kapitza, Florian; Warschkow, Rene; Lange, Jochen; Meyenberger, Christa M; Binek, Janek

    2010-05-01

    To date, transgastric access in humans for natural orifice transluminal endoscopic surgery (NOTES) has been poorly evaluated. To compare endoscopic visualization of the transgastric access point with the laparoscopically defined ideal entrance to the peritoneal cavity. Prospective pilot study in humans. Single tertiary-care center. This study involved 31 patients referred for laparoscopic cholecystectomy. Access points were marked by endoscopy alone, endoscopy combined with diaphanoscopy, and endoscopy after pneumoperitoneum. Points were correlated with a laparoscopically visualized, previously defined ideal access area. To choose the appropriate access point within the laparoscopically defined ideal access area to the peritoneal cavity away from major vessels and adjacent organs, by using endoscopy and to establish landmarks for the endoscopist, look for a learning curve, and identify potential problems. The percentage of access points within the laparoscopically defined ideal area was 35.5% with endoscopy alone, 13.8% using the diaphanoscopy method, and 45.2% after transcutaneous pneumoperitoneum. A safe access point (> or = 3 cm from major gastric vessels) could be achieved with the 3 techniques in 83.9%, 65.5%, and 87.1% of patients, respectively. A positive learning curve for endoscopic localization was identified before (P = .008) and after (P = .014) pneumoperitoneum. Virtual complications were greater in obese patients. This was a small pilot study with hypothetical complications and problems, because actual transgastric access was not performed. The criteria for an ideal access area were very strict. Endoscopy, especially with the use of pneumoperitoneum, can reliably locate a safe transgastric entrance point. However, the endoscopically chosen site correlates poorly with the ideal laparoscopically determined site for transgastric access. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  15. Cauda equina syndrome caused by epidural pneumorrhachis: treatment with percutaneous computed tomography-guided translaminar trephination.

    PubMed

    Paik, Nam Chull; Lim, Chun Soo; Jang, Ho Suk

    2013-04-01

    A case report and review of the literature. To present a rare case, and its treatment, of cauda equina syndrome (CES) caused by epidural pneumorrhachis after repeated caudal epidural injections. Pneumorrhachis is defined as the presence of air in the epidural or subarachnoid space. Epidural pneumorrhachis is usually asymptomatic and managed conservatively, but rare cases of lumbar radiculopathy resulting from epidural air have been reported. To the best of our knowledge, there has been no previous report of CES caused by epidural air. A 63-year-old male presented with recent aggravation of a low backache, with pain radiating to both lower limbs. He also complained of newly developed numbness in the buttocks, groins, and perineum, and difficulty with urination and defecation, after repeated caudal epidural injections during a 3-week period. Computed tomography and magnetic resonance imaging revealed epidural pneumorrhachis compressing the lumbar dural sac at the L2-L3 and L3-L4 levels. The patient's symptoms persisted despite 3 days of oxygen inhalation therapy. Attempted needle aspiration of the epidural air was unsuccessful and percutaneous computed tomography-guided translaminar trephination was performed. The day after trephination, the patient's lower extremity motor strength began to improve; sphincter dysfunction began to resolve on the second day. During 8 weeks, his pain resolved and he gradually regained sensation. Two years later, the patient was free of symptoms or signs of CES. Epidural pneumorrhachis may cause dural sac compression, thus worsening a patient's previous symptoms and possibly eliciting new problems such as CES. Conservative treatment should be the first-line approach, but surgery is often necessary when the problem remains unsolved. Percutaneous computed tomography-guided translaminar trephination may be an alternative to surgical decompression of the epidural space in selected patients.

  16. 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.

  17. Flexible transgastric endoscopic liver cyst fenestration: A feasibility study in humans (with video).

    PubMed

    Wang, Dong; Liu, Yaping; Chen, Danlei; Li, Xi; Wu, Renpei; Liu, Weifen; Leung, Joseph W; Zhang, Chuansen; Li, Zhaoshen

    2016-12-01

    There is no clinical report on the use of natural orifice transluminal endoscopic surgery (NOTES) for the management of patients with large liver cysts.This study aims to evaluate the feasibility and safety of NOTES for liver cyst fenestration in humans using a currently available technique.From February 2009 to June 2010, 4 cases of transgastric endoscopic liver cyst fenestration were performed; in which 3 cases received NOTES only, while 1 case received additional laparoscopic assistance.Mean time to endoscopically locate the liver cyst was 16 minutes (5-22 minutes). Cysts that were present in the left lobe or on the liver surface were easier to locate endoscopically. Transgastric endoscopic liver cyst fenestration was successful in all patients. The use of an occlusion balloon helped in the endoscopic clipping of the gastrotomy incision. Mean operative time was 101.3 minutes (range, 90-112 minutes), and there were no intra- or postoperative complications including infections. All patients recovered well after the surgery, with only minor postoperative throat pain. There was no recurrence at a mean follow-up of 12 months (range, 6-48 months).Small sample size.It may be technically feasible and safe to perform transgastric endoscopic liver cyst fenestration in humans with no recurrence at follow up.

  18. Intramural Dissection of the Renal Collecting System During Percutaneous Nephrostomy: Computed Tomography Findings of a Rare Complication

    SciTech Connect

    Michaelides, Michael Dimarelos, Vasileios Stratilati, Sofia Tsitouridis, Ioannis

    2011-02-15

    Intramural dissection of the renal collecting system during percutaneous nephrostomy (PCN) is a rare complication that can be challenging to diagnose. In this report, we describe the computed tomography (CT) and fluoroscopic findings of urothelial dissection during CT-guided PCN in a 65-year old patient with an obstructed congenital solitary left kidney due to an urinary bladder carcinoma. To our knowledge, CT findings of urothelial dissection have not yet been described.

  19. Percutaneous laser discectomy guided with stereotactic computer-assisted surgical navigation.

    PubMed

    von Jako, Ronald A; Cselik, Zsolt

    2009-01-01

    Percutaneous laser discectomy at various wavelengths has been used for minimally invasive surgery of herniated intervertebral discs. Using a high-intensity diode laser at 980-nm wavelength, we aimed to improve the safe insertion of the laser trocar with the aid of a stereotactic computer-assisted surgical navigation system. The experiments were performed on ex vivo porcine spines with intact soft tissue. Before laser irradiation, each specimen was imaged by computed tomography (CT) with fiduciary markers. The Digital Imaging and Communications in Medicine (DICOM standard) data sets were retrieved into the GE Healthcare Surgery InstaTRAK3500 Plus computer-assisted surgical navigation platform via the hospital Ethernet using a picture archiving and communication system. A special trocar with quartz waveguide connected to the navigation system was inserted into a total of 12 lumbar discs of two fresh intact porcine specimens. Various laser energies (200-700 J) with different exposure times were delivered. Pre- and post-irradiation magnetic resonance (MR) imaging and postoperative macroscopic and histologic studies were carried out. A navigation system accuracy of better than 2 mm was achieved. Tracking of the instrument from pre-acquired formatted CT reconstructed images reduced overall radiation exposure by limiting the need for continuous intraoperative C-arm fluoroscopy. The use of surgical navigation by CT images enhanced the precision insertion of the laser trocar. Irradiation with the 980-nm wavelength diode laser resulted in tissue evaporation changes of the intervertebral disc material as demonstrated by comparing pre- and post-irradiation changes of MR images and macro- and microscopic changes of the dissected disc material. This preclinical study demonstrates the clinical utility of a 980-nm diode laser delivered through a fiber-optic waveguide trocar in which precise insertion was enabled by the use of surgical navigation. This in turn decreases the

  20. Computed tomography-guided percutaneous microwave ablation therapy for lung cancer.

    PubMed

    Sun, Y H; Song, P Y; Guo, Y; Sheng, L J

    2015-05-11

    This study evaluated the clinical efficacy and value of computed tomography (CT)-guided percutaneous microwave ablation therapy (PMAT) for lung cancer without surgical treatment. A total of 39 lesions in 29 patients with peripheral lung cancer were treated by CT-guided PMAT under local anesthesia. The microwave energy was 50-70 W at a frequency of 2450 MHz. The treatment was performed by using 1 or 2 points of ablation emission according to the size and shape of the tumor. Operations were completed in 29 patients. The average operating time was 8 min (range: 5-12 min). After PMAT, lower density in the ablated area was observed by CT. Pre- and post-treatment CT values were 52.60 and 26.12 Hu, respectively. Eight, 14, 4, and 3 patients achieved complete remission, partial remission, stable status, and progression, respectively, for an effectiveness rate of 75.86%. Complications included 5, 2, and 15 cases of pneumothorax, pleural effusion, and fever, respectively. No needle track implantation was observed. Mean progression-free survival was 14.6 months. The 1- and 2-year survival rates were 91.3 and 82.6%, respectively. Thus, PMAT is a minimally invasive, safe, and effective treatment for lung cancer. It can improve quality of life, prolong survival, and improve the survival rate.

  1. Preoperative computed tomography-guided percutaneous localization of ground glass pulmonary opacity with polylactic acid injection.

    PubMed

    Hu, Mu; Zhi, Xiuyi; Zhang, Jian

    2015-07-01

    Localization of a ground glass nodule is a difficult challenge for thoracic surgeons, especially for ground glass opacities (GGOs) less than 10 mm in diameter. In this study we implement a new method for preoperative localization of pulmonary (GGOs). From October 2013 to December 2014, computed tomography-guided percutaneous polylactic acid injection localizations were performed for five pulmonary nodules in five patients (2 men and 3 women; mean age, 59.8 years; range, 54-65 years). The injection was feasible in all patients and the localization effect was excellent. The total procedure duration was 12.6 minutes (range; 10-15) and the volume of polylactic acid injected was 0.38 mL. The wedge resections were easily and successfully performed in all five cases. The cutting margin was no less than 2 cm from the lesion. This technique is promising for the determination of GGO location in thoracoscopic surgery for wedge resection.

  2. Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus.

    PubMed

    Fang, You-Qiang; Wu, Jie-Ying; Li, Teng-Cheng; Zheng, Hao-Feng; Liang, Guan-Can; Chen, Yan-Xiong; Hong, Xiao-Bin; Cai, Wei-Zhong; Zang, Zhi-Jun; Di, Jin-Ming

    2017-06-01

    This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.

  3. Usefulness of the transgastric view by transesophageal echocardiography in evaluating thickened pericardium in patients with constrictive pericarditis.

    PubMed

    Izumi, Chisato; Iga, Kanji; Sekiguchi, Kiyomi; Takahashi, Shuichi; Konishi, Takashi

    2002-09-01

    Detection of thickened pericardium in patients with constrictive pericarditis is essential for pericardiectomy because restrictive cardiomyopathy and severe tricuspid regurgitation show similar hemodynamic data. The purpose of this study was to clarify whether transesophageal echocardiography can evaluate thickened pericardium. We investigated 7 patients with constrictive pericarditis who underwent pericardiectomy. Thickened pericardium over the right atrium was detected in 6 patients, but the borders were not clear. Thickened pericardium over the left ventricle was not detected in any patients in the standard longitudinal and horizontal views. On the other hand, thickened pericardium over the ventricles was detected in all patients in the transgastric view as an echogenic area between the liver and ventricular wall. Tissue characteristics of the thickened pericardium could be evaluated because of the high-quality images in the transgastric view. The transgastric view by transesophageal echocardiography allows high-quality images of the pericardium, which might be useful in diagnosing constrictive pericarditis.

  4. Non-contrast computed tomography after percutaneous nephrolithotomy: findings and clinical significance.

    PubMed

    Sofer, Mario; Druckman, Ido; Blachar, Arye; Ben-Chaim, Jacob; Matzkin, Haim; Aviram, Galit

    2012-05-01

    To describe the post-percutaneous nephrolithotomy (PNL) non-contrast-enhanced computed tomography (NCCT) findings and assessed their clinical significance. NCCT evaluates stone clearance after PNL and also reveals procedure-related changes. One hundred consecutive patients who underwent PNL were evaluated by NCCT one day post-procedure. Two radiologists analyzed the type and severity of the NCCT findings, which were then statistically analyzed in relation to the patient's clinical course. The patients' mean age was 54 years (range 18-82) and the mean maximal stone diameter was 37 mm (range 15-70). The median operative time was 110 minutes for an immediate stone-free rate of 83%, changing to 94% (P = .073) after a second-look PNL in 11 patients. The post-PNL NCCT findings were hydronephrosis (70%), atelectasis (54%), ipsilateral pleural effusion (52%), paracolic gutter fluid (44%), perinephric hematoma (40%), perinephric fluid (32%), ureteronephrosis (31%), renal swelling (23%), contralateral pleural effusion (22%), residual fragments (RFs) (17%), subcapsular hematoma (10%), and flank hematoma (6%). Univariate analysis revealed a significant association with clinical variables for all NCCT findings except for atelectasis, ureteronephrosis, contralateral pleural effusion, RFs, and flank hematoma. In multivariate analysis, only perinephric fluid (P = .007) and ipsilateral pleural effusion (P = .034) were associated with longer hospitalization, and perinephric fluid with longer recovery (P = .004). The complication rate was 12%, but none were linked with the radiological findings. This work describes the post-PNL NCCT findings and their clinical significance. Perinephric fluid and ipsilateral pleural effusion were found to independently predict longer hospitalization and recovery time. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. The utility of noncontrast computed tomography in the prompt diagnosis of postoperative complications after percutaneous nephrolithotomy.

    PubMed

    Gnessin, Ehud; Mandeville, Jessica A; Handa, Shelly E; Lingeman, James E

    2012-04-01

    Noncontrast computed tomography (CT) is commonly utilized after percutaneous nephrolithotomy (PNL) to assess stone-free (SF) status. In addition to assessing SF status, CT is useful in the recognition of complications after PNL. We characterized complications demonstrated by postoperative CT scan and compared hospital re-admission rates based on whether or not CT was performed. We retrospectively reviewed records of 1032 consecutive patients from April 1999 to June 2010. Patients were divided into two cohorts based on whether they had a CT within 24 hours of PNL. Demographic data, CT findings, and need for re-admission for complication management were assessed. Nine hundred fifty-seven patients (92.7%) underwent post-PNL CT. CT-diagnosed complications were perinephric hematoma in 41 (4.3%; 2 requiring embolization and 9 necessitating transfusion), pleural effusion in 25 (2.6%; 10 requiring intervention), colon perforation in 2 (0.2%), and splenic injury in 2 (0.2%). Of patients with postoperative complications, 33% required intervention. Among patients with a CT, 6 (0.6%) were readmitted despite negative postoperative CT (four perinephric hematomas, one calyceal-pleural fistula, and one pseudoaneurysm). The sensitivity of CT for diagnosing complications was 92.7%. Seventy-five patients (7.3%) did not undergo CT post-PNL. Of these, four (5.33%) were readmitted: three for perinephric hematomas and one for ureteral clot obstruction. Patients undergoing post-PNL CT were less likely to be readmitted because of missed complications (p=0.02). Serious post-PNL complications are uncommon, but their prompt diagnosis and treatment is imperative. In addition to identifying residual stones, CT is useful in diagnosing postoperative complications. Postoperative CT could potentially be considered for all patients undergoing PNL, particularly in complex cases such as patients with anatomical abnormalities (renal anatomic abnormality or retrorenal colon), patients requiring upper

  6. Experimental Computed Tomography-guided Vena Cava Puncture in Pigs for Percutaneous Brachytherapy of Middle Mediastinal Lymph Node Metastases

    PubMed Central

    Zhao, Min; Liu, Bin; Li, Sheng-Yong; Wang, Yong-Zheng; Li, Yu-Liang; Hertzanu, Yancu

    2015-01-01

    Background: Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model (group of 12 pigs) to assess the safety and feasibility of computed tomography (CT)-guided vena cava puncture. Methods: Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava (AVC) in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results: Following postoperative enhanced CT, two animals were found to have a small pneumothorax (one being hemopneumothorax). The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93–100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions: CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava. PMID:25881603

  7. Accuracy of Percutaneous Lumbosacral Pedicle Screw Placement Using the Oblique Fluoroscopic View Based on Computed Tomography Evaluations

    PubMed Central

    Sato, Koji; Kanemura, Tokumi; Iwase, Toshiki; Togawa, Daisuke; Matsuyama, Yukihiro

    2016-01-01

    Study Design Retrospective. Purpose This study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS). Overview of Literature Although PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures. Methods We retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, <2 mm, 2–4 mm, or >4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time. Results Inaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes. Conclusions Minimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle

  8. Mapping epicardial fat with multi-detector computed tomography to facilitate percutaneous transepicardial arrhythmia ablation.

    PubMed

    Abbara, Suhny; Desai, Jay C; Cury, Ricardo C; Butler, Javed; Nieman, Koen; Reddy, Vivek

    2006-03-01

    A sizable portion of ventricular tachycardia circuits are epicardial, especially in patients with non-ischemic cardiomyopathy, e.g. Chagas disease. Thus there is a growing interest among the electrophysiologists in transepicardial mapping and myocardial ablation for treatment of arrhythmias. However, increased epicardial fat can be a significant hindrance in procedural success as it can mimic infarct during mapping and can also decrease the effectiveness of ablation. Quantitative knowledge of epicardial fat pre-procedure can potentially significantly facilitate the conduct and outcomes of these procedures. In this study we assessed the epicardial fat distribution and thickness in vivo in 59 patients who underwent multi-detector computed tomography (MDCT) for coronary artery assessment using a 16-slice scanner. Multiplanar reconstructions were obtained in the ventricular short axis at the basal, mid ventricular, and near the apex level, and in a four-chamber view. In the short axis slices, we measured epicardial fat diameter in nine segments, and in the four-chamber view, it was measured in five segments. In grooved segments the maximum fat thickness was recorded, while in non-grooved segments thickness at three equally spaced points were averaged. The results were as follows starting clockwise: superior inter-ventricular (IV) groove (all measurements are in mm, in basal, mid ventricular, and apical levels, respectively) (11.2, 8.6, 7.3), left ventricular (LV) superior lateral wall (1.0, 1.5, 1.7), LV inferior lateral wall (1.3, 2.2, 3.5), inferior IV groove (9.2, 6.5, 6.1), right ventricular (RV) diaphragmatic wall (1.4, 0.2, 1.0), acute margin (9.2, 7.3, 7.8), RV anterior free wall inferior (6.8, 4.0, 4.7), RV anterior free wall superior (6.5, 3.2, 3.1), RV superior wall (5.6, 2.7, 4.0), We measured the following four-chamber segments: LV apex (2.8 mm), left atrio-ventricular (AV) groove (12.7), right AV groove (14.8), RV apex (4.8), and anterior IV groove (7

  9. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study

    PubMed Central

    Koethe, Yilun; Xu, Sheng; Velusamy, Gnanasekar; Wood, Bradford J.; Venkatesan, Aradhana M.

    2014-01-01

    Objective To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). Methods The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. Results Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). Conclusion Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. PMID:24220755

  10. Can the need for colectomy after computed tomography-guided percutaneous drainage for diverticular abscess be predicted?

    PubMed

    Felder, Seth I; Barmparas, Galinos; Lynn, Juliane; Murrell, Zuri; Margulies, Daniel R; Fleshner, Phillip

    2013-10-01

    The primary aim of this study was to define predictors of computed tomography (CT)-guided percutaneous abscess drainage treatment failure in complicated diverticulitis. A 10-year retrospective analysis of inpatients seen in surgical consultation for diverticular abscess management subsequently referred for CT-guided percutaneous drainage (PD) was conducted. The clinical courses of patients undergoing a technically successful PD were categorized into three groups: 1) no colectomy; 2) elective colectomy; and 3) nonelective colectomy. Forty study patients were identified. Thirteen (33%) of the 40 patients required a nonelective colectomy, 20 patients (50%) underwent elective resection, and seven patients (18%) have been managed nonoperatively with no recurrent diverticulitis for a median of 46.8 months (range, 3.2 to 84.3 months). Forward logistic regression identified the presence of immunosuppression or renal insufficiency (creatinine 1.5 mg/dL or greater) as factors independently associated with failure of PD and need for nonelective colectomy. No clinical, laboratory, or radiologic variables were predictive of long-term nonoperative success. Although PD allows for the resolution of intra-abdominal sepsis for most cases of diverticulitis complicated by an abscess, a substantial proportion progress to nonelective colectomy, emphasizing the need for clinical vigilance in follow-up.

  11. Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study.

    PubMed

    Bergman, Simon; Fix, Daniel J; Volt, Kevin; Roland, Jason C; Happel, Lynn; Reavis, Kevin M; Cios, Theodore J; Ho, Vincent; Evans, Alan; Narula, Vimal K; Hazey, Jeffrey W; Melvin, W Scott

    2010-05-01

    The optimal method for closing gastrotomies after transgastric instrumentation has yet to be determined. To compare gastrotomy closure with endoscopically delivered bioabsorbable plugs with no closure. Prospective, controlled study. Animal laboratory. Twenty-three dogs undergoing endoscopic transgastric peritoneoscopy between July and August 2007. Endoscopic anterior wall gastrotomies were performed with balloon dilation to allow passage of the endoscope into the peritoneal cavity. The plug group (n = 12) underwent endoscopic placement of a 4 x 6-cm bioabsorbable mesh plug in the perforation, whereas the no-treatment group (n = 11) did not. Animals underwent necropsy 2 weeks after the procedure. Complications related to gastrotomy closure, gastric burst pressures, relationship of burst perforation to gastrotomy, and the degree of adhesions and inflammation at the gastrotomy site. After the gastrotomy, all dogs survived without any complications. At necropsy, burst pressures were 77 +/- 11 mm Hg and 76 +/- 15 mm Hg (P = .9) in the plug group and no-treatment group, respectively. Perforations occurred at the site of the gastrotomy in 2 of 12 animals in the plug group and in none of the 11 dogs in the no-treatment group (P = .5). Finally, there were minimal adhesions in all dogs (11/11) in the no-treatment group and minimal adhesions in 3 and moderate adhesions or inflammatory masses in 9 of the 12 animals in the plug group (P = .004). Small number of subjects, animal model, no randomization. Gastrotomy trauma during short peritoneoscopy may not be applicable to longer procedures. After endoscopic gastrotomy, animals that were left untreated did not show any clinical ill effects and demonstrated adequate healing, with fewer adhesions and less inflammation compared with those treated with a bioabsorbable plug. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  12. Pure NOTES rectosigmoid resection: transgastric endoscopic IMA dissection and transanal rectal mobilization in animal models.

    PubMed

    Park, Sun Jin; Lee, Kil Yeon; Choi, Sung Il; Kang, Byung Mo; Huh, Chang; Choi, Dong Hyun; Lee, Chang Kyun

    2013-07-01

    We report a pure natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) rectosigmoidectomy in animal models using transgastric endoscopic inferior mesenteric artery (IMA) dissection and transanal rectal mobilization. Ten live animals (2 pigs weighing 35-40 kg each and 8 dogs weighing 25-30 kg each) were used. A gastrotomy was made using a needle-knife puncture and the balloon dilatation technique or following the creation of a submucosal tunnel. A circular stapler shaft was transanally inserted up to the sigmoid colon for spatial orientation and traction of the mesocolon. The IMA was endoscopically dissected using a Coagrasper™ (Olympus, Tokyo, Japan) and then clipped. Endoscopic division of the sigmoid mesocolon was conducted laterally toward the marginal artery. Transanal full-thickness circumferential rectal and mesorectal dissections were performed, and a colorectal anastomosis was performed using a circular stapler with a single stapling technique. During the transanal approach, the gastrotomy was closed using four endoscopic clips. Endoscopic dissection of the IMA was successful in all cases, but minor bleedings occurred in 3 cases. The mean time from dissection and clipping to division of the IMA was 36.7 minutes (range, 25-45 minutes). The mean operation time was 180.5 minutes (range, 145-210 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 11.2 cm (range, 9-17 cm). A pure NOTES approach to rectosigmoid resection using transgastric endoscopic IMA dissection is technically feasible in animal models.

  13. [Transgastric laparo-endoscopic approach for difficult access lesions. Experimental mode].

    PubMed

    Tapia-Vega, Marcel Adalid; Morales-Chávez, Carlos Ernesto; Aguirre-Olmedo, Itzé; Cuendis-Velázquez, Adolfo; Rojano-Rodríguez, Martín Edgardo; Cárdenas-Lailson, Luis Eduardo

    2014-01-01

    Gastric neoplasms can be treated by laparoscopy in a safe and efficient way. Some lesions are not accessible to laparoscopic surgery due to their location. A transgastric approach is proposed as an alternative. Show the results with the application of an endoscopic laparotomy in an animal model that maintains functional anatomy, to resect the posterior gastric neoplasms of the stomach wall, close to the cardia and pre-pyloric region. The laparo-endoscopic technique for resection of gastric neoplasms located in the posterior wall was developed in twelve pigs at the Hospital General Gea González from May to December 2011. An endoscopy was performed to establish the site of insertion of intragastric trocars. Three gastrotomies were made in the anterior wall; under endoscopic and laparoscopic vision the trocars were inserted. The stomach was insufflated with CO2. The lesion was resected maintaining a 20 mm circumferencial margin. The gastrotomies were sutured. The statistic analysis was made with t Student and exact Fisher tests. One-hundred percent of resections were achieved in an average time of 102.33 minutes (± 4.50). Two complications and no transoperatory deceases occurred. The technique we describe allows an appropriate approach to gastric lesions located in the posterior wall, those near to the esophagogastric juntion and the prepiloric region, due to the excellent exposure managed by working inside the stomach with a laparoscopic vision and the two intragastric movile ports. The laparoscopic transgastric approach is feasible and safe for the resection of gastric neoplasms located in the posterior wall, those close to the esophago-gastric junction, and the pre-pyloric region.

  14. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature.

    PubMed

    Lyu, Rong-Kuo; Chen, Chi-Jen; Tang, Lok-Ming; Chen, Sien-Tsong

    2002-08-01

    We describe a case of a posterior spinal epidural abscess that was successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy. A 48-year-old man experienced acute pain in the paralumbar region for 1 week, followed by gait disturbance and micturition difficulty. Laboratory studies demonstrated leukocytosis and hyperglycemia. Blood cultures yielded Staphylococcus aureus. Magnetic resonance imaging scans of the thoracolumbar spine revealed a posterior spinal epidural abscess located between L2 and the lower cervical spine. The patient's low back pain persisted despite 10 days of antibiotic therapy. Therefore, percutaneous, computed tomography-guided, needle aspiration was performed. The low back pain was relieved dramatically and immediately after the procedure. The spinal epidural abscess completely resolved after 6 weeks of antibiotic treatment. Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscesses. Selected patients may be treated nonsurgically. Rarely, percutaneous drainage of the abscess has been reported to be helpful. Our case suggests that percutaneous, computed tomography-guided, needle aspiration might be a rational alternative to surgical decompression for treatment of spinal epidural abscesses.

  15. One-step percutaneous gastrojejunostomy in early infancy.

    PubMed

    Michaud, Laurent; Robert-Dehault, Amélie; Coopman, Stéphanie; Guimber, Dominique; Turck, Dominique; Gottrand, Frédéric

    2012-06-01

    In certain conditions that obviate the use of gastric feedings, the insertion of a jejunal feeding tube via gastrostomy constitutes an alternative to jejunostomy but requires a preexisting gastrostomy. Our aim was to assess a new technique of 1-step gastrojejunal tube insertion through a de novo gastrostomy. A total of 3 infants between 3 and 7 months old and weighing between 4.1 and 5.4 kg had a gastrojejunal feeding tube inserted using a 16-CH French introducer percutaneous endoscopic gastrostomy kit and a transgastric-jejunal feeding tube. No technical difficulties occurred and the gastrojejunal feeding tube was placed successfully in the 3 patients, the total procedure lasting 15 to 20 minutes. Enteral feeding was started within 4 to 6 hours of the procedure. Neither immediate (<24 hours) nor late complications related to the gastrojejunostomy occurred. Nissen fundoplication was performed in 2 of our patients at 12 and 15 months of age, respectively. The gastrojejunostomy tube was still in place in the third patient at age 15 months. Our first experience suggests that 1-step endoscopic placement of a transgastric-jejunal feeding tube without a preexisting gastrostomy tract is feasible in young and low-weight infants.

  16. Successful Post-Pancreatitis Pseudoaneurysm Coagulation by Percutaneous Computed Tomography (CT)-Guided Thrombin Injection

    PubMed Central

    Spezia, Laura; Sozzi, Carlo; Contro, Alberto; Mansueto, Giancarlo

    2017-01-01

    Summary Background Pseudoaneurysm is a rare but potentially life-threatening vascular complication of acute pancreatitis, with a mortality rate of 20–43% in untreated patients. The treatment usually involves trans-arterial embolization or surgical resection. Case Report A 44-year-old man with a history of acute pancreatitis developed a pseudoaneurysm of the pancreatic tail, diagnosed as a splenic artery pseudoaneurysm by CT. Selective arteriography performed with the purpose of embolization did not reveal the pseudoaneurysm. The day after, under CT guidance, human thrombin (1,000 IU) was injected inside the aneurysmatic sac with its complete occlusion. A control MRI 6 months later confirmed a complete resolution of the pseudoaneurysm. Conclusions Percutaneous coagulation of a post-pancreatitis pseudoaneurysm is a relatively easy and safe procedure, and it can be considered as an alternative to trans-arterial embolization when the pseudoaneurysm cannot be visualized on selective arteriography. PMID:28203308

  17. Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws.

    PubMed

    Ravi, Bheeshma; Zahrai, Ali; Rampersaud, Raja

    2011-01-01

    Clinical case series. The primary objective of this study was to evaluate the clinical accuracy of computer-assisted two-dimensional fluoroscopy (2D-CAS) for the percutaneous placement of lumbosacral pedicle screws. Loss of visual anatomic landmarks and reduced tactile feedback increases the risk of pedicle screw misplacement by when using minimally invasive (MIS) percutaneous techniques. However, objective data on screw misplacement in this scenario is lacking. A MIS-2D-CAS technique (FluoroNav) was used for the placement of pedicle screws in 41 consecutive patients undergoing MIS-interbody instrumented fusion. Postoperative computerized tomography (CT) was obtained in all patients at 6 months after surgery and was evaluated by 3 observers. The relative position of the screw to the pedicle was graded regarding pedicle breach (I, no breach; II, <2 mm; III, 2-4 mm; IV, >4 mm), breach direction, vertebral body perforation and screw trajectory. Interobserver reliability of CT grading was assessed with kappa statistics. A total of 161 screws were placed. No neurologic, vascular, or visceral injuries occurred. About 37 (23%) screws breached the pedicle. The majority (83.8%, 31/37) of breaches were graded II. There were 5 Grade III and 1 Grade IV breaches. Medial versus lateral breaches occurred in 30% (11/37) and 60% (22/37), respectively; 10% (4/37) of the breaches were superior. Overall, 8 (5%) vertebral body breaches occurred. Of the pedicle screws, 19 (12%) had trajectories that deviated from acceptable, with the majority being medial (16/19, 84%). Fluoroscopy time for screw placement was typically less than 20 seconds total per case. There was 1 clinically significant breach at L5 (III, medial) which resulted in a L5 radiculopathy. Kappa statistics showed excellent overall agreement between reviewers (k = 0.73-0.92; 90%-96% agreement). The two-dimensional (2D) virtual fluoroscopy is a clinically acceptable option for percutaneous placement of pedicle screws

  18. Accuracy and efficacy of percutaneous biopsy and ablation using robotic assistance under computed tomography guidance: a phantom study.

    PubMed

    Koethe, Yilun; Xu, Sheng; Velusamy, Gnanasekar; Wood, Bradford J; Venkatesan, Aradhana M

    2014-03-01

    To compare the accuracy of a robotic interventional radiologist (IR) assistance platform with a standard freehand technique for computed-tomography (CT)-guided biopsy and simulated radiofrequency ablation (RFA). The accuracy of freehand single-pass needle insertions into abdominal phantoms was compared with insertions facilitated with the use of a robotic assistance platform (n = 20 each). Post-procedural CTs were analysed for needle placement error. Percutaneous RFA was simulated by sequentially placing five 17-gauge needle introducers into 5-cm diameter masses (n = 5) embedded within an abdominal phantom. Simulated ablations were planned based on pre-procedural CT, before multi-probe placement was executed freehand. Multi-probe placement was then performed on the same 5-cm mass using the ablation planning software and robotic assistance. Post-procedural CTs were analysed to determine the percentage of untreated residual target. Mean needle tip-to-target errors were reduced with use of the IR assistance platform (both P < 0.0001). Reduced percentage residual tumour was observed with treatment planning (P = 0.02). Improved needle accuracy and optimised probe geometry are observed during simulated CT-guided biopsy and percutaneous ablation with use of a robotic IR assistance platform. This technology may be useful for clinical CT-guided biopsy and RFA, when accuracy may have an impact on outcome. • A recently developed robotic intervention radiology assistance platform facilitates CT-guided interventions. • Improved accuracy of complex needle insertions is achievable. • IR assistance platform use can improve target ablation coverage.

  19. Percutaneous drainage of enteric-related abscesses.

    PubMed

    Fulcher, A S; Turner, M A

    1996-12-01

    Percutaneous drainage is a routinely performed radiologic procedure used in the management of abdominal abscesses. This technique has become the preferred method of treatment for most abdominal and pelvic abscesses, specifically those of enteric origin related to surgical procedures, appendicitis, diverticulitis, and Crohn disease. The well-documented safety and therapeutic efficacy of percutaneous abscess drainage (PAD) lead to the acceptance of this procedure as the primary means of managing abdominal abscesses, obviating the need for surgery in many instances. PAD may provide definitive therapy or may serve as a temporizing measure before delayed surgical treatment. Although PAD was originally reserved for treatment of unilocular, relatively superficial fluid collections, the role of PAD has evolved such that it is now used to manage complex multilocular fluid collections and abscesses that lie deep within the abdomen or pelvis. Although the standard transabdominal approach is preferred, a variety of approaches, including transgastric, transrectal, transvaginal, and transgluteal, may be used. PAD is performed using CT or sonographic guidance.

  20. Transgastral retroperitoneal endoscopy in septic patients with pancreatic necrosis or infected pancreatic pseudocysts.

    PubMed

    Hocke, M; Will, U; Gottschalk, P; Settmacher, U; Stallmach, A

    2008-12-01

    Peripancreatic fluid collections are common complications of acute pancreatitis or acute exacerbations of chronic pancreatitis. Surgery is required when these fluid collections become infected or cause obstruction or pain. However, morbidity and mortality after surgery in these cases are still too high, therefore minimally invasive approaches have been encouraged. The aim of this study was to evaluate the feasibility of endoscopic ultrasound-guided transmural drainage with intracystic endoscopy and necrosectomy. From 2000 to 2006 30 patients (age: 57 +/- 10 years, range: 34 - 74 years) with an infected pancreatic pseudocyst or infected pancreatic necrosis were included in the study. The diagnosis of infection in patients who had fever despite an adequate antibiotic regime was confirmed by endoscopic fine needle aspiration with a positive bacterial or mycological result. The mean C-reactive protein value before treatment was 202 +/- 58 mg/L and the mean leukocyte count was 13.25 +/- 4.75 GPt/L. Transgastric cyst drainage was performed using a therapeutic endoscopic ultrasound probe (Pentax 38 UX or Olympus GF UCT 140) with insertion of an 8-Fr double pigtail prosthesis. After balloon dilatation (12 mm) a normal gastroscope was inserted into the cavity and all the fluid and easy removable necrosis were removed. The prosthesis was removed 4 weeks after the end of the endoscopic treatment. Clinical and ultrasound follow-up were carried out 3 and 6 months after removal of the prosthesis. The mean follow-up was 60 weeks. The technical success of the procedure was 96.7 %, the long-term success was 83.4 %. On average 2.7 (range: 1 - 16) procedures were necessary for complete removal of necrosis and the remaining fluid. Major complications (bleeding, perforation, fistulation) occurred in 10 %. In 10 % a secondary operation was necessary. The overall mortality rate was 6.6 %. Endoscopic treatment of infected pseudocysts and infected postacute pancreatic necrosis using

  1. Automatic path proposal computation for CT-guided percutaneous liver biopsy.

    PubMed

    Helck, A; Schumann, C; Aumann, J; Thierfelder, K; Strobl, F F; Braunagel, M; Niethammer, M; Clevert, D A; Hoffmann, R T; Reiser, M; Sandner, T; Trumm, C

    2016-12-01

    To evaluate feasibility of automatic software-based path proposals for CT-guided percutaneous biopsies. Thirty-three patients (60 [Formula: see text] 12 years) referred for CT-guided biopsy of focal liver lesions were consecutively included. Pre-interventional CT and dedicated software (FraunhoferMeVis Pathfinder) were used for (semi)automatic segmentation of relevant structures. The software subsequently generated three path proposals in downward quality for CT-guided biopsy. Proposed needle paths were compared with consensus proposal of two experts (comparable, less suitable, not feasible). In case of comparable results, equivalent approach to software-based path proposal was used. Quality of segmentation process was evaluated (Likert scale, 1 [Formula: see text] best, 6 [Formula: see text] worst), and time for processing was registered. All biopsies were performed successfully without complications. In 91 % one of the three automatic path proposals was rated comparable to experts' proposal. None of the first proposals was rated not feasible, and 76 % were rated comparable to the experts' proposal. 7 % automatic path proposals were rated not feasible, all being second choice ([Formula: see text]) or third choice ([Formula: see text]). In 79 %, segmentation at least was good. Average total time for establishing automatic path proposal was 42 [Formula: see text] 9 s. Automatic software-based path proposal for CT-guided liver biopsies in the majority provides path proposals that are easy to establish and comparable to experts' insertion trajectories.

  2. Cerebral air embolism treated with hyperbaric oxygen therapy following percutaneous transthoracic computed tomography-guided needle biopsy of the lung.

    PubMed

    Tomabechi, Makiko; Kato, Kenichi; Sone, Miyuki; Ehara, Shigeru; Sekimura, Kenshi; Kizawa, Tetsuya; Kin, Masakado

    2008-07-01

    A 71-year-old man presented with cough and sputum for 12 months. Chest radiography showed a homogeneous opacity in the right lower lobe. Computed tomography (CT) showed a nodular opacity, 2 cm in diameter, in the posterior segment of the right lower lobe. Mild emphysematous changes were also seen. With the patient in a prone position, a 19-gauge 7.8-cm introducer was placed in the lesion during a single inspiratory breath-hold. A coaxial 20-gauge automated needle was inserted through the introducer using a biopsy gun. Although the patient did not complain of any symptoms, postbiopsy CT showed air in the left ventricle and ascending aorta. After 5 h of bed rest, we found weakness in his left lower extremity. He was transferred to a hyperbaric oxygen chamber and recovered the next day. Air embolism is a rare, potentially fatal complication of percutaneous lung biopsy. Although the true effect of hyperbaric oxygen therapy is controversial, knowledge regarding the prompt management of such cases may help radiologists who perform this procedure.

  3. Does the Hounsfield unit value determined by computed tomography predict the outcome of percutaneous nephrolithotomy?

    PubMed

    Gücük, Adnan; Uyetürk, Uğur; Oztürk, Ufuk; Kemahli, Eray; Yildiz, Mevlüt; Metin, Ahmet

    2012-07-01

    We aimed to evaluate whether the Hounsfield unit (HU) value predicts outcome in percutaneous nephrolithotomy (PCNL). One hundred and seventy-nine patients who had undergone PCNL in our clinics in the last 4 years were included. Demographic and clinical data of the patients and complications, if any, were recorded. The mean age of the patients was 45.3 ± 14.3 years (range 5-82 y), and 111 of them were males (62%). The mean stone size and HU values were found to be 693.1 ± 628.0 (95-4200) mm(2) and 706.3 ± 245.0 (214-1325), respectively. In logistic regression analysis, the size of the stone, the opacity of the stone, and the HU values were found to be independent predictors of the failure of the procedure (P<0.05). A cutoff value of 677.5 was used for the HU in the receiver operating characteristics analysis. Having a HU value under the cutoff value increased the likelihood of procedure failure by 2.65 times, whereas stones residing in the staghorn localization increased failure by 5.68. It was also observed that if the stone's size was 485 mm(2) or more, the chance of failure increased by 1.9, whereas when the stone was nonopaque, failure increased by 6.04 times (P<0.05). There was a positive correlation between hematocrit decrease and a decrease in HU values (P<0.05), but no correlation was observed between the HU values and duration of surgery or fluoroscopy (P>0.05). In addition to the size and location of the stones, the HU value determined in the unenhanced CT scan may be one of the parameters affecting PCNL outcomes. PCNL is a more efficient method in stones with higher HU values. Therefore, the HU values may be a useful tool for the selection of the treatment modality in patients with renal stones.

  4. Percutaneous Cystogastrostomy with a New Catheter for Drainage of Pancreatic Pseudocysts and Fluid Collections

    SciTech Connect

    Davies, Roger P.; Cox, Michael R.; Wilson, Thomas G.; Bowyer, Richard C.; Padbury, Robert T. A.; Toouli, James

    1996-03-15

    We describe a new catheter for the initial percutaneous drainage of large symptomatic pancreatic fluid collections and abscesses using a transgastric approach to allow fluid drainage into the gastric lumen. A double-mushroom stent is placed secondarily for long-term internal drainage to the stomach, avoiding the need for an extended period of external catheter drainage. This technique, termed percutaneous cystogastrostomy (PCG), has been used in 19 consecutive patients with one recurrent symptomatic pseudocyst in the follow-up period of 9<+>-<+>43 months. There was one death within 30 days of PCG and 1 patient proceeded to surgical necrosectomy. After evidence of resolution of the pseudocysts, the internal stent was retrieved in 17 patients by endoscopic snare.

  5. Preoperative planning with noncontrast computed tomography in the prone and supine position for percutaneous nephrolithotomy: a practical overview.

    PubMed

    Marchini, Giovanni S; Berto, Fernanda Christina G; Vicentini, Fabio C; Shan, Chen Jen; Srougi, Miguel; Mazzucchi, Eduardo

    2015-01-01

    To evaluate kidney/adjacent organs positional changes in patients undergoing percutaneous nephrolithotomy (PCNL) using noncontrast computed tomography (NCCT) in prone and supine positions. Patients scheduled PCNL were prospectively enrolled in the study and underwent NCCT in supine and in prone position (with boosters). Two imaginary lines for the posterior calyx of upper/mid/lower poles of both kidneys in prone and supine decubitus were considered and compared. Line I (LI): drawn horizontally in the coronal plane in contact with the posterior edge of the kidney. Line II (LII): drawn from the antero-lateral edge of the vertebra through the middle of the posterior calyx (ideal puncture line). Renal depth (d) was measured from LI to the anterior extremity of the vertebra. The maximum access angle (a) considered the window available in the axial plane to perform a secure approach to each calyx. Thirty-seven patients were analyzed; 56.7% were female; mean BMI was 28.3±4.9 kg/m(2). For the right kidney, prone position was associated with more organs crossed by LI (54.1% vs 18.9%; p<0.01) and LII (56.8% vs 27%; p=0.03) in the upper calyx. For the left kidney, LII crossed more organs in prone in the upper calyx (54.1% vs 29.7%; p=0.03). Both kidneys showed a tendency to be deeper in the supine position, which provided a wider access angle. Supine NCCT is not accurate to plan PCNL access in prone position. Prone decubitus is associated with more potential organ injuries in the upper pole. In supine, the kidney situates deeper in the abdomen but the access angle is wider than in prone.

  6. Diagnosing filamentous fungal infections in immunocompromised patients applying computed tomography-guided percutaneous lung biopsies: a 12-year experience.

    PubMed

    Lass-Flörl, Cornelia; Aigner, Maria; Nachbaur, David; Eschertzhuber, Stephan; Bucher, Brigitte; Geltner, Christian; Bellmann, Romuald; Lackner, Michaela; Orth-Höller, Dorothea; Würzner, Reinhard; Weiss, Günter; Glodny, Bernhard

    2017-09-27

    Invasive fungal diseases (IFD) are an important cause of morbidity and mortality in immunocompromised patients, and early diagnosis and management are a challenge. We evaluated the clinical utility of computed tomography (CT)-guided percutaneous lung biopsies in diagnosing IFD. Between 2003 and 2014, we analyzed 2671 CT-guided lung biopsies, from which 157 were IFD associated; we aimed to determine microbiological-based diagnostic accuracy of calcofluor white staining (CFWS), culture, Aspergillus antigen detection (GM), broad-range fungal PCR, and Aspergillus PCR per sample. 127 (81%) specimens were microscopically positive for any fungal elements, 30 (19%) negative. Aspergillus and non-Aspergillus like hyphae were obtained in 85 (67%) and 42 (33%) specimens, respectively. CFWS positivity was defined as proof of infection. Sensitivity, specificity, and positive (PPV) and negative predictive (NPV) values for CT scan were 100, 44, 80, and 100%, for Aspergillus PCR 89, 58, 88, and 58%, for broad-range fungal PCR 90, 83, 95, and 90%, and for GM 94, 83, 95, and 90%. The most common CT features were patchy opacifications with central necrosis (78%) or cavern defects (50%), less common were air bronchograms (39%) or ground glass halos (39%), and all other features were rare. The overall pneumothorax rate subsequent to biopsy was 19%, but in only 2% of all cases the placement of a chest tube was indicated. One case of fatal air embolism occurred. CT-guided lung biopsies have high diagnostic accuracy in terms of microscopic examination, and complication rates are low. Molecular-based and antigen tests applied on fungal hyphae-positive specimens showed comparable results.

  7. Efficacy of Multidetector Computed Tomography to Predict Periprocedural Myocardial Injury After Percutaneous Coronary Intervention for Chronic Total Occlusion.

    PubMed

    Usui, Eisuke; Lee, Tetsumin; Murai, Tadashi; Kanaji, Yoshihisa; Matsuda, Junji; Araki, Makoto; Yonetsu, Taishi; Yamakami, Yosuke; Kimura, Shigeki; Kakuta, Tsunekazu

    2017-02-07

    Specific signatures of culprit lesions detected on multidetector computed tomography (MDCT) were identified as predictors of periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) in patients with stable angina; PMI has been shown to be associated with a worse prognosis. We investigated the association between preprocedural culprit lesion characteristics, assessed by MDCT, and PMI after PCI for chronic total occlusion (CTO). From three medical centers, 81 patients who underwent pre-PCI MDCT and CTO PCI, and systematic cardiac troponin (cTn) sampling before and after PCI, were included. Patients were divided into two groups according to the presence or absence of post-PCI cTn elevation. Patient characteristics, MDCT findings, and procedural variables were compared between the two groups. Procedure success was observed in 65 patients (80.2%) and was not associated with PMI. The incidence of PMI was higher in patients treated with the retrograde versus the antegrade approach. On MDCT, lesion length and the presence of the napkin-ring sign were significantly associated with PMI. Multivariate analysis revealed that the lesion length (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.01-1.08; P < 0.05), napkin-ring sign (OR: 5.41; 95% CI: 1.01-29.0; P < 0.05), and retrograde approach (OR: 4.78; 95% CI: 1.28-15.4; P < 0.05) were significant predictors of PMI. PMI is not uncommon in patients undergoing elective CTO PCI, regardless of procedure success or failure. Pre-PCI MDCT may help identify patients at high risk for PMI after CTO PCI.

  8. Accuracy of J-CTO Score Derived From Computed Tomography Versus Angiography to Predict Successful Percutaneous Coronary Intervention.

    PubMed

    Fujino, Akiko; Otsuji, Satoru; Hasegawa, Katsuyuki; Arita, Toyohiro; Takiuchi, Shin; Fujii, Kenichi; Yabuki, Masanori; Ibuki, Motoaki; Nagayama, Shinya; Ishibuchi, Kasumi; Kashiyama, Toshikazu; Ishii, Rui; Tamaru, Hiroto; Yamamoto, Wataru; Hara, Masahiko; Higashino, Yorihiko

    2017-06-14

    The aim of this study was to compare the ability of conventional versus computed tomography angiography (CTA) to predict procedural success and 30-min wire crossing rates in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions. Coronary CTA can be used to assess the morphology of CTO lesions. We examined 205 consecutive patients (218 CTO lesions) who underwent coronary CTA pre-PCI. The J-CTO (Multicenter CTO Registry of Japan) score (the sum of the following 5 binary parameters: blunt proximal cap, calcification, bending >45°, and length of occluded segment >20 mm plus previously failed PCI attempt) was calculated using both CTA and conventional coronary angiography and compared. The median patient age was 69 years (interquartile range: 62 to 75 years), 82.4% were male, and a retrograde approach was attempted in 72 (33.0%) cases. The procedural success rate of the CTO-PCI procedures was 82.6%, and 29.4% of cases achieved 30-min wire crossing. The areas under the curve of the CTA-derived J-CTO score for predicting procedural success and 30-min wire crossing were significantly greater than those derived from conventional angiography (0.855 vs. 0.698; p < 0.001 for procedural success and 0.812 vs. 0.692; p < 0.001, for 30-min wire crossing). In addition, the areas under the curve of CTA-derived evaluations of calcification, bending, and occlusion length were significantly higher than those of derived from angiography for predicting procedural success. The CTA-derived J-CTO score was a more useful predictor of both procedural success and 30-min wire crossing than the J-CTO score derived from conventional angiography. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy

    SciTech Connect

    Braak, Sicco J.; Zuurmond, Kirsten Aerts, Hans C. J.; Leersum, Marc van Overtoom, Timotheus T. Th. Heesewijk, Johannes P. M. van Strijen, Marco J. L. van

    2013-08-01

    ObjectiveTo investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.Materials and MethodsOn 4 spine phantoms with 11 vertebrae (Th7-L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.ResultsMean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm{sup 2}, respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.ConclusionCBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.

  10. Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study.

    PubMed

    Men, Min; Ye, Xin; Fan, Weijun; Zhang, Kaixian; Bi, Jingwang; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wei, Zhigang

    2016-01-01

    To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.

  11. Computed tomography-guided percutaneous microwave ablation of patients 75 years of age and older with early-stage nonsmall cell lung cancer.

    PubMed

    Han, X; Yang, X; Ye, X; Liu, Q; Huang, G; Wang, J; Li, W; Zheng, A; Ni, Y; Men, M

    2015-12-01

    We aimed to assess the clinical outcome of computed tomography (CT)-guided percutaneous microwave ablation (MWA) in patients 75 years of age and older with early stage peripheral nonsmall cell lung cancer (NSCLC). Twenty-eight patients, aged ≥ 75 years, with Stage I and lymph node-negative IIa peripheral NSCLC underwent CT-guided percutaneous MWA in our hospital between July 2007 and March 2015. The overall 1-, 2-, 3-, and 4-year survival rates were estimated using Kaplan-Meier analysis. Adverse events were recorded. The median follow-up time was 22.5 months. The overall median survival time (MST) was 35 months (95% confidence interval [CI] 22.3-47.7 months), and the cancer-specific MST was 41.9 months (95% CI 38.8-49.9 months). The 1-, 2-, 3-, and 4-year overall survival rates were 91.7%, 76.5%, 47.9%, and 47.9%, while the cancer-specific survival rates were 94.7%, 73.9%, 64.7%, and 64.7%, respectively. Median time to local progression was 28.0 months (95% CI 17.7-38.3 months). Major complications were included pneumothorax (21.4%, requiring drainage), pleural effusions (3.6%, requiring drainage), and pulmonary infection (3.6%). CT-guided percutaneous MWA is safe and effective for the treatment of patients 75 years of age and older with medically inoperable early stage peripheral NSCLC.

  12. Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study

    PubMed Central

    Men, Min; Fan, Weijun; Zhang, Kaixian; Bi, Jingwang; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wei, Zhigang

    2016-01-01

    Objective To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. Materials and Methods From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Results Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). Conclusion CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer. PMID:27833402

  13. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) after Roux-en-Y gastric bypass: technical features.

    PubMed

    Facchiano, Enrico; Quartararo, Giovanni; Pavoni, Vittorio; Liscia, Gadiel; Naspetti, Riccardo; Sturiale, Alessandro; Lucchese, Marcello

    2015-02-01

    Laparoscopic gastric bypass is one of the most performed bariatric operations worldwide. The exclusion of stomach and duodenum after this operation makes the access to the biliary tree, in order to perform an endoscopic retrograde cholangiopancreatography (ERCP), very difficult. This procedure could be more often required than in overall population due to the increased incidence of gallstones after bariatric operations. Among the different techniques proposed to overcome this drawback, laparoscopic access to the excluded stomach has been described by many authors with a high rate of success reported. We herein describe our technique to perform laparoscopic transgastric ERCP. A gastrotomy on the excluded stomach is performed to introduce a 15-mm trocar. Two stitches are passed through the abdominal wall and placed at the two sides of the gastrotomy for traction. The intragastric trocar is used to pass a side-viewing endoscope to access the biliary tree. In patients with a past history of Roux-en-Y gastric bypass (RYGB), the present technique allows us a standardized, safe, and reproducible access to the major papilla and the biliary tree using a transgastric access. This will lead to simplify the procedure and reduce the risk of peritoneal contamination.

  14. Laparoscopic Transgastric Enucleation of a Gastric Leiomyoma near the Esophagogastric Junction and Concomitant Sleeve Gastrectomy: Video Report.

    PubMed

    Genser, Laurent; Torcivia, Adriana; Vaillant, Jean-Christophe; Siksik, Jean-Michel

    2016-04-01

    Obesity and bariatric surgery (BS) are increasing worldwide and can potentially lead to incidental diagnosis of benign gastric tumor including gastric leiomyoma (GL). When indicated, local tumor enucleation, completed through laparoscopic minimal-invasive approaches, has proven to be safe and effective especially when located near the esophagogastric junction (EGJ) with limited morbidity as compared to partial or total gastrectomies. Little is known regarding the most appropriate strategy concerning the management of GL regardless of the location in patients' candidate for BS. We present the case of a 67-year-old morbidly obese woman. She presented with an incidental 3-cm GL developed near the EGJ and antral histologic abnormalities mandating a gastric follow-up. Therefore, we performed both laparoscopic transgastric enucleation and sleeve gastrectomy simultaneously. After identification of the lesion, the gastrocolic ligament was divided and a gastrotomy was performed along the greater curvature to expose the tumor. Once the submucosal plan was identified, the lesion was enucleated from the submucosamuscle junction. After closure of the mucosal defect and ensuring the absence of gastric wall perforation, a conventional laparoscopic sleeve gastrectomy was performed. No adverse outcomes occurred during the post-operative period. The final pathologic diagnosis showed a completely resected and benign leiomyoma. Herein, we report the first laparoscopic transgastric enucleation of a GL localized close to the EGJ performed concomitant with a sleeve gastrectomy. This combined approach appeared feasible, safe, and do not compromise the access to the GI tract as well as potential future curative treatments on the gastric sleeve.

  15. Can Computer Tomography Predict Compromise of Cardiac Structures After Percutaneous Closure of Interatrial Septal Defects?

    PubMed Central

    Wagdi, Philipp

    2011-01-01

    Background Erosion of a cardiac structure after device closure of an interatrial septal communication (IASC-C), although rare, is a major and severe adverse event which may be underreported. On the other hand, unexplained episodes of transient chest pain occur more often and may be quite distressing. We sought to define the parameters relating the devices to the adjacent cardiac structures and to determine whether computer tomography (CT) could predict erosion of atrial or aortic wall or precordial pain symptoms occurring in the first months after device implantation. Methods Retrospective observational study of 20 patients who underwent CT for de novo chest pain occurring after IASC-C or as a diagnostic test for suspected or proven coronary artery disease (CAD). Clinical follow up was for 20.5 ± 17.6 (6-84) months. CT was done 18 ± 10 (2-28) weeks after IASC-C. Results Indentation of the aortic root was found in 11 (55%) patients, the left atrial wall in 13 (65%) and the right atrial wall in eight (40%) of patients. Contact without indentation was found in nine (45%), 6 (30%) and 11 (55%) of patients respectively. Conclusions Device indenting of the left and right atrial, as well as the aortic wall, occured in the majority of the patients examined after IASC-C. This finding may explain bouts of chest pain after the intervention in some patients, but does not predict clinically relevant erosion of a cardiac structure.

  16. Painful pathologic fracture of the humerus: percutaneous osteoplasty with bone marrow nails under hybrid computed tomography and fluoroscopic guidance.

    PubMed

    Anselmetti, Giovanni Carlo; Manca, Antonio; Chiara, Gabriele; Tutton, Sean; Iussich, Gabriella; Gino, Giancarlo; Grignani, Giovanni; Ortega, Cinzia; Moselli, Nora; Regge, Daniele

    2011-07-01

    A case of a 75-year-old patient with a painful pathologic humeral shaft fracture, with unacceptably high surgical risk and unsatisfactory analgesia is reported. In this case, impaired arm function and persistent pain with conservative management resulted in a poor quality of life. Palliation with image-guided percutaneous osteoplasty was considered. Because of potential cement leakage, inadequate fracture reduction, the site of the fracture, and the mobility of the joints in that area, image-guided percutaneous delivery of metallic bone marrow nails implanted together with polymethyl methacrylate (PMMA) osteoplasty was performed. This procedure achieved humeral shaft stabilization, bone fragment alignment, fracture reduction, and pain relief.

  17. Coronary Computed Tomography Angiography Predicts Guidewire Crossing and Success of Percutaneous Intervention for Chronic Total Occlusion: Korean Multicenter CTO CT Registry Score as a Tool for Assessing Difficulty in Chronic Total Occlusion Percutaneous Coronary Intervention.

    PubMed

    Yu, Cheol-Woong; Lee, Hyun-Jong; Suh, Jon; Lee, Nae-Hee; Park, Sang-Min; Park, Taek Kyu; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo-Yong; Choi, Seung Hyuk; Gwon, Hyeon-Cheol; Lee, Sang-Hoon; Choe, Yeon Hyeon; Kim, Sung Mok; Choi, Jin-Ho

    2017-04-01

    We developed a model that predicts difficulty of percutaneous coronary intervention for coronary chronic total occlusion (CTO) using coronary computed tomographic angiography. A total of 684 CTO lesions with preprocedural computed tomographic angiography were enrolled from 4 centers. Data were randomly divided into derivation and validation datasets at 2:1 ratio. The end point was successful guidewire crossing ≤30 minutes, which was met in 50%. The KCCT (Korean Multicenter CTO CT Registry) score was developed based on independent predictors identified by multivariable analysis, which were proximal blunt entry, proximal side branch, bending, occlusion length ≥15 mm, severe calcification, whole luminal calcification, reattempt, and ≥12 months or unknown duration of occlusion. The KCCT score was compared with the other prediction scores, including angiography-based J-CTO, PROGRESS-CTO, CL-score, and CT-based CT-RECTOR. The probability of guidewire crossing ≤30 minutes declined consistently from 100% to 0% according to the KCCT score (P<0.01, all). The KCCT score showed higher discriminative performance compared with the other scoring systems (c-statistics=0.78 versus 0.65-0.72, P<0.001, all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of a KCCT score of <4 for guidewire crossing ≤30 minutes was 70%, 68%, 72%, 73%, and 70%, respectively. The KCCT score also showed consistent results with procedural success (P<0.05, all). These results could be reproduced in validation data set (P<0.05, all). KCCT scoring could predict successful guidewire crossing ≤30 minutes and also procedural success. KCCT scoring may enable noninvasive grading difficulty of CTO percutaneous coronary intervention. © 2017 American Heart Association, Inc.

  18. Lung Tumors Treated With Percutaneous Radiofrequency Ablation: Computed Tomography Imaging Follow-Up

    SciTech Connect

    Palussiere, Jean Marcet, Benjamin; Descat, Edouard; Deschamps, Frederic; Rao, Pramod; Ravaud, Alain; Brouste, Veronique; Baere, Thierry de

    2011-10-15

    Purpose: To describe the morphologic evolution of lung tumors treated with radiofrequency ablation (RFA) by way of computed tomography (CT) images and to investigate patterns of incomplete RFA at the site of ablation. Materials and Methods: One hundred eighty-nine patients with 350 lung tumors treated with RFA underwent CT imaging at 2, 4, 6, and 12 months. CT findings were interpreted separately by two reviewers with consensus. Five different radiologic patterns were predefined: fibrosis, cavitation, nodule, atelectasis, and disappearance. The appearance of the treated area was evaluated at each follow-up CT using the predefined patterns. Results: At 1 year after treatment, the most common evolutions were fibrosis (50.5%) or nodules (44.8%). Differences were noted depending on the initial size of the tumor, with fibrosis occurring more frequently for tumors <2 cm (58.6% vs. 22.9%, P = 1 Multiplication-Sign 10{sup -5}). Cavitation and atelectasis were less frequent patterns (2.4% and 1.4%, respectively, at 1 year). Tumor location (intraparenchymatous, with pleural contact <50% or >50%) was not significantly correlated with follow-up image pattern. Local tumor progressions were observed with each type of evolution. At 1 year, 12 local recurrences were noted: 2 cavitations, which represented 40% of the cavitations noted at 1 year; 2 fibroses (1.9%); 7 nodules (7.4%); and 1 atelectasis (33.3%). Conclusion: After RFA of lung tumors, follow-up CT scans show that the shape of the treatment zone can evolve in five different patterns. None of these patterns, however, can confirm the absence of further local tumor progression at subsequent follow-up.

  19. Percutaneous computed tomography-guided radiofrequency thermal ablation of small unresectable lung tumours.

    PubMed

    Rossi, S; Dore, R; Cascina, A; Vespro, V; Garbagnati, F; Rosa, L; Ravetta, V; Azzaretti, A; Di Tolla, P; Orlandoni, G; Pozzi, E

    2006-03-01

    The aim of the current study was to evaluate the safety and the efficacy of radiofrequency thermal ablation (RFTA) for the treatment of nonsmall cell lung cancer (NSCLC) and isolated pulmonary metastases (METs) from colorectal cancer (CRC). A total of 31 patients (15 with NSCLCs and 16 with CRC lung METs), with 36 lung tumour nodules (mean+/-sd diameter: 22+/-8 mm, range: 10-35 mm) underwent computed tomography (CT)-guided RFTA using expandable electrodes. Contrast-enhanced CT was performed before and after (immediately and 30+/-5 days) each RFTA session to assess immediate results and complications and repeated 3 and 6 months post-RFTA, as well as every 6 months thereafter, to evaluate long-term results. Complete radiological necrosis was defined as a nonenhancing area at the tumour site that was equal to or larger than the treated tumour; persistence of enhancement at the tumour site indicated incomplete treatment. Local recurrence was defined as an increase in tumour size and/or enhancing tissue at the tumour site. Complete radiological necrosis of the 36 tumours was achieved with 39 RFTA sessions and 42 electrode insertions. No major complications or deaths were observed. Six patients experienced mild-to-moderate pain during the procedure. There were five cases of pneumothorax, none requiring drainage and four cases of pneumonia, which were successfully treated with antibiotics. After a mean follow-up of 11.4+/-7.7 months (range of 3-36 months), the overall local recurrence rate was 13.9% (20 and 9.5% for NSCLC and CRC-METs patients, respectively). Nineteen of the 31 (61.3%) patients were alive (15 apparently disease free) and 12 (38.7%) had died (three from causes unrelated to their cancer). Radiofrequency thermal ablation seems to be a safe, effective method for producing complete ablation of small nonsmall cell lung cancers and pulmonary colorectal cancer metastases.

  20. Evaluating the quality of implantation of percutaneous ventricular restoration device (Parachute®) by cardiac computed tomography.

    PubMed

    Alaiti, Mohamad Amer; Fares, Anas; Erglis, Andrejs; Nshisso, Lemba; Shaikh, Kashif; DeCicco, Anthony E; Nasif, Marwan; Alkhalil, Ahmad; Ince, Hüseyin; Abraham, William T; Simon, Daniel I; Costa, Marco A; Attizzani, Guilherme F; Bezerra, Hiram G

    2017-03-01

    The Parachute is a novel percutaneously implanted ventricular partitioning device (VPD) that has emerged as a safe and feasible treatment option for patients with heart failure following anterior wall myocardial infarction. VPD efficacy is likely dependent on optimal device placement, but to date there are no published data examining the effect of device positioning on patient outcomes. We retrospectively identified 32 patients successfully implanted with the Parachute device, all of whom underwent cardiac computed tomography (CCT) at baseline and after 6 months of follow-up. Patients were divided into two groups based on self-reported improvement in New York Heart Association (NYHA) functional class: "not improved NYHA" (n = 12) and "improved NYHA" (n = 20). There were significant differences between both groups with regard to device positioning on follow-up CCT. Compared to patients with "improved NYHA," patients with "not improved NYHA" had longer distances from device foot to left ventricular apex (8.0 ± 4.9 vs. 2.9 ± 4.6 mm; P = 0.01), and higher lateral angles (18.0 ± 14 vs. 9.1 ± 6.8 degrees; P = 0.02), respectively. There was no significant difference between the two groups in landing zone (45.4 ± 7. vs. 45.1 ± 6.9 mm; P = 0.92) and inferior angle (14.0 ± 11.9 vs. 14.3 ± 10.1 degrees; P = 0.95). There was a numerically larger malapposition area in the "not improved NYHA" group (5.1 ± 4.5 vs. 3.2 ± 2.2 cm2; P = 0.12). Quality of Parachute implant impacted clinical outcome, these findings should be applied prospectively in helping operators to achieve optimal implant. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Early assessment of myocardial viability by the use of delayed enhancement computed tomography after primary percutaneous coronary intervention.

    PubMed

    Rodriguez-Granillo, Gastón A; Rosales, Miguel A; Baum, Santiago; Rennes, Paola; Rodriguez-Pagani, Carlos; Curotto, Valeria; Fernandez-Pereira, Carlos; Llaurado, Claudio; Risau, Gustavo; Degrossi, Elina; Doval, Hernán C; Rodriguez, Alfredo E

    2009-09-01

    We sought to explore the relationship between established parameters of reperfusion and the extent of myocardial damage measured by the delayed enhancement (DE) of iodinated contrast by multidetector computed tomography (MDCT) immediately after primary percutaneous coronary intervention (PCI). Early detection of myocardial viability should be valuable for risk stratification of patients with reperfused acute myocardial infarction (AMI). Consecutive patients without a history of previous AMI who underwent primary PCI for an ST-segment elevation AMI were examined by DE-MDCT without an additional contrast injection immediately after completion of PCI. No medication was administrated to lower the heart rate. Dose modulation lead to an approximate mean radiation dose of 5.5 mSv. Thirty patients constituted the study population. Mean age was 61.4 +/- 15.6 years, 24 (80%) were men, and 4 (13%) were diabetic. Although post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in all patients, DE was detected in 14 (47%) patients. Age, sex, hypertension, diabetes, smoking history, serum creatinine levels, and pain duration were not associated with the presence of DE. Door-to-balloon time (DE 70.3 +/- 33.6 min vs. non-DE 98.3 +/- 70.7 min, p = 0.19) and lesion crossing time (DE 18.6 +/- 11.4 min vs. non-DE 16.4 +/- 9.6 min, p = 0.58) did not differ between groups. The TIMI myocardial perfusion grade (0 to 1 vs. 2 to 3) after stent implantation and electrocardiogram ST-segment resolution (<50% or >/=50%) were associated with the presence of DE (p = 0.001 and p = 0.02, respectively). Pre-discharge left ventricular ejection fraction was lower in DE than in non-DE patients (44.6 +/- 12.4% vs. 54.1 +/- 10.3%, respectively, p = 0.05). Hospitalization days (DE 5.6 +/- 3.8 vs. non-DE 4.8 +/- 1.0, p = 0.41) and 6-month cardiac events (DE 3 of 14 vs. non-DE 1 of 16, p = 0.22) did not differ between groups. Early detection of myocardial viability immediately

  2. Computational simulation of the predicted dosimetric impact of adjuvant yttrium-90 PET/CT-guided percutaneous ablation following radioembolization.

    PubMed

    Pasciak, Alexander S; Lin, Abigail; Georgiades, Christos; Findeiss, Laura K; Kauffman, Shannon; Bradley, Yong C

    2016-12-01

    (90)Y PET/CT post-radioembolization imaging has demonstrated that the distribution of (90)Y in a tumor can be non-uniform. Using computational modeling, we predicted the dosimetric impact of post-treatment (90)Y PET/CT-guided percutaneous ablation of the portions of a tumor receiving the lowest absorbed dose. A cohort of fourteen patients with non-resectable liver cancer previously treated using (90)Y radioembolization were included in this retrospective study. Each patient exhibited potentially under-treated areas of tumor following treatment based on quantitative (90)Y PET/CT. (90)Y PET/CT was used to guide electrode placement for simulated adjuvant radiofrequency ablation in areas of tumor receiving the lowest dose. The finite element method was used to solve Penne's bioheat transport equation, coupled with the Arrhenius thermal cell-death model to determine 3D thermal ablation zones. Tumor and unablated tumor absorbed-dose metrics (average dose, D50, D70, D90, V100) following ablation were compared, where D70 is the minimum dose to 70% of tumor and V100 is the fractional tumor volume receiving more than 100 Gy. Compared to radioembolization alone, (90)Y radioembolization with adjuvant ablation was associated with predicted increases in all tumor dose metrics evaluated. The mean average absorbed dose increased by 11.2 ± 6.9 Gy. Increases in D50, D70, and D90 were 11.0 ± 6.9 Gy, 13.3 ± 10.9 Gy, and 11.8 ± 10.8 Gy, respectively. The mean increase in V100 was 7.2 ± 4.2%. All changes were statistically significant (P < 0.01). A negative correlation between pre-ablation tumor volume and D50, average dose, and V100 was identified (ρ < - 0.5, P < 0.05) suggesting that adjuvant radiofrequency ablation may be less beneficial to patients with large tumor burdens. This study has demonstrated that adjuvant (90)Y PET/CT-guided radiofrequency ablation may improve tumor absorbed-dose metrics. These data may justify a prospective

  3. Computed tomography imaging-guided percutaneous argon-helium cryoablation of muscle-invasive bladder cancer: initial experience in 32 patients.

    PubMed

    Sun, Lijun; Zhang, Wei; Liu, Heliang; Yuan, Jianlin; Liu, Weiying; Yang, Yan

    2014-10-01

    To evaluate the initial clinical experience of computed tomography (CT) imaging-guided percutaneous cryotherapy of bladder cancer. This study was approved by the human subjects committee. Written informed consent was obtained from all patients. Thirty-two patients (22 males and 10 females; mean age, 62.7 years) with muscle-invasive bladder cancer were treated with CT imaging-guided percutaneous cryoablation. By using CT imaging system and local anesthesia in patients, a single or multiple 1.47 mm cryoprobes were used to freeze the target bladder tumor (mean tumor size, 2.8 cm; range, 1.3-4.5 cm) with a dual freeze-thaw cycle. Follow-up was performed to assess the clinical and technical outcome of patients treated with cryoablation for a minimum of 6 months (mean, 33 months; range, 6-48 months). Tumors were considered completely ablated if there was no evidence to suggest tumor enhancement at follow-up CT images. Bladder cryoablation was clinically and technically successful in all 32 cases, 30 of which required only one treatment session. Bladder integrity was maintained in all patients. Major complications were not observed in any patient. Our initial experience of a minimally invasive method for ablating bladder tumors with CT imaging-guided percutaneous argon-helium cryoablation appears to be favorable, with acceptable operative and short-term clinical outcomes. The technique is safe and effective for the treatment of patients with muscle-invasive bladder cancer; however, long-term follow-up is needed. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Transgastric small bowel resection with the new multitasking platform EndoSAMURAI™ for natural orifice transluminal endoscopic surgery.

    PubMed

    Fuchs, Karl-Hermann; Breithaupt, Wolfram

    2012-08-01

    Recently, natural orifice transluminal endoscopic surgery has been introduced using flexible endoscopic technology. Traditional endoscopes lack several capabilities that are needed to perform complex surgical procedures safely. The purpose of this study was to evaluate the new multitasking platform for transgastric small bowel resection including dissection of the mesentery and suturing an anastomosis. A new prototype of endoscopic multifunctional platform, EndoSAMURAI™ (ES), was tested. A standardized in vitro setting was established with segments of small bowel and an anastomosis was sutured with the device and compared with that by stapler (ST) and hand-sewn (HS). Leak pressure was measured. In addition, the system was tested in an experimental in vivo situation by performing a transgastric small bowel segmental resection under general anesthesia. Median time to perform an anastomosis in the bench test was 41 min; median leak pressure for the anastomosis by ES was 14 mmHg, by ST 25 mmHg, and HS 15 mmHg. For the in vivo study, the median total procedure time was 110 min and leak pressure 53 mmHg. These results show that the end-to-end small bowel anastomosis can be sutured sufficiently. This study has shown that with a multifunctional platform such as the EndoSAMURAI™, the majority of complex surgical tasks can be performed if technically independently moving instruments can be used via an ergonomic workstation interface that allows for laparoscopy-like maneuvers by the operator. Even with the shortcomings of the prototype, it was possible to perform an anastomosis of the small bowel of acceptable quality within a reasonable time.

  5. Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance.

    PubMed

    Kinoshita, Mitsuhiro; Takao, Shoichiro; Takechi, Katsuya; Takeda, Yoshitsugu; Miyamoto, Kanako; Yamanaka, Moriaki; Akagawa, Yoko; Iwamoto, Seiji; Osaki, Kyosuke; Tani, Hayato; Ohnishi, Norio; Shirono, Ryozo

    2016-01-01

    To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients' symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation. J. Med. Invest. 63: 323-327, August, 2016.

  6. Dataset of calcified plaque condition in the stenotic coronary artery lesion obtained using multidetector computed tomography to indicate the addition of rotational atherectomy during percutaneous coronary intervention.

    PubMed

    Akutsu, Yasushi; Hamazaki, Yuji; Sekimoto, Teruo; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Suyama, Jumpei; Gokan, Takehiko; Sakai, Koshiro; Kosaki, Ryota; Yokota, Hiroyuki; Tsujita, Hiroaki; Tsukamoto, Shigeto; Sakurai, Masayuki; Sambe, Takehiko; Oguchi, Katsuji; Uchida, Naoki; Kobayashi, Shinichi; Aoki, Atsushi; Kobayashi, Youichi

    2016-06-01

    Our data shows the regional coronary artery calcium scores (lesion CAC) on multidetector computed tomography (MDCT) and the cross-section imaging on MDCT angiography (CTA) in the target lesion of the patients with stable angina pectoris who were scheduled for percutaneous coronary intervention (PCI). CAC and CTA data were measured using a 128-slice scanner (Somatom Definition AS+; Siemens Medical Solutions, Forchheim, Germany) before PCI. CAC was measured in a non-contrast-enhanced scan and was quantified using the Calcium Score module of SYNAPSE VINCENT software (Fujifilm Co. Tokyo, Japan) and expressed in Agatston units. CTA were then continued with a contrast-enhanced ECG gating to measure the severity of the calcified plaque condition. We present that both CAC and CTA data are used as a benchmark to consider the addition of rotational atherectomy during PCI to severely calcified plaque lesions.

  7. Dataset of calcified plaque condition in the stenotic coronary artery lesion obtained using multidetector computed tomography to indicate the addition of rotational atherectomy during percutaneous coronary intervention

    PubMed Central

    Akutsu, Yasushi; Hamazaki, Yuji; Sekimoto, Teruo; Kaneko, Kyouichi; Kodama, Yusuke; Li, Hui-Ling; Suyama, Jumpei; Gokan, Takehiko; Sakai, Koshiro; Kosaki, Ryota; Yokota, Hiroyuki; Tsujita, Hiroaki; Tsukamoto, Shigeto; Sakurai, Masayuki; Sambe, Takehiko; Oguchi, Katsuji; Uchida, Naoki; Kobayashi, Shinichi; Aoki, Atsushi; Kobayashi, Youichi

    2016-01-01

    Our data shows the regional coronary artery calcium scores (lesion CAC) on multidetector computed tomography (MDCT) and the cross-section imaging on MDCT angiography (CTA) in the target lesion of the patients with stable angina pectoris who were scheduled for percutaneous coronary intervention (PCI). CAC and CTA data were measured using a 128-slice scanner (Somatom Definition AS+; Siemens Medical Solutions, Forchheim, Germany) before PCI. CAC was measured in a non-contrast-enhanced scan and was quantified using the Calcium Score module of SYNAPSE VINCENT software (Fujifilm Co. Tokyo, Japan) and expressed in Agatston units. CTA were then continued with a contrast-enhanced ECG gating to measure the severity of the calcified plaque condition. We present that both CAC and CTA data are used as a benchmark to consider the addition of rotational atherectomy during PCI to severely calcified plaque lesions. PMID:26977441

  8. 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.

  9. Percutaneous arthrodesis.

    PubMed

    Lauge-Pedersen, Henrik

    2003-02-01

    It has been generally accepted that residual cartilage and subchondral bone has to be removed in order to get bony fusion in arthrodeses. In 1998 we reported successful fusion of 11 rheumatoid ankles, all treated with percutaneous fixation only. In at least one of these ankle joint there was cartilage left. This was confirmed by arthrotomy in order to remove an osteophyte, which hindered dorsiflexion. More than 25 rheumatoid patients with functional alignment in the ankle joint have subsequently been operated on with the percutaneous technique, and so far we have had only one failure. Patients with rheumatoid arthritis are known to sometimes fuse at least their subtalar joints spontaneously, and the destructive effect of the synovitis on the cartilage could contribute to fusion when using the percutaneous technique. In a rabbit study we therefore tested the hypothesis that even a normal joint can fuse merely by percutaneous fixation. The patella was fixated to the femur with lag screw technique without removal of cartilage, and in 5 of 6 arthrodeses with stable fixation bony fusion followed. Depletion of synovial fluid seemed to be the mechanism behind cartilage disappearance. The stability of the fixation achieved at arthrodesis surgery is an important factor in determining success or failure. Dowel arthrodesis without additional fixation proved to be deleterious. A good fit of the bone surfaces appears necessary. In the ankle joint, it would be technically demanding to retain the arch-shaped geometry of the joint after resection of the cartilage. Normally the joint surfaces are resected to produce flat osteotomy surfaces that are thus easier to fit together, encouraging healing to occur. On the other hand it is considered an advantage to preserve as much subchondral bone as possible, as the strong subchondral bone plate can contribute to the stability of the arthrodesis. Ankle arthrodesis can be successfully performed in patients with rheumatoid arthritis by

  10. Feasibility and safety of augmented-reality glass for computed tomography-assisted percutaneous revascularization of coronary chronic total occlusion: A single center prospective pilot study.

    PubMed

    Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Staruch, Adam D; Kepka, Cezary; Rokicki, Jakub K; Sieradzki, Bartosz; Witkowski, Adam

    2017-09-21

    Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) may be facilitated by projection of coronary computed tomography angiography (CTA) datasets in the catheterization laboratory. There is no data on the feasibility and safety outcomes of CTA-assisted CTO PCI using a wearable augmented-reality glass. A total of 15 patients scheduled for elective antegrade CTO intervention were prospectively enrolled and underwent preprocedural coronary CTA. Three-dimensional and curved multiplanar CT reconstructions were transmitted to a head-mounted hands-free computer worn by interventional cardiologists during CTO PCI to provide additional information on CTO tortuosity and calcification. The results of CTO PCI using a wearable computer were compared with a time-matched prospective angiographic registry of 59 patients undergoing antegrade CTO PCI without a wearable computer. Operators' satisfaction was assessed by a 5-point Likert scale. Mean age was 64 ± 8 years and the mean J-CTO score was 2.1 ± 0.9 in the CTA-assisted group. The voice-activated co-registration and review of CTA images in a wearable computer during CTO PCI were feasible and highly rated by PCI operators (4.7/5 points). There were no major adverse cardiovascular events. Compared with standard CTO PCI, CTA-assisted recanalization of CTO using a wearable computer showed more frequent selection of the first-choice stiff wire (0% vs 40%, p < 0.001) and lower contrast exposure (166 ± 52 vs 134 ± 43 ml, p = 0.03). Overall CTO success rates and safety outcomes remained similar between both groups. CTA-assisted CTO PCI using an augmented-reality glass is feasible and safe, and might reduce the resources required for the interventional treatment of CTO. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  11. Prosthetic mesh contamination during NOTES(®) transgastric hernia repair: a randomized controlled trial with swine explants.

    PubMed

    Earle, D B; Romanelli, J R; McLawhorn, T; Omotosho, P; Wu, P; Rossini, C; Swayze, H; Desilets, D J

    2012-12-01

    Natural Orifice Translumenal Endoscopic Surgery (NOTES(®)) is a developing field in minimally invasive surgery that has been applied across a wide range of procedures; however, infectious concerns remain. Most of the applications have been for extraction, rather than reconstructive procedures. Prosthetic hernia repair, is a constructive procedure, has the unique challenge of avoiding contamination and infection of a permanent implant. Utilizing a novel device, we hypothesize that we can significantly reduce or eliminate prosthetic contamination during a transgastric approach for delivery of a clinically relevant, permanent, synthetic prosthetic. 20 swine explants of stomach with attached esophagus were prepared by placing an ultraviolet (UV) light sensitive gel within the lumen of the stomach. Each stomach then underwent endoscopic gastrotomy utilizing a needle, wire guide, and 18-mm balloon dilator. A 10 × 15 cm polypropylene prosthetic was rolled and tied with a 2-0 silk suture, and delivered with one of two methods. Group A (control) utilized a snare to grasp the prosthetic adjacent to the endoscope, which was used to drag it through the gastrotomy. Group B (device) utilized a modified esophageal stent delivery system to deliver the prosthetic through the gastrotomy. Each prosthetic was then digitally photographed with UV illumination, with the contaminated areas illuminating brightly. Software analysis was performed on the photographs to quantify areas of contamination for each group. Statistical analysis was performed using a two-tailed t test with unequal variance. Group A demonstrated a mean of 57 % of the surface area of the prosthetic contaminated with UV light sensitive gel. Group B (experimental group) showed a mean of 0.01 % of the surface area contaminated (p < 0.0001). 95 % confidence intervals indicated that the unprotected delivery technique exposes approximately 6,000 times more of the surface area to contamination than the delivery

  12. Feasibility and applicability of computer-assisted myocardial blush quantification after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

    PubMed

    Haeck, Joost D E; Gu, Youlan L; Vogelzang, Mathijs; Bilodeau, Luc; Krucoff, Mitchell W; Tijssen, Jan G P; De Winter, Robbert J; Zijlstra, Felix; Koch, Karel T

    2010-04-01

    The aim of the study was to evaluate whether the "Quantitative Blush Evaluator" (QuBE) score is associated with measures of myocardial reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) treated in two hospitals with 24/7 coronary intervention facilities. QuBE is an open source computer program to quantify myocardial perfusion. Although QuBE has shown to be practical and feasible in the patients enrolled in the Thrombus Aspiration during Percutaneous Coronary Intervention in Acute Myocardial Infarction Study (TAPAS), QuBE has not yet been verified on reperfusion outcomes of primary percutaneous coronary intervention (PCI) patients treated in other catheterization laboratories. Core lab adjudicated angiographic outcomes and QuBE values were assessed on angiograms of patients who were enrolled in the PRoximal Embolic Protection in Acute myocardial infarction and Resolution of ST-Elevation (PREPARE) trial. ST-segment resolution immediately after PCI measured by continuous ST Holter monitoring was calculated by a blinded core lab. The QuBE score could be assessed on 229 of the 284 angiograms (81%) and was significantly associated with visually assessed myocardial blush grade (P < 0.0001). Patients with improved postprocedural Thrombolysis in Myocardial Infarction-graded flow, myocardial blush grade, ST-segment resolution immediately after PCI, or a small infarct size measured by peak CK-MB had a significant better QuBE score. QuBE is feasible and applicable at angiograms of patients with STEMI recorded at other catheterization laboratories and is associated with measures of myocardial reperfusion. (c) 2010 Wiley-Liss, Inc.

  13. EUS-directed transgastric ERCP for Roux-en-Y gastric bypass anatomy: a minimally invasive approach.

    PubMed

    Kedia, Prashant; Tyberg, Amy; Kumta, Nikhil A; Gaidhane, Monica; Karia, Kunal; Sharaiha, Reem Z; Kahaleh, Michel

    2015-09-01

    ERCP is challenging in patients with Roux-en-Y gastric bypass. Using EUS to gain access to the excluded stomach and subsequently performing transcutaneous ERCP was described recently. We describe our initial experience with an internal EUS-directed transgastric ERCP (EDGE) procedure by using a lumen-apposing metal stent (LAMS). Single-center case series. Tertiary center with expertise in EUS-guided procedures. Five patients with Roux-en-Y gastric bypass underwent EDGE via a LAMS. A linear echoendoscope was used to access the excluded stomach. A LAMS was deployed over a wire to create a gastrogastric or jejunogastric fistula. A duodenoscope was then passed through the LAMS and conventional ERCP was performed. Technical and clinical success rates as well as adverse events. EUS-guided creation of a gastrogastric or jejunogastric fistula via placement of a LAMS was successful in all cases (100%). The ability to perform ERCP through the fashioned fistula during the index procedure was successful in 3 of 5 cases (60%). Two LAMS dislodgments requiring restenting were observed. No major adverse events were observed. No weight regain occurred. The median procedure time was 68.0 minutes. Small sample, single-institution experience. The internal EDGE procedure may offer a cost-effective, minimally invasive option for a common problem in a growing patient demographic. Further refinement of the technique is required to minimize adverse events. ( NCT01522573.). Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  14. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

    PubMed

    Ho, Chi-Kung; Chen, Fu-Cheng; Chen, Yung-Lung; Wang, Hui-Ting; Lee, Chien-Ho; Chung, Wen-Jung; Lin, Cheng-Jui; Hsueh, Shu-Kai; Hung, Shin-Chiang; Wu, Kuan-Han; Liu, Chu-Feng; Kung, Chia-Te; Cheng, Cheng-I

    2017-01-01

    This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p < 0.05). There were also no remarkable differences in the complication rate and 30-day mortality between two groups. The multivariate analysis revealed that the independent predictors of 30-day mortality were elderly patients, advanced Killip score, and higher level of troponin-I. This study showed that patients transferred through our present protocol could reduce pain to electrocardiography and catheterization laboratory to balloon time in Killip I/II and III/IV patients separately. However, this study showed that using a cloud computing system in our present protocol did not reduce DTB time.

  15. Percutaneous Tracheostomy

    PubMed Central

    Mehta, Chitra; Mehta, Yatin

    2017-01-01

    Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists. This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU. PMID:28074819

  16. Percutaneous tracheostomy.

    PubMed

    Mehta, Chitra; Mehta, Yatin

    2017-01-01

    Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU.

  17. The hounsfield unit value calculated with the aid of non-contrast computed tomography and its effect on the outcome of percutaneous nephrolithotomy.

    PubMed

    Gok, Alper; Polat, Haci; Cift, Ali; Yucel, Mehmet Ozgur; Gok, Bahri; Sirik, Mehmet; Benlioglu, Can; Kalyenci, Bedreddin

    2015-06-01

    To evaluate the effect of the Hounsfield unit (HU) value, calculated with the aid of non-contrast computed tomography, on the outcome of percutaneous nephrolithotomy (PCNL). Data for 83 patients evaluated in our clinic between November 2011 and February 2014 that had similar stone sizes, localizations, and radio opacities were retrospectively reviewed. The patients were grouped according to their HU value, in a low HU group (HU ≤ 1000) or a high HU group (HU > 1000). The two groups were compared based on their PCNL success rates, complications, duration of surgery, duration of fluoroscopy, and decrease in the hematocrit. There were no significant differences in terms of mean age, female-male ratio, or mean body mass index between the two groups (p > 0.05). The stone size and stone surface area did not differ significantly between the groups (p = 0.820 and p = 0.394, respectively). The unsuccessful PCNL rate and the prevalence of complications did not differ significantly between the two groups (p > 0.05). The duration of surgery, duration of fluoroscopy, and decrease in the hematocrit were significantly greater in the high HU group compared to the low HU group (p < 0.001). Calculating the HU value using this imaging method may predict cases with longer surgery durations, longer fluoroscopy durations, and greater decreases in hematocrite levels, but this value is not related to the success rate of PCNL.

  18. Recent developments in percutaneous mitral valve treatment.

    PubMed

    La Canna, Giovanni; Denti, Paolo; Buzzatti, Nicola; Alfieri, Ottavio

    2016-01-01

    In recent years, various percutaneous techniques have been introduced for the treatment of mitral regurgitation (MR), including direct leaflet repair, annuloplasty and left ventricular remodeling. Percutaneous mitral repair targets both primary degenerative and secondary mitral valve regurgitation and may be considered in selected high-surgical-risk patients. The assessment of mitral functional anatomy by echocardiography and computed tomography is crucial when selecting the appropriate repair strategy, according to the regurgitant valve lesion and the surrounding anatomy. The ongoing clinical use of new devices in annuloplasty and percutaneous mitral valve replacement is a promising new scenario in the treatment of MR that goes beyond the conventional surgical approach.

  19. Unenhanced Cone Beam Computed Tomography and Fusion Imaging in Direct Percutaneous Sac Injection for Treatment of Type II Endoleak: Technical Note

    SciTech Connect

    Carrafiello, Gianpaolo Ierardi, Anna Maria; Radaelli, Alessandro; Marchi, Giuseppe De; Floridi, Chiara; Piffaretti, Gabriele; Federico, Fontana

    2016-03-15

    AimTo evaluate safety, feasibility, technical success, and clinical success of direct percutaneous sac injection (DPSI) for the treatment of type II endoleaks (T2EL) using anatomical landmarks on cone beam computed tomography (CBCT) and fusion imaging (FI).Materials and MethodsEight patients with T2EL were treated with DPSI using CBCT as imaging guidance. Anatomical landmarks on unenhanced CBCT were used for referencing T2EL location in the first five patients, while FI between unenhanced CBCT and pre-procedural computed tomography angiography (CTA) was used in the remaining three patients. Embolization was performed with thrombin, glue, and ethylene–vinyl alcohol copolymer. Technical and clinical success, iodinated contrast utilization, procedural time, fluoroscopy time, and mean radiation dose were registered.ResultsDPSI was technically successful in all patients: the needle was correctly positioned at the first attempt in six patients, while in two of the first five patients the needle was repositioned once. Neither minor nor major complications were registered. Average procedural time was 45 min and the average administered iodinated contrast was 13 ml. Mean radiation dose of the procedure was 60.43 Gy cm{sup 2} and mean fluoroscopy time was 18 min. Clinical success was achieved in all patients (mean follow-up of 36 months): no sign of T2EL was reported in seven patients until last CT follow-up, while it persisted in one patient with stability of sac diameter.ConclusionsDPSI using unenhanced CBCT and FI is feasible and provides the interventional radiologist with an accurate and safe alternative to endovascular treatment with limited iodinated contrast utilization.

  20. Outcomes and computed tomography scan follow-up of bioresorbable vascular scaffold for the percutaneous treatment of chronic total coronary artery occlusion.

    PubMed

    Ojeda, Soledad; Pan, Manuel; Romero, Miguel; Suárez de Lezo, Javier; Mazuelos, Francisco; Segura, José; Espejo, Simona; Morenate, Carmen; Blanco, Marta; Martín, Pedro; Medina, Alfonso; Suárez de Lezo, José

    2015-06-01

    Everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in chronic total occlusion (CTO) could provide theoretical advantages at follow-up compared with metallic stents. This study aimed to assess the feasibility of BVS use for the percutaneous treatment of CTO by analyzing clinical outcomes and patency at midterm follow-up. From February 2013 to June 2014, 42 patients with 46 CTOs were treated by BVS implantation. Once the guidewire reached the distal lumen, all the occluded segments were predilated. Postdilation was performed in all patients. A multislice computed tomography was scheduled for all patients at 6 months. The mean age was 58 ± 9 years, 41 (98%) were men and 14 (33%) diabetic. The target vessel was predominantly the left anterior descending artery (22, 48%). According to the Japanese-CTO score, 21 CTOs (46%) were difficult or very difficult. Most cases were treated with an anterograde strategy (34 lesions, 74%). A hybrid procedure with a drug-eluting stent at the distal segment was the applied treatment in 7 CTOs (15%). The mean scaffold length was 43 ± 21 mm. Technical success was achieved in 45 lesions (98%), and 1 patient (2.4%) presented a non-Q periprocedural myocardial infarction. Re-evaluation was obtained in all patients at 6 ± 1 months. Two re-occlusions and a focal restenosis were identified. After 13 ± 5 months of follow-up, there were 2 repeat revascularizations (4.8%). Neither death nor myocardial infarction was documented. In conclusion, BVS for CTO seems to be an interesting strategy with a high rate of technical success and low rate of cardiac events at midterm follow-up in selected patients.

  1. Percutaneous Transcatheter Mitral Valve Replacement: Patient-specific Three-dimensional Computer-based Heart Model and Prototyping.

    PubMed

    Vaquerizo, Beatriz; Theriault-Lauzier, Pascal; Piazza, Nicolo

    2015-12-01

    Mitral regurgitation is the most prevalent valvular heart disease worldwide. Despite the widespread availability of curative surgical intervention, a considerable proportion of patients with severe mitral regurgitation are not referred for treatment, largely due to the presence of left ventricular dysfunction, advanced age, and comorbid illnesses. Transcatheter mitral valve replacement is a promising therapeutic alternative to traditional surgical valve replacement. The complex anatomical and pathophysiological nature of the mitral valvular complex, however, presents significant challenges to the successful design and implementation of novel transcatheter mitral replacement devices. Patient-specific 3-dimensional computer-based models enable accurate assessment of the mitral valve anatomy and preprocedural simulations for transcatheter therapies. Such information may help refine the design features of novel transcatheter mitral devices and enhance procedural planning. Herein, we describe a novel medical image-based processing tool that facilitates accurate, noninvasive assessment of the mitral valvular complex, by creating precise three-dimensional heart models. The 3-dimensional computer reconstructions are then converted to a physical model using 3-dimensional printing technology, thereby enabling patient-specific assessment of the interaction between device and patient. It may provide new opportunities for a better understanding of the mitral anatomy-pathophysiology-device interaction, which is of critical importance for the advancement of transcatheter mitral valve replacement. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  2. Effectiveness of Computed Tomography Guided Percutaneous Radiofrequency Ablation Therapy for Osteoid Osteoma: Initial Results and Review of the Literature

    PubMed Central

    Karagöz, Erdal; Özel, Deniz; Özkan, Fuat; Özel, Betül Duran; Özer, Özgur; Coşkun, Zafer Ünsal

    2016-01-01

    Summary Background The aim of this retrospective study is to determine our experience of technique success rate, complications and clinical results in long term follow up for computed tomography (CT)-guided radiofrequency ablation [RA] therapy for osteoid osteoma (OO). Material/Methods We performed RA therapy to 18 patients with OO referred to interventional radiology from other clinics primarily from orthopedics; between January 2011 to May 2014. Daytime and nighttime pain intensity of 18 patients was noted according to visual analog scale (VAS). After procedure pain intensity was compared with before one. We also discussed other factors can affect it. Results All procedures were completed technically successful for all patients [100%]. We did not experience any major complication or mortality. However we had 3 minor complications. Pain came back in 1 patient after 5 months from procedure and it was considered as recurrence. Dramatic pain intensity fall was seen in patients after procedure, both daytime and nighttime. However we did not find and statistically significant change in comparison of pain intensity reduce and time needed to return back to routine life when using patients demographic data and lesion size. Conclusions CT guided RA therapy of OO is minimally invasive, effective and secure procedure. PMID:27429671

  3. Cardiac computed tomography assessment of the near term impact of percutaneous ventricular restoration therapy (parachute(®) ) on mitral valve geometry.

    PubMed

    Tam, Chor Cheung; Fares, Anas; Alaiti, Amer; Shaikh, Kashif; Ince, Hüseyin; Erglis, Andrejs; Bezerra, Hiram G; Abraham, William T; Costa, Marco A; Attizzani, Guilherme F

    2016-08-01

    The aim of current study is to assess the near term impact of percutaneous ventricular restoration therapy (PVR), Parachute(®) on mitral valve (MV) geometry by cardiac computed tomography (CCT). Recent data demonstrates the feasibility of PVR for treatment of post anterior myocardial infarction (MI) heart failure. Little is known, however, about the interaction of the device and left ventricular structures, particularly the MV apparatus. This is a retrospective Core Laboratory analysis of Parachute Trials' CCT data. Patients with paired (before and after Parachute implant) CCT acquisitions were included into analysis. MV geometric parameters were measured. Thirty-three patients were included in the analysis. The mean time of follow-up CCT post procedure was 188 ± 52 days. There were significant reduction in tenting height (A1P1: -1.70 ± 1.89 mm, -17.40 ± 20.20%; A2P2: -1.43 ± 1.89 mm, -12.10 ± 15.00%; A3P3: -1.54 ± 1.58 mm, -15.50 ± 15.20%, P < 0.001), tenting volume (-0.93 ± 0.60 mm3, -22.00 ± 11.40%, P < 0.001), systolic interpapillary muscle distance (-2.22 ± 2.11 mm, -7.51 ± 7.23%, P < 0.001) and diastolic interpapillary muscle distance (-3.14 ± 2.20 mm, -8.46 ± 5.73%, P < 0.001) post PVR. In post anterior MI heart failure patients, PVR has favorable near term impact on MV geometry as assessed by CCT. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  4. Percutaneous Nephroscopic Surgery

    PubMed Central

    2010-01-01

    With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases. PMID:20495691

  5. Percutaneous forefoot surgery.

    PubMed

    Bauer, T

    2014-02-01

    Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2 cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments.

  6. Percutaneous Posterior Calcaneal Osteotomy.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Different types of posterior calcaneal osteotomy are used for calcaneal realignment in the management of hindfoot deformity. We describe a percutaneous technique of posterior calcaneal osteotomy that can be either a Dwyer-type closing wedge osteotomy or displacement osteotomy.

  7. Percutaneous gastrojejunostomy in children: efficacy and safety.

    PubMed

    Michaud, Laurent; Coopman, Stéphanie; Guimber, Dominique; Sfeir, Rony; Turck, Dominique; Gottrand, Frédéric

    2012-08-01

    Transgastric jejunal intubation via gastrostomy (GJ) can be indicated when enteral nutrition via gastrostomy is not possible. Between 2001 and 2008, the authors prospectively assessed the outcomes in 29 patients (median age, 10 months) after GJ. Indications for jejunal feeding were severe gastro-oesophageal reflux (n=27) and intestinal dysmotility (n=2). The GJ was successfully placed in 27/29 patients. Complications were: 31 tube dislodgements, 16 obstructions, 7 leakages around the tube, 6 internal balloon ruptures and 1 intussusception. The median lifetime of the tube was 3 months. 9/27 patients died during the study period, 11 patients required surgery, 2 required parenteral nutrition, gastric feeding became tolerated in 3 and the gastrojejunal feeding tube was kept in place in the remaining 2. A transgastric jejunal feeding tube may constitute a transitory alternative to antireflux surgery or prolonged parenteral nutrition. However, the high frequency of complications and tube replacement limits its use.

  8. [Techniques for percutaneous access during percutaneous nephrolithotomy.

    PubMed

    Pérez-Fentes, Daniel

    2017-01-01

    The creation of the access is one of the main steps in percutaneous nephrolithotomy, the most complicated for many urologists and the one that limited most the universalization of the technique. From a purely technical point of view, it includes puncture of the excretory tract and dilatation of the percutaneous tract to end with the introduction of an Amplatz type working sheath. The objective of the puncture is to try to access the excretory system through the renal papilla, minimizing the risk of bleeding. The puncture may be guided by ultrasound, fluoroscopy, both, under endoscopic or laparoscopic control, by CT scan or MRI, or even by application of new technologies (Robotic, augmented reality, electromagnetic navigation,...). Due to the versatility and independence involved in having the ability to perform the renal puncture in the operative room, as well as its influence in the results of PCNL, it must be the urologist himself who performs this basic step of percutaneous surgery. The tract may be dilated by Alken type metallic dilators, semirrigid Amplatz type dilators or high pressure balloons. To date, there is no single ideal dilatation method, being the selection based on the endourologist's experience and the knowledge of the advantages and limitations of each option. The objective of this review is to present the main methods for puncture guiding and tract dilatation for PCNL, as well as to provide technical details to improve its result.

  9. Negative correlation between extent of physeal ablation after percutaneous permanent physiodesis and postoperative growth: volume computer tomography and radiostereometric analysis of 37 physes in 27 patients.

    PubMed

    Gunderson, Ragnhild B; Horn, Joachim; Kibsgård, Thomas; Kristiansen, Leif Pål; Pripp, Are Hugo; Steen, Harald

    2013-08-01

    Percutaneous physiodesis in the knee region is a well-established method for treating leg-length inequality. Longitudinal growth in the physis is believed to stop almost immediately after the operation. The extent of physis ablation required has never been investigated by any kind of tomography in humans. Using radiostereometric analysis (RSA), we determined when definite growth arrest occurred after surgery. We also studied the correlation between the extent of physis ablation and postoperative growth. Finally, we assessed any bone bridging across the physis. 6, 12, and 30 weeks after surgery, we used RSA to measure longitudinal growth in 27 patients (37 physes) with a mean age of 13 years. CT scanning of the knee region was performed 12 weeks after surgery to measure the percentage of the ablated physis and to determine the distribution of bone bridges across the physis. RSA showed that growth rate was reduced to less than half of the expected rate after 6 weeks. During the next 6 weeks, the growth ceased completely. CT scans revealed a large variation in the extent of ablated physes (17-69%). In the ablated areas, tissues of various densities were mixed with mature bone. Bridges were found both laterally and medially across the physes in all of the patients. There was a negative correlation between the extent of ablation and total postoperative growth (rho = -0.37, p = 0.03). Growth across the physis is effectively stopped by percutaneous physiodesis. RSA is well-suited for observation of this phenomenon. Volume CT scanning can be used to detect bone bridges that cross the physis and to calculate the extent of physis ablation.

  10. 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.

  11. Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

    PubMed Central

    Jin, Kwang Nam; Kim, Tae Jung; Song, Yong Sub; Kim, Dong Il

    2014-01-01

    Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue. PMID:24431917

  12. Computed tomography guided percutaneous injection of a mixture of lipiodol and methylene blue in rabbit lungs: evaluation of localization ability for video-assisted thoracoscopic surgery.

    PubMed

    Jin, Kwang Nam; Lee, Kyung Won; Kim, Tae Jung; Song, Yong Sub; Kim, Dong Il

    2014-01-01

    Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.

  13. Surgical Trauma Caused by Different Abdominal Access Routes-Comparison of Open Surgical, Laparoscopic, and NOTES Transgastric Techniques in a Porcine Model.

    PubMed

    Arroyo Vázquez, Jorge; Bergström, Maria; Dot, Joan; Abu-Suboh-Abadia, Monder; Fonseca, Carla; Esteves, Marielle; Azadani, Asghar; Armengol, Jordi; Masachs, Miquel; Armengol-Miró, José Ramon; Park, Per-Ola

    2016-07-01

    Investigations indicate that natural orifice translumenal endoscopic surgery (NOTES) procedures induce a less pronounced postoperative inflammatory response than open or laparoscopic surgery, inflicting less trauma. In NOTES procedures, no skin incision is performed. We compare the inflammatory response added by the type of incision by measuring C-reactive protein (CRP) and tumors necrosis factor-alfa (TNF-α). Twenty-seven pigs were randomized to open surgical, laparoscopic, or transgastric NOTES abdominal access. After completion of the accesses, no surgery was performed. All accesses were left open for 40 minutes followed by closure, animals were survived for 7 days. Blood samples were drawn at the start of the accesses, at 20 and 40 minutes during the procedure, and at postoperative day (POD) 1, 3, and 7. Analyses of CRP and TNF-α were performed. CRP increased in all animals until POD1. This increase was greater in the open group (P = .006). No significant differences in CRP-levels were found at POD 1, 3, or 7. TNF-α showed a peak during the procedure, at 20 and 40 minutes, with normalization at POD1 for 1/3 of the open and laparoscopic animals, but not for the NOTES animals. Due to variations within the groups, no statistical difference was shown between them. At postmortem, 1/3 of the pigs in the laparoscopic and open groups had wound infections, while no NOTES animals showed infections. This study provides no statistically significant differences in inflammatory response after the different abdominal accesses. However, the lack of a TNF-α-peak in the NOTES group might indicate a less pronounced response, supporting the initial theories.

  14. Percutaneous Abscess Drainage

    MedlinePlus

    ... the local anesthetic is injected. Most of the sensation is at the skin incision site which is numbed using local anesthetic. ... open surgical drainage. Risks Any procedure where the skin is penetrated ... organ may be damaged by percutaneous abscess drainage. Occasionally ...

  15. 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.

  16. Percutaneous navigation surgery of osteoid osteoma of the femur neck.

    PubMed

    Kang, Hyun Guy; Cho, Chang Nho; Kim, Kwang Gi

    2014-01-01

    Surgery on benign bone tumors such as osteoid osteoma does not necessarily require bone exposure through a surgical incision. In most reported cases of the osteoid osteoma resection through computer-assisted surgery, registration and surgery were performed by exposing the bone. We have succeeded in performing percutaneous registration and navigated burr excision of the osteoid osteoma using computer-assisted navigation.

  17. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer.

    PubMed

    Wei, Zhigang; Zhang, Kaixian; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao

    2015-10-01

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28%); among these, major complications were reported in two (7.7%) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1% (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases.

  18. Percutaneous tracheostomy: ready or not?

    PubMed

    Pelausa, E O

    1991-04-01

    A novel approach to tracheostomy has recently been introduced, based on the Seldinger guide-wire technique. A well-packaged percutaneous tracheostomy kit promises a rapid and safe alternative to the traditional surgical tracheostomy. At the National Defence Medical Centre, this percutaneous approach was tried on four patients. Deficiencies in the kit instruments were discovered which, with the expected "learning curve," led to unexpected difficulties. Thus, the promise of percutaneous tracheostomy remains as yet unfulfilled.

  19. Brachiocephalic Artery Haemorrhage During Percutaneous Tracheostomy

    PubMed Central

    Kumar, G; Hill, CS; Kaddour, H

    2015-01-01

    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

  20. 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.

  1. Percutaneous approaches to enteral alimentation.

    PubMed

    Ponsky, J L; Gauderer, M W; Stellato, T A; Aszodi, A

    1985-01-01

    Feeding gastrostomy and jejunostomy provide effective access for long-term enteral nutrition. Traditional operative techniques for the performance of these procedures requires laparotomy and often, general anesthesia. This report describes our experience with two relatively new methods, percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy. Results of percutaneous gastrostomy and jejunostomy to date in 323 cases include a morbidity of 5.9 percent and a 0.3 percent operative mortality. Percutaneous endoscopic gastrostomy and jejunostomy should become the procedures of choice for the establishment of enteral access in patients requiring long-term enteral alimentation.

  2. Percutaneous gastrostomy and gastrojejunostomy.

    PubMed

    Lyon, Stuart M; Pascoe, Diane M

    2004-09-01

    Gastrostomy allows enteral nutrition to continue in patients who are unable to meet their caloric requirements orally. Though the indications for gastrostomy placement are varied, dysphagia secondary to a neurological condition is the most common. These catheters were initially placed surgically, but percutaneous endoscopic placement is now the routine in most centers. Interventional radiologists have been performing this procedure under fluoroscopic guidance for several years with encouraging results. Percutaneous radiological gastrostomy is reported to have a success rate comparable to that of the endoscopic method, with lower morbidity and mortality rates. A further benefit is that it may be performed in patients for whom the endoscopic method would be difficult or dangerous, such as those with head and neck malignancies. One of the main factors currently limiting the use of this procedure is the shortage of interventional radiology facilities and specialists.This article describes a technique for routine percutaneous radiological gastrostomy catheter placement and procedural variations for difficult cases. Indications and contraindications will be discussed, as will complication rates and how these compare with the traditional methods of gastrostomy tube placement.

  3. Training for percutaneous renal access on a virtual reality simulator.

    PubMed

    Zhang, Yi; Yu, Cheng-fan; Liu, Jin-shun; Wang, Gang; Zhu, He; Na, Yan-qun

    2013-01-01

    The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training. Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt. During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively). The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in

  4. Percutaneous nephrolithotomy: technique.

    PubMed

    Knoll, Thomas; Daels, Francisco; Desai, Janak; Hoznek, Andras; Knudsen, Bodo; Montanari, Emanuele; Scoffone, Cesare; Skolarikos, Andreas; Tozawa, Keiichi

    2017-01-25

    Percutaneous nephrolithotomy (PCNL) is considered to be the first line of treatment for large renal stones. Though PCNL comes with higher morbidity, its efficacy is unbeaten by other minimally invasive modalities. However, potential complications, such as bleeding, occur. Improved skills and modifications of the procedure may reduce the probability of adverse outcomes. This article discusses the current trends and standards in PCNL technique with special focus on all important steps as positioning, access, instruments, dilation, disintegration, and exit, including outcomes, complication management, and training modalities.

  5. Computed tomography guided navigation assisted percutaneous ablation of osteoid osteoma in a 7-year-old patient: the low dose approach.

    PubMed

    Krokidis, Miltiadis; Tappero, Carlo; Bogdanovic, Daniel; Ziebarth, Kai; Stamm, Anna-Christina

    2017-07-01

    Osteoid osteoma (OO) is a benign tumour that can cause severe pain and functional limitation to children and young adults; the treatment of choice is image-guided ablation. Due to the very small size of the lesion, detection and accurate needle placement may be challenging. Computed tomography (CT) offers very detailed imaging of the skeleton and is the modality of choice for the detection of small OO and for ablation guidance. Nevertheless, CT-guided positioning of the ablation applicator is linked to significant radiation exposure, particularly for the paediatric population. This case describes the successful use of a novel CT-based navigation system that offers the possibility of accurate ablation with only minimal radiation exposure in a paediatric patient.

  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.

  7. Complications in percutaneous nephrolithotomy.

    PubMed

    Kyriazis, Iason; Panagopoulos, Vasilios; Kallidonis, Panagiotis; Özsoy, Mehmet; Vasilas, Marinos; Liatsikos, Evangelos

    2015-08-01

    Percutaneous nephrolithotomy (PCNL) is generally considered a safe technique offering the highest stone-free rates after the first treatment as compared to the other minimal invasive lithotripsy techniques. Still, serious complications although rare should be expected following this percutaneous procedure. In this work, the most common and important complications associated with PCNL are being reviewed focusing on the perioperative risk factors, current management, and preventing measures that need to be taken to reduce their incidence. In addition, complication reporting is being criticized given the absence of a universal consensus on PCNL complications description. Complications such as perioperative bleeding, urine leak from nephrocutaneous fistula, pelvicalyceal system injury, and pain are individually graded as complications by various authors and are responsible for a significant variation in the reported overall PCNL complication rate, rendering comparison of morbidity between studies almost impossible. Due to the latter, a universally accepted grading system specialized for the assessment of PCNL-related complications and standardized for each variation of PCNL technique is deemed necessary.

  8. Determination of optimal dosage and delay time for computed tomographic lymphography after percutaneous injection of Iohexol into popliteal lymph nodes in dogs.

    PubMed

    Chun, Hyeyoung; Cho, Hangmyo; Cheon, Haengbok; Kim, Juhyung; Kim, Taehun; Kang, Ji-Houn; Kim, Gonhyung; Lee, Youngwon; Choi, Hojung; Lee, Heechun; Chang, Dongwoo

    2009-07-01

    The purposes of this study were to determine the optimal dose and delay time for lymphography by injection of Iohexol into popliteal lymph nodes and to assess images of computed tomography by the established protocol. Three different doses (30, 60 and 90 mgI/kg) of water-soluble iodinated contrast medium were injected into 15 popliteal lymph nodes of 10 adult beagles, and fluoroscopy was performed. Filling and duration of contrast media and the number of visible ducts from popliteal lymph nodes to the thoracic duct and its branches were recorded. CT lymphography was performed, and the number of visible thoracic ducts was compared with that found by radiographic lymphography. Radiographs obtained between 130 and 800 seconds after injection of contrast medium provided a detailed view of the thoracic duct. The dose of 60 mgI/kg was determined to enable quality diagnostic imaging without extranodal leakage in radiographic lymphography. There was no significant difference in the number of thoracic ducts between the two modalities at each anatomic location. However, CT lymphography provided images of the thoracic duct with better spatial resolution and without superimposition of surrounding tissue. The present study provides an adequate delay time and injection for identification of the canine thoracic duct, and therefore, this technique could be applied to diagnosis of disease associated with chest lymphatic drainage.

  9. Percutaneous computed tomography-guided high-dose-rate brachytherapy ablation of breast cancer liver metastases: initial experience with 80 lesions.

    PubMed

    Collettini, Federico; Golenia, Mascha; Schnapauff, Dirk; Poellinger, Alexander; Denecke, Timm; Wust, Peter; Riess, Hanno; Hamm, Bernd; Gebauer, Bernhard

    2012-05-01

    To analyze initial experience with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM). Between January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34-83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid-enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter. Two patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3-32 mo). Mean tumor diameter was 25.5 mm (range 8-74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3-39 months (median 18 months). CT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  10. Determinants of Local Progression After Computed Tomography-Guided Percutaneous Radiofrequency Ablation for Unresectable Lung Tumors: 9-Year Experience in a Single Institution

    SciTech Connect

    Okuma, Tomohisa Matsuoka, Toshiyuki; Yamamoto, Akira; Oyama, Yoshimasa; Hamamoto, Shinichi; Toyoshima, Masami; Nakamura, Kenji; Miki, Yukio

    2010-08-15

    The purpose of this study was to retrospectively determine the local control rate and contributing factors to local progression after computed tomography (CT)-guided radiofrequency ablation (RFA) for unresectable lung tumor. This study included 138 lung tumors in 72 patients (56 men and 16 women; age 70.0 {+-} 11.6 years (range 31-94); mean tumor size 2.1 {+-} 1.2 cm [range 0.2-9]) who underwent lung RFA between June 2000 and May 2009. Mean follow-up periods for patients and tumors were 14 and 12 months, respectively. The local progression-free rate and survival rate were calculated to determine the contributing factors to local progression. During follow-up, 44 of 138 (32%) lung tumors showed local progression. The 1-, 2-, 3-, and 5-year overall local control rates were 61, 57, 57, and 38%, respectively. The risk factors for local progression were age ({>=}70 years), tumor size ({>=}2 cm), sex (male), and no achievement of roll-off during RFA (P < 0.05). Multivariate analysis identified tumor size {>=}2 cm as the only independent factor for local progression (P = 0.003). For tumors <2 cm, 17 of 68 (25%) showed local progression, and the 1-, 2-, and 3-year overall local control rates were 77, 73, and 73%, respectively. Multivariate analysis identified that age {>=}70 years was an independent determinant of local progression for tumors <2 cm in diameter (P = 0.011). The present study showed that 32% of lung tumors developed local progression after CT-guided RFA. The significant risk factor for local progression after RFA for lung tumors was tumor size {>=}2 cm.

  11. Recent Advances in Percutaneous Cardioscopy.

    PubMed

    Uchida, Yasumi

    2011-08-01

    Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies.

  12. Percutaneous transluminal coronary angioplasty (PTCA)

    MedlinePlus Videos and Cool Tools

    Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The procedure begins with ...

  13. Percutaneous Nephrolithotomy in Children

    PubMed Central

    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. PMID:22013438

  14. 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.

  15. Difficulties with access in percutaneous renal surgery

    PubMed Central

    Rais-Bahrami, Soroush; Friedlander, Justin I.; Duty, Brian D.; Okeke, Zeph; Smith, Arthur D.

    2011-01-01

    Percutaneous renal surgery provides a minimally invasive approach to the kidney for stone extraction in a number of different clinical scenarios. Certain clinical cases present inherent challenges to percutaneous access to the kidney. Herein, we present scenarios in which obtaining and/or maintaining percutaneous access is difficult along with techniques to overcome the challenges commonly encountered. Also, complications associated with these challenging percutaneous renal surgeries are discussed. PMID:21869906

  16. Percutaneous transbiliary biopsy.

    PubMed

    Andrade, Gustavo Vieira; Santos, Miguel Arcanjo; Meira, Marconi Roberto; Meira, Mateus Duarte

    2017-01-01

    Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct. RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.

  17. Percutaneous renal tumour biopsy.

    PubMed

    Delahunt, Brett; Samaratunga, Hemamali; Martignoni, Guido; Srigley, John R; Evans, Andrew J; Brunelli, Matteo

    2014-09-01

    The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed. © 2014 John Wiley & Sons Ltd.

  18. Percutaneous absorption of urea.

    PubMed

    Ackermann, C; Flynn, G L; Wyk, C J

    1985-12-01

    Synopsis The effect of several variables on the in vitro permeation of urea through hairless mouse skin has been studied in order to determine the causes of an increasing permeability phenomenon found in studies with a range of hydrophilic compounds. The permeation of urea increased for a period of approximately 100 h after which a steady state permeation pattern was observed for approximately 25 h. Urea did not effect its own permeation in concentrations between 0.01 M and 1.67 M, and the same pattern of increasing permeation was followed in the presence of (N-morpholine)propanesulphonic acid and tris(hydroxyme)amino-methane buffers, as in the presence of normal saline. Urea did not affect the permeation of tritiated water. Methanol and water exhibited the same pattern of increasing permeation as urea. The continuously increasing permeation rate of urea up to 100 h is believed to be due to penetration and extensive association of water with the components of the stratum corneum, altering the ultra-structure of the stratum corneum and leading to the formation of large and extensive hydrophilic diffusion channels which do not exist in fresh, untreated skin. These presumed channels open the stratum corneum to facile permeation of highly polar substances such as urea. The physical events leading up to the ultra structural changes within the tissue at the microscopic level remain obscure and are the subject of ongoing research. L'absorption percutanée de l'urée.

  19. Percutaneous radiofrequency ablation of renal cell carcinoma.

    PubMed

    Chiou, Yi-You; Hwang, Jen-I; Chou, Yi-Hong; Wang, Jia-Hwia; Chiang, Jen-Huey; Chang, Cheng-Yen

    2005-05-01

    Preliminary data regarding the use of percutaneous radiofrequency ablation (RFA) for the treatment of renal cell carcinoma (RCC) are encouraging, and show the technique to be associated with minimal morbidity. Thus, the current study was designed to evaluate the clinical applications, treatment efficacy, and complications of percutaneous RFA in RCC. From February 2003 to February 2004, 12 consecutive patients with histopathologically proven RCC underwent imaging-guided percutaneous RFA. The mean age of the patients (8 men and 4 women) was 76 years (range, 56-87 years), and mean tumor diameter was 3.7 cm (range, 2.2-8.0 cm). The efficacy of RFA was evaluated with contrast-enhanced, dynamic computed tomography (CT) performed 1 month after treatment, and then every 3 months. A Radionics device with an internally cooled electrode was used in 7 patients, and a radiofrequency interstitial tissue ablation (RITA) device with an expandable needle electrode was used in 5. Complete necrosis was defined as a lack of contrast enhancement in the treated region on follow-up CT studies. Overall, 16 sessions of RFA were performed for 12 solitary renal tumors in 12 patients: 8 patients underwent a single RFA session, whereas 4 had 2 sessions. Dynamic CT after RFA showed complete necrosis in 9 of 12 tumors. In 3 patients with tumors of 4.5-8.0 cm in diameter, enhancement of residual tissue was observed after RFA treatment, thus indicating residual tumor. Complete tumor necrosis was seen in all 5 tumors (100%) of diameter < or = 3.0 cm; 3 of 4 tumors (75%) of diameter 3.1-5.0 cm; and 1 of 3 tumors (33%) of diameter > 5.0 cm. A big subcapsular hematoma, which was found in 1 patient after RFA, resolved completely within 10 months without treatment; no serious complications occurred in the other 11 patients. Percutaneous RFA is effective in the treatment of RCC. It is most successful for tumors not larger than 3 cm in diameter, and has a satisfactory success rate in tumors of 3-5 cm in

  20. Percutaneous vertebroplasty: the follow-up.

    PubMed

    Barbero, S; Casorzo, I; Durando, M; Mattone, G; Tappero, C; Venturi, C; Gandini, G

    2008-02-01

    This article reports on our experience treating vertebral fractures with percutaneous vertebroplasty. A clinical and imaging follow-up designed to identify the early (especially pulmonary embolism of bone cement) and late complications of the technique is proposed. On the basis of the current guidelines, 101 patients were selected: 64 osteoporotic and 37 neoplastic. A total of 173 vertebrae were treated. Procedures were performed with both computed tomography and fluoroscopic guidance. Residual pain was evaluated with a visual analogue scale score immediately after vertebroplasty and 1, 15, 30, 90, 180 and 270 days later. Spine and chest radiographs were obtained 24 h after vertebroplasty; spine radiography was repeated 30 days later. Therapeutic success was obtained in 88% of osteoporotic patients and in 84% of neoplastic patients. Pulmonary cement emboli were identified in four patients, all of whom were asymptomatic. Percutaneous vertebroplasty is a safe and effective technique for the treatment of osteoporotic and neoplastic vertebral fractures. Clinical and imaging followup allows effective patient monitoring and early detection of possible complications.

  1. Kissing balloon inflation in percutaneous coronary interventions.

    PubMed

    Sgueglia, Gregory A; Chevalier, Bernard

    2012-08-01

    Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Percutaneous Hindfoot and Midfoot Fusion.

    PubMed

    Bauer, Thomas

    2016-09-01

    Hindfoot and midfoot fusions can be performed with percutaneous techniques. Preliminary results of these procedures are encouraging because they provide similar results than those obtained with open techniques with less morbidity and quick recovery. The best indications are probably fusions for mild-to-moderate reducible hindfoot and midfoot deformities in fragile patients with general or local bad conditions. The main limit is linked to the surgeon's experience in percutaneous foot surgery because a learning curve with the specific tools is necessary before doing these procedures.

  3. Safety of fluoroscopy guided percutaneous access to the thoracic spine.

    PubMed

    Clamp, Jonathan A; Bayley, Edward J; Ebrahimi, Firooz V; Quraishi, Nasir A; Boszczyk, Bronek M

    2012-05-01

    Fluoroscopy-guided percutaneous access to thoracic vertebrae is technically demanding due to the complex radiological anatomy and close proximity of the spinal cord, major vessels and pleural cavity. There is a trend towards computed tomography (CT) guidance due to a perceived reduction in the risk of spinal canal intrusion by instrumentation causing neurological injury. Due to limited access to CT guidance, there is a need for safe fluoroscopy-guided percutaneous access to the thoracic spine. To evaluate the safety of a strict radio-anatomical protocol in avoiding access-related neurological complications due to tool misplacement in fluoroscopy-guided percutaneous procedures on the thoracic spine. A combined two-surgeon prospective case series of 444 procedures (biopsy, vertebroplasty or kyphoplasty) covering all thoracic vertebral levels T1-T12. Clinical examination and routine observations were used to identify access-related complications including neurological, vascular and visceral injury using physiological parameters. No patient in our series was identified to have sustained a neurological deficit or deterioration of preoperative neurological status. Percutaneous access to the thoracic spine using fluoroscopic guidance is safe. The crucial step of the protocol is not to advance the tool beyond the medial pedicle wall on the anterior-posterior projection until the tip of the instrument has reached the posterior vertebral cortex on the lateral projection.

  4. 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.

  5. PAIR as percutaneous treatment of hydatid liver cysts.

    PubMed

    Peláez, V; Kugler, C; Correa, D; Del Carpio, M; Guangiroli, M; Molina, J; Marcos, B; Lopez, E

    2000-03-25

    Hydatid disease of the liver remains an important and challenging problem in rural areas; although, surgery is considered the treatment of choice, percutaneous treatment of hydatid cysts is relatively new, and the data related to it are limited. The purpose of the study was to present the results of percutaneous treatment of liver hydatid cysts. Thirty-four patients (13 male and 21 female), ranging in age between 14 and 80 years, with 55 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Cysts were treated with a one-stage procedure that consisted of puncture of the cysts under guidance with computed tomography, aspiration of fluid, injection of hypertonic saline solution as scolicidal agent and reaspiration. Follow-up examinations showed progressive reduction and solidification of the cysts. The mean reduction in volume was 72%. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria with pruritus in two patients. One patient had a subcapusular hematoma without problem. Hospitalization courses varied from ambulatory procedures to 15 days of in-patient, mean hospital stay was 1.82 days. The results of percutaneous liver hydatid cyst treatment, indicating that the procedure is efficient and safe and offers complete cure in selected patients with a short hospitalization and that this technique should be considered an alternative to surgery.

  6. 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

  7. Current Status of Percutaneous Endografting

    PubMed Central

    Patel, Parag J.; Kelly, Quinton; Hieb, Robert A.; Lee, Cheong Jun

    2015-01-01

    Totally percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using suture-mediated closure devices (SMCDs) has several well-established advantages over standard open femoral exposure as a direct consequence of being less invasive and having shorter times to hemostasis and procedure completion. The first multicenter randomized controlled trial designed to assess the safety and efficacy of PEVAR and to compare percutaneous access with standard open femoral exposure was recently published (the PEVAR trial). The PEVAR trial demonstrated that percutaneous endografting is safe, effective, and noninferior to standard open femoral exposure among trained operators. The study reaffirmed the results of several recent single center and nonrandomized studies, demonstrating that percutaneous access facilitated shorter procedures, shorter times to secure hemostasis, and improved quality of life for patients. As PEVAR has gained popularity among patients and physicians, refinements to the technique and patient selection process have been made. There has been growing interest in treating patients with anatomical characteristics previously thought to be unsuitable for PEVAR, such as common femoral artery (CFA) calcifications, scarred groins, small CFA diameter, and high patient body mass index (BMI). However, observance of strict procedural technique and consideration for patient selection criteria remain paramount in achieving acceptable technical success rates with PEVAR. PMID:26327747

  8. Image guided percutaneous splenic interventions.

    PubMed

    Kang, Mandeep; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit; Rajwanshi, Arvind

    2007-10-01

    The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n=93) or CT (n=2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n=78) and aspiration (n=10) or percutaneous catheter drainage of a splenic abscess (n=7). Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery.

  9. 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

  10. Percutaneous fixation of scaphoid fractures.

    PubMed

    Slade, J F; Jaskwhich, D

    2001-11-01

    The scaphoid proximal pole and waist fractures presented here were treated by a novel dorsal percutaneous technique with arthroscopic assistance. All fractures healed, with good final functional results and no complications. The advantages of the dorsal percutaneous approach to scaphoid fixation are: (1) the proximal-to-distal placement of the guide pin and screw allow for more precise placement along the central axis of the scaphoid, which decreases healing time and reduces risk of screw thread exposure. (2) The dorsal approach avoids injuring the vulnerable volar ligament anatomy. And (3) the insertion of the screw from the proximal to distal direction allows the more rigid fixation of proximal scaphoid fractures. Arthroscopy allows confirmation of fracture reduction and screw implantation as well as evaluation of concurrent ligament injuries not detected with standard imaging. Percutaneous K-wires act as joysticks to reduce and compress fracture fragments prior to fixation. The presented technique allows for early, rigid internal fixation with minimal associated morbidity. Patients successfully treated with this technique include those with stable and unstable acute fractures of the scaphoid at all locations, including the proximal pole. Nondisplaced fractures that present with delayed or fibrous union without evidence of avascular necrosis, cyst formation, or bony sclerosis may also be treated with this technique. This technique allows for faster rehabilitation and an earlier return to work or avocation without restriction once CT scan confirms a solid union. Some articles document extraordinary rapid healing by standard radiographs; however, we caution that scaphoid bone healing cannot accurately be determined without CT scan. Percutaneous, arthroscopically assisted internal fixation by a dorsal approach may be considered in all acute scaphoid fractures selected for surgical fixation. The dorsal guidewire permits dorsal and volar implantation of a cannulated

  11. Creation of a gastroenteric anastomosis with endoscopy and percutaneous gastrostomy in pigs.

    PubMed

    Cope, Constantin; Faigel, Douglas O; Ginsberg, Gregory G; Timmermans, Hans A; Uchida, Barry T

    2008-01-01

    The authors have previously shown in pigs an immediate transgastric technique for stapling the stomach and jejunum to allow a functioning gastroenteric anastomosis (GEA) with use of balloons and stent placement. The aim of this approach in six pigs was to replicate this procedure by using a flexible endoscopic technique. All pigs had GEAs that were well attached and fully patent.

  12. Percutaneous Cementoplasty for Kienbock's Disease.

    PubMed

    Vallejo, Eduardo Crespo; Martinez-Galdámez, Mario; Martin, Ernesto Santos; de Gregorio, Arturo Perera; Gallego, Miriam Gamo; Escobar, Angeles Ramirez

    2017-03-08

    Kienböck disease typically presents with wrist pain, swelling, restricted range of motion, and difficulty in performing activities of daily living. Because the etiology and evolution of disease remain unclear, broad ranges of treatments have been designed. Percutaneous cementoplasty is expanding its role for managing painful bone metastases outside the spine. We can draw a parallel between lytic tumoral lesions and Kienbock's disease. Increasing the strength and rigidity of lunate with cementoplasty can prevent it from collapse, relieve the symptoms associated with the process of avascular necrosis, and increase the wrist range of motion. We report the case of 30-year-old man with a painful stage IIIA Kienböck disease who underwent percutaneous cementoplasty and experienced immediate effective pain relief and recovery of wrist mobility.

  13. 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

  14. Cangrelor in percutaneous coronary intervention.

    PubMed

    Oestreich, Julie H; Steinhubl, Steven R

    2009-03-01

    Cangrelor is a novel, intravenous P2Y12 receptor antagonist in development for use in percutaneous coronary intervention. Currently in Phase III testing, the reversible platelet inhibitor provides several inherent advantages over other P2Y12 receptor antagonists in this setting for the prevention of adverse cardiac events. Unlike the class of thienopyridines (ticlopidine, clopidogrel and potentially soon to be available, prasugrel), cangrelor has nearly immediate onset after a bolus dose and a short half-life, and achieves maximal inhibition of ADP-mediated platelet function. Cangrelor's distinct mechanism of action allows for intravenous administration and avoids both hepatic and renal metabolism. These unique characteristics make cangrelor a promising agent for use in cardiovascular patients undergoing percutaneous coronary intervention.

  15. Percutaneous cryoablation for hepatocellular carcinoma

    PubMed Central

    Song, Kyoung Doo

    2016-01-01

    Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC). Although radiofrequency (RF) ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety. PMID:28081593

  16. Percutaneous Transpedicular Fixation: Technical tips and Pitfalls of Sextant and Pathfinder Systems.

    PubMed

    Mohi Eldin, Mohamed M; Hassan, Ahmed Salah Aldin

    2016-02-01

    The efficacy of the operative techniques, possible benefits as well as pitfalls and limitations of the techniques are discussed. Potential drawbacks are also detected. This study aims to report indications, techniques, and our experience with the use of the Sextant and PathFinder percutaneous transpedicular screw fixation systems. 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. 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. 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. 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.

  17. 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

  18. Percutaneous Transumbilical Portal Vein Embolization in a Patient with a Ruptured Hepatocellular Carcinoma Supplied by the Portal Vein

    SciTech Connect

    Kim, Soo Chin; Kim, Hyo-Cheol Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2011-02-15

    We describe a case of a ruptured hepatocellular carcinoma supplied by the portal vein that was successfully treated with portal vein embolization via a percutaneous transumbilical approach. A contrast material-enhanced computed tomographic (CT) scan showed the presence of a large hypervascular tumor on portal venous phase as well as right hepatic vein thrombosis and hemoperitoneum that prevented portal vein embolization by the use of the percutaneous and transjugular transhepatic approach. The use of percutaneous transumbilical portal vein embolization can be an alternative option in this situation.

  19. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1250 Percutaneous catheter...

  20. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1250 Percutaneous catheter...

  1. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1250 Percutaneous catheter...

  2. Percutaneous Radiofrequency Ablation of Nodal Metastases

    SciTech Connect

    Gervais, Debra A.; Arellano, Ronald S.; Mueller, Peter R.

    2002-12-15

    We report our experience with percutaneous image-guided radiofrequency (RF) ablation to treat isolated nodal metastases. Four patients underwent image-guided percutaneous RF ablation of metastatic disease involving retrocrural nodes,retroperitoneal nodes, or pelvic nodes. Coagulation necrosis was achieved in all cases.

  3. [The percutaneous absorption of diclofenac].

    PubMed

    Riess, W; Schmid, K; Botta, L; Kobayashi, K; Moppert, J; Schneider, W; Sioufi, A; Strusberg, A; Tomasi, M

    1986-07-01

    The percutaneous absorption of diclofenac diethylammonium 1.16% (w/w) in a combination of emulsion cream and gel (Voltaren Emulgel) and of diclofenac sodium 1% (w/w) in a cream formulation (Voltaren cream) was investigated in guinea-pig, rabbit and man. The percutaneous absorption of diclofenac sodium in guinea-pig was 3 to 6% of the dose when the cream formulation in doses of 320, 100 or 40 mg was applied on 10 cm2 of occluded skin and left in place for 6 h. The transdermal delivery of 14C-labelled diclofenac yielded plateau plasma concentrations of radiotracer from 1.5 h after application until removal of the residual cream. Subsequently the steady state drug depots in the skin and muscle tissue were depleted promptly. During daily administration the steady state levels in the muscle tissue in proximity to the application site were about 3 times higher than in distant muscle tissue. By topical application on knee joints of rabbits diclofenac penetrated into the patellar ligament, the adipose corpus and the synovial fluid. In man the percutaneous absorption was 6% of the dose when the Emulgel formulation was spread by 5 mg/cm2 and left for 12 h on non-occluded skin. The pattern of metabolites of diclofenac in human urine was the same after topical and oral administration. In man, upon daily topical administration of 3 times 2.5 g cream formulation (10 mg/cm2) the diclofenac steady state plasma levels were 20 to 40 nmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

  4. 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%.

  5. Percutaneous Surgery of the Forefoot.

    PubMed

    Redfern, David; Vernois, Joel; Legré, Barbara Piclet

    2015-07-01

    This article describes some of the common techniques used in percutaneous surgery of the forefoot. Techniques such as minimally invasive chevron Akin osteotomy for correction of hallux valgus, first metatarsophalangeal joint cheilectomy, distal minimally invasive metatarsal osteotomies, bunionette correction, and hammertoe correction are described. This article is an introduction to this rapidly developing area of foot and ankle surgery. Less invasive techniques are continually being developed across the whole spectrum of surgical specialties. The surgical ethos of minimizing soft-tissue disruption in the process of achieving surgical objectives remains at the center of this evolution.

  6. Percutaneous transluminal angioplasty: newer applications.

    PubMed

    Novelline, R A

    1980-11-01

    Recent experience suggests that there is a wider spectrum of applications for percutaneous transluminal angioplasty than just dilating lesions of the ileofemoral, popliteal, renal and coronary arteries. Atherosclerotic and nonatherosclerotic lesions of other blood vessels as well as postoperative stenoses may be treated. Five patients from Massachusetts General Hospital are described in whom transluminal angioplasty was successful in relieving atherosclerotic stenoses of the axillary, subclavian, and superior mesenteric arteries; a stenotic, splenorenal shunt anastomosis; and an anastomotic stenosis in a renal dialysis angioaccess shunt. The experience of other investigators in dealing with these less common applications of transluminal angioplasty is summarized.

  7. Percutaneous angioscopy. Work in progress.

    PubMed

    Ferris, E J; Ledor, K; ben-Avi, D D; Baker, M L; Robbins, K V; McCowan, T C; Sharma, B

    1985-11-01

    The cardiovascular applications of flexible fiber-optic technology are imminent because of recent advances in miniaturization. In the work described here, angioscopy, or vascular endoscopy, was performed in the cadaveric aorta and in the systemic and pulmonary circulations of the canine model and selected human patients. Subsequent to our development of percutaneous techniques, clinical trials have ranged from lower-extremity venoscopy to aortic-root arterioscopy. Angioscopy could be clinically useful because of relative or absolute contraindications to iodinated contrast material. The ability to see in color and three dimensions may afford some other advantages to angioscopy over conventional angiography.

  8. Value of CT angiography in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy

    PubMed Central

    Meng, Xiang-Jun; Mi, Qi-Wu; Hu, Tao; Zhong, Wei-De

    2015-01-01

    ABSTRACT Purpose: To evaluate the clinical value of computed tomography angiography (CTA) in reducing the risk of hemorrhage associated with mini-percutaneous nephrolithotomy (PCNL). Materials and Methods: A total of 158 patients with renal or ureter stones who had undergone mini-percutaneous nephrolithotomy were retrospectively enrolled into this study from May of 2011 to April of 2014. Group 1 (65 patients) underwent computed tomography angiography, and Group 2 (93 patients) underwent non-contrast CT. The clinical characteristics of the patients and hemorrhagic complications were recorded. The hematologic complications (transfusion rate, and preoperative and postoperative hemoglobin values) were assessed. Results: There were no statistically significant differences in age, body mass index(BMI), stone diameter, operative time, stone-free rate, and hospital stay between the 2 groups. In group 2, 1 patient (1.1%) developed a renal arteriovenous fistula and was treated with embolus therapy. In addition, Group 2 showed significantly drop in hemoglobin (3.6 g/dL vs. 2.4 g/dL, respectively; P <0.001) and more transfusions (9.7% vs. 1.5%, respectively; P <0.05) compared with Group 1. Conclusion: The study showed that patients who underwent computed tomography angiography prior to percutaneous nephrolithotomy had lower drop of hemoglobin and needed less transfusions. These findings may suggest that the use of computed tomography angiography may reduce the risk of bleeding during percutaneous nephrolithotomy. PMID:26401861

  9. Percutaneous gastrostomy of the excluded gastric segment after Roux-en-Y gastric bypass surgery.

    PubMed

    Stein, Evan G; Cynamon, Jacob; Katzman, Marc Joshua; Goodman, Elliott; Rozenblit, Alla; Wolf, Ellen L; Jagust, Marcy B

    2007-07-01

    A new technique for percutaneous gastrostomy of a decompressed excluded gastric segment after Roux-en-Y gastric bypass (RYGBP) surgery is described and the results in a single institution are reviewed. Computed tomography guidance was used to place a 21- or 22-gauge needle into the lumen of the stomach and distend it to allow placement of a feeding catheter. Ten women underwent the procedure, and despite only three patients having clear access windows, gastrostomy placement was ultimately successful in all 10 patients. Percutaneous gastrostomy of the decompressed excluded gastric segment after RYGBP surgery can be challenging, but a high rate of success can be achieved.

  10. Incidence of retrorenal colon during percutaneous nephrolithotomy

    PubMed Central

    Balasar, Mehmet; Kandemir, Abdülkadir; Poyraz, Necdet; Unal, Yunus; Ozturk, Ahmet

    2015-01-01

    Objective The aim of this study was to investigate retrorenal colon incidence in percutaneous nephrolithotomy (PNL) interventions made in our clinic. Materials and Methods Clinical data of 804 PNL patients, accumulated over a 7 year period (2006-2012), was surveyed. The patient files were reviewed retrospectively, and only those who had abdominal computed tomography (CT) images before PNL intervention were included in the study. In the CT images, the position of both the ascending and descending colon in relation to the right and left kidneys were evaluated. Results According to our hospital reports, 394 patients with CT images were included in the present study 27 patients (6.9%) had retrorenal colon, of which 18 (4.6%) were on the left side, 4 (1.0%) on the right side and 5 (1.3%) had bilateral retrorenal colons. Colonic perforation complication was seen only in two patients and the colonic perforation rate was 0.3%. These two cases had no CT images. Conclusions PNL, in the process of becoming the standard treatment modality, is a safe and reliable technique for renal stone treatment. Colonic injury should be taken into consideration during PNL interventions of the lower pole of the kidney (especially on the left side) due to the location of retrorenal colon. PMID:26005968

  11. Patient and operator exposure during percutaneous vertebroplasty.

    PubMed

    Tappero, C; Barbero, S; Costantino, S; Bergui, M; Ropolo, R; Bradac, G; Gandini, G

    2009-06-01

    The purpose of this study was to compare exposure of patient and operator to ionising radiation during percutaneous vertebroplasty performed under combined computed tomography (CT) and fluoroscopic guidance or fluoroscopic guidance alone. With the collaboration of our physics department, we measured exposure on ten patients undergoing vertebroplasty with combined CT and fluoroscopic guidance and on ten undergoing vertebroplasty with fluoroscopic guidance alone. Mean operator dose was approximately 0.8 microSv during vertebroplasty done with combined CT and fluoroscopic guidance and 5.8 microSv in procedures with fluoroscopic guidance alone. Mean patient dose was approximately 6 mSv for combined guidance and 8 mSv for fluoroscopic guidance, a difference that was not found to be statistically significant. Although combined CT and fluoroscopic guidance is normally preferred for difficult areas such as the cervical and upper thoracic vertebrae, to ensure operator radiation protection, the technique should also be considered for areas normally treated under fluoroscopic guidance alone. However, a larger patient series is needed to correctly evaluate the real contribution of low-dose CT to patient exposure.

  12. Aneurysmal bone cysts: percutaneous embolization with an alcoholic solution of zein--series of 18 cases.

    PubMed

    Guibaud, L; Herbreteau, D; Dubois, J; Stempfle, N; Bérard, J; Pracros, J P; Merland, J J

    1998-08-01

    To assess the efficacy of percutaneous embolization with an alcoholic solution of zein in the treatment of aneurysmal bone cysts. Eighteen patients with aneurysmal bone cysts were treated percutaneously with alcoholic zein. The cysts were in the lower limb (n = 7), upper limb (n = 5), pelvis (n = 3), cervical spine (n = 2), and mandible (n = 1). All patients were symptomatic, three had previously undergone surgery. Percutaneous embolization was performed with fluoroscopic or computed tomographic guidance with the patient under general anesthesia. Clinical and imaging follow-up lasted 18 months to 4 years. Percutaneous embolization was performed in 16 cases. In two cases, cystograms showed marked venous drainage and thus embolization was not attempted. Six patients underwent repeat embolization. Complications consisted of a local transitory inflammatory reaction (n = 5), aseptic osteitis (n = 1), and a small pulmonary infarct without sequelae (n = 1). Relief of symptoms was achieved in all patients except one, who underwent surgery. At imaging, improvement was total in 13 cases (87%) and partial in two cases (13%). No recurrence was noted during follow-up. Percutaneous embolization of aneurysmal bone cysts with alcoholic zein should be considered a reliable alternative to surgery, especially in cases with a difficult surgical approach or cases of postsurgical recurrence.

  13. Treatment of osteoid osteoma with CT-guided percutaneous radiofrequency thermoablation.

    PubMed

    de Palma, Luigi; Candelari, Roberto; Antico, Ettore; Politano, Rocco; Luniew, Eugenio; Giordanengo, Maurizio; Di Giansante, Silvio; Marinelli, Mario; Paci, Enrico

    2013-05-01

    Osteoid osteoma is a benign bone tumor with a male predominance occurring mainly in children and young adults. The most common symptom is intermittent pain that worsens at night and is at least partially relieved by nonsteroidal anti-inflammatory drugs. The purpose of this study was to assess the long-term effectiveness of computed tomography-guided percutaneous radiofrequency thermoablation in patients with a minimum follow-up of 2 years. Twenty patients with osteoid osteoma (15 men and 5 women) with a mean age of 20.7 years (range, 4-61 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency thermoablation. Lesion sites were the femur (n=9), tibia (n=7), pelvis (n=1), talus (n=1), cuneiform bone (n=1), and humerus (n=1). Mean follow-up was 44 months (range, 3-106 months). Pain relief was significant in 95% of patients; it disappeared within 24 hours in 14 patients, within 3 days in 4, and within 7 days in 1. The patient with persistent symptoms underwent another percutaneous radiofrequency thermoablation procedure that was successful. The difference between pre- and postoperative pain was significant (P ≤ .01). No recurrences occurred. Computed tomography-guided percutaneous radiofrequency thermoablation is a safe, minimally invasive, and economical procedure with high technical and clinical success rates, and it effectively and durably enhances quality of life.

  14. The vacuum cleaner effect in minimally invasive percutaneous nephrolitholapaxy.

    PubMed

    Nicklas, André P; Schilling, David; Bader, Markus J; Herrmann, Thomas R W; Nagele, Udo

    2015-11-01

    Percutaneous stone removal increasingly plays an important role among the different approaches of interventional stone therapy, particularly since the development of miniaturized instruments is resulting in lower morbidity for the patients. One major drawback of smaller instruments is the increased difficulty of stone retrieval after disintegration due to the reduced tract diameter. This results in longer operation time and the need of additional tools such as disposable retrieval baskets. One of the key factors in the development of minimally invasive percutaneous nephrolitholapaxy (MIP) was the design of an Amplatz sheath which provides a built-in vacuum cleaner effect for stone retrieval. A series of flow analyses with the gauges and shapes of the most commonly used nephroscopes and sheaths in percutaneous nephrolitholapaxy was performed by computational fluid dynamics. Flow velocity and direction in front of the nephroscope were computed and visualized by the software. In our study, the vacuum cleaner effect developed exclusively when a round-shaped nephroscope was used (Nagele Miniature Nephroscope System, Karl Storz GmbH & Co. KG) and depended on the relation between nephroscope diameter and inner sheath diameter. The strongest effect was observed with a 12 F nephroscope and an inner sheath diameter of 15 F. It did not develop when an oval- or crescent-shaped nephroscope was used. In front of the distal end of the round-shaped nephroscope, a slipstream develops, induced by the excursive change of width of the fluid flow on the outlet of the flushing canal. This allows the adhesion of a stone fragment in the eddy while the fluid flow is circulating around the stone. This study illustrates and explains the vacuum cleaner effect which has been detected in the development of the Nagele Miniature Nephroscope System used in MIP. It combines the reduced morbidity of smaller kidney puncture diameters with the benefit of quick and complete stone removal.

  15. Ultrasound-guided percutaneous microwave coagulation therapy with a "cooled-tip needle" for the treatment of hepatocellular carcinoma adjacent to the gallbladder.

    PubMed

    Pan, Wei-Dong; Zheng, Rong-Qin; Nan, Lin; Fang, He-Ping; Liu, Bo; Tang, Zhao-Feng; Deng, Mei-Hai; Xu, Rui-Yun

    2010-09-01

    Curative percutaneous microwave coagulation therapy is difficult or contraindicated in patients with tumors adjacent to the gallbladder because of the associated risk of injury. To date, no clinical data have been published regarding the effects and safety of percutaneous microwave coagulation therapy on tumors that are adjacent to the gallbladder. We investigated the efficacy and safety of a combined treatment involving laparoscopic cholecystectomy and subsequent percutaneous microwave coagulation therapy in patients with hepatocellular carcinoma adjacent to the gallbladder. Twenty-three patients with hepatocellular carcinoma nodules (of less than 5 cm diameter) and adjacent to the gallbladder were treated by percutaneous microwave coagulation therapy with a "cooled-tip needle" after laparoscopic cholecystectomy. The therapeutic efficacy was evaluated with enhanced helical computed tomography and sonography, and the rates of complete necrosis as well as postoperative complications were also analyzed. All of the patients exhibited complete necrosis of their tumor lesions after treatment with percutaneous microwave coagulation therapy. During the follow-up period (which lasted more than 21 months), 22 of 23 patients were alive. Recurrent nodules appeared in other subsegments, but not at the original site treated with percutaneous microwave coagulation therapy. Of note, no fatal complications were observed in any of the patients treated with percutaneous microwave coagulation therapy. Our results suggest that combined treatment comprising both laparoscopic cholecystectomy and subsequent percutaneous microwave coagulation therapy is an effective and safe approach for patients with small (<5 cm) hepatocellular carcinomas that are adjacent to the gallbladder.

  16. Percutaneous umbilical cord blood sampling - series (image)

    MedlinePlus

    ... your doctor may recommend percutaneous umbilical cord blood sampling (PUBS), which is performed at 18 weeks' gestation. ... it connects to the umbilical cord determine which method your doctor uses. If the placenta is attached ...

  17. Shaving effects on percutaneous penetration: clinical implications.

    PubMed

    Hamza, Muhammad; Tohid, Hassaan; Maibach, Howard

    2015-01-01

    Human/animal shaving biology. To assess the effect of shaving on percutaneous penetration and skin function. We screened 500+publications in Pub Med, Scopus, Cochrane Library and pertinent journals out of which only 17 were deemed relevant. Terms for searches included shaving and skin, percutaneous penetration and shaving, skin absorption and shaving, absorption of dyes and shaving, skin penetration, effects of shaving and absorption, shave and dyes, axillary shaving and stratum corneum, shaving and breast cancer, shaving and infections, etc. Shaving appears to have an exaggerated effect on percutaneous absorption; however, some studies do not support this evidence. Shaving enhances percutaneous penetration of some chemicals; however this effect is species and chemical specific. Further investigations of chemicals of varying physio-chemical properties are mandated before a generalized theory can be promulgated.

  18. Percutaneous ablation of pancreatic cancer

    PubMed Central

    D’Onofrio, Mirko; Ciaravino, Valentina; De Robertis, Riccardo; Barbi, Emilio; Salvia, Roberto; Girelli, Roberto; Paiella, Salvatore; Gasparini, Camilla; Cardobi, Nicolò; Bassi, Claudio

    2016-01-01

    Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review. PMID:27956791

  19. Prone and supine percutaneous nephrolithotomy.

    PubMed

    Lucarelli, G; Breda, A

    2013-06-01

    Since the first successful stone extraction through a nephrostomy in 1976, percutaneous nephrolithotomy (PCNL) has became the preferred procedure especially for treatment of large, complex and staghorn calculi. For decades this method has been performed with the patient in the prone position. More recently, particular interest has been taken on supine PCNL due to less anestesiological risks and the possibility of simultaneous anterograde and retrograde access to the whole urinary tract. Although many retrospective studies have been published, only two prospective trials comparing the two positions are reported in the literature. The best access to PCNL represents still a controversial issue. The overall experience reported in literature indicates that each modality is equally feasible and safe. Therefore, to date the surgeon's preference is the prime indication to one access over the other.

  20. [Percutanous dilation tracheotomy: our experience].

    PubMed

    Domènech, I; Mateu, T; Cisa, E; Juan, A; Gil, E; Palau, M; Dicenta, M

    2004-01-01

    Percutaneous dilation Tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our hospital, we recently adopted the use of the PDT in intensive care unit patients. The objective [corrected] of this investigation is to characterize and quantify the rate of complications for PDT. A prospective study of 60 PDT performed at different intesive care units, betweem September 2002 to July 2003. The intraoperative time for PDT was 8 minutes. Complications included 6 cases of mild intraoperative hemorrhage, 1 case of moderate intraoperative hemorrhage, 4 cases of mild postoperative hemorrhage and 1 case of subcutaneous emphysema. PDT is a good alternative to surgical tracheotomy and should be added to the otolaryngologists armamentarium of surgical airway procedures.

  1. Pilot experience with transhepatic percutaneous renal cryoablation.

    PubMed

    Malcolm, John B; Gold, Robert; Derweesh, Ithaar H

    2007-07-01

    Percutaneous renal cryoablation has been shown to be a feasible therapeutic option for small renal tumors. Despite advances in equipment design and imaging capabilities, tumor location can present challenges to the percutaneous approach. We present our pilot experience with transhepatic percutaneous cryoablation of right upper-pole renal tumors. Three patients aged 75 to 87 years with American Society of Anesthesiologists scores of III or IV underwent transhepatic percutaneous cryoablation between November 2005 and February 2006. Tumor size ranged from 2 to 5 cm. Cryoprobe placement was guided by CT imaging, and two freeze-thaw cycles were used. Additionally, 60-second freeze-thaw cycles were used to assist with hemostasis in the transhepatic tract. The procedure was completed percutaneously in all cases with the patient under conscious sedation. The procedure time ranged from 67 to 167 minutes. Postoperative pain was managed with minimal use of nonnarcotic oral medications. Although one patient developed a moderate perinephric hematoma and required a blood transfusion, no hepatic complications were manifest. Local treatment failure was evident in one patient with a 5-cm mass showing enhancement at follow-up imaging. Transhepatic access for percutaneous cryoablation of renal tumors is feasible. Limitations include tumor size, as larger tumors may introduce prohibitive risks.

  2. [Percutaneous myocardial laser revascularization (PMR)].

    PubMed

    Lauer, B; Stahl, F; Bratanow, S; Schuler, G

    2000-09-01

    In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser revascularization" (PMR) has been performed in 101 patients at the Herzzentrum Leipzig. In 63 patients, only 1 region of the heart (anterior, lateral, inferior or septal) was treated with PMR, in 38 patients 2 or 3 regions were treated in 1 session. There were 12.3 +/- 4.5 (range 4 to 22) channels/region created into the myocardium. After 3 months, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4, after 6 months: 1.6 +/- 0.8) (p < 0.001) and an increased exercise capacity (baseline: 397 +/- 125 s, after 6 months: 540 +/- 190 s) (p < 0.05). After 2 years, the majority of patients had experienced sustained clinical benefit after PMR, the CCS class after 2 years was 1.3 +/- 0.7, exercise capacity was 500 +/- 193 s. However, thallium scintigraphy failed to show increased perfusion in the PMR treated regions. The pathophysiologic mechanisms of myocardial laser revascularization is not yet understood. Most of the laser channels are found occluded after various time intervals after intervention. Other possible mechanisms include myocardial denervation or angioneogenesis after laser revascularization, however, unequivocal evidence for these theories is not yet available. In conclusion, PMR seems to be a safe and feasible new therapeutic option for patients with refractory

  3. Clinical Outcomes of Percutaneous Endoscopic Surgery for Lumbar Discal Cyst

    PubMed Central

    Ha, Sang Woo; Kim, Seok Won; Lee, SeungMyung; Kim, Yong Hyun; Kim, Hyeun Sung

    2012-01-01

    Objective Discal cyst is rare and causes indistinguishable symptoms from lumbar disc herniation. The clinical manifestations and pathological features of discal cyst have not yet been completely known. Discal cyst has been treated with surgery or with direct intervention such as computed tomography (CT) guided aspiration and steroid injection. The purpose of this study is to evaluate the safety and efficacy of the percutaneous endoscopic surgery for lumbar discal cyst over at least 6 months follow-up. Methods All 8 cases of discal cyst with radiculopathy were treated by percutaneous endoscopic surgery by transforaminal approach. The involved levels include L5-S1 in 1 patient, L3-4 in 2, and L4-5 in 5. The preoperative magnetic resonance imaging and 3-dimensional CT with discogram images in all cases showed a connection between the cyst and the involved intervertebral disc. Over a 6-months period, self-reported measures were assessed using an outcome questionaire that incorporated total back-related medical resource utilization and improvement of leg pain [visual analogue scale (VAS) and Macnab's criteria]. Results All 8 patients underwent endoscopic excision of the cyst with additional partial discectomy. Seven patients obtained immediate relief of symptoms after removal of the cyst by endoscopic approach. There were no recurrent lesions during follow-up period. The mean preoperative VAS for leg pain was 8.25±0.5. At the last examination followed longer than 6 month, the mean VAS for leg pain was 2.25±2.21. According to MacNab' criteria, 4 patients (50%) had excellent results, 3 patients (37.5%) had good results; thus, satisfactory results were achieved in 7 patients (87.5%). However, one case had unsatisfactory result with persistent leg pain and another paresthesia. Conclusion The radicular symptoms were remarkably improved in most patients immediately after percutaneous endoscopic cystectomy by transforaminal approach. PMID:22737300

  4. Management of hangman's fracture with percutaneous transpedicular screw fixation.

    PubMed

    Wu, Yao-Sen; Lin, Yan; Zhang, Xiao-Lei; Tian, Nai-Feng; Sun, Liao-Jun; Xu, Hua-Zi; Chi, Yong-Long; Pan, Zhi-Jun

    2013-01-01

    This study describes a percutaneous technique for C2 transpedicular screw fixation and evaluates its safety and efficacy in the treatment of patients with hangman's fracture. Ten patients with hangman's fracture were treated by percutaneous C2 transpedicular screw fixation. There are six males and four females, who were, based on the classification of Levine and Edwards, sorted as follows: type I fracture, three cases; type II, five cases; type IIa, two cases. The causes of injury were road traffic accident in six patients and falling injury in four patients. Other associated lesions included rib fractures (7 patients), head injuries (4 patients), and fractures of extremities (6 patients). The new technique was performed successfully in all cases. The average operation time was 98 min (range 60-130 min) and the estimated blood loss was 25 ml (range 15-40 ml). No complications such as vascular or neural structures injuries were found intraoperatively. Postoperative CT scans demonstrated that 17 (85 %) of 20 screws were placed satisfactorily, and 3 (15 %) screws showed perforations of the pedicle wall (<2 mm). These patients were asymptomatic and no further intervention was required postoperatively. After 8-25 months follow-up (mean 15.3 months), solid fusion was demonstrated by computed tomography. All cases got well-sagittal alignment and no angulation or dislocation was found at the segment of C2-C3. There was no loss of fixation. Clinical examination showed a full range of motion in the neck in all patients. The fluoroscopically assisted percutaneous C2 transpedicular screw fixation method is a technically feasible and minimally invasive technique for hangman's fracture.

  5. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    PubMed

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. Copyright 2016, SLACK Incorporated.

  6. Frequency of complications in image guided percutaneous nephrostomy.

    PubMed

    Ali, Syed Mubarak; Mehmood, Khalid; Faiq, Syed Muhammed; Ali, Bux; Naqvi, Syed Ali Anwar; Rizvi, Adib-ul-Hasan

    2013-07-01

    To assess the frequency of complications in image-guided percutaneous nephrostomy and to identify common sources of error. The study was carried out at the Sindh Institute of Urology and Transplantation, Karachi, between November 2006 and May 2007. Patients of all age groups between 1 and 80 years were included using nonprobability convenience sampling technique. Those suffering from obstructive uropathy due to various causes were diagnosed by imaging modalities like ultrasound, computed tomography scan, conventional X-ray and contrast studies. It also included cases where percutaneous nephrostomy was used to temporarily divert urine in the presence of urinary tract leaks and fistula so that healing may occur. Patients with uncorrectable bleeding diathesis were excluded. Nephrostomies performed for supplementary procedures were also excluded. One-month follow-up was performed by means of direct communications and using various imaging modalities. SPSS 12 was used for statistical analysis. Three hundred patients enrolled in the study. The procedure was successful in all encounters. The complications were categorised as early and late complications. Early complications were sepsis in 6 (2%) patients, retroperitoneal haematoma in 5 (1.6%) patients, bleeding in 2 (0.6%), and urinoma in 1 (0.3%). Late complications included catheter blockage in 15 (5%) patients, and dislodgement of catheter in 7 (2.3%). Total early complications were noted in 14 (4.66%) patients, and there were 22 (7.33%) late complications. Percutaneous nephrostomy is a safe, simple and cost-effective technique with low morbidity and no major life-threatening complications.

  7. Aortic valve laceration following coronary angiography and percutaneous coronary intervention.

    PubMed

    Roy, James; Manganas, Con; Youssef, George; Rees, David

    2016-11-01

    Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement. © 2016 Wiley Periodicals, Inc.

  8. Safety assessment and therapeutic efficacy of percutaneous microwave ablation therapy combined with percutaneous ethanol injection for hepatocellular carcinoma adjacent to the gallbladder.

    PubMed

    Huang, Hui; Liang, Ping; Yu, Xiao-ling; Cheng, Zhi-gang; Han, Zhi-yu; Yu, Jie; Liu, Fang-yi

    2015-02-01

    This study sought to evaluate the safety and efficacy of ultrasound-guided (US-guided) percutaneous microwave (MW) ablation combined with percutaneous ethanol injection (PEI) to treat liver tumours adjacent to the gallbladder. A total of 136 patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder, who underwent ultra-sonographically-guided percutaneous MW ablation, which was combined with PEI in 132 patients, were retrospectively assessed. The patient population characteristics, tumour features, local tumour progression and treatment were compared and analysed. The safety and efficacy of the therapy were assessed by clinical data and imaging in follow-up examinations. All patients were completely treated with two sessions; 120 patients underwent one session, 16 patients underwent two sessions. The primary technique was effective in 95.6% of the cases, according to the computed tomography (CT) or magnetic resonance imaging (MRI) in the one-month follow-up (132 of 138 sessions). PEI and other therapies were performed in the patients who had been incompletely treated (all six patients underwent PEI, and some underwent other therapies, including one transcatheter arterial chemoembolisation (TACE), one liver transplantation and two liver resections). There was a median follow-up period of 30.1 months and a range of 4 to 68 months. None of the patients had major complications. There were no treatment-related deaths. Twenty-six patients died of primary disease progression that was not directly attributable to MW ablation (19.1%, 26/136). Local tumour progression was noted in five patients (3.7%, 5/136), who had completely ablated tumours at follow-up. The patients with locally progressing tumours underwent additional therapy (three patients underwent PEI, one patient TACE, and one liver resection). Ultrasound-guided percutaneous MW ablation, in combination with percutaneous ethanol injection and thermal monitoring, is a safe and effective treatment for

  9. Percutaneous venovenous bypass in orthotopic liver transplantation.

    PubMed

    Washburn, W K; Lewis, W D; Jenkins, R L

    1995-11-01

    Since January 1994, we have used percutaneous placement of both the subclavian and femoral cannulae to establish access for venovenous bypass during orthotopic liver transplantation. Percutaneous subclavian and femoral cannulae were used in 36 patients of which 5 had portal decompression by placement of a cannula in inferior mesenteric vein percutaneously through the abdominal wall. Intraoperative placement of the subclavian cannula is facilitated by placing a subclavian central venous line before the abdominal incision. One patient underwent exploration for femoral vein bleeding early in our experience. Another patient sustained hypotension as a result of a kinked subclavian cannula. In 4 patients, early in this experience, we had difficulty placing the subclavian cannula and resorted to axillary vein cut-down. There were no episodes of deep venous thrombosis detected by routine postoperative duplex ultrasonography. Minimum and maximum flow rates were significantly better (P < .01), with percutaneously placed cannulae in comparison to a control group of patients who underwent transplantation in whom we used the standard venous cut-down approach with a #7 Gott shunt (2.14 and 3.17 L/min v 1.65 and 2.41 L/min, respectively). Percutaneous placement of cannulae for venovenous bypass during liver transplantation is quick, safe, and effective. We would advocate this technique as an alternative approach for patients in whom bypass is deemed necessary.

  10. Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage.

    PubMed

    Ohara, N; Tominaga, O; Uchiyama, M; Nakano, H; Muto, T

    1998-01-01

    We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5 degrees C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm3) with a leftward shift and elevated C-reactive protein (5.2 mg/dl). Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough.

  11. Percutaneous MRI-guided laser thermal therapy in canine prostate

    NASA Astrophysics Data System (ADS)

    McNichols, Roger J.; Gowda, Ashok; Gelnett, Marc D.; Stafford, Roger J.

    2005-04-01

    Prostate cancer is the most common cancer in American men excluding skin cancer, and approximately 230,000 cases of prostate cancer will be diagnosed in the U.S. in 2004. In the non-surgical treatment of localized prostate cancer, fiberoptically delivered interstitial laser thermal therapy may be ideal for treating discrete tumors with minimal invasiveness. Real-time magnetic resonance imaging can be used to compute temperature changes based on the proton resonance frequency (PRF) shift, and two-dimensional maps of temperature rise and chronic thermal damage can be constructed in order to control laser therapy. In this work, we describe an MRI-compatible percutaneous grid template and localization and planning software for precise placement of minimally invasive laser catheters to effect a target ablation zone. We evaluated the accuracy of the catheter placement, and we present our preliminary experience with percutaneous MRI-guided feedback controlled laser ablation in a canine prostate model. Histological analysis is used to assess the effectiveness and accuracy of treatment visualization.

  12. Percutaneous mechanical thrombectomy of superior mesenteric artery embolism

    PubMed Central

    Kuhelj, Dimitrij; Kavcic, Pavel; Popovic, Peter

    2013-01-01

    Background The present series present three consecutive cases of successful percutaneous mechanical embolectomy in acute superior mesenteric artery ischemia. Superior mesenteric artery embolism is a rare abdominal emergency that commonly leads to bowel infarction and has a very high mortality rate. Prompt recognition and treatment are crucial for successful outcome. Endovascular therapeutic approach in patients with acute SMA embolism in median portion of its stem is proposed. Case reports. Three male patients had experienced a sudden abdominal pain and acute superior mesenteric artery embolism in median portion of its stem was revealed on computed tomography angiography. No signs of intestinal infarction were present. The decision for endovascular treatment was made in concordance with the surgeons. In one patient 6 French gauge Rotarex® device was used while in others 6 French gauge Aspirex® device were used. All patients experienced sudden relief of pain after the procedure with no signs of intestinal infarction. Minor procedural complication – rupture of a smaller branch of SMA during Aspirex® treatment was successfully managed by coiling while transient paralytic ileus presented in one patient resolved spontaneously. All three patients remained symptom-free with patent superior mesenteric artery during the follow-up period. Conclusions Percutaneous mechanical thrombectomy seems to be a rapid and effective treatment of acute superior mesenteric artery embolism in median portion of its stem in absence of bowel necrosis. Follow-up of our patients showed excellent short- and long-term results. PMID:24133388

  13. Ultrasound-guided percutaneous breast biopsy.

    PubMed

    Newell, Mary S; Mahoney, Mary C

    2014-03-01

    Ultrasound-guided percutaneous tissue sampling of the breast has positively altered the management of breast lesions, both benign and malignant, since its inception in the 1980s and subsequent widespread acceptance in the 1990s. Its safety, accuracy, and cost-effectiveness have been validated in several studies. However, percutaneous biopsy serves a patient best when performed by an operator with full awareness of patient׳s salient imaging findings; a knowledge of the benefits, limitations, and technical requirements of breast ultrasound; and a thorough understanding of what constitutes an adequate and concordant pathologic specimen. This article outlines a general approach to ultrasound (US)-guided percutaneous breast biopsy and discusses indications, potential complications, and technical aspects of the procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. [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.

  15. Percutaneous ablation of benign bone tumors.

    PubMed

    Welch, Brian T; Welch, Timothy J

    2011-09-01

    Percutaneous image-guided ablation has become a standard of practice and one of the primary modalities for treatment of benign bone tumors. Ablation is most commonly used to treat osteoid osteomas but may also be used in the treatment of chondroblastomas, osteoblastomas, and giant cell tumors. Percutaneous image-guided ablation of benign bone tumors carries a high success rate (>90% in case series) and results in decreased morbidity, mortality, and expense compared with traditional surgical methods. The ablation technique most often applied to benign bone lesions is radiofrequency ablation. Because the ablation technique has been extensively applied to osteoid osteomas and because of the uncommon nature of other benign bone tumors, we will primarily focus this discussion on the percutaneous ablation of osteoid osteomas.

  16. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    PubMed Central

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  17. [Algorithm for percutaneous origin of irreversible icterus ].

    PubMed

    Marković, Z; Milićević, M; Masulović, D; Saranović, Dj; Stojanović, V; Marković, B; Kovacević, S

    2007-01-01

    It is retrospective analysis of all percutaneous billiary dranage typs used in 600 patients with opstructive icterus in last 10 years.The procedure technics is analysed. It had positiv therapeutical result in about 75% cases. The most frequent complication are showed. The most coressponding percutaneous derivation algorithm is discussed. As initial method is suggested the usage of externo-internal derivation which, in dependence of the procedure, continue by internal derivation-catheteral endoprosthesys or matelic stent. The covered metalic stents usage is suggested as method of choise in metalic endoprosthesys application.

  18. 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.

  19. Percutaneous absorption with emphasis on sunscreens.

    PubMed

    Gonzalez, Helena

    2010-04-01

    Sunscreens are widely used products. When recreationally used they are applied to large areas of the skin repeatedly. In moisturizers and foundation it is common to find sun protective ingredients, in these cases the product is usually applied to smaller areas but often done daily. Active ingredients in sunscreens can be absorbed by the skin. Percutaneous absorption is an important factor to take into consideration. There are several methods to measure the percutaneous absorption, both in vivo and/or in vitro. This paper will give an overview of the different methods.

  20. Percutaneous Nephrostomy: Technical Aspects and Indications

    PubMed Central

    Dagli, Mandeep; Ramchandani, Parvati

    2011-01-01

    First described in 1955 by Goodwin et al as a minimally invasive treatment for urinary obstruction causing marked hydronephrosis, percutaneous nephrostomy (PCN) placement quickly found use in a wide variety of clinical indications in both dilated and nondilated systems. Although the advancement of modern endourological techniques has led to a decline in the indications for primary nephrostomy placement, PCNs still play an important role in the treatment of multiple urologic conditions. In this article, the indications, placement, and postprocedure management of percutaneous nephrostomy drainage are described. PMID:23204641

  1. Percutaneous Pediatric Foot and Ankle Surgery.

    PubMed

    Uglow, Michael G

    2016-09-01

    The techniques for performing percutaneous osteotomies in treating deformities of the foot in children are presented along with a detailed description of the operative details. The author's use of minimal-access surgery for tibial, os calcis, and midfoot osteotomies is described using a cooled side-cutting burr that has not previously been described for use in the child's foot. The cancellous nature of the bones in the child are easily cut with the burr and the adjacent soft tissues are not damaged. The early experience of the healing times are not impaired and the complications associated with percutaneous scars seem to be negligible. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Tubeless percutaneous nephrolithotomy in children.

    PubMed

    Khairy Salem, H; Morsi, H A; Omran, A; Daw, M A

    2007-06-01

    To assess the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) as an alternative to extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis in children. In 2003-2005 we operated on 20 cases that met the inclusion criteria. Extensive follow-up tests were performed in all patients; stone clearance was defined as the absence of residual fragments on plain abdominal X-ray and renal ultrasound. Pain-scale ruler (0-10) was used to evaluate pain postoperatively. Comparison was made with a group of 10 patients with very similar criteria operated upon with PCN tube. Mean follow-up period was 9 months (3-18 months) and mean age 7.5 years (4-15 years). Mean operative time was 115 min (45-180) with no significant bleeding intra- or postoperatively. Conversion to open surgery was necessary in one case. There were no major perioperative complications. In the tubeless group the pain score was 3-6 (mean 4.6), there was no need for IV analgesia, and median hospital stay was 1.7 days (1-4 days); urine leakage occurred in one patient. In the group with PCN tube the pain score was 5-8 (mean 5.5), IV analgesia was mandatory in four patients, and median hospital stay was 2.8 days (3-4 days); urine leakage occurred in five patients and a small residual stone was detected in one child. Tubeless PCNL in children has the advantages of being less painful, less troublesome and shortening the hospital stay of the child. The decision to use this procedure is best made intraoperatively and depends on the experience of the surgeon.

  3. Treatment of Infected Aneurysms of the Abdominal Aorta and Iliac Artery with Endovascular Aneurysm Repair and Percutaneous Drainage.

    PubMed

    Chino, Shuji; Kato, Noriyuki; Noda, Yoshihiro; Oue, Kensuke; Tanaka, Satofumi; Hashimoto, Takashi; Higashigawa, Takatoshi; Miyake, Yoichiro; Okabe, Manabu

    2016-10-01

    Infected aneurysm remains one of the most challenging diseases for vascular surgeons. We describe the successful treatment of 2 cases of infected aneurysms with endovascular aneurysm repair and percutaneous computed tomography-guided drainage. This strategy may be an effective alternative to open surgical repair in selected patients.

  4. 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.

  5. Percutaneous cyanoacrylate glue injection into the renal pseudoaneurysm to control intractable hematuria after percutaneous nephrolithotomy.

    PubMed

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

    2009-07-01

    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 Retrieval of a Radiolucent Foreign Body from an EVAR Device by Combining Different Image Modalities

    SciTech Connect

    Barbiero, Giulio; Cognolato, Diego; Polverosi, Roberta; Guarise, Alessandro

    2009-07-15

    Percutaneous extraction techniques are an established method for removing endovascular foreign bodies. Generally, the foreign body to be removed is radiopaque (i.e., catheter and guidewire fragments, vena cava filters, embolization coils, endovascular stents). We propose an application of these techniques to remove a radiolucent foreign body (i.e., pigtail cover) by means of a combination of different imaging techniques (fluoroscopy, digital subtraction angiography, ultrasound, and computed axial tomography).

  7. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    SciTech Connect

    Becce, Fabio; Mouhsine, Elyazid; Mosimann, Pascal John; Anaye, Anass; Letovanec, Igor; Theumann, Nicolas

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  8. Percutaneous Retrograde Sclerotherapy for Refractory Bleeding of Jejunal Varices: Direct Injection via Superficial Epigastric Vein

    SciTech Connect

    Nakata, Manabu Nakata, Waka; Isoda, Norio Yoshizawa, Mitsuyo; Sugimoto, Hideharu

    2012-02-15

    Small-bowel varices are rare and almost always occur in cases with portal hypertension. We encountered a patient with bleeding jejunal varices due to liver cirrhosis. Percutaneous retrograde sclerotherapy was performed via the superficial epigastric vein. Melena disappeared immediately after treatment. Disappearance of jejunal varices was confirmed by contrast-enhanced computed tomography. After 24 months of follow-up, no recurrent melena was observed.

  9. Cystic artery pseudoaneurysm presenting as a complication of laparoscopic cholecystectomy treated with percutaneous thrombin injection.

    PubMed

    Kumar, Abhishek; Sheikh, Ahmed; Partyka, Luke; Contractor, Sohail

    2014-01-01

    A 45-year-old woman status post laparoscopic cholecystectomy 3years ago presented with upper gastrointestinal bleeding. Endoscopy revealed hemobilia. Computed tomographic abdomen demonstrated a 2-cm aneurysm in the gall bladder fossa, consistent with a pseudoaneurysm. Initially, transcatheter coil embolization was attempted but recanalization of the aneurysm with recurrent bleeding in 2 days ensued. The aneurysm was then accessed percutaneously under ultrasound guidance and thrombin was injected into the aneurysm with subsequent complete thrombosis of the aneurysm and cessation of bleeding.

  10. Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis.

    PubMed

    Funao, Haruki; Kebaish, Khaled M; Isogai, Norihiro; Koyanagi, Takahiro; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. Case 1 is a 77-year-old man who presented with low back pain and high fever. He was diagnosed with spondylodiscitis at L4-5. He had a history of lung cancer, which was complicated by the recurrence. Because nonsurgical treatment failed, MISt with percutaneous S2AI screws was performed. The patient's low back pain subsided markedly 1 week after surgery, and there was no screw/rod breakage or recurrence of infection during the follow-up period. Case 2 is a 71-year-old man who presented with hemiparesis because of a stroke. He also developed high fever and was diagnosed with spondylodiscitis at L5-S1. Because nonsurgical treatment failed, the patient was treated by MISt with percutaneous S2AI screws while being maintained on anticoagulants for stroke. Although his clinical symptoms had markedly improved, a postoperative lumbar computed tomography scan demonstrated a bone defect at L5-S1. An anterior spinal fusion with an iliac bone graft at L5-S1 was performed when a temporary cessation of anticoagulants was permitted. Both patients tolerated the procedures well and had no major perioperative complications. MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Does Navigation Improve Pedicle Screw Placement Accuracy? Comparison Between Navigated and Non-navigated Percutaneous and Open Fixations.

    PubMed

    Innocenzi, Gualtiero; Bistazzoni, Simona; D'Ercole, Manuela; Cardarelli, Giovanni; Ricciardi, Francesco

    2017-01-01

    The aim of our study was to assess how a preoperative computed tomography (CT)-based navigation system affected the correctness and safety of transpedicular screw insertion, compared with standard techniques. Between January 2012 and February 2014, 203 patients underwent thoracic and lumbar fixation, with open and percutaneous techniques; 218 screws were implanted through an open navigated technique (1.0 Spine & Trauma 3d ver. 2.0 BrainLab, Feldkirchen Germany) in 43 patients; 220 screws were inserted with an open free-hand technique in 45 patients; 230 screws were implanted in 56 patients using percutaneous CT-based navigation; and 236 screws were inserted in 59 patients using a percutaneous fluoroscopy-guided technique. To our knowledge, this is the first work comparing these four different techniques. The position of each screw was evaluated on CT scan reconstruction and classified according to a four-point grading scale (grade 0: no breach, grade 1: breach < 2 mm, grade 2: breach between 2 and 4 mm; grade 3: breach >4 mm). Statistical analysis was assessed by two-way analysis of variance (ANOVA) t test, while the Fisher least significant difference (LSD) method was employed to determine statistical significance. Statistical analysis showed a significant difference in accuracy between the open CT-based navigation and the percutaneous CT-based navigation techniques (P= 0.0263) and between the open CT-based navigation and the percutaneous fluoroscopy-guided techniques (P=0.0258): a particular difference was observed in anterior misplacement between open CT-based navigation and the percutaneous fluoroscopy-guided technique (P= 0.0153). Our results confirm the advantages of the navigation technique, which ensures greater accuracy, in open as well as percutaneous procedures.

  12. 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.

  13. The effect of volatility on percutaneous absorption.

    PubMed

    Rouse, Nicole C; Maibach, Howard I

    2016-01-01

    Topically applied chemicals may volatilize, or evaporate, from skin leaving behind a chemical residue with new percutaneous absorptive capabilities. Understanding volatilization of topical medications, such as sunscreens, fragrances, insect repellants, cosmetics and other commonly applied topicals may have implications for their safety and efficacy. A systematic review of English language articles from 1979 to 2014 was performed using key search terms. Articles were evaluated to assess the relationship between volatility and percutaneous absorption. A total of 12 articles were selected and reviewed. Key findings were that absorption is enhanced when coupled with a volatile substance, occlusion prevents evaporation and increases absorption, high ventilation increases volatilization and reduces absorption, and pH of skin has an affect on a chemical's volatility. The articles also brought to light that different methods may have an affect on volatility: different body regions; in vivo vs. in vitro; human vs. Data suggest that volatility is crucial for determining safety and efficacy of cutaneous exposures and therapies. Few articles have been documented reporting evaporation in the context of percutaneous absorption, and of those published, great variability exists in methods. Further investigation of volatility is needed to properly evaluate its role in percutaneous absorption.

  14. Blue toe syndrome: treatment with percutaneous atherectomy.

    PubMed

    Dolmatch, B L; Rholl, K S; Moskowitz, L B; Dake, M D; van Breda, A; Kaplan, J O; Katzen, B T

    1989-12-01

    "Blue toe syndrome" refers to digital ischemia of the foot in the presence of palpable or Doppler audible pedal pulses. This clinical syndrome is caused by microembolization to small vessels from a proximal source. The use of percutaneous transluminal atherectomy is described in the treatment of embologenic superficial femoral artery lesions in seven patients. All seven had prompt healing of the ischemic toes, and none required surgical revascularization or amputation. One patient developed a recurrent stenosis at the atherectomy site and had a second episode of digital ischemia, which was treated by means of atherectomy with a larger device. Histologic study of atherectomy specimens suggests that emboli arise from adherent fibrinoplatelet aggregates or thrombus and less often from cholesterol-rich atheromatous plaque. Although either percutaneous transluminal angioplasty or atherectomy can be used to treat the underlying stenosis, percutaneous atherectomy offers the advantage of nonsurgical removal of embologenic material and provides material for histologic study. Percutaneous atherectomy is an effective method of treating embologenic superficial femoral stenoses in patients with ipsilateral blue toe syndrome.

  15. Percutaneous endoscopic gastrostomy in Trinidad and Tobago.

    PubMed

    Bartholomew, M M; Mohammed, S L; Williams, D H

    2003-12-01

    Percutaneous endoscopic gastrostomy tube placement is rapidly becoming the preferred method of gastrostomy tube placement. We describe our experience with this procedure in nine patients. The main complications were minor and due to local infection. This report demonstrates the simplicity and safety of this technique.

  16. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class II...

  17. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class II...

  18. 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

  19. 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. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  20. Percutaneous cardioscopy of the left ventricle in patients with myocarditis

    NASA Astrophysics Data System (ADS)

    Uchida, Yasumi; Tomaru, Takanobu; Nakamura, Fumitaka; Oshima, Tomomitsu; Fujimori, Yoshiharu; Hirose, Junichi

    1992-08-01

    The morphology and function of the cardiac chambers have been evaluated clinically using cineventriculography, computed tomography, magnetic resonance imaging, and endomyocardial biopsy. Excluding the invasive technique of biopsy where tissue is actually removed, these other non-invasive techniques reveal only indirect evidence of endocardial and subendocardial pathology and, therefore, allow the potential for misdiagnosis from insufficient data. Fiberoptic examinations, as recently demonstrated in coronary, pulmonary, and peripheral vessels, allow direct observation of pathology otherwise unobtainable. Recently, similar techniques have been applied to examine the cardiac chambers of dogs and the right heart of humans. In this study, we examine the feasibility and safety of percutaneous fiberoptic cardioscopy of the left ventricle in patients with myocarditis.

  1. Conservative management of migrated percutaneous endoscopic colostomy tube

    PubMed Central

    Chase, Thomas J.G.; Luck, Joshua; Harris, Lauren S.; Bashir, Gareth

    2017-01-01

    A 68-year-old male nursing home resident presented following dislodgement of a percutaneous endoscopic colostomy (PEC) tube originally sited to prevent recurrent sigmoid volvulus. Computed tomography demonstrated tube migration into the lumen of the recto-sigmoid junction, where it remained for 12 days before passing spontaneously. During this period, the patient remained asymptomatic; the residual colocutaneous fistula functioned as a decompressive valve. Originally, the patient was due to be discharged with early flexible sigmoidoscopy follow-up. However, complex social issues delayed discharge. During his admission, a second PEC tube was successfully inserted next to the previous colostomy site without complication. This is an unusual case and no similar episodes of asymptomatic PEC migration have been reported. We demonstrate that such cases may be offered an appropriate trial of conservative management. Here, we describe our experience and critically appraise the literature. PMID:28064245

  2. Late complications of percutaneous tracheostomy using the balloon dilation technique.

    PubMed

    Araujo, J B; Añón, J M; García de Lorenzo, A; García-Fernandez, A M; Esparcia, M; Adán, J; Relanzon, S; Quiles, D; de Paz, V; Molina, A

    2017-06-22

    The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. A prospective, observational cohort study was carried out. Two medical-surgical intensive care units (ICU). All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. All patients underwent PT according to the Ciaglia Blue Dolphin(®) method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. Percutaneous tracheostomy using the Ciaglia Blue Dolphin(®) technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Percutaneous repair or surgery for mitral regurgitation.

    PubMed

    Feldman, Ted; Foster, Elyse; Glower, Donald D; Glower, Donald G; Kar, Saibal; Rinaldi, Michael J; Fail, Peter S; Smalling, Richard W; Siegel, Robert; Rose, Geoffrey A; Engeron, Eric; Loghin, Catalin; Trento, Alfredo; Skipper, Eric R; Fudge, Tommy; Letsou, George V; Massaro, Joseph M; Mauri, Laura

    2011-04-14

    Mitral-valve repair can be accomplished with an investigational procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet. We randomly assigned 279 patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation in a 2:1 ratio to undergo either percutaneous repair or conventional surgery for repair or replacement of the mitral valve. The primary composite end point for efficacy was freedom from death, from surgery for mitral-valve dysfunction, and from grade 3+ or 4+ mitral regurgitation at 12 months. The primary safety end point was a composite of major adverse events within 30 days. At 12 months, the rates of the primary end point for efficacy were 55% in the percutaneous-repair group and 73% in the surgery group (P=0.007). The respective rates of the components of the primary end point were as follows: death, 6% in each group; surgery for mitral-valve dysfunction, 20% versus 2%; and grade 3+ or 4+ mitral regurgitation, 21% versus 20%. Major adverse events occurred in 15% of patients in the percutaneous-repair group and 48% of patients in the surgery group at 30 days (P<0.001). At 12 months, both groups had improved left ventricular size, New York Heart Association functional class, and quality-of-life measures, as compared with baseline. Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. (Funded by Abbott Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.).

  4. Percutaneous discal cyst rupture in a professional football player using sublaminar epidural injection for thecal sac displacement.

    PubMed

    Friedman, Michael V; Park, Andrew; Bumpass, David; Jennings, Jack W; Matava, Matthew J

    2015-01-01

    A case of percutaneous discal cyst rupture in a 25-year-old professional American football player is reported. The patient presented with a 3-day history of severe left-sided back pain. Magnetic resonance imaging examination demonstrated a discal cyst effacing the left L4-L5 lateral recess, with interposed thecal sac. A sublaminar epidural injection was performed displacing the thecal sac, exposing the discal cyst, and allowing for percutaneous perforation. The patient had complete resolution of symptoms after discal cyst rupture and was able to compete in a professional football game 3 days later. Computed tomography-guided percutaneous rupture is a therapeutic modality that may be considered for treatment of a symptomatic discal cyst.

  5. Percutaneous vertebroplasty: a new animal model.

    PubMed

    Oliveira, Maria Teresa; Potes, José; Queiroga, Maria Cristina; Castro, José L; Pereira, Alfredo F; Rehman, Sarrawat; Dalgarno, Kenneth; Ramos, António; Vitale-Brovarone, Chiara; Reis, Joana C

    2016-10-01

    Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure and is frequently performed in humans who need surgical treatment of vertebral fractures. PVP involves cement injection into the vertebral body, thereby providing rapid and significant pain relief. The testing of novel biomaterials depends on suitable animal models. The aim of this study was to develop a reproducible and safe model of PVP in sheep. This study used ex vivo and in vivo large animal model study (Merino sheep). Ex vivo vertebroplasty was performed through a bilateral modified parapedicular access in 24 ovine lumbar hemivertebrae, divided into four groups (n=6). Cerament (Bone Support, Lund, Sweden) was the control material. In the experimental group, a novel composite was tested-Spine-Ghost-which consisted of an alpha-calcium sulfate matrix enriched with micrometric particles of mesoporous bioactive glass. All vertebrae were assessed by micro-computed tomography (micro-CT) and underwent mechanical testing. For the in vivo study, 16 sheep were randomly allocated into control and experimental groups (n=8), and underwent PVP using the same bone cements. All vertebrae were assessed postmortem by micro-CT, histology, and reverse transcription-polymerase chain reaction (rt-PCR). This work has been supported by the European Commission under the 7th Framework Programme for collaborative projects (600,000-650,000 USD). In the ex vivo model, the average defect volume was 1,275.46±219.29 mm(3). Adequate defect filling with cement was observed. No mechanical failure was observed under loads which were higher than physiological. In the in vivo study, cardiorespiratory distress was observed in two animals, and one sheep presented mild neurologic deficits in the hind limbs before recovering. The model of PVP is considered suitable for preclinical in vivo studies, mimicking clinical application. All sheep recovered and completed a 6-month implantation period. There was no evidence of

  6. Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

    PubMed Central

    Xia, Ning; Gong, Ju; Lu, Jian; Chen, Zhi-Jin; Zhang, Li-Yun; Wang, Zhong-Min

    2017-01-01

    AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to follow-up. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 ± 65 μmol/L and 63 ± 29 μmol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients’ stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach. PMID:28348491

  7. Percutaneous and combined percutaneous and intralesional Nd:YAG-laser therapy for vascular malformations.

    PubMed

    Wimmershoff, M B; Landthaler, M; Hohenleutner, U

    1999-01-01

    The numerous types of vascular abnormality are classified in groups according to their pathological and anatomical features. We present case histories of 2 patients who had vascular malformations of the face since birth or early childhood. Application methods, side-effects and complications of percutaneous and intra-lesional Nd:YAG-laser therapy are reviewed for these patients. A 54-year-old woman was treated percutaneously with the Nd: YAG-laser at 1064 nm, with 20 30 W, cw 1-5 s pulses and 2 - 3 mm spot size. A 59-year-old woman was treated with the combined percutaneous and intralesional laser therapy with 30 W, cw 1-5 s pulses and 2-3 mm spot size. In both cases, percutaneous or combined percutaneous and intra-lesional Nd: YAG-laser application resulted in a significant shrinking of the lesion. The Nd:YAG-laser radiation at 1064 nm presents an effective treatment of vascular malformations due to its deep penetration into the tissue. No standardized guidelines for Nd: YAG-laser therapy exist and the treatment parameters should be chosen individually according to the type of vascular malformation.

  8. [A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement].

    PubMed

    Ko, Geun Jun; Han, Ki Jun; Han, Seo Goo; Hwang, Sang Yon; Choi, Chang Hwan; Gham, Chang Woo; Cho, Hyeon Geun; Song, Soon-Young; Jung, Jin Ho

    2006-02-01

    Acute mesenteric ischemia can result from emboli, arterial and venous thrombi or vasoconstriction secondary to low-flow states. Isolated spontaneous dissection of the superior mesenteric artery is a rare cause of acute mesenteric ischemia. The mortality rates of acute mesenteric ischemia averages 71% with a range of 59-93%. Diagnosis before the occurrence of intestinal infarction is the most important factor in improving survival rate for patients with acute mesenteric ischemia. A 68-year-old female presented with postprandial epigastric pain, and a dissection of the superior mesenteric artery and a gallbladder polyp were shown in abdominal computed tomographic scan. After the percutaneous metalic stent placement and laparoscopic cholecystectomy, her symptoms improved. We report a case of spontaneous dissection of main trunk of the superior mesenteric artery which was successfully treated by percutaneous stent placement with a review of literature.

  9. Co-activation of saphenous nerve fibers: a potential therapeutic mechanism of percutaneous tibial nerve stimulation?

    PubMed

    Elder, Christopher W; Yoo, Paul B

    2016-08-01

    Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive and effective treatment for overactive bladder (OAB). However, clinical trials show that positive therapeutic outcomes among patients are difficult to predict (failure rate = 35% to 50%). Inconsistencies in the stimulation amplitudes used clinically and those used in preclinical animal studies led us to hypothesize that OAB therapy involves a secondary bladder-inhibitory pathway. In this paper, we implemented and tested a computer model of the human lower leg that investigated the differential activation of the saphenous nerve (SAFN) and tibial nerve (TN) during percutaneous electrical stimulation. Our preliminary findings show that concomitant activation of SAFN branches occurs during PTNS, which suggests the possibility that the SAFN may influence the clinical outcome of treatment.

  10. Avoiding hemodynamic collapse during high-risk percutaneous coronary intervention: Advanced hemodynamics of impella support.

    PubMed

    Verma, Sanjay; Burkhoff, Daniel; O'Neill, William W

    2017-03-01

    The rate of performing primary percutaneous coronary intervention in patients with complex coronary artery disease is increasing. The use of percutaneous mechanical circulatory support devices provides critical periprocedural hemodynamic support. Mechanical support has increased the safety and efficacy of interventional procedures in this high-risk patient population. Predicting patient response to the selected intervention can be clinically challenging. Here we demonstrate a case where complete hemodynamic collapse during PCI was avoided by mechanical support provided by the Impella device. Further, we employ a comprehensive cardiovascular model to predict ventricular function and patient hemodynamics in response to the procedure. New computational tools may help interventionists visualize, understand, and predict the multifaceted hemodynamic aspects of these high risk procedures in individual patients. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  11. 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. © The Author(s) 2014.

  12. [Pulmonary embolism following percutaneous vertebroplasty].

    PubMed

    Bedini, Marianela Patricia; Albertini, Ricarso Arturo; Orozco, Santiago

    2013-01-01

    Vertebroplasty is a minimally invasive technique for the treatment of osteoporotic fractures. Within its complications is pulmonary embolism, which can be asymptomatic or with respiratory distress and may be notes by radiography or computed tomography. At present there is no guide to indicate the routine performance of imaging techniques after treatment, and all agreed on the need to start anticoagulant therapy for 3 months or so with coumarin in symptomatic or asymptomatic central emboli.

  13. Delayed cerebral air embolism complicating percutaneous needle biopsy of the lung.

    PubMed

    Shi, Liuhong; Zhang, Ruifeng; Wang, Zhengyang; Zhou, Pan

    2013-06-01

    Computed tomography-guided percutaneous needle biopsy of the lung is a common and frequently performed procedure for diagnosis of lung lesions. However, this procedure is not without risks. The major complications include pneumothorax and hemoptysis, which are mild and self-limiting. The rare complications include air embolism, tension pneumothorax, pulmonary hemorrhage, and tumor dissemination, which are severe and life threatening. Cerebral air embolism is a very rare and fatal complication. In previous reports, cerebral air embolism generally occurred during or immediately after lung biopsy. Herein, we present the first case of cerebral infarction secondary to cerebral air embolism 6 hours after computed tomography-guided lung biopsy.

  14. Comparison of Isocentric C-Arm 3-Dimensional Navigation and Conventional Fluoroscopy for Percutaneous Retrograde Screwing for Anterior Column Fracture of Acetabulum

    PubMed Central

    He, Jiliang; Tan, Guoqing; Zhou, Dongsheng; Sun, Liang; Li, Qinghu; Yang, Yongliang; Liu, Ping

    2016-01-01

    Abstract Percutaneous screw insertion for minimally displaced or reducible acetabular fracture using x-ray fluoroscopy and computer-assisted navigation system has been advocated by some authors. The purpose of this study was to compare intraoperative conditions and clinical results between isocentric C-arm 3-dimensional (Iso-C 3D) fluoroscopy and conventional fluoroscopy for percutaneous retrograde screwing of acetabular anterior column fracture. A prospective cohort study was conducted. A total of 22 patients were assigned to 2 different groups: 10 patients in the Iso-C 3D navigation group and 12 patients in the conventional group. The operative time, fluoroscopic time, time of screw insertion, blood loss, and accuracy were analyzed between the 2 groups. There were significant differences in operative time, screw insertion time, fluoroscopy time, and mean blood loss between the 2 groups. Totally 2 of 12 (16.7%) screws were misplaced in the conventional fluoroscopy group, and all 10 screws were in safe zones in the navigation group. Percutaneous screw fixation using the Iso-C 3D computer-assisted navigation system significantly reduced the intraoperative fluoroscopy time and blood loss in percutaneous screwing for acetabular anterior column fracture. The Iso-C 3D computer-assisted navigation system provided a reliable and effective method for percutaneous screw insertion in acetabular anterior column fractures compared to conventional fluoroscopy. PMID:26765448

  15. Bilothorax as a complication of percutaneous transhepatic biliary drainage.

    PubMed

    Sano, Atsushi; Yotsumoto, Takuma

    2016-01-01

    We report two cases of bilothorax that occurred as a complication of percutaneous transhepatic biliary drainage. In an 86-year-old woman who had undergone percutaneous transhepatic biliary drainage for obstructive jaundice, bilothorax occurred after accidental removal of the tube. She recovered with chest drainage only. An 83-year-old man who had undergone percutaneous transhepatic biliary drainage for cholecystitis developed bilothorax with infection. He recovered with thoracoscopic curettage. Although bilothorax is a rare complication of percutaneous transhepatic biliary drainage, appropriate diagnosis and prompt treatment is important, especially when bilothorax is accompanied by infection.

  16. Risk scoring for percutaneous coronary intervention: let's do it!

    PubMed Central

    Siotia, A

    2006-01-01

    The recent publication of a robust percutaneous coronary intervention (PCI) risk scoring system should stimulate every interventional cardiologist to incorporate risk adjustment into their everyday practice PMID:16621880

  17. Needle track seeding following percutaneous procedures for hepatocellular carcinoma

    PubMed Central

    Cabibbo, Giuseppe; Craxì, Antonio

    2009-01-01

    Neoplastic seeding may arise after diagnostic or therapeutic percutaneous procedures for hepatocellular carcinoma. The true incidence of seeding with hepatocellular carcinoma is difficult to assess precisely, but a significant risk of seeding exists and is greater when performing diagnostic biopsy as compared to therapeutic percutaneous procedures [radiofrequency ablation, radiofrequency ablation (RFA); percutaneous ethanol injection, Percutaneous ethanol injection (PEI)]. Whenever liver transplantation is feasible, diagnostic needle biopsies should be avoided, but RFA and PEI are often needed as “bridge” treatments. The role of adjuvant treatments in reducing the incidence of seeding following RFA or PEI requires further evaluation. PMID:21160966

  18. 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

  19. In vitro Methodology for Percutaneous Absorption Studies

    DTIC Science & Technology

    1985-05-01

    from the flow-through cell (area - 0.32 c02) were auto- matically collected in a fraction collector. The skin surface 307 temperature was maintained at...through the skin of toxic compounds can be significant and must be considered when dermal contact occurs. In vitro methods for measuring percutaneous...facilitate analysis of material permeating the skin . The 3H and l1C materials were obtained from commercial sources with a radiochemical purity of at least

  20. Percutaneous endoscopic gastrostomy feeding: indications and management.

    PubMed

    Slater, Rebecca

    Percutaneous endoscopic gastrostomy (PEG) has become one of the most useful and established enteral nutrition techniques available to patients requiring nutritional support worldwide. Good nutrition and the receiving of essential nutrients and electrolytes are vital for growth, healing, repair and delivery of essential energy to carry out daily tasks. The article looks specifically at PEG as a form of enteral nutrition delivery, how it is undertaken, and the care needs of the patient post-insertion of a PEG tube.

  1. Infected hepatic cyst treated with percutaneous transhepatic drainage.

    PubMed

    Ishii, Kazuhito; Yoshida, Hiroshi; Taniai, Nobuhiko; Moneta, Sho; Kawano, Youichi; Tajiri, Takashi

    2009-06-01

    Simple hepatic cysts are common benign lesions that are usually asymptomatic and require no treatment. However, complications can occur. This report describes a patient with an infected hepatic cyst treated with percutaneous transhepatic drainage. A 64-year-old woman presented at a nearby hospital because of acute right-upper-quadrant pain, mild left-lower-quadrant pain, diarrhea, and fever. She was admitted and received intravenous antibiotics for 1 week, but symptoms persisted. She was, therefore, referred to our hospital. On admission, ultrasonography demonstrated multiple hepatic cysts. One 13-cm lesion was hypoechoic, unlike the other simple cysts, which were anechoic. Computed tomography showed that the density of the hypoechoic cyst was slightly higher than that of the other cysts. The wall of the cyst was thickened and showed contrast enhancement. On initial laboratory tests the serum C-reactive protein concentration was 18.49 mg/dL, and the white-cell count was 13,300/microL. An infected hepatic cyst was suspected, and percutaneous transhepatic drainage of the cyst was performed. A catheter was inserted into the cyst, and dark red fluid was obtained. The right-upper-quadrant pain gradually resolved after drainage. An infected hepatic cyst was diagnosed, and system antibiotics were administered. However, the mild left-lower-quadrant pain persisted. No pathogens were isolated from the drainage fluid. Minocycline hydrochloride (200 mg) was injected, and the catheter was clamped for 30 minutes, once daily for 3 days. The serum C-reactive protein concentration was 1.78 mg/dL, and the white-cell count was 5,700/microL. The left-lower-quadrant pain resolved, and colonoscopic examination revealed multiple diverticula of the sigmoid colon. Infection has not recurred, and the hepatic cyst has not become larger.

  2. Thoracolumbar fracture reduction by percutaneous in situ contouring.

    PubMed

    Charles, Yann Philippe; Walter, Axel; Schuller, Sébastien; Aldakheel, Dakheel; Steib, Jean-Paul

    2012-11-01

    Percutaneous in situ contouring is based on bilateral bending of rods on the spine, thus increasing lordosis at the fracture. It was analyzed if this technique would provide a better reduction than prone positioning and how sagittal alignment would behave. Twenty-nine patients were operated using in situ contouring and selective anterior fusion for non-neurologic A2, A3 or B2 fractures. Clinical results were assessed prospectively using visual analog scale (VAS) and Oswestry Disability Index (ODI). The radiographic deformity correction was measured by sagittal index and regional kyphosis. Sagittal balance was assessed using kyphosis, lordosis, T9 tilt, pelvic incidence, pelvic tilt and sacral slope. Posterior wall fragment reduction was evaluated by computed tomography. After 2 years, VAS and ODI were comparable to the status prior to the accident. The sagittal index was 19.7° preoperatively, 5.3° after prone positioning and -1.1° after in situ contouring (p < 0.001). The loss of correction was 2.4°, mainly during the first 3 months. Similar observations were made for regional kyphosis. The sagittal spino-pelvic alignment was stable postoperatively. A preoperative canal obstruction ≥50 % was observed in 16 patients, and the fragments migrated anteriorly in all patients. Percutaneous instrumentation and anterior fusion provides good clinical results. In situ contouring increases lordosis obtained by prone positioning. Anterior column lengthening and ligamentotaxis reduce posterior wall fragments, which decompress the canal without laminectomy. The fusion of anterior defects prevents the loss of correction and provides a stable sagittal profile. The instrumentation may be removed without damaging the paravertebral muscles and loss of correction.

  3. Management of hemorrhage after percutaneous renal surgery.

    PubMed

    Gallucci, M; Fortunato, P; Schettini, M; Vincenzoni, A

    1998-12-01

    Percutaneous renal surgery is routine therapy for a number of renal pathologies. It is a technique not without complications, often serious ones, of which the worst is bleeding. We reviewed our experience of the incidence, etiology, and management of this serious complication to determine a protocol of treatment that will minimize the consequences. Between 1984 and 1996, we carried out 976 percutaneous operations for reno-calix stones, pyeloureteral junction stenosis, neoplasia of the renal pelvis, diagnosis, and ureteral prostheses. In all cases, the percutaneous access was achieved through a lower calix in the posterior axillary line with the patient in a prone position. The lithotripsy was performed with ultrasound and balistic energy lithotripters. Antegrade endopyelotomy was performed according to our technique. At the end of the procedure, a nephrostomy tube was positioned, 24F for lithotripsy and 16F for endopyelotomy. The nephrostomy tube was removed after 24 to 48 hours. In this series, 146 patients (15%) presented significant perioperative bleeding. In 97 cases (10%), this complication was resolved with the repositioning of the nephrostomy tube, bedrest in a supine position, and observation, whereas in 49 cases (5%), clamping of the nephrostomy tube for 24 hours was necessary. In 56 patients (5.7%), two blood transfusions were necessary, and three patients (0.3%) had bleeding 10, 12, and 20 days after the operation, which was resolved by embolization of the lacerated vessel.

  4. Percutaneous absorption of arsenic from environmental media.

    PubMed

    Lowney, Yvette W; Ruby, Michael V; Wester, Ronald C; Schoof, Rosalind A; Holm, Stewart E; Hui, Xiao-Ying; Barbadillo, Sherry; Maibach, Howard I

    2005-03-01

    Current knowledge of percutaneous absorption of arsenic is based on studies of rhesus monkeys using soluble arsenic in aqueous solution, and soluble arsenic mixed with soil (Wester et al., 1993). These studies produced mean dermal absorption rates in the range of 2.0-6.4% of the applied dose. Subsequently, questions arose as to whether these results represent arsenic absorption from environmental media. Factors such as chemical interactions, the presence of other metals, and the effects of weathering on environmental media all can affect the nature of arsenic and its potential for percutaneous absorption. Therefore, research specific to more relevant matrices is important. The focus of this effort is to outline study design considerations, including particle size, application rates, means of ensuring skin contact and appropriate statistical evaluation of the data. Appropriate reference groups are also important. The potential for background exposure to arsenic in the diet possibly obscuring a signal from a dermally applied dose of arsenic will also be addressed. We conclude that there are likely to be many site- or sample-specific factors that will control the absorption of arsenic, and matrix-specific analyses may be required to understand the degree of percutaneous absorption.

  5. 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)

  6. 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.

  7. 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.

  8. Percutaneous Cryoablation for Renal Cell Carcinoma

    PubMed Central

    Georgiades, Christos

    2015-01-01

    Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Nephron sparing resection (partial nephrectomy) has been the “gold standard” for the treatment of resectable disease. With the widespread use of cross sectional imaging techniques, more cases of renal cell cancers are detected at an early stage, i.e. stage 1A or 1B. This has provided an impetus for expanding the nephron sparing options and especially, percutaneous ablative techniques. Percutaneous ablation for RCC is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection or when there is a need to preserve renal function due to comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. During the last few years, percutaneous cryoablation has been gaining acceptance as a curative treatment option for small renal cancers. Clinical studies to date indicate that cryoablation is a safe and effective therapeutic method with acceptable short and long term outcomes and with a low risk, in the appropriate setting. In addition it seems to offer some advantages over radio frequency ablation (RFA) and other thermal ablation techniques for renal masses.

  9. Electromagnetic Navigation in Minimally Invasive Spine Surgery: Results of a Cadaveric Study to Evaluate Percutaneous Pedicle Screw Insertion

    PubMed Central

    Fraser, Justin F.; Von Jako, Ron; Carrino, John A.

    2008-01-01

    Background This cadaveric study compared efficacy and safety of an electromagnetic (EM) guidance system versus conventional fluoroscopy for percutaneous pedicle screw fixation. As percutaneous pedicle screw fixation becomes increasingly common in spinal surgery, intraoperative imaging systems that maximize efficiency while minimizing radiation exposure and inaccurate trajectories will be progressively more important. Published studies have validated the safety of percutaneous screw fixation using conventional fluoroscopic guidance and frameless optical stereotaxy, though EM guidance systems have not been evaluated for percutaneous placement in the lumbosacral spine. The aim of the study was to evaluate the clinical applicability of an EM system for minimally invasive spine fusion in the lumbosacral spine. Methods Five human cadaveric specimens underwent bilateral lumbosacral percutaneous screw fixation from L1 to S1 using conventional anteroposterior (AP) and lateral fluoroscopic techniques on one side and 2-dimesional (2D) EM guidance on each matching side. Intraoperative efficiency was evaluated, and pedicle, vertebral, and critical breach rates were assessed on postoperative computed tomography (CT). Results Overall mean fluoroscopy time per screw was 58.9 ± 44.7 seconds for conventional fluoroscopy compared to 27.4 ± 13.5 seconds for electromagnetic guidance (P = .0003). Pedicle, vertebral, and critical breach rates for the L1-S1 were 32.1%, 10.7%, and 25.0% for conventional fluoroscopy and 42.8%, 10.7%, and 14.1% for electromagnetic guidance (difference not statistically significant [ns]). In comparing critical breaches in the lumbar spine (L1-L5), there was a significant difference between 2-D EM guidance (0) and CF guidance (6) (P = .02). Conclusions Two-dimensional EM navigation provides a modality for lumbosacral percutaneous pedicle screw fixation that is more efficient and safer than conventional fluoroscopy. This data provides a foundation for further

  10. 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.

  11. 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. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Percutaneous image-guided ablation of breast tumors: an overview.

    PubMed

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

    2014-06-01

    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.

  13. 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

  14. Percutaneous Drainage of 300 Intraperitoneal Abscesses with Long-Term Follow-Up

    SciTech Connect

    Akinci, Devrim; Akhan, Okan Ozmen, Mustafa N.; Karabulut, Nevzat; Ozkan, Orhan; Cil, Barbaros E.; Karcaaltincaba, Musturay

    2005-12-15

    The purpose of the study was to evaluate the efficacy of percutaneous drainage of intraperitoneal abscesses with attention to recurrence and failure rates. A retrospective analysis of percutaneous treatment of 300 intraperitoneal abscesses in 255 patients (147 male, 108 female; average age: 38 years; range: 40 days to 90 years) for whom at least 1-year follow-up data were available was performed. Abscesses were drained with fluoroscopic, sonographic, or computed tomographic guidance. Nine abscesses were drained by simple aspiration; catheter drainage either by Seldinger or trocar technique was used in the remaining 291 abscesses with 6F to 14 F catheters. Initial cure and failure rates were 68% (203/300) and 12% (36/300), respectively. Sixty-one abscesses (20%) were either palliated or temporized. The recurrence rate was 4% (12/300) and nine of them were cured by recatheterization, whereas three of them were treated by medication or surgery. The overall success and failure rates were 91% (273/300) and 9% (27/300), respectively, with temporized, palliated, and recatheterized recurred abscesses. The 30-day mortality rate was 3.1% (8/255). The mean duration of catheterization was 13 days. Intraperitoneal abscesses with safe access routes should be drained percutaneously because of high success and low morbidity, mortality, and recurrence rates.

  15. Successful percutaneous stent implantation for isolated dismal transverse aortic arch kinking

    PubMed Central

    Zuo, Zhi-Liang; Tsauo, Jia-Yu; Chen, Mao; Feng, Yuan

    2017-01-01

    Abstract Rationale: Isolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered. Patient concerns: We report a 46-year-old woman who suffered from recurrent migraine and refractory hypertension with a significant systolic blood pressure difference between upper limbs. Diagnoses: The woman was diagnosed with isolated dismal transverse aortic arch kinking with refractory hypertension. Interventions: Percutaneous stent implantation was performed. Due to the kinking nature of the diseased transverse aortic arch, the first covered stent moved forward to the proximal transverse aortic arch during deploying without the left common carotid artery occlusion. And then, a second stent was placed to cover the residual kinked part of the dismal transverse arch. Outcomes: Angiography and post-procedural computed tomography angiography revealed fully corrected of the diseased segment. At 6-month follow-up after procedure, the patient was free of any symptoms and had a normal blood pressure under antihypertensive treatment. Lessons: This case indicates that transverse aortic arch kinking in isolation can be well treated by percutaneous stent implantation in adult patients. Unlike pure aortic coarctation, elongation and bucking give the rise to the occurrence rate of stent sliding and migration and sometimes a second stent is needed. PMID:28272200

  16. Percutaneous Extraction of Cement Leakage After Vertebroplasty Under CT and Fluoroscopy Guidance: A New Technique

    SciTech Connect

    Amoretti, Nicolas Huwart, Laurent

    2012-12-15

    Purpose: We report a new minimally invasive technique of extraction of cement leakage following percutaneous vertebroplasty in adults. Methods: Seven adult patients (five women, two men; mean age: 81 years) treated for vertebral compression fractures by percutaneous vertebroplasty had cement leakage into perivertebral soft tissues along the needle route. Immediately after vertebroplasty, the procedure of extraction was performed under computed tomography (CT) and fluoroscopy guidance: a Chiba needle was first inserted using the same route as the vertebroplasty until contact was obtained with the cement fragment. This needle was then used as a guide for an 11-gauge Trocar t'am (Thiebaud, France). After needle withdrawal, a 13-gauge endoscopy clamp was inserted through the cannula to extract the cement fragments. The whole procedure was performed under local anesthesia. Results: In each patient, all cement fragments were withdrawn within 10 min, without complication. Conclusions: This report suggests that this CT- and fluoroscopy-guided percutaneous technique of extraction could reduce the rate of cement leakage-related complications.

  17. Percutaneous management of complications of tuberculous spondylodiscitis: short- to medium-term results.

    PubMed

    Pieri, S; Agresti, P; Altieri, A M; Ialongo, P; Cortese, A; Alma, M G; de' Medici, L

    2009-09-01

    Psoas abscesses are the most frequent complication of tuberculosis with skeletal involvement. The aim of this paper is to report our experience with the systematic application of percutaneous drainage to tuberculous psoas abscesses. Between January 1997 and December 2005, 23 patients (14 men and nine women; age range 21-48 years), after a previous study with computed tomography (CT) and/or magnetic resonance (MR) imaging, underwent percutaneous drainage of a tuberculous fluid collection in the psoas muscles. Follow-up consisted of monthly clinical and laboratory assessment, and plain chest radiography and spinal CT every 6-12 months. Spondylodiscitis involved the thoracolumbar spine. Fluid collections were bilateral in 14 cases and communicating in ten of these. Maximum transverse diameter was 7 cm, whereas longitudinal diameter was 14 cm. Placement of the drainage catheter was successful in all cases, and the catheter was left in place for 5-36 (mean 18.4) days. Symptom regression occurred immediately after drainage of the fluid collection. The drainage procedure was curative in 100% of cases. Dislodgement of the drainage catheter occurred in two cases as a result of excessive traction during dressing removal. A serious complication of bone tuberculosis, psoas abscesses, can be effectively treated by percutaneous drainage, leading to immediate pain resolution. The drainage catheter requires daily monitoring to identify when it can be safely removed without risk of recurrence.

  18. Operative techniques of percutaneous endoscopic mini-hemilaminectomy using a uniportal approach in dogs.

    PubMed

    Moon, Hee-Sup; Hwang, Yong-Hyun; Lee, Hee-Chun; Lee, Jae-Hoon

    2017-09-12

    The present study aimed to investigate the technical feasibility of percutaneous endoscopic mini-hemilaminectomy via a uniportal approach, and to evaluate the possibility of decompression and endoscopic examination of the thoracic and lumbar spinal canals in small dogs during such procedures. Fresh canine cadavers of mixed-breed dogs (n=7) were used in this study. Following injection of a barium and agarose mixture (BA-gel) to stimulate intervertebral disc herniation, percutaneous endoscopic mini-hemilaminectomy was performed using a lateral approach to the thoracic and lumbar vertebrae. BA-gel was removed to decompress the spinal cord using an elevator and rongeurs after mini-hemilaminectomy. Pre and post-operative computed tomography (CT) scans were obtained to evaluate surgical outcomes. Intra-operative complications, incision length, and procedure time were recorded. All procedures were completed with clear visualization of the spinal cord and floor of the spinal canal. The mean total operating time was 58.00 ± 18.06 min. Lengths of incision were under 1 cm in all dogs. Intra-operative complications included iatrogenic nerve root injuries caused by the micro-rongeur in two dogs. CT imaging revealed that removal of BA-gel resulted in sufficient spinal cord decompression. Our findings indicated that percutaneous endoscopic thoracolumbar mini-hemilaminectomy is feasible for spinal cord decompression and allows for adequate observation of the spinal canal. Thus, this technique may be an alternative surgical option for treatment of thoracolumbar disk disease in dogs.

  19. Imaging Techniques in Percutaneous Cardiac Structural Interventions: Atrial Septal Defect Closure and Left Atrial Appendage Occlusion.

    PubMed

    Rodríguez Fernández, Antonio; Bethencourt González, Armando

    2016-08-01

    Because of advances in cardiac structural interventional procedures, imaging techniques are playing an increasingly important role. Imaging studies show sufficient anatomic detail of the heart structure to achieve an excellent outcome in interventional procedures. Up to 98% of atrial septal defects at the ostium secundum can be closed successfully with a percutaneous procedure. Candidates for this type of procedure can be identified through a systematic assessment of atrial septum anatomy, locating and measuring the size and shape of all defects, their rims, and the degree and direction of shunting. Three dimensional echocardiography has significantly improved anatomic assessments and the end result itself. In the future, when combined with other imaging techniques such as cardiac computed tomography and fluoroscopy, 3-dimensional echocardiography will be particularly useful for procedure guidance. Percutaneous closure of the left atrial appendage offers an alternative for treating patients with atrial fibrillation and contraindication for oral anticoagulants. In the future, the clinical focus may well turn to stroke prevention in selected patients. Percutaneous closure is effective and safe; device implantation is successful in 94% to 99% of procedures. However, the procedure requires an experienced cardiac structural interventional team. At present, 3-dimensional echocardiography is the most appropriate imaging technique to assess anatomy suitability, select device type and size, guide the procedure alongside fluoroscopy, and to follow-up the patient afterwards.

  20. Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia

    PubMed Central

    Blomstedt, Patric; Bergenheim, A. Tommy

    2015-01-01

    BACKGROUND: Despite >30 years of clinical use, the literature is still sparse when it comes to comparisons between percutaneous balloon compression (PBC) and percutaneous retrogasserian glycerol rhizolysis (PRGR) as treatments for trigeminal neuralgia. OBJECTIVE: To perform a retrospective cohort comparison between PBC and PRGR with regard to therapeutic effect, side effects, and complications. METHODS: Medical records and follow-up data from 124 primary PRGRs performed from 1986 to 2000 and 82 primary PBCs performed from 2000 to 2013 were reviewed. All patients had undergone clinical sensory testing and assessment of sensory thresholds. Analyses were performed to compare duration of pain relief, frequency of sensory disturbances, and side effects. RESULTS: Median duration of pain relief was 21 months after PRGR and 20 months after PBC. Both methods carried a high risk of hypesthesia/hypalgesia (P < .001) that was partly reversed with time. Decreased corneal sensibility was common after PRGR (P < .001) but not after PBC. Dysesthesia was more common after PRGR (23%) compared after PBC (4%; P < .001). Other side effects were noted but uncommon. CONCLUSION: PBC and PRGR are both effective as primary surgical treatment of trigeminal neuralgia. Both carry a risk of postoperative hypesthesia, but in this series, the side effect profile favored PBC. Furthermore, PBC is technically less challenging, whereas PRGR requires fewer resources. Between these 2 techniques, we propose PBC as the primary surgical technique for percutaneous treatment of trigeminal neuralgia on the basis of its lower incidence of dysesthesia, corneal hypesthesia, and technical failures. ABBREVIATIONS: MS, multiple sclerosis PBC, percutaneous balloon compression PRGR, percutaneous retrogasserian glycerol rhizotomy TN, trigeminal neuralgia PMID:26465639

  1. Percutaneous Cryoablation of Small Hepatocellular Carcinoma with US Guidance and CT Monitoring: Initial Experience

    SciTech Connect

    Orlacchio, Antonio Bazzocchi, Gabriele; Pastorelli, Daniela; Bolacchi, Francesca; Angelico, Mario; Almerighi, Cristiana; Masala, Salvatore; Simonetti, Giovanni

    2008-05-15

    The purpose of this study was to retrospectively determine the safety and effectiveness of percutaneous cryoablation, monitored with computed tomography (CT) and ultrasonographic (US) guidance, for the treatment of hepatocellular carcinoma (HCC). Four patients with small HCCs underwent one percutaneous cryoablation treatment session monitored with CT and US guidance. All patients underwent pretreatment blood chemistry testing and imaging evaluation. We treated lesions with simultaneous insertion of multiple 17-G cryoprobes (two or three) and defined technical success when the extension of a visible iceball was beyond 5 mm from the tumor margin. Intralesional enhancement or tumoral size increase was defined as local progression compared with that on images obtained immediately after ablation. We evaluated complications and follow-up (at 1, 3, and 6 months). All patients survived without short- or long-term complications. Cryoablation was technically successful in all patients at the end of the procedure. During follow-up two patients developed disease recurrence. One patient developed local tumor progression on the margin of the lesion; the other, a new HCC. In the case of local tumor progression a new elevation of {alpha}-fetoprotein ({alpha}FP) levels occurred at first follow-up control. In the other case levels of {alpha}FP remained stable during the first 3 months after the procedure, then demonstrated a progressive increase in {alpha}FP levels beginning at the fourth month, without tumor evidence during CT control at 3 months. We conclude that percutaneous cryotherapy with US guidance and CT monitoring is a feasible, safe, and effective for treatment of HCC. If local ablative procedures of hepatic lesions are to be performed, percutaneous cryoablation, not laparotomic, should be discussed as an alternative therapeutic measure. Longer follow-up should provide proof of the effectiveness of this technique.

  2. Spondylodiscitis: a rare complication following percutaneous nephrostomy.

    PubMed

    Chiancone, Francesco; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Fabiano, Marco; Fedelini, Paolo

    2016-11-28

    Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient.

  3. Percutaneous management of prosthetic valve thrombosis.

    PubMed

    Hariram, Vuppaladadhiam

    2014-01-01

    Thrombosis of a prosthetic valve is a serious complication in patients with prosthetic heart valves. Thrombolysis is the initial choice of treatment. Patients who do not respond to thrombolysis are subjected to surgery which carries a high risk. We report a case series of 5 patients with prosthetic mitral valve thrombosis who did not respond to thrombolysis and were subjected to percutaneous manipulation of the prosthetic valves successfully and improved. Five patients who were diagnosed to have prosthetic mitral valve thrombosis and failed to respond to a minimum of 36 h of thrombolysis (persistent symptoms with increased gradients, abnormal findings on fluoroscopy),were subjected to percutaneous treatment after receiving proper consent. None of them had a visible thrombus on transthoracic echocardiogram. All patients underwent transseptal puncture following which a 6F JR4 guiding catheter was passed into the left atrium. The valve leaflets were repeatedly hit gently under fluoroscopic guidance till they regained their normal mobility. Mean age was 38.8 years. Average peak and mean gradients prior to the procedure were 38 and 25 and after the procedure were 12 and 6 mm of Hg respectively. All patients had successful recovery of valve motion on fluoroscopy with normalization of gradients and complete resolution of symptoms. None of the patients had any focal neurological deficits, embolic manifestations or bleeding complications. Percutaneous manipulation of prosthetic valves in selected patients with prosthetic valve thrombosis who do not respond to thrombolytic therapy is feasible and can be used as an alternative to surgery. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  4. Percutaneous Microwave Ablation of Renal Angiomyolipomas.

    PubMed

    Cristescu, Mircea; Abel, E Jason; Wells, Shane; Ziemlewicz, Timothy J; Hedican, Sean P; Lubner, Megan G; Hinshaw, J Louis; Brace, Christopher L; Lee, Fred T

    2016-03-01

    To evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML). From January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4-4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits. All ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60-70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3-8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8% (3.4-3.3 cm) and 1.7% (27.5-26.3 cm(3)), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9-47) demonstrated mean tumor diameter and volume decreases of 29% (3.4-2.4 cm) and 47% (27.5-12.1 cm(3)), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation. Our early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

  5. 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

  6. Percutaneous needle fasciotomy for recurrent Dupuytren disease.

    PubMed

    van Rijssen, Annet L; Werker, Paul M N

    2012-09-01

    Increasing options to treat Dupuytren disease include percutaneous needle fasciotomy (PNF), a minimally invasive technique that has proven to be effective for the treatment of primary disease. However, its effect on recurrent disease is not clear. We studied 30 patients with recurrent Dupuytren disease in 40 fingers, with a mean follow-up of 4.4 years. Primary outcome measures were total passive extension deficit reduction and interval to a second recurrence, defined as an increase of more than 30° compared with the result at the end of the previous treatment. We noted complications. Total passive extension reduction was 76%. Percutaneous needle fasciotomy was especially effective for the metacarpophalangeal joint, with an average reduction of 93%, whereas the average reduction in the proximal interphalangeal joint was 57%. A total of 50% of patients did not develop a secondary recurrence during follow-up. The other 50% did, and we treated recurrence within an average of 1.4 years after PNF. By means of PNF, we postponed tertiary treatment an average of 2.9 years starting from the initial treatment for Dupuytren disease. We successfully treated all secondary recurrences by limited fasciectomy, according to patients' wishes. We noted no major adverse effects. Percutaneous needle fasciotomy can be applied effectively for recurrent disease; 50% of patients remain free of recurrence for a mean of 4.4 years. If a secondary recurrence occurs, it does so relatively early after treatment. Patients must therefore be willing to accept this uncertainty in the context of the advantages of PNF, such as fast recovery, low complication rate, and minimal invasiveness. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Correction of Coagulopathy for Percutaneous Interventions

    PubMed Central

    Wiltrout, Charles; Kondo, Kimi L.

    2010-01-01

    Due to medical illness or pharmacotherapy, patients undergoing percutaneous interventions often have abnormal hemostasis. Its etiology may include alterations in the protein-based coagulation system, thrombocytopenia, deficient platelet function, or mixed deficits such as disseminated intravascular coagulation. In this article, the authors review the basic science of each of these etiologies, as well as their available methods of correction. They also review the evidence and guidelines regarding the assessment and treatment of coagulopathy in image-guided procedures. The periprocedural bleeding risk and the urgency of a given procedure guide the management of abnormal hemostasis in this patient population. PMID:22550375

  8. 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.

  9. Pneumomediastinum after percutaneous endoscopic gastrostomy tube placement.

    PubMed

    Yount, Kenan W; Mallory, Melissa A; Turza, Kristin C; Griffiths, Eric R; Lau, Christine L; Sawyer, Robert G

    2014-02-01

    The incidence of esophageal perforation or confounding mechanisms of pneumomediastinum specifically introduced by the addition of percutaneous endoscopic gastrostomy (PEG) tube insertion to esophagogastroduodenoscopy have not been described, and pneumomediastinum in the absence of esophageal perforation after PEG has not been reported. Typically, pneumomediastinum is an ominous finding, although benign causes exist. We present two cases of post-PEG pneumomediastinum not correlated with esophageal perforation on follow-up imaging. When pneumomediastinum is detected after PEG, appropriate studies should be undertaken to confirm its cause and to determine treatment plans. Further investigation may be warranted to ascertain the true incidence, causes, and clinical significance of post-PEG pneumomediastinum.

  10. 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.

  11. Rationale for Percutaneous Intervention of CTO.

    PubMed

    Waram, Kethes C; Willis, Nicholas P; Girotra, Sudhakar; Shaker, Rimon L; Pershad, Ashish

    2012-07-01

    Chronic total occlusion accounts for 15% of cases during diagnostic angiography with higher referral rate to surgical revascularization. With contemporary strategies and techniques, the success rate with experienced operators can exceed 90%. Currently available observational studies in carefully selected patient populations show evidence of a trend toward symptom relief; improvement in quality of life, left ventricular function, and mortality; and improved tolerance toward future ischemic events. Lack of randomized controlled trials comparing current optimal medical management with percutaneous coronary intervention for chronic total occlusion is a major barrier to widespread adaptation of this advanced complex interventional technique. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Arthroscopically assisted percutaneous fixation of Bennett fractures.

    PubMed

    Culp, Randall W; Johnson, Jeff W

    2010-01-01

    Arthroscopic-assisted reduction and fixation of Bennett-type fractures of the thumb metacarpal allow for the confirmation of reduction as well as the assessment of the degree of chondral damage. With use of a 1.9-mm arthroscope and a traction tower, direct visualization and reduction is possible. Traditional methods of fixation are used to secure the fracture fragment. Postoperative rehabilitation follows the usual protocol used in both open and percutaneous techniques. However, the potential to obtain and confirm a more accurate articular reduction may reduce the incidence of late arthritis of the thumb carpometacarpal articulation.

  13. 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

  14. Percutaneous penetration modifiers and formulation effects.

    PubMed

    Kaushik, Diksha; Costache, Aurora; Michniak-Kohn, Bozena

    2010-02-15

    The enhancement/retardation of percutaneous permeation of diethyl-m-toluamide (DEET) in the presence of five percutaneous penetration modifiers (laurocapram, 3-dodecanoyloxazolidin-2-one (N-0915), S,S-dimethyl-N-(4-bromobenzoyl) iminosulfurane (DMBIS), S,S-dimethyl-N-(2-methoxycarbonylbenzenesulfonyl) iminosulfurane (DMMCBI) and tert-butyl 1-dodecyl-2-oxoazepan-3-yl-carbamate (TBDOC)) was investigated. These permeation modifiers were formulated in either water, propylene glycol (PG), ethanol or polyethylene glycol 400 (PEG 400). The permeation studies indicated that laurocapram enhanced DEET permeation in PG, but retarded in PEG 400. Likewise, N-0915 acted as a retardant with ethanol and PEG 400, but not with water. DMBIS decreased the permeation with ethanol as compared to permeation with water, PEG 400 or PG. Similarly, DMMCB acted as a retardant with ethanol and PEG 400, but not with water or PG. TBDOC formulations revealed its activity as a retardant with ethanol, but behaved as enhancer with water, PG and PEG 400. In addition, penetration modifier interactions with stratum corneum ceramide were investigated using chemical modeling. This investigation is significant since it confirms the role of pharmaceutical formulations and shows for the first time that an enhancer can become a retardant or vice versa depending upon the vehicle in which it is applied to the skin. Hence, we should be using the term "penetration modifiers" for all such compounds. Copyright 2009 Elsevier B.V. All rights reserved.

  15. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy.

    PubMed

    Thaker, Adarsh M; Sedarat, Alireza

    2016-09-01

    There are a variety of techniques for gastrostomy tube placement. Endoscopic and radiologic approaches have almost entirely superseded surgical placement. However, an aging population and significant advancements in modern healthcare have resulted in patients with increasingly complex medical issues or postsurgical anatomy. The rising prevalence of obesity has also created technical challenges for proceduralists of many specialties. When patients with these comorbidities develop the need for long-term enteral nutrition and feeding tube placement, standard approaches such as percutaneous endoscopic gastrostomy (PEG) by endoscopists and percutaneous image-guided gastrostomy (PIG) by interventional radiologists may be technically difficult or impossible. For these challenging situations, laparoscopic-assisted PEG (LAPEG) is an alternative option. LAPEG combines the advantages of PEG with direct intraperitoneal visualization, helping ensure a safe tube placement tract free of intervening organs or structures. In this review, we highlight some of the important factors of first-line gastrostomy techniques, with an emphasis on the utility and procedural technique of LAPEG when they are not feasible.

  16. Percutaneous toxicity of anticoagulant warfarin in rats.

    PubMed

    Kataranovski, Milena; Mirkov, Ivana; Vrankovic, Jelena; Kataranovski, Dragan; Subota, Vesna

    2008-01-01

    Percutaneous toxicity of anticoagulant rodenticides is usually manifested by coagulopathy and/or fatal outcome. There are, however, virtually no data on other biological effects of this class of pesticides that gain access into the organism via skin. In this study, percutaneous toxicity of epicutaneously applied warfarin was evaluated by measuring changes in peripheral blood granulocytes in rats. Application of 10 mug (0.05 mg/kg) or 100 mug (0.5 mg/kg) of warfarin (WF) for 3 consecutive days resulted in an increase in prothrombin time, documenting the access of warfarin to systemic circulation. Application of warfarin led to an increase in relative numbers of granulocytes at higher dose, whereas both doses resulted in increased metabolical viability, evaluated by 3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2H-tetrazolium bromide (MTT) reduction assay. Higher warfarin dose resulted in both granulocyte activation and priming (evaluated by cytochemical nitroblue tetrazolium, NBT, reduction assay of respiratory burst), whereas only a tendency toward activation was noted at lower WF dose. Soluble mediators from the circulation seem responsible for the observed effects, as exogenous plasma from WF-treated animals stimulated NBT reduction by isologous or naïve granulocytes. Data presented in this study are relevant for the recognition of biological effects, other than those affecting hemostasis, of anticoagulant rodenticides that gain access to systemic circulation through the skin.

  17. Percutaneous nephrolithotomy in children: A preliminary report.

    PubMed

    Elderwy, Ahmad A; Gadelmoula, Mohamed; Elgammal, Mohamed A; Osama, Ehab; Al-Hazmi, Hamdan; Hammouda, H; Osman, Esam; Abdullah, Medhat A; Neel, Khalid Fouda

    2014-07-01

    The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

  18. [Treatment of atherosclerosis. New percutaneous intraluminal techniques].

    PubMed

    Lablanche, J M

    1990-10-06

    Balloon-catheter angioplasty was introduced by Gruntzig in 1977 and has since proved effective, but 3 problems are still encountered: immediate reobstruction, restenosis during the first 3 months and extension of the procedure to a greater number of cases. In an attempt to solve these problems, other percutaneous/technics, associated or not with balloon angioplasty, have been devised. They are: (1) intraluminal stents which perfectly keep the vessel open after balloon angioplasty; (2) vaporization of atheromatous plaques by laser, and notably excimer laser which results in immediate recanalization, later completed by balloon angioplasty; (3) heating balloons which stick dissections and improve the immediate success rate; (4) atheroma-cutting and storing systems, such as Simpson's atherocath, cutting and aspirating systems, such as Stack's transluminal extraction catheter, or erasing systems, such as Auth's rotablator; (5) other sources of energy, such as ultrasounds, microwaves and radiofrequencies, will perhaps, be used in the near future. None of these new technics has solved the restenosis problem, but all have proved effective in suppressing the obstacle, there by giving hopes of reducing immediate complications and gradually widening the indications of percutaneous revascularization.

  19. 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

  20. Midazolam sedation for percutaneous liver biopsy.

    PubMed

    Alexander, J A; Smith, B J

    1993-12-01

    Control of patient respiration is needed to safely perform percutaneous liver biopsy (PLB) and may be adversely affected by sedation. The purpose of this study was to evaluate the safety of PLB with intravenous midazolam and to evaluate patient acceptance of PLB with and without sedation. Two hundred seventeen consecutive patients underwent 301 percutaneous liver biopsies. One hundred fifty-one of the biopsies were done after the patients were sedated with intravenous midazolam immediately before the biopsy. The last 61 patients were questioned after the biopsy to evaluate the discomfort of the procedure, their memory of the procedure, and their willingness to undergo another PLB. The major complication rate was similar in the midazolam-treated (0.7%) and untreated (0.7%) groups. The midazolam-treated patients had a numerically lower mean pain score (1.5 +/- 0.4 vs 4.0 +/- 0.7) (mean +/- SEM) (P = 0.07) and significantly lower mean memory score (4.8 +/- 0.7 vs 9.9 +/- 0.1) (P < 0.01) than the untreated patients. The treated and untreated groups had similar mean willingness for repeat PLB scores (9.3 +/- 0.3 vs 9.1 +/- 0.6). We conclude that: (1) there is no increased risk of PLB with midazolam and (2) patients have less memory of the procedure with midazolam.

  1. Percutaneous tracheostomy in patients on anticoagulants

    PubMed Central

    Pasin, Laura; Frati, Elena; Cabrini, Luca; Landoni, Giovanni; Nardelli, Pasquale; Bove, Tiziana; Calabrò, Maria Grazia; Scandroglio, Anna Mara; Pappalardo, Federico; Zangrillo, Alberto

    2015-01-01

    Aims: To determine if percutaneous tracheostomy is safe in critically ill patients treated with anticoagulant therapies. Settings and Design: Single-center retrospective study including all the patients who underwent percutaneous dilatational tracheostomy (PDT) placement over a 1-year period in a 14-bed, cardiothoracic and vascular Intensive Care Unit (ICU). Materials and Methods: Patients demographics and characteristics, anticoagulant and antiplatelet therapies, coagulation profile, performed technique and use of bronchoscopic guidance were retrieved. Results: Thirty-six patients (2.7% of the overall ICU population) underwent PDT over the study period. Twenty-six (72%) patients were on anticoagulation therapy, 1 patient was on antiplatelet therapy and 2 further patients received prophylactic doses of low molecular weight heparin. Only 4 patients had normal coagulation profile and were not receiving anticoagulant or antiplatelet therapies. Overall, bleeding of any severity complicated 19% of PDT. No procedure-related deaths occurred. Conclusions: PDT was proved to be safe even in critically ill-patients treated with anticoagulant therapies. Larger prospective studies are needed to confirm our findings. PMID:26139737

  2. [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. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  3. 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

  4. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy in Children and Adolescents

    PubMed Central

    Yu, Sherman C.; Petty, John K.; Bensard, Denis D.; Partrick, David A.; Bruny, Jennifer L.

    2005-01-01

    Objective: Pediatric gastric access for long-term enteral feeding may be performed via a laparotomy, laparoscopy, or a percutaneous approach. In children and adolescents, laparoscopic-assisted gastrostomy may be difficult due to a thick abdominal wall. Therefore, if the abdominal wall is estimated to be >2 cm on physical examination, or in children in whom a percutaneous endoscopic gastrostomy was unsuccessfully attempted by a gastroenterologist, we routinely perform a laparoscopic-assisted percutaneous endoscopic gastrostomy. Methods: From January 1998 through February 2003, we retrospectively reviewed 15 cases of a laparoscopic-assisted percutaneous endoscopic gastrostomy. Instruments used to perform this technique are a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and one 5-mm STEP port placed through an infraumbilical incision for a 5-mm, 30-degree scope. Results: Age range was 2 years to 20 years (mean, 10). Operative time ranged from 20 minutes to 45 minutes. When a concurrent laparoscopic Nissen fundoplication was performed (n = 6), the percutaneous endoscopic gastrostomy was placed after completion of the Nissen fundoplication. No intraoperative complications occurred, and all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. To date, no postoperative complications have occurred, and revision has not been necessary. Conclusions: Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents is safe and effective. Utilizing laparoscopy permits evaluation of the peritoneum and lysis of adhesions, if necessary. Moreover, laparoscopy provides excellent exposure for accurate placement of the PEG, while avoiding injury to other organs. PMID:16121876

  5. Villous Adenoma in Renal Pelvis With Manifestation of Percutaneous Fistula and Mucus Secretion.

    PubMed

    Liu, Danqi; Tan, Jing; Huang, Kai; Jiang, Zhiqiang; He, Leye; Yin, Guangming

    2017-01-06

    A 70-year-old man, complaining of percutaneous fistula with jelly-like yellow mucus in the right kidney for a month, was admitted to our department. From computed tomography, stones and severe hydronephrosis but no suspicious mass was found in right kidney. Nephrectomy of right kidney was performed and pathological examination revealed a villous adenoma in the renal pelvis with moderate to severe atypical hyperplasia of glandular epithelium. Primary villous adenoma in renal pelvis is rare and believed to be related to chronic irritation of stone and inflammation. Mostly nephrectomy was performed before diagnosis was made.

  6. Unsuspected pheochromocytoma: Risk of blood-pressure alterations during percutaneous adrenal biopsy

    SciTech Connect

    Casola, G.; Nicolet, V.; van Sonnenberg, E.; Withers, C.; Bretagnolle, M.; Saba, R.M.; Bret, P.M.

    1986-06-01

    Four unsuspected pheochromocytomas were discovered during percutaneous fine-needle biopsy of the adrenal gland under ultrasound (n = 1) and computed tomographic (n = 3) guidance. One patient suffered an acute episode of alternating hypertension and hypotension during the procedure. A second patient had no alterations in vital signs during the procedure but had a severe hypertensive crisis during induction of anesthesia at surgery. Neither biopsy nor surgery affected the vital signs in the other two patients. During biopsy study of adrenal lesions, the possibility of unsuspected pheo-chromocytoma should be considered, and the interventional radiologist must be familiar with the emergency treatment of hypotensive or hypertensive crises that may occur.

  7. Myocardial perfusion imaging with thallium-201 to evaluate patients before and after percutaneous transluminal coronary angioplasty

    SciTech Connect

    DePuey, E.G. )

    1991-09-01

    Thallium-201 imaging may be used to help determine the distribution and amount of myocardium in jeopardy and the success of revascularization after percutaneous transluminal coronary angioplasty. Single photon emission computed tomography is particularly advantageous because of its ability to differentiate vascular territories and thus evaluate patients with multivessel disease. Myocardial infarction resulting from complications such as distal embolization and side-branch occlusion can be detected. Thallium-201 imaging early after angioplasty may show abnormal results caused by transiently insufficient coronary flow reserve. However, studies performed 6 weeks or more after angioplasty accurately detect early restenosis and may identify those individuals likely to become symptomatic and eventually develop restenosis in the future.

  8. Percutaneous Radiofrequency Ablation of a Small Renal Mass Complicated by Appendiceal Perforation

    SciTech Connect

    Boone, Judith; Bex, Axel; Prevoo, Warner

    2012-06-15

    Percutaneous radiofrequency ablation (RFA) has gained wide acceptance as nephron-sparing therapy for small renal masses in select patients. Generally, it is a safe procedure with minor morbidity and acceptable short-term oncologic outcome. However, as a result of the close proximity of vital structures, such as the bowel, ureter, and large vessels, to the ablative field, complications regarding these structures may occur. This is the first article describing appendiceal perforation as a complication of computed tomography-guided RFA despite hydrodissection. When performing this innovative and promising procedure one should be aware of the possibility of particular minor and even major complications.

  9. Percutaneous Mechanical Support in Cardiogenic Shock: A Review

    PubMed Central

    Gilani, Fahad Syed; Farooqui, Sarah; Doddamani, Rajiv; Gruberg, Luis

    2015-01-01

    Cardiogenic shock (CS) is a life-threatening condition associated with significant morbidity and mortality. Pharmacological therapy is often the first line of treatment but mechanical support can provide substantial hemodynamic improvement in refractory CS. Percutaneous mechanical support devices are placed in a minimally invasive manner and provide life-saving assistance to the failing myocardium. We review the percutaneous devices currently available, the evidence behind their use, and the new advances in percutaneous technology being evaluated for the treatment of CS. PMID:26052235

  10. 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.

  11. Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy

    PubMed Central

    Park, Auh-Whan

    2010-01-01

    Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy. PMID:21103291

  12. Updates on percutaneous radiologic gastrostomy/gastrojejunostomy and jejunostomy.

    PubMed

    Shin, Ji Hoon; Park, Auh-Whan

    2010-09-01

    Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy.

  13. 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. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures

    PubMed Central

    Nguyen, Cam Tu; Lee, Eunice; Luo, Huai

    2011-01-01

    Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes. PMID:24282682

  15. 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

  16. Percutaneous unroofing of renal simple cysts: Experience from one centre.

    PubMed

    Tehranchi, Ali; Hamedanchi, Sepehr; Badalzadeh, Afshin

    2011-12-01

    To assess the efficacy of percutaneous unroofing (PU) for treating simple renal cysts, compared with laparoscopic decortication and open surgery. From November 2009 to October 2010, 11 patients with 12 simple cysts in renal units were managed by PU. All cysts were evaluated with ultrasonography and abdominal computed tomography. A standard transurethral resectoscope was used to resect the cyst wall, and the parenchymal portion of the cyst was subsequently cauterised. A drain was left in place for 2 days. Success was defined as a >50% reduction in cyst diameter. At the 5-month follow-up, patients were asked about their symptoms and assessed by ultrasonography. Of the 12 cyst units, eight were completely resolved, three were reduced to <50% in diameter and one was persistent, close to the original size. Simple renal cysts can be managed safely by PU, with a success rate of >90%. This technique offers several advantages over open surgery, with a shorter hospital stay, improved convalescence and reduced risk of complications. PU also avoids the multiple trocar sites, extensive dissection, and technical difficulty associated with laparoscopy.

  17. Myocardial Perfusion SPECT Imaging in Patients after Percutaneous Coronary Intervention.

    PubMed

    Georgoulias, Panagiotis; Valotassiou, Varvara; Tsougos, Ioannis; Demakopoulos, Nikolaos

    2010-05-01

    Coronary artery disease (CAD) is the most prevalent form of cardiovascular disease affecting about 13 million Americans, while more than one million percutaneous transluminal intervention (PCI) procedures are performed annually in the USA. The relative high occurrence of restenosis, despite stent implementation, seems to be the primary limitation of PCI. Over the last decades, single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), has proven an invaluable tool for the diagnosis of CAD and patients' risk stratification, providing useful information regarding the decision about revascularization and is well suited to assess patients after intervention. Information gained from post-intervention MPI is crucial to differentiate patients with angina from those with exo-cardiac chest pain syndromes, to assess peri-intervention myocardial damage, to predict-detect restenosis after PCI, to detect CAD progression in non-revascularized vessels, to evaluate the effects of intervention if required for occupational reasons and to evaluate patients' long-term prognosis. On the other hand, chest pain and exercise electrocardiography are largely unhelpful in identifying patients at risk after PCI.Although there are enough published data demonstrating the value of myocardial perfusion SPECT imaging in patients after PCI, there is still debate on whether or not these tests should be performed routinely.

  18. Temporary Percutaneous Instrumentation and Selective Anterior Fusion for Thoracolumbar Fractures.

    PubMed

    Charles, Yann Philippe; Walter, Axel; Schuller, Sébastien; Steib, Jean-Paul

    2017-05-01

    Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density, and global sagittal balance. Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion. After consolidation, instrumentation can be removed at 1 year to provide mobility in non-fused segments. Fifty-one patients, 47 (18-75) years, were operated for A2, A3, or B-type fractures. Visual analog scale (VAS) for back pain and Oswestry Disability Index (ODI) were assessed. Radiographic measurements were: sagittal index, regional kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, and T9 tilt. Anterior fusion and facet joints were analyzed on computed tomography (CT) at 1 year. The ODI was 8.8 before accident, 35.4 at 3 months, 17.8 at 2 years, 14.4 at 5 years. The VAS was 2.0 at 3 months and 1.0 at 5 years. The sagittal index was 18.0° preoperatively and 1.0° at 3 months (P < 0.0001). A loss of reduction of 1.1° occurred after implant removal (P = 0.009). Global sagittal balance remained unchanged. Ten patients with osteopenia or osteoporosis had a worse ODI: 24.7 versus 11.9 (P = 0.016), and a greater loss of correction: 4.9° versus 1.3° (P = 0.007). Cages filled with cancellous bone from the fractured vertebra fused regularly. Spontaneous facet joint fusions were observed in two patients at the fracture level in B-type injuries. Percutaneous instrumentation and selective anterior fusion using autologous bone and mesh cages lead to high fusion rates, which provided good long-term clinical results in younger patients with thoracolumbar fractures. Sagittal alignment was maintained after instrumentation removal without damaging paravertebral muscles. Outcomes were worse in

  19. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

    SciTech Connect

    Tamura, Akio Kato, Kenichi Suzuki, Michiko; Sone, Miyuki; Tanaka, Ryoichi Nakasato, Tatsuhiko Ehara, Shigeru

    2016-02-15

    PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

  20. 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.

  1. Percutaneous Microwave Ablation of Renal Angiomyolipomas

    SciTech Connect

    Cristescu, Mircea; Abel, E. Jason; Wells, Shane Ziemlewicz, Timothy J.; Hedican, Sean P.; Lubner, Megan G. Hinshaw, J. Louis Brace, Christopher L. Lee, Fred T.

    2016-03-15

    PurposeTo evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML).Materials and MethodsFrom January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4–4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits.ResultsAll ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60–70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3–8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8 % (3.4–3.3 cm) and 1.7 % (27.5–26.3 cm{sup 3}), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9–47) demonstrated mean tumor diameter and volume decreases of 29 % (3.4–2.4 cm) and 47 % (27.5–12.1 cm{sup 3}), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation.ConclusionOur early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

  2. New percutaneously inserted spinal fixation system.

    PubMed

    Teitelbaum, George P; Shaolian, Samuel; McDougall, Cameron G; Preul, Mark C; Crawford, Neil R; Sonntag, Volker K H

    2004-03-15

    We describe a new percutaneous minimally invasive spinal fixation system based on pedicle screws and inflatable rods. The rods are inserted in a flexible state and harden following deployment. We test this system in terms of biocompatibility, ferromagnetism, magnetic resonance artifact production, bench top mechanical testing, ease of insertion within cadavers, potential thermal damage to paraspinous muscles in pigs, and long-term device tolerability in sheep. To determine the safety and utility of this system before its use in human subjects. Composite materials and epoxy compounds have been used safely in a variety of implanted medical devices for years with no signs of systemic toxicity or significant device failures. Long-term biocompatibility test of system components was conducted according to International Standards Organization 10993 and Food and Drug Administration Blue Book Memorandum #G95-1 standards. Device components were assessed for magnetic deflection and torque and imaged in a 1.5 Tesla magnetic resonance unit. Full constructs of the system were tested for compression strength, torque, and fatigue per American Society for Testing and Materials F1717 standards. The system was deployed using C-arm fluoroscopic guidance in 11 cadavers and 2 live sheep. Further, the inflatable rods were tested for exothermic damage to paraspinous musculature in 2 pigs. All system components were found to be biocompatible, nonferromagnetic, and produce little magnetic resonance artifact. Compression and torque results for the new system were found to be comparable to standard metallic pedicle screw and rod fixation systems. However, the new system displayed a superior modulus of elasticity relative to standard surgical systems. The new system endured 5 million cycles of repetitive compressions without breakage or significant wear. All cadaver and sheep insertions were performed successfully. Sheep suffered no complications, and minimal blood loss occurred during device

  3. Minimally invasive percutaneous posterior lumbar interbody fusion.

    PubMed

    Khoo, Larry T; Palmer, Sylvain; Laich, Daniel T; Fessler, Richard G

    2002-11-01

    The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF). The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused. Preoperative variables measured from imaging included interpedicular distance, pedicular height and width, interspinous distance, lordosis, intervertebral height, Cobb angle, and foraminal height and volume. Using the METRx and MD spinal access systems (Medtronic Sofamor Danek, Memphis, TN), bilateral laminotomies were performed using a hybrid of microsurgical and microendoscopic techniques. The intervertebral disc spaces were then distracted and prepared with the Tangent (Medtronic Sofamor Danek) interbody instruments. Either a 10 or 12 by 22 mm interbody graft was then placed. Using the Sextant (Medtronic Sofamor Danek) system, percutaneous pedicle screw-rod fixation of the motion segment was completed. We then applied MIP-PLIF in three patients. For segments with preoperative intervertebral/foraminal height loss, MIP-PLIF was effective in restoring both heights in all cases. The amount of improvement (9.7 to 38% disc height increase; 7.7 to 29.9% foraminal height increase) varied directly with the size of the graft used and the original degree of disc and foraminal height loss. Segmental lordosis improved by 29% on average. Graft and screw placement was accurate in the cadavers, except for a single Grade 1 screw violation of one pedicle. The average operative time was 3.5 hours per level. In our three clinical cases, the MIP-PLIF procedure required a mean of 5.4 hours, estimated blood loss was 185 ml, and inpatient stay was 2.8 days, with no intravenous narcotic use after 2 days in

  4. Percutaneous gastrojejunostomy in amyotrophic lateral sclerosis.

    PubMed

    Strong, M J; Rowe, A; Rankin, R N

    1999-10-31

    We have performed a retrospective review of the use of a percutaneous gastrojejunostomy in patients with amyotrophic lateral sclerosis (ALS). Forty-one patients with initial bulbar manifestations of ALS and 32 patients with initial limb manifestations underwent a percutaneous gastrojejunostomy under fluoroscopic control using the Rankin gastrojejunostomy tube. Survival characteristics were compared with 86 bulbar onsetting and 207 limb onsetting ALS patients who did not require nutritional support. The 30-day mortality rate was 9.6% (respiratory death in three bulbar onsetting patients and four limb onsetting patients) and the 30 day morbidity rate was 4.1% (one operative site infection and intraperitoneal leakage in two patients). The most frequent long-term complication was the requirement for tube changing (blockage in six; dislodgment in two). Gastric reflux was not described amongst the treated patients. Overall survivorship (symptom onset to death) was less in the bulbar onsetting patients receiving a gastrojejunostomy tube than in the control population (median survival 22.0 vs. 33.7 months, respectively, P=0.005). As a group, the median survivorship for limb onsetting patients was not different for those receiving a gastrojejunostomy than for those who did not. However, a significant reduction in survival was observed in limb onsetting patients receiving a gastrojejunostomy early in the course of their disease (P=0.001) compared to those with a longer duration prior to the procedure. This was not observed in the bulbar onsetting patients. In both patient populations, no relationship was observed between survival post-gastrojejunostomy and the severity of pulmonary involvement at the time of the intervention, serum chloride, or age at onset. These studies demonstrate that a percutaneous gastrojejunostomy is a well-tolerated and safe alternative technique for enteral nutritional support in ALS patients. It also offers the advantage of not requiring either a

  5. 3D heart model printing for preparation of percutaneous structural interventions: description of the technology and case report.

    PubMed

    Dankowski, Rafał; Baszko, Artur; Sutherland, Michael; Firek, Ludwik; Kałmucki, Piotr; Wróblewska, Katarzyna; Szyszka, Andrzej; Groothuis, Adam; Siminiak, Tomasz

    2014-01-01

    Structural heart disease, including valvular disease as well as congenital defects, causes important alterations in heart anatomy. As a result, individualised planning for both surgical and percutaneous procedures is crucial for procedural optimisation. Three dimensional (3D) rapid prototyping techniques are being utilised to aid operators in planning structural heart procedures. We intend to provide a description of 3D printing as a clinically applicable heart modelling technology for the planning of percutaneous structural heart procedures as well as to report our first clinical use of a 3D printed patient-specific heart model in preparation for a percutaneous mitral annuloplasty using the Mitralign percutaneous annuloplasty system. Retrospectively gated, contrast enhanced, multi-slice computed tomography (MSCT) scans were obtained. MSCT DICOM data was analysed using software that creates 3D surface files of the blood volume of specific regions of interest in the heart. The surface files are rendered using a software package that creates a solid model that can be printed using commercially available stereolithography machines. The technique of direct percutaneous mitral annuloplasty requires advancement of a guiding catheter through the aorta, into the left ventricle, and requires the positioning of the tip of the catheter between the papillary muscles in close proximity to the mitral annulus. The 3D heart model was used to create a procedural plan to optimise potential device implantation. The size of the deflectable guiding catheter was selected on the basis of the patient's heart model. Target locations for annulus crossing wires were evaluated pre-procedurally using the individual patient's 3D heart model. In addition, the ability to position the Bident Catheter at the appropriate locations under the mitral annulus as well as the manoeuvrability between the papillary muscles were analysed on the heart model, enabling safe completion of the procedure, which

  6. Stomal Varices: Treatment by Percutaneous Transhepatic Coil Embolization

    SciTech Connect

    Kishimoto, Keiko; Hara, Akihiko; Arita, Takeshi; Tsukamoto, Katsuhiko; Matsui, Norichika; Kaneyuki, Toshihiro; Matsunaga, Naofumi

    1999-11-15

    Bleeding from stomal varices in a patient with portal hypertension, uncontrolled by surgical ligation and sclerotherapy, was well controlled by percutaneous transhepatic embolization with platinum and stainless-steel coils.

  7. 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.

  8. Conchotome and needle percutaneous biopsy of skeletal muscle.

    PubMed Central

    Dietrichson, P; Coakley, J; Smith, P E; Griffiths, R D; Helliwell, T R; Edwards, R H

    1987-01-01

    Percutaneous muscle biopsy is an important and acceptable technique in the study of conditions involving human skeletal muscle. A review of 436 conchotome and needle muscle biopsies obtained over 18 months in this centre is presented. Images PMID:3694206

  9. [New techniques to perform percutaneous nephrolithotripsy total dorsal decubitus].

    PubMed

    Melchert, E; De Farias Junior, J O

    2010-09-01

    Based on the knowledge on percutaneous surgeries performed by Valdivia-Uría technique, we developed changes which set a new technique to perform percutaneous nephrolithotripsy. A retrospective study encompassing 1775 procedures was performed from 1996 to 2009, including all the patients who had undergone percutaneous nephrolithotripsy to treat urinary lithiasis. Patients were in total dorsal decubitus position, and it was performed a puncture in the posterior axillary line, dilation and placement of the Amplatz sheath in parallel position to the radio transparent table or slightly inclined downward. The median operating time was 55 min and a complete clearance of the stones was achieved in 81.8% of the cases. In 12% of the cases the concurrent removal of the renal and ureteral lithiasis was performed. This technique facilitates simultaneous ureteroscopy and nephroscopy without the need of repositioning the patient, and it is also a good option for percutaneous access.

  10. Percutaneous Portal Vein Access and Transhepatic Tract Hemostasis

    PubMed Central

    Saad, Wael E. A.; Madoff, David C.

    2012-01-01

    Percutaneous portal vein interventions require minimally invasive access to the portal venous system. Common approaches to the portal vein include transjugular hepatic vein to portal vein access and direct transhepatic portal vein access. A major concern of the transhepatic route is the risk of postprocedural bleeding, which is increased when patients are anticoagulated or receiving pharmaceutical thrombolytic therapy. Thus percutaneous portal vein access and subsequent closure are important technical parts of percutaneous portal vein procedures. At present, various techniques have been used for either portal access or subsequent transhepatic tract closure and hemostasis. Regardless of the method used, meticulous technique is required to achieve the overall safety and effectiveness of portal venous procedures. This article reviews the various techniques of percutaneous transhepatic portal vein access and the various closure and hemostatic methods used to reduce the risk of postprocedural bleeding. PMID:23729976

  11. Percutaneous Retrieval of a Retained Jackson-Pratt Drain Fragment

    SciTech Connect

    Namyslowski, Jan; Halin, Neil J.; Greenfield, Alan J.

    1996-11-15

    A retained intraabdominal Jackson-Pratt drain fragment was percutaneously retrieved using an inflated angioplasty balloon that had been maneuvered inside of the drain lumen over a hydrophilic-coated steerable guidewire.

  12. Percutaneous endoscopic gastrostomy in patients with an open abdomen.

    PubMed

    Block, E F; Cheatham, M L; Bee, T K

    2001-09-01

    Percutaneous endoscopic gastrostomy is a commonly performed procedure for enteral access. In the past decade surgeons have used the open abdomen technique with increased frequency for the treatment of intra-abdominal compartment syndrome. Because these patients often have associated malnutrition long-term enteral access is complicated by the massive ventral hernia. We reviewed the records of two patients with an open abdomen who needed long-term enteral access. Both patients had a large midabdominal soft tissue defect, which posed a concern about the technique for gastrostomy creation. Both patients underwent percutaneous endoscopic gastrostomy. In each case the entrance site was located on a portion of intact abdominal wall lateral to the open abdomen tissue defect. No intraoperative or postoperative complications were noted. We conclude that percutaneous endoscopic gastrostomy can be safely performed in patients with an open abdomen. Adherence to standard principles of performing percutaneous endoscopic gastrostomy allows for enteral access in these patients.

  13. Percutaneous drilling of symptomatic accessory navicular in young athletes.

    PubMed

    Nakayama, Shoichiro; Sugimoto, Kazuya; Takakura, Yoshinori; Tanaka, Yasuhito; Kasanami, Ryoji

    2005-04-01

    Results of percutaneous drilling for symptomatic type II accessory tarsal navicular bone are not determined. Percutaneous drilling of accessory navicular synchondrosis will induce or accelerate bone union between the accessory and primary navicular bones. Bone union of the synchondrosis leads to symptomatic relief. Case series; Level of evidence, 4. Thirty-one feet of 29 patients with type II accessory tarsal navicular treated by percutaneous drilling were reviewed. Twenty-four feet (77.4%) were assessed as excellent, 6 (19.4%) as good, and 1 (3.2%) as fair. No feet were assessed as poor. Bone union was obtained in 16 (80%) of the 20 feet when the proximal phalanx of the great toe was immature and in 2 of the 11 feet when it was mature. Percutaneous drilling of the synchondrosis was effective for a symptomatic type II accessory navicular, especially in patients with immature proximal phalanx of the great toe.

  14. Percutaneous image-guided biopsy of the musculoskeletal system.

    PubMed

    Welch, Brian T; Welch, Timothy J

    2011-09-01

    Percutaneous image-guided biopsy plays an important role in the management of multiple pathologic conditions involving the musculoskeletal system. The vast majority of these conditions require histologic diagnosis to guide decision making concerning treatment. Percutaneous image-guided biopsy has supplanted open surgical biopsy as the primary modality for tissue diagnosis in this patient cohort. The safety, efficacy, and clinical outcome of percutaneous image-guided biopsy for a multitude of musculoskeletal conditions are well documented. Improvements in needle design and image guidance have continued to further the efficacy and safety of this diagnostic technique. Complications associated with percutaneous biopsy are minimal compared with those seen in open surgical biopsy, whereas diagnostic accuracy is comparable to that of surgical biopsy.

  15. Percutaneous & Mini Invasive Achilles tendon repair

    PubMed Central

    2011-01-01

    Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon. PMID:22082172

  16. Magnetic electrical connectors for biomedical percutaneous implants

    NASA Technical Reports Server (NTRS)

    Owens, L. J. (Inventor)

    1977-01-01

    A biomedical percutaneous connector is described which includes a socket having an enlarged disk shaped base portion for being implanted below the patient's skin and cylindrical portion which is integral with the base portion and extends outwardly of the skin. A conical recess in an upper end of the cylindrical portion has a magnet located in the base. Inclined conductive strips are carried on an upper end of the cylindrical portion to which electrical conductors are attached and extend into the patient's body. A complementary shaped plug which also has electrical contacts provided thereon is adapted to fit within the conical recess of the socket. The plug is held in the socket by magnetic force.

  17. 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.

  18. Percutaneous endoscopic gastrostomy following previous abdominal surgery.

    PubMed Central

    Stellato, T A; Gauderer, M W; Ponsky, J L

    1984-01-01

    During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy. PMID:6428334

  19. Percutaneous endoscopic gastrostomy. Procedure of choice.

    PubMed Central

    Miller, R E; Kummer, B A; Tiszenkel, H I; Kotler, D P

    1986-01-01

    Operative gastrostomy (OG) for gastrointestinal decompression or feeding has stood the test of time. Nevertheless, this procedure is often associated with significant morbidity and occasional mortality. Furthermore, although it is often performed under local anesthesia, general anesthesia is frequently necessary. A recent alternative to OG is percutaneous endoscopic gastrostomy (PEG). The purpose of this study is to describe our experience with 100 consecutive PEGs in 98 patients. There were no complications, and no patient died as a result of PEG. Furthermore, PEG never required general anesthesia and was rapid and less costly than OG. Since PEG is so simple to perform, it may be employed earlier in the patient's course, thus avoiding nasogastric feedings or parenteral alimentation. PEG is the procedure of choice should gastrostomy be needed. PMID:3767486

  20. Robotic-assisted percutaneous coronary intervention.

    PubMed

    Mangels, Daniel R; Giri, Jay; Hirshfeld, John; Wilensky, Robert L

    2017-07-19

    Performance of percutaneous coronary intervention (PCI) is associated with several occupational hazards including radiation exposure and musculoskeletal injury. Current methods to mitigate these risks range from suspended radiation suits to adjustable lead-lined glass shields. Robotic-assisted PCI is a novel approach to PCI that utilizes remote-controlled technology to manipulate catheters thereby significantly reducing radiation exposure to the operator and catheterization laboratory staff. Although limited, current evidence indicates that robotic-assisted PCI is associated with a high technical success rate and may have additional advantages over conventional PCI, such as a decreased incidence of geographical miss. However, as the technology is nascent, further studies including larger, randomized controlled trials are needed to expand on the long-term clinical and safety outcomes. © 2017 Wiley Periodicals, Inc.

  1. Complications of the percutaneous kidney biopsy.

    PubMed

    Whittier, William L

    2012-05-01

    Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.

  2. Tubeless percutaneous nephrolithotomy using hemostatic gelatin matrix.

    PubMed

    Borin, James F; Sala, Leandro G; Eichel, Louis; McDougall, Elspeth M; Clayman, Ralph V

    2005-01-01

    We describe using hemostatic gelatin matrix (FloSeal; Baxter Inc., Irvine, CA) to provide hemostasis of the tract after percutaneous nephrolithotomy, thereby obviating a nephrostomy tube. For patients who are rendered stone free, a 7F, 11.5-mm occlusion balloon catheter, passed retrograde, is used to occlude the collecting system at the level of entry of the 30F Amplatz sheath. FloSeal is then injected through the partially retracted Amplatz sheath while withdrawing the applicator and the sheath in tandem. The guidewire is withdrawn per urethra until its tip resides in the renal pelvis. A 36-cm, 7F tail stent is passed retrograde, and the skin is closed with cyanoacrylate adhesive (Ethicon, Somerville, NJ). A Foley catheter is placed, to be removed the next morning; the patient can be discharged on postoperative day 1. The ureteral stent is removed in 5 to 7 days as an outpatient procedure.

  3. Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis

    PubMed Central

    Malhotra, Rohit; Sharma, Anjali; Kakouros, Nikolaos

    2017-01-01

    Percutaneous transcatheter tricuspid balloon valvuloplasty (PTTBV) is an accepted treatment option for symptomatic severe native tricuspid valve stenosis, although surgical tricuspid valve replacement remains the treatment of choice. There have been few reports of successful PTTBV for bioprosthetic tricuspid valve stenosis. We present case reports of 3 patients from our hospital experience. Two of the 3 cases were successful, with lasting clinical improvement, whereas the 3rd patient failed to show a reduction in valve gradient. We describe the standard technique used for PTTBV. We present results from a literature review that identified 16 previously reported cases of PTTBV for bioprosthetic severe tricuspid stenosis, with overall favorable results. We conclude that PTTBV should perhaps be considered for a select patient population in which symptomatic improvement and hemodynamic stability are desired immediately, and particularly for patients who are inoperable or at high surgical risk. PMID:28265212

  4. Ultrasound guided percutaneous EVAR success is predicted by vessel diameter

    PubMed Central

    Bensley, Rodney P.; Hurks, Rob; Huang, Zhen; Pomposelli, Frank; Hamdan, Allen; Wyers, Mark; Chaikof, Elliot; Schermerhorn, Marc L.

    2012-01-01

    Introduction Ultrasound guided access allows for direct visualization of the access artery during percutaneous endovascular aortic aneurysm repair. We hypothesize that the use of ultrasound guidance allowed us to safely increase the utilization of percutaneous endovascular aortic aneurysm repair to almost all patients and decrease access complications. Methods A retrospective chart review of all elective endovascular aortic aneurysm repairs, both abdominal and descending thoracic, from 2005-2010 was performed. Patients were identified using ICD9 codes and stratified based on access type: percutaneous vs. cutdown. We examined the success rate of percutaneous access and the cause of failure. Sheath size was large (18-24 Fr) or small (12-16 Fr). Minimum access vessel diameter was also measured. Outcomes were wound complications (infections or clinically significant hematomas that delayed discharge or required transfusion), operative and incision time, length of stay, and discharge disposition. Predictors of percutaneous failure were identified. Results 168 patients (296 arteries) had percutaneous access (P-EVAR) while 131 patients (226 arteries) had femoral cutdown access (C-EVAR). Ultrasound guided access was introduced in 2007. P-EVAR increased from zero cases in 2005 to 92.3% of all elective cases in 2010. The success rate with percutaneous access was 96%. Failures requiring open surgical repair of the artery included 7 for hemorrhage and 6 for flow limiting stenosis or occlusion of the femoral artery. P-EVAR had fewer wound complications (0.7% vs. 7.4%, P = .001) shorter operative time (153.3 vs. 201.5 minutes, P < .001) and larger minimal access vessel diameter (6.7 mm vs. 6.1 mm, P < .01). Patients with failed percutaneous access had smaller minimal access vessel diameters when compared to successful P-EVAR (4.9 mm vs. 6.8 mm, P < .001). More failures occurred in small sheaths than large ones (7.4% vs. 1.9%, P = .02). Access vessel diameter < 5 mm is predictive

  5. Autologous blood use in percutaneous nephrolithotomy.

    PubMed

    Stoller, M L; Lee, K L; Schwartz, B F; Viele, M K

    1999-09-01

    Preoperative autologous blood (AUB) donation has decreased patient exposure to allogenic blood (ALB) products and associated infectious risk. The risk of contracting hepatitis C and human immunodeficiency virus is 1 in 103,000 and 1 in 678,000, respectively, after receiving 1 U ALB. Elective surgical procedures require surgeons to offer preoperative AUB donation in California. Unused AUB is discarded. We report our use of AUB obtained for percutaneous nephrolithotomy. A retrospective study of 144 consecutive patients who underwent 193 percutaneous nephrolithotomies between January 1994 and April 1998 at one of four teaching hospitals at the University of California, San Francisco was performed. Preoperative AUB donation, transfusion rates, hemoglobin levels, blood use, and costs were analyzed. Ninety-six units of blood were collected from 63 patients (44%) and were available for 70 procedures (36%). The overall transfusion rate per procedure was 7%, with 13 patients receiving a total of 24 U, 7 AUB and 17 ALB. Eighty-nine units (92.7%) of AUB were discarded, and the transfusion rate in donors and nondonors was similar. There was no significant difference in preoperative hemoglobin or operative blood loss between donors and nondonors. The 13 transfused patients had a lower preoperative hemoglobin ( 11.5 versus 12.8 g/dL; P = 0.029) and higher operative blood loss as measured by hemoglobin level (3.2 versus 1.6 g/dL; P <0.001). Blood bank charges for ALB and AUB were $ 119/U and $244 to $498/U, respectively, depending on transportation and thawing charges. Routine preoperative blood donation adds substantial cost for minimal benefit, given the low infectious risk of ALB and the two- to fourfold higher cost of AUB. In our series, women had an increased incidence of blood transfusion compared with men. AUB donation may provide peace of mind but is rarely used and is discarded 93% of the time.

  6. Renal Vein Injury During Percutaneous Nephrolithotomy Procedure.

    PubMed

    Mahmood, Sarwar Noori; Toffeq, Hewa Mahmood

    2016-01-01

    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.

  7. Percutaneous nephrolithotomy in children: A preliminary report

    PubMed Central

    Elderwy, Ahmad A.; Gadelmoula, Mohamed; Elgammal, Mohamed A.; Osama, Ehab; Al-Hazmi, Hamdan; Hammouda, H.; Osman, Esam; Abdullah, Medhat A.; Neel, Khalid Fouda

    2014-01-01

    Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children. PMID:25125889

  8. Factors predicting infectious complications following percutaneous nephrolithotomy

    PubMed Central

    Sharma, Kuldeep; Sankhwar, Satya Narayan; Goel, Apul; Singh, Vishwajeet; Sharma, Pradeep; Garg, Yogesh

    2016-01-01

    Objective: To determine the predictors of infectious complications following percutaneous nephrolithotomy (PCNL) in a prospective study. Materials and Methods: A total of 332 patients with renal or upper ureteric calculi who underwent PCNL between January 2013 and June 2014 were included in the study. Infectious complications included febrile urinary tract infection and septicemia. The patients were divided into Group A and B depending on whether they developed or did not develop infectious complications. Patient, stone, renal, and procedure-related factors were compared between the two groups. Results: There was no significant (P > 0.05) correlation among age (37.03 ± 16.24 vs. 36.72 ± 14.88), sex, and body mass index (21.00 ± 1.77 vs. 21.03 ± 2.25) between Group A and B. The patients in Group A were found to have significantly higher incidence of renal failure (39.5% vs. 9.2%,P= 0.0001), diabetes mellitus (12 [31.5%] vs. 33 [11.2%],P= 0.0001), previous percutaneous nephrostomy (PCN) tube placement (11 [28%] vs. 21 [7.1%]P= 0.0001), moderate to severe hydronephrosis (HDN), larger stone surface area (812.68 ± 402.07 vs. 564.92 ± 361.32,P= 0.0001), mean number of punctures (1.57 ± 0.50 vs. 1.20 ± 0.47,P= 0.002), and mean duration of surgery (94.28 ± 18.23 vs. 69.12 ± 21.23,P= 0.0001) than Group B. Conclusion: Post-PCNL infectious complications were found to be more common in patients with renal failure, diabetes mellitus, preoperative PCN placement, staghorn calculi, severe HDN, multiple punctures, and prolonged duration of surgery. PMID:28057987

  9. Fever after percutaneous nephrolithotomy: contributing factors.

    PubMed

    Sharifi Aghdas, Farzaneh; Akhavizadegan, Hamed; Aryanpoor, Aryan; Inanloo, Hassan; Karbakhsh, Mojgan

    2006-08-01

    The exact mechanism of fever and urosepsis after percutaneous procedures has not been established. This research studied the frequency of fever after percutaneous nephrolithotomy (PCNL) and the contributing factors. In a cross-sectional study, from September 2003 to March 2004, all 217 patients with nephrolithiasis treated with PCNL at the Labbafinegad Specialized Urology Center were studied. Data were collected before, during, and after surgery. The frequency of fever after PCNL was 25.8% (n=56) although in 62.2% of the cases (n=135), no prophylactic antibiotics had been administered. The mean durations of hospitalization in patients with and without fever were 5.4+/-2.3 and 3.4+/-1.7 days, respectively (p=0.001). Significant correlations were observed between fever and female sex (p=0.005), positive urine culture (p=0.02), and nephrostomy tube insertion (p=0.041). Other variables did not prove to be significant. In logistic regression analysis, female sex and nephrostomy tube insertion were independently related to post-operative fever. Although a considerable proportion of our patients had not received prophylactic antibiotics, the rate of fever after PCNL was no higher than is reported in the literature. Use of only a short course of antibiotics before surgery for staghorn stones did not result in a higher rate of fever. Female sex created a higher risk for fever, probably because of the greater propensity to urinary tract infection. The significant relation of a nephrostomy tube to fever could be attributed to its role as a foreign body or to use in more complicated cases.

  10. [The use of laser for percutaneous nephrolithotomy].

    PubMed

    Valdivia Uría, José Gabriel; Sánchez Zalabardo, José Manuel; Elizalde Benito, Angel; Navarro Gil, Joaquín; Hijazo Conejos, Ignacio; Subirá Ríos, Jorge; García-Magariño, Jesús; García Calero, David

    2008-11-01

    The non negligible number of residual stones after extracorporeal lithotripsy is leading to a revision of the indications of percutaneous nephrolithotomy (PCNL). The laser, managed with flexible nephroscopes, plays an important role in this field. Pulsed Nd: YAG, dye and alexandrite lasers have given way to the holmium:yag laser in the endourological treatment of urinary lithiasis. More than one lithotripter are often required for percutaneous nephrolithotomy of great volume stones, and ballistic and electrokinetic lithotripters are generally preferred due to their high performance. The best indications for Holmium laser is the treatment of caliceal stones far from the pelvis, only accessible through flexible nephroscopes. Midi and minipercs, renal lithiasis in children and some earthy calculi, of low consistency, are also good indications for it. Depending on the anatomical characteristics of the kidney and localization, number, size and hardness of the stone 200, 365, or 500 nanometer fibers may be employed. Due to the fact that the laser drills a hole in the stone like if it is a thermal barrier, it may break in different ways: applying the quartz fiber in between the layers, drilling all the interior before breaking the surface, or drilling multiple points to weaken it and creating broad fracture lines. To accelerate the breaking process one can choose to use larger fibers or to modify the settings of the equipment increasing the potency, although this has some potential risk for the kidney. The theoretical 100% of good results is reduced due to multiple technical and anatomical factors: size, number, localization, and hardness of the stone, as well as the possibility of reaching and seeing the calculus and being able to place the tip of the fiber against it. Although the holmium laser develops on excellent role at the time of avoiding leaving residual calculi or diminishing the number of them, sometimes the electrohydraulic lithotripsy is more effective.

  11. Percutaneous catheter drainage of pancreatic pseudocysts.

    PubMed

    Adams, D B; Harvey, T S; Anderson, M C

    1991-01-01

    Pancreatic pseudocysts represent a complication of severe pancreatic inflammatory disease. Although operative drainage is the cornerstone of therapy for pseudocysts, we have undertaken percutaneous catheter drainage in a selected group of 28 patients over a six-year period (1982-88). This represents 42 per cent of pseudocyst patients managed by the senior author and 1.7 per cent of admissions for pancreatitis at the Medical University Hospitals during that period of time. There were 26 men and two women with an age range of 26-66 years (mean = 42.1). Twenty-six patients had alcohol abuse as the cause of pancreatitis; two were due to surgical trauma. Nondilated pancreatic ducts were demonstrated in 25 patients. Six had pancreatic ascites associated with pseudocysts. Four had previous operative drainage (2 internal and 2 external drainage procedures). Five patients received octreotide acetate, a synthetic peptide which mimics the action of somatostatin, in an attempt to aid closure of external fistulas. The mean length of catheter drainage was 48 days (range 7-210 days). Eight (29%) patients developed procedure-related complications (1 pneumothorax, 1 sheared guidewire, six drain tract infections). There was no mortality. Successful resolution of pseudocysts was achieved in 26 patients (93%). Two patients subsequently had elective caudal pancreaticojejunostomy (CPJ), and one lateral pancreaticojejunostomy (LPJ) to drain obstructed pancreatic ducts. One patient has required repeat external drainage. Percutaneous external drainage is successful in pseudocyst eradication. When underlying pancreatic pathology remains uncorrected, elective surgical decompression of obstructed, dilated ducts may be necessary.

  12. [Pull percutaneous endoscopic gastrostomy: personal experience].

    PubMed

    Geraci, G; Sciumè, C; Pisello, F; Li Volsi, F; Facella, T; Tinaglia, D; Modica, G

    2007-04-01

    To review the indications, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG), that are placed routinely in patients unable to obtain adequate nutrition from oral feeding for swallowing disorders (neurological diseases, head and neck cancer, oesophageal cancer, psychological disorders). Retrospective review of patients referred for PEG placement from 2003 to 2005. Endoscopic Surgery in Section of General and Thoracic Surgery, Faculty of Medicine and Surgery, Palermo, Italy. A total of 50 patients, 11 women and 39 men, referred our Section for PEG placement. Indications for PEG placement included various neurologic impairment (82%), oesophageal non-operable cancer (6%), cardia non-operable cancer (4%), cerebrovascular accident (2%), anorexia (2%), pharyngeal esophageal obstruction (2%), head and neck cancer (2%). All patients received preoperative antibiotics as short-term profilaxis. 51 PEGs were positioned in 50 patients. No major complications were registered; 45 patients (90%) were alive at 1 year follow-up and no mortality procedure-related was registered. Percutaneous endoscopic gastrotomy removal had been performed on 2 patients as end-point of treatment, and 43 patients continued to have PEGs in use at 2006. Outpatients PEG placement using conscious sedation is a safe and effective method for providing enteral nutrition. This technique constitutes the gold standard treatment for enteral nutrition in patients with neurologic impairment or as prophylactic in patients affected by head and neck cancer who needs demolitive surgery. Patients should be carefully assessed, and discussion with the patient and their families should be held to determine that the patient is an appropriate candidate. The Authors feel prophylactic antibiotics lessened the incidence of cutaneous perigastrostomy infection.

  13. 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

  14. Traction removal of percutaneous endoscopic gastrostomy devices in children.

    PubMed

    Srinivasan, Ramesh; Irvine, Tracey; Dalzell, A M

    2010-10-01

    There are few published data on non-endoscopic removal of percutaneous endoscopic gastrostomy devices in children. To describe prospective data acquired for traction removal of percutaneous endoscopic gastrostomy devices at a single pediatric center over a 5-year period. Data were obtained from endoscopy records, computerized hospital patient information systems and case note analysis. The device that could be removed by traction was the Corflo (Merck) 12-Fr percutaneous endoscopic gastrostomy tube with a collapsible internal retention dome. All procedures were performed under general anesthesia. Between 2002-2006, 220 children underwent percutaneous endoscopic gastrostomy removals (166 by traction, 51 endoscopically and 3 Foley catheter to button conversions). The median duration between percutaneous endoscopic gastrostomy insertion and low profile button device substitution was 0.83 years (0.12-3.86). Complications from traction removal included internal retention dome separation in two cases (allowed to pass per rectum, uneventfully), failure to a insert a low profile button device needing percutaneous endoscopic gastrostomy reinsertion, enterocutaneous fistula requiring surgical closure in one patient and laparoscopy for suspected low profile button device misplacement in one instance. The material cost of endoscope disinfection (£10) and disposable usage (£80) avoided by traction removal was calculated at £90 per procedure. No mortality occurred as a result of the traction removal of percutaneous endoscopic gastrostomy tubes. Laparoscopy for suspected low profile button device misplacement was needed in one case (0.60%). Traction removal of percutaneous endoscopic gastrostomy tubes was generally safe and a cost-saving procedure in our experience.

  15. Percutaneous closure of a prosthetic pulmonary paravalvular leak.

    PubMed

    Seery, Thomas J; Slack, Michael C

    2014-01-01

    Paravalvular leak following prosthetic valve surgery has the potential to cause serious complications such as hemolysis and congestive heart failure. Successful percutaneous closures of prosthetic mitral and aortic paravalvular leaks have been performed as an alternative to reoperation. This case represents the first known report of successful percutaneous closure of a prosthetic pulmonary paravalvular leak in an adult patient with a history of congenital heart disease using two muscular ventricular septal defect occluder devices. © 2013 Wiley Periodicals, Inc.

  16. 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

  17. Two-vessel chronic total occlusion. Complete percutaneous revascularisation

    PubMed Central

    Dębski, Artur; Opolski, Maksymilian P.; Kłopotowski, Mariusz; Karcz, Maciej A.; Witkowski, Adam

    2014-01-01

    Little is known about the success rate of second attempts to open chronic total occlusions. Two-vessel occlusion makes the procedure is even more challenging. Thus, embarking on complete percutaneous revascularization of such lesions requires adequate experience, especially after first unsuccessful attempt. We present a case of a 52-year-old male patient in whom successful percutaneous opening of two chronic coronary at staged procedure was performed. PMID:25489332

  18. Percutaneous tracheostomy-beware of the thyroidea-ima artery.

    PubMed

    Kamparoudi, Pagona; Paliouras, Dimitrios; Gogakos, Apostolos S; Rallis, Thomas; Schizas, Nikolaos C; Lazopoulos, Achilleas; Chatzinikolaou, Fotios; Sarafis, Pavlos; Serchan, Paschalitsa; Katsikogiannis, Nikolaos; Sarika, Eirini; Zarogoulidis, Paul; Karapantzos, Ilias; Barbetakis, Nikolaos

    2016-11-01

    Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy.

  19. Successful percutaneous management of acute left ventricular assist device stoppage.

    PubMed

    Chrysant, George S; Horstmanshof, Douglas A; Snyder, Trevor; Chaffin, John S; Elkins, C Craig; Kanaly, Paul J; Long, James W

    2010-01-01

    The HeartMate II left ventricular assist device (LVAD) is a small axial-flow next-generation pump. Acute stoppage of this device is a potentially lethal complication. As these devices proliferate, many patients will be in areas remote to their implant center. Therefore, percutaneous stabilization of these patients before definitive surgical replacement could be potentially life saving. We present two cases of acute LVAD stoppage managed successfully using percutaneous means.

  20. Percutaneous central line extravasation masquerading as an abscess.

    PubMed

    Govind, Binu; Tete, Prakash Ignace; Thomas, Niranjan

    2014-04-01

    Percutaneous central line insertion is a common procedure in the neonatal intensive care unit. A preterm baby, who had a percutaneous central line inserted developed an erythematous swelling over the infraclavicular area. A diagnosis of abscess was made, and an incision and drainage done that revealed a white fluid with high triglyceride content, confirming lipid extravasation. The lesion healed completely few days after removal of the catheter. This case highlights the importance of proper placement and confirmation of central line position.

  1. Open versus percutaneous dilatational tracheostomy: efficacy and cost analysis.

    PubMed

    Grover, A; Robbins, J; Bendick, P; Gibson, M; Villalba, M

    2001-04-01

    The economic advantages of percutaneous dilatational tracheostomies versus open tracheostomies in the operating room have been thoroughly evaluated. We are now reporting our comparison of the costs and charges of percutaneous dilatational tracheostomies with those of open bedside tracheostomies at our institution. The current literature comparing the two open techniques and the percutaneous method of placing tracheostomies was reviewed and the charges and costs for these procedures at our institution were compared. Patients were placed into one of three groups for analysis: open tracheostomies in the operating room (Group I), open tracheostomies in the intensive care unit (Group II), and percutaneous dilatational tracheostomies in the intensive care unit (Group III). Based on our own experience and a literature review it is evident that all three approaches to tracheostomies are safe. Economic analysis showed a savings of $180 in cost per procedure and a $658 savings in charges per procedure for the open method at the bedside when compared with the percutaneous method at the bedside. The professional fee for bronchoscopy was not included in this calculation; including this would lead to greater savings with the open method over the percutaneous method. Open tracheostomy in the operating room increased costs over the bedside procedure by $2194 and increased charges by $2871. For the 150 to 180 tracheostomies done each year at our institution utilization of the open technique at the bedside results in a cost savings of approximately $31,500 and a charge savings of $109,000 compared with the percutaneous dilatational tracheostomy. Both the open bedside and percutaneous dilatational methods are reasonable and safe options. However, the open bedside tracheostomy is a better utilization of resources and is more cost effective, and it is the procedure of choice at our institution.

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. Percutaneous techniques versus surgical techniques for tracheostomy.

    PubMed

    Brass, Patrick; Hellmich, Martin; Ladra, Angelika; Ladra, Jürgen; Wrzosek, Anna

    2016-07-20

    Tracheostomy formation is one of the most commonly performed surgical procedures in critically ill intensive care participants requiring long-term mechanical ventilation. Both surgical tracheostomies (STs) and percutaneous tracheostomies (PTs) are used in current surgical practice; but until now, the optimal method of performing tracheostomies in critically ill participants remains unclear. We evaluated the effectiveness and safety of percutaneous techniques compared to surgical techniques commonly used for elective tracheostomy in critically ill participants (adults and children) to assess whether there was a difference in complication rates between the procedures. We also assessed whether the effect varied between different groups of participants or settings (intensive care unit (ICU), operating room), different levels of operator experience, different percutaneous techniques, or whether the percutaneous techniques were carried out with or without bronchoscopic guidance. We searched the following electronic databases: CENTRAL, MEDLINE, EMBASE, and CINAHL to 28 May 2015. We also searched reference lists of articles, 'grey literature', and dissertations. We handsearched intensive care and anaesthesia journals, abstracts, and proceedings of scientific meetings. We attempted to identify unpublished or ongoing studies by contacting manufacturers and experts in the field, and searching in trial registers. We included randomized and quasi-randomized controlled trials (quasi-RCTs) comparing percutaneous techniques (experimental intervention) with surgical techniques (control intervention) used for elective tracheostomy in critically ill participants (adults and children). Three authors independently checked eligibility and extracted data on methodological quality, participant characteristics, intervention details, settings, and outcomes of interest using a standardized form. We then entered data into Review Manager 5, with a double-entry procedure. Of 785 identified

  9. Should anyone perform percutaneous endoscopic laser diskectomy and percutaneous lumbar disc decompressions?

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: Increasingly, pain management specialists (P-S) (e.g., anesthesiologists, radiologists, or physiatrists), who are not spinal surgeons, are performing percutaneous endoscopic laser diskectomy (PELD), percutaneous lumbar disc decompression (PLDD), and target percutaneous laser disc decompression (T-PLDD) in patients with minimal/mild disc herniations. Here, theoretically, the laser vaporizes/shrinks a small portion of disc tissue that lowers intradiscal pressure/volume, and thereby provides “symptomatic relief” (e.g., low back pain/radiculopathy). Nevertheless, the vast majority of these patients experience spontaneous relief of their complaints over several months without any intervention. Methods: A literature review revealed that P-S specialists are performing PELD/PLDD/T-PLDD to address minimal/mild disc herniations. However, multiple well-designed studies confirmed that PELD/PLDD/T-PLDD were ineffective for managing acute/chronic pain in these patients. Results: Several randomized clinical trials documented the lack of clinical efficacy of PELD/PLDD/T-PLLD procedures over microdiskectomy. PELD/PLDD/T-PLDD correlated with only 60–70% success rates with higher reoperation rates (e.g., up to 38%) vs. 90% success rates for routine microdiskectomy (e.g., with faster recovery and only 16% reoperation rates). Nevertheless, without surgical training, P-S are performing these procedures and are, therefore, unable to adddress perioperative/postoperative PELD/PLDD/T-PLDD surgical complications. Conclusions: Pain management specialists, who are not trained spinal surgeons, should not perform PELD/PLDD/T-PLDD surgery to treat minimal/mild disc herniations. Not only do most of these discs resolve spontaneously over several months but also they are largely ineffective. Furthermore, there is no evidence to support the superiority of PELD/PLDD/T-PLDD procedures over microdiskectomy even if performed by spinal specialists. PMID:28144489

  10. Percutaneous Radiologic, Surgical Endoscopic, and Percutaneous Endoscopic Gastrostomy/Gastrojejunostomy: Comparative Study and Cost Analysis

    SciTech Connect

    Barkmeier, Jeffrey M.; Trerotola, Scott O.; Wiebke, Eric A.; Sherman, Stuart; Harris, Veronica J.; Snidow, John J.; Johnson, Matthew S.; Rogers, Wendy J.; Zhou Xiaohua

    1998-07-15

    Purpose: To compare the results and costs of three different means of achieving direct percutaneous gastroenteric access. Methods: Three groups of patients received the following procedures: fluoroscopically guided percutaneous gastrostomy/gastrojejunostomy (FPG, n= 42); percutaneous endoscopic gastrostomy/gastrojejunostomy (PEG, n= 45); and surgical endoscopic gastrostomy/gastrojejunostomy (SEG, n= 34). Retrospective review of the medical records was performed to evaluate indications for the procedure, procedure technical success, and outcome. Estimated costs were compared for each of the three procedures, using a combination of charges and materials costs. Results: Technical success was greater for FPG and SEG (100% each) than for PEG (84%, p= 0.008 vs FPG and p= 0.02 vs SEG). All patients (n= 7) who failed PEG subsequently underwent successful FPG. Success in placing a gastrojejunostomy was 91% for FPG, and estimated at 43% for PEG and 0 for SEG. Complications did not differ in frequency among groups. For gastrostomy, the average cost per successful tube was lowest in the PEG group ($1862, p= 0.02); FPG averaged $1985, and SEG $3694. SEG costs significantly more than FPG or PEG (p= 0.0001). For gastrojejunostomy, FPG averaged $2201, PEG $3158, and SEG $3045. Conclusion: Technical success for gastrostomy is higher for FPG and SEG than PEG. Though PEG is the least costly procedure, the difference is modest compared with FPG. For gastrojejunostomy, FPG offers the highest technical success rate and lowest cost. Due to high costs associated with the operating room, SEG should be reserved for those patients undergoing a concurrent surgical procedure.

  11. Peritonitis following percutaneous gastrostomy tube insertions in children.

    PubMed

    Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A; John, Philip R; Amaral, Joao G; Connolly, Bairbre L

    2016-09-01

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  12. Percutaneous Therapies for Peripheral Artery Disease.

    PubMed

    Shishehbor, Mehdi H; Jaff, Michael R

    2016-12-13

    Percutaneous therapies for peripheral artery disease continue to evolve with new techniques and devices. Although guidelines-recommended therapies have impacted cardiovascular morbidity and mortality, endovascular interventions have been shown to reduce limb pain, improve quality of life, and prolong walking distance for those with claudication and to reduce amputation rates among those with critical limb ischemia. Novel devices such as drug-eluting stents and drug-coated balloons have improved patency for moderate-length lesions, whereas others allow treatment of heavily calcified and tortuous segments. New adjunctive devices to cross lesions and reduce or modify associated plaque have also been developed, although level 1 data regarding their efficacy are sparse. There has also been a better mechanistic understanding of lower extremity endovascular treatment using tools such as intravascular ultrasound. This information has highlighted the need for better stent size selection for the femoropopliteal arterial segments and larger balloon diameters for the tibial arteries. Moreover, a wound perfusion approach with direct in-line flow, the so-called angiosome approach, and reconstruction of the pedal loop have been advocated for improved wound healing. Technical advances such as the tibiopedal access and reentry methods have allowed crossing of lesions that were considered no option for the endovascular approach in the past. Collectively, there has been increased awareness, interest, and commitment by various specialty societies and organizations to advance the treatment of peripheral artery disease and critical limb ischemia. This is also evident by the recent coalition of 7 professional societies and organizations that represented >150 000 allied health professionals and millions of patients with peripheral artery disease at the 2015 Centers for Medicaid and Medicare Services Medicare Evidence Development and Coverage Analysis Committee meeting. The percutaneous

  13. Percutaneous mitral valve repair for mitral regurgitation.

    PubMed

    Block, Peter C

    2003-02-01

    Mitral regurgitation (MR) associated with, ischemic, and degenerative (prolapse) disease, contributes to left ventricular (LV) dysfunction due to remodeling, and LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair has provided improvement in survival, LV function and symptoms, especially when performed early. Surgical repair is complex, due to diverse etiologies and has significant complications. The Society for Thoracic Surgery database shows that operative mortality for a 1st repair is 2% and for re-do repair is 4 times that. Cardiopulmonary bypass and cardiac arrest are required. The attendant morbidity prolongs hospitalization and recovery. Alfieri simplified mitral repair using an edge-to-edge technique which subsequently has been shown to be effective for multiple etiologies of MR. The MV leaflers are typically brought together by a central suture producing a double orifice MV without stenosis. Umana reported that MR decreased from grade 3.6 +/- 0.5 to 0.8 +/- 0.4 (P < 0.0001) and LV ejection fraction increased from 33 +/- 13% to 45 +/- 11% (P = 0.0156). In 121 patients, Maisano reported freedom from re-operation of 95 +/- 4.8% with up to 6 year follow-up. Oz developed a MV "grasper" that is directly placed via a left ventriculotomy and coapts both leaflets which are then fastened by a graduated spiral screw. An in-vitro model using explanted human valves showed significant reduction in MR and in canine studies, animals followed by serial echo had persistent MV coaptation. At 12 weeks the device was endothelialized. These promising results have paved the way for a percutaneous or minimally invasive-off pump mitral repair. Evalve has developed catheter-based technology, which, by apposing the edges of a regurgitant MV, results in edge-to-edge repair. Release of the device is done after echo and fluoroscopic evaluation under normal loading conditions. If the desired effect is not produced the device can be repositioned or retrieved

  14. Complications of ultrasound-guided percutaneous microwave ablation of renal cell carcinoma

    PubMed Central

    Dong, Xuejuan; Li, Xin; Yu, Jie; Yu, Ming-an; Yu, Xiaoling; Liang, Ping

    2016-01-01

    Purpose To retrospectively review the complications of ultrasound (US)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma. Patients and methods In this study, 101 patients with 105 tumors seen from April 2006 to Feb 2014 were enrolled retrospectively. The patients were treated with US-guided percutaneous MWA and were followed up with contrast-enhanced US and computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. Results Technical success was achieved in 99 of 105 tumors (94.3%). The median follow-up time was 25 (range 1.13–93.23) months. Among the 105 tumors, 26 complications in 24.8% of patients and 23 minor complications (Clavien–Dindo Grades I and II) in 21.9% of patients were noted, accounting for 88.5% of all complications. All the minor complications were cured. Three major complications (Clavien–Dindo Grade ≥III) occurred in 2.9% of the patients, accounting for 11.5% of all complications: hydrothorax in two patients and bowel injury in one. The two patients who had hydrothorax post-MWA had a history of cirrhosis and were treated with catheter drainage. The bowel injury was treated surgically. In all patients, the changes in serum creatinine and urea nitrogen levels from before to after the procedure were small. Conclusion US-guided percutaneous MWA is a beneficial treatment for renal cell carcinoma in selected patients; however, if the renal tumor is close to the bowel, or the patient has serious comorbidities or has undergone abdominal surgery, the procedure must be performed more carefully. PMID:27713644

  15. Percutaneous vertebral augmentation for painful osteolytic vertebral metastasis: a case report

    PubMed Central

    Anselmetti, Giovanni C; Tutton, Sean M; Facchini, Francis R; Miller, Larry E; Block, Jon E

    2012-01-01

    Introduction Vertebral metastases are associated with significant pain, disability, and morbidity. Open surgery for fracture stabilization is often inappropriate in this population due to a poor risk-benefit profile, particularly if life expectancy is short. Percutaneous vertebroplasty and kyphoplasty are appealing adjunctive procedures in patients with malignancy for alleviation of intractable pain. However, these patients have higher risk of serious complications, notably cement extravasation. Described in this report is a case of a painful osteolytic vertebral metastasis that was successfully treated by a novel percutaneous vertebral augmentation system. Case presentation A 42-year-old Caucasian female presented with a history of metastatic lung cancer unresponsive to radiation and chemotherapy with symptoms inadequately controlled by opiates over the previous 6 months. Magnetic resonance imaging and spiral computed tomography with two-dimensional reconstruction showed an osteolytic vertebral metastasis with complete involvement of the T10 vertebral body, extending to the cortical vertebral wall anteriorly and posteriorly. The patient was treated with percutaneous vertebral augmentation (Kiva® VCF Treatment System, Benvenue Medical, Inc, Santa Clara, CA) utilizing a novel coil-shaped polyetheretherketone implant designed to minimize the risk of cement extravasation. After the minimally invasive procedure, bone cement distribution within the vertebral body was ideal, with no observed cement extravasation. No complications were reported, pain completely resolved within 24 hours, and use of intravenous narcotics was progressively diminished within 1 week. Complete pain relief was maintained throughout 4 months of follow-up. Conclusion The Kiva System represents a novel and effective minimally invasive treatment option for patients suffering from severe pain due to osteolytic vertebral metastasis. PMID:23754917

  16. MR imaging-guided percutaneous cryotherapy for lung tumors: initial experience.

    PubMed

    Liu, Shangang; Ren, Ruimei; Liu, Ming; Lv, Yubo; Li, Bin; Li, Chengli

    2014-09-01

    To evaluate prospectively the initial clinical experience of magnetic resonance (MR) imaging-guided percutaneous cryotherapy of lung tumors. MR imaging-guided percutaneous cryotherapy was performed in 21 patients with biopsy-proven lung tumors (12 men, 9 women; age range, 39-79 y). Follow-up consisted of contrast-enhanced chest computed tomography (CT) scan performed at 3-month intervals to assess tumor control; CT scanning was carried out for 12 months or until death. Cryotherapy procedures were successfully completed in all 21 patients. Pneumothorax occurred in 7 (33.3%) of 21 patients. Chest tube placement was required in one (4.8%) case. Hemoptysis was exhibited by 11 (52.4%) patients, and pleural effusion occurred in 6 (28.6%) patients. Other complications were observed in 14 (66.7%) patients. The mean follow-up period was 10.5 months (range, 9-12 mo) in patients who died. At month 12 of follow-up, 7 (33.3%) patients had a complete response to therapy, and 10 (47.6%) patients showed a partial response. In addition, two patients had stable disease, and two patients developed progressive disease; one patient developed a tumor in the liver, and the other developed a tumor in the brain. The 1-year local control rate was 81%, and 1-year survival rate was 90.5%. MR imaging-guided percutaneous cryotherapy appears feasible, effective, and minimally invasive for lung tumors. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  17. Percutaneous Endovascular Treatment of Hepatic Artery Stenosis in Adult and Pediatric Patients After Liver Transplantation

    SciTech Connect

    Maruzzelli, Luigi; Miraglia, Roberto Caruso, Settimo; Milazzo, Mariapina; Mamone, Giuseppe; Gruttadauria, Salvatore; Spada, Marco; Luca, Angelo; Gridelli, Bruno

    2010-12-15

    The purpose of this study was to evaluate the efficacy of percutaneous endovascular techniques for the treatment of hepatic artery stenosis (HAS) occurring after liver transplantation (LT) in adult and pediatrics patients. From February 2003 to March 2009, 25 patients (15 adults and 10 children) whose developed HAS after LT were referred to our interventional radiology unit. Technical success was achieved in 96% (24 of 25) of patients. Percutaneous transluminal angioplasty (PTA) was performed in 13 patients (7 children), and stenting was performed in 11 patients (2 children). After the procedure, all patients were followed-up with liver function tests, Doppler ultrasound, and/or computed tomography. Mean follow-up was 15.8 months (range 5 days to 58 months). Acute hepatic artery thrombosis occurred immediately after stent deployment in 2 patients and was successfully treated with local thrombolysis. One patient developed severe HA spasm, which reverted after 24 h. After the procedure, mean trans-stenotic pressure gradient decreased from 30.5 to 6.2 mmHg. Kaplan-Meyer curve of HA primary patency was 77% at 1 and 2 years. During the follow-up period, 5 patients (20%) had recurrent stenosis, and 2 patients (8.3%) had late thrombosis. Two of 7 patients with stenosis/thrombosis underwent surgical revascularization (n = 1) and liver retransplantation (n = 1). Six (25%) patients died during follow-up, but overall mortality was not significantly different when comparing patients having patent hepatic arteries with those having recurrent stenosis/thrombosis. There were no significant differences in recurrent stenosis/thrombosis and mortality comparing patients treated by PTA versus stenting and comparing adult versus pediatric status. Percutaneous interventional treatment of HAS in LT recipients is safe and effective and decreases the need for surgical revascularization and liver retransplantation. However, the beneficial effects for survival are not clear, probably because

  18. Does the nephrostomy tract length impact the outcomes of percutaneous nephrolithotomy (PNL)?

    PubMed

    Astroza, Gaston M; Neisius, Andreas; Tsivian, Matvey; Wang, Agnes J; Preminger, Glenn M; Lipkin, Michael E

    2014-12-01

    Different factors can determine the outcomes of percutaneous nephrolithotomy (PNL). We analyzed the effect of tract length (TL) on outcomes after PNL. We performed a retrospective review of patients undergoing PNL between 2006 and 2011. Patients with preoperative computed tomography (CT), one percutaneous access tract and follow-up imaging within 3 months were included. TL was defined as distance between the skin to the calyx of puncture as measured on preoperative CT. Measurements were independently performed by two urologists and the average was used for analysis. Stone-free rate (SFR) was defined as zero fragments on follow-up imaging. Factors independently associated with the likelihood of being stone-free after PNL were determined using multivariable analysis adjusted for TL, location of access, the presence of incomplete or complete staghorn calculi and type of follow-up imaging. Complications (Clavien score) were independently assessed. A total of 222 patients were included. Median stone burden and body mass index (BMI) was 239.4 mm(2) and 30.5 [interquartile range (IQR): 25.7-36.2]. The median TL was 85.0 mm (IQR: 70.3-100.0) and highly correlated with BMI (ρ = 0.66, p < 0.001). A total of 101 patients (45.5 %) were stone-free. TL was not associated with SFR (p = 0.53). Clavien 1 and 2 complications occurred in 38 (17 %) while Clavien 3 and 4 complications occurred in 17 (8 %) patients. Multivariable analysis revealed no association between complications and TL even when adjusted for gender. Percutaneous TL is not associated with outcomes of PNL. PNL is a safe and effective treatment for stones in patients with differing body habitus.

  19. Operative Techniques and Preliminary Outcomes Following Percutaneous Endoscopic Thoracolumbar Pediculectomy in Dogs.

    PubMed

    Hwang, Yong-Hyun; Lee, Hee-Chun; Lee, Jae-Hoon

    2016-11-01

    To examine the technical feasibility of percutaneous endoscopic pediculectomy using a lateral approach and to evaluate its use for decompression and examination of the thoracic and lumbar spinal canals in small dogs. Experimental study. Clinically normal adult dogs (n=10). After optimizing the technique in cadavers, percutaneous endoscopic pediculectomy was performed using a lateral approach to the thoracic (T12) or lumbar (L2) vertebrae in 5 dogs each. Using fluoroscopic guidance, a K-wire, dilator, and (cannula) working sleeve were placed. A window for visualizing the spinal cord and floor of the spinal canal was created using a specialized drill, rongeurs, trephine, and elevator. Gait and neurologic status were monitored postoperatively, and computed tomography (CT) and magnetic resonance imaging (MRI) performed. All procedures were completed successfully (T12, 45 ± 13 minutes; L2, 59 ± 14 minutes) with clear observation of the spinal cord and floor of the spinal canal. Normal ambulation was maintained in 9 dogs. One dog in the L2 group had ipsilateral hind limb weakness that resolved within 4 days. One dog in the L2 group suffered a fracture of the accessory process. One dog each in the T12 and L2 groups had hyperintense lesions on T2-weighted MRI images, suspicious of focal edema, which reduced at 4 weeks after initial examination, possibly reflecting gliosis. Pediculectomy using a percutaneous endoscopic thoracolumbar lateral approach is feasible, provides a good view of the spinal canal, and may be an alternative for treatment of disk disease in dogs. © Copyright 2016 by The American College of Veterinary Surgeons.

  20. Microwave ablation of hepatocellular carcinoma using a new percutaneous device: preliminary results.

    PubMed

    Poggi, Guido; Montagna, Benedetta; DI Cesare, Pamela; Riva, Giulia; Bernardo, Giovanni; Mazzucco, Mauro; Riccardi, Alberto

    2013-03-01

    Thermal ablative techniques have gained increasing popularity as safe and effective options for patients with unresectable solid malignancies. Microwave ablation has emerged as a relatively new technique with the promise of larger and faster ablation areas without some of the limitations of radiofrequency thermal ablation. Herein, we report our preliminary results on the feasibility and efficacy of thermal ablation for hepatocellular carcinoma (HCC) with a new 2.45-MHz microwave generator. Under ultrasound guidance 194 HCCs in 144 patients were treated through a percutaneous approach. The median diameter of lesions was 2.7 cm (range=2.0-11.0 cm); 68 lesions had a diameter greater than 30 mm. We used a microwave generator (AMICA-GEM, Apparatus for MICrowave Ablation) connected to a 14- or 16-gauge coaxial antenna endowed with a miniaturized sleeve choke to reduce back heating effects and increase the sphericity of the ablated area. Contrast-enhanced computed tomography scan was carried out one month after treatment, and then every three months to assess efficacy. Complete ablation was achieved in 94.3% of the lesions after a mean of 1.03 percutaneous sessions. For small HCCs (diameter <3 cm) complete necrosis was obtained in 100%. Local tumor progressions were found in 10 treated lesions (5.1%) a median of 19.5 months after ablation. Minor complications occurred in 5.1% procedures. No deaths, or other major complications occurred. In our experience, the new device for microwave ablation proved to provide an effective and safe percutaneous ablative method, capable of producing large areas of necrosis.

  1. 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

  2. [Percutaneous laser disc decompression for lumbar discogenic radicular pain].

    PubMed

    Duarte, R; Costa, J C

    2012-01-01

    The aim of our study was to directly evaluate the effectiveness of percutaneous laser disc decompression (PLDD) for treatment of lumbar discogenic radicular pain. From June 2006 through July 2009, 205 patients with contained disc herniation demonstrated on computed tomography (CT) or magnetic resonance, concordance between the radicular pain and the nerve root compressed by the herniated disc, neurological findings referring to a single nerve root and no improvement after conservative therapy for a minimum of six weeks were enrolled. All patients were treated with PLDD under CT guidance and local anaesthesia. Follow-up was scheduled at 1, 2 days, 3, 6 months. Subsequent follow-ups at 12, 24 and 36 months were carried out through visits or by telephone. Clinical outcome was quantified using the MacNab criteria. The age of patients ranged from 27 to 78 years (mean 58±11 years). The levels of involvement were 18 cases at L3-L4, 123 cases at L4-L5 and 64 cases at L5-S1. Using the MacNab criteria, the results were as follows: 67% (n=137) showed a good outcome and 9% (n=18) a fair outcome. There were no serious complications in our series. PLDD is effective treatment for lumbar discogenic radicular pain, associated with only minimal discomfort to the patient. This minimally invasive technique is a valid alternative for those patients not responding to conservative medical treatment, allowing in many cases to obviate the need of spine surgery. Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.

  3. Visual servoing for automatic and uncalibrated percutaneous procedures

    NASA Astrophysics Data System (ADS)

    Loser, Michael H.; Navab, Nassir; Bascle, Benedicte; Taylor, Russell H.

    2000-04-01

    Visual servoing is well established in the field of industrial robotics, when using CCD cameras. This paper describes one of the first medical implementations of uncalibrated visual servoing. To our knowledge, this is the first time that visual servoing is done using x-ray fluoroscopy. In this paper we present a new image based approach for semi-automatically guidance of a needle or surgical tool during percutaneous procedures and is based on a series of granted and pending US patent applications. It is a simple and accurate method which requires no prior calibration or registration. Therefore, no additional sensors, no stererotactic frame and no additional calibration phantom is needed. Our techniques provides accurate 3D alignment of the tool with respect to an anatomic target and estimates the required insertion depth. We implemented and verified this method with three different medical robots at the Computer Integrated Surgery (CIS) Lab at the Johns Hopkins University. First tests were performed using a CCD-camera and a mobile uniplanar x-ray fluoroscope as imaging modality. We used small metal balls of 4 mm in diameter as target points. These targets were placed 60 to 70 mm deep inside a test-phantom. Our method led to correct insertions with mean deviation of 0.20 mm with CCD camera and mean deviation of about 1.5 mm in clinical surrounding with an old x-ray imaging system, where the images were not of best quality. These promising results present this method as a serious alternative to other needle placement techniques, which require cumbersome and time consuming calibration procedures.

  4. Percutaneous versus open repair of acute Achilles tendon ruptures.

    PubMed

    Karabinas, Panagiotis K; Benetos, Ioannis S; Lampropoulou-Adamidou, Kalliopi; Romoudis, Pavlos; Mavrogenis, Andreas F; Vlamis, John

    2014-05-01

    Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures. We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10-24 months) for the open repair group and 20 months (range 9-24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients' return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded. No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7-9 weeks. The mean time of patients' return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study. The present study showed similarly successful clinical and functional results

  5. Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review.

    PubMed

    Vogel, Arndt; Gupta, Sanjay; Zeile, Martin; von Haken, Rebecca; Brüning, Roland; Lotz, Gösta; Vahrmeijer, Alexander; Vogl, Thomas; Wacker, Frank

    2017-01-01

    The Hepatic CHEMOSAT(®) Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile.

  6. Flank suspended supine position for percutaneous nephrolithotomy.

    PubMed

    Pan, Tie-jun; Li, Gong-cheng; Ye, Zhang-qun; Wen, Han-dong; Shen, Guo-qiu; Zhang, Jia-qiao

    2012-01-01

    Prone and supine positions for percutaneous nephrolithotomy are widely used but have their drawbacks. We report a new positioning method called "flank suspended supine position" (FSSP) for PCNL and describe our experience with PCNL in this position to evaluate its safety and efficacy. Retrospective study of 150 cases of renal stone patients treated with PCNL in a new position called flank suspended supine position (FSSP) from June 2009 to July 2010. All patients were treated with PCNL in FSSP under epidural anesthesia. Operation time, bleeding rate, stone free rate, and complications were recorded. All patients tolerated FSSP. Mean operation time was 78.29±26.13 min. Initial stone-free rate was 83%. For those with residual stones (26 cases), 18 were stone-free after a second PCNL, 8 after extracorporeal shock wave lithotripsy (ESWL). Mean hospital stay was 7.63±2.39 days. No penetrating injury of the pleural cavity or injury to visceral organs was reported. FSSP is an effective and safe position for PCNL in our hands and its effectiveness relative to traditional prone position needs to be determined in future randomized studies.

  7. 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.

  8. Percutaneous management of postoperative anastomotic biliary strictures.

    PubMed

    Saad, Wael E A

    2008-06-01

    Postoperative anastomotic biliary strictures can occur after surgery in bile ducts belonging to transplanted or native (nontransplanted) livers. The majority of postoperative anastomotic strictures encountered by interventional radiologists are most likely in liver transplant recipients due to the large and growing liver transplant recipient population worldwide compared with patients with native livers and biliary enteric anastomoses. They occur after 2.5 to 13% of liver transplantations and they represent at least one-half of biliary strictures encountered after liver transplantation. Anastomotic biliary strictures are considered technical in nature, accentuated by fibrosis and scarring that may be secondary to, if not exacerbated by, graft ischemia. There are numerous variables in the percutaneous transhepatic balloon dilation protocols applied to treat anastomotic biliary strictures. These include (1) types of balloons, (2) how long balloons are inflated, (3) how frequently patients return for additional dilation sessions, and (4) the interval(s) at which they return. No alteration in these variables has proven to improve long-term patency. In addition, new technology such as cutting balloons and stents has not been fully evaluated to determine their effect on long-term patency. The current article describes the overall theme of balloon dilation protocols for the management of anastomotic biliary strictures and discusses possible future management of such strictures.

  9. Effectiveness of percutaneous coronary interventions in nonagenarians.

    PubMed

    Moreno, Raúl; Salazar, Abel; Bañuelos, Camino; Hernández, Rosana; Alfonso, Fernando; Sabaté, Manel; Escaned, Javier; Pérez, Maria J; Azcona, Luis; Macaya, Carlos

    2004-10-15

    Data on percutaneous coronary intervention (PCI) in nonagenarians are very scarce. The investigators present a series of 26 nonagenarians who underwent PCI (29 lesions, 1.1 +/- 0.3 per patient). Most (96%) had acute coronary syndrome at presentation, 27% underwent primary PCI for acute myocardial infarctions, and 54% had multivessel disease. Angiographically successful results were obtained in 24 patients (92%), and coronary stents were used in 81%. Five patients (19%) died during hospitalization. In-hospital mortality was significantly greater in patients with Killip class III or IV at presentation (100% vs 9%, p = 0.001), in those in whom the procedure was a primary PCI for acute myocardial infarction (57% vs 5%, p = 0.010), and in the presence of angiographic failure (100% vs 13%, p = 0.031). In-hospital mortality was 0% after excluding patients in cardiogenic shock and those with primary PCI. Thus, most nonagenarians who undergo PCI have a high-risk profile. However, PCI achieves a successful angiographic result in most patients. Mortality is high but concentrated in patients in cardiogenic shock and with primary angioplasty as PCI.

  10. Percutaneous aspiration thromboembolectomy: a preliminary experience.

    PubMed

    Murray, J G; Brown, A L; Wilkins, R A

    1994-08-01

    Percutaneous aspiration thromboembolectomy (PAT) is a radiological alternative to surgical embolectomy or thrombolysis in the treatment of acute arterial thromboembolic disease. We report our experience in eight patients aged 63-83 years (mean 71 years). Indications were graft thrombosis (1) or emboli from atrial fibrillation (3), abdominal aneurysm (2) or proximal angioplasty (2). PAT was performed at 10 arterial sites; common iliac (1), profunda femoris (1), superficial femoral (2), femoro-popliteal graft (1), popliteal (2) and arteries of the trifurcation (3). PAT was used as an adjunct to thrombolysis or angioplasty in five patients and as the sole procedure in three patients. It was successful in six patients (seven sites) with mean ABI rising from 0.4 pre- to 0.8 post-procedure. Two of the failures required amputations. One of these was a completely thrombosed dacron femoro-popliteal graft with poor run-off, and the second case had a failed surgical embolectomy prior to amputation. There were no major complications, and no mortality on follow-up at 1 month. PAT is a useful adjunct to thrombolysis and balloon angioplasty in the radiological treatment of acute thromboembolic disease. In patients in whom thrombolysis is contraindicated, it offers an alternative to surgical embolectomy.

  11. Treatment of Colonic Injury During Percutaneous Nephrolithotomy

    PubMed Central

    Öztürk, Hakan

    2015-01-01

    Colonic injury during percutaneous nephrolithotomy (PCNL) persists despite the advances in technical equipment and interventional radiology techniques. According to the Clavien-Dindo classification of surgical complications, colonic injury is regarded as a stage IVa complication. Currently, the rate of colonic injury ranges between 0.3% and 0.5%, with an unremarkable difference in incidence between supine and prone PCNL procedures. Colon injury is the most significant complication of PCNL. Colonic injury can result in more complicated open exploration of the abdomen, involving colostomy construction. The necessity of a second operation for the closure of the colostomy causes financial and emotional burden on the patients, patients’ relatives, and surgeons. Currently, the majority of colonic injuries occurring during PCNL are retroperitoneal. The primary treatment option is a conservative approach. It must be kept in mind that the time of diagnosis is as important as the diagnosis itself in colonic injury. Surgeons performing PCNL are advised to be conservative when considering exploratory laparotomy and colostomy construction during treatment of colonic injury. We present the case of a 49-year-old woman who underwent left prone PCNL that resulted in retroperitoneal colonic injury, along with a review of the current literature. PMID:26543436

  12. Treatment of Colonic Injury During Percutaneous Nephrolithotomy.

    PubMed

    Öztürk, Hakan

    2015-01-01

    Colonic injury during percutaneous nephrolithotomy (PCNL) persists despite the advances in technical equipment and interventional radiology techniques. According to the Clavien-Dindo classification of surgical complications, colonic injury is regarded as a stage IVa complication. Currently, the rate of colonic injury ranges between 0.3% and 0.5%, with an unremarkable difference in incidence between supine and prone PCNL procedures. Colon injury is the most significant complication of PCNL. Colonic injury can result in more complicated open exploration of the abdomen, involving colostomy construction. The necessity of a second operation for the closure of the colostomy causes financial and emotional burden on the patients, patients' relatives, and surgeons. Currently, the majority of colonic injuries occurring during PCNL are retroperitoneal. The primary treatment option is a conservative approach. It must be kept in mind that the time of diagnosis is as important as the diagnosis itself in colonic injury. Surgeons performing PCNL are advised to be conservative when considering exploratory laparotomy and colostomy construction during treatment of colonic injury. We present the case of a 49-year-old woman who underwent left prone PCNL that resulted in retroperitoneal colonic injury, along with a review of the current literature.

  13. Cangrelor: A Review in Percutaneous Coronary Intervention.

    PubMed

    Keating, Gillian M

    2015-08-01

    Cangrelor (Kengrexal(®), Kengreal(™)) is an intravenously administered P2Y12 receptor inhibitor. It is direct-acting and reversible, with a very rapid onset and offset of action. The randomized, double-blind, multinational, phase III CHAMPION PHOENIX trial compared the efficacy of intravenous cangrelor with that of oral clopidogrel in patients requiring percutaneous coronary intervention (PCI) for stable angina pectoris, a non-ST-segment elevation acute coronary syndrome or ST-segment elevation myocardial infarction (MI). The primary composite efficacy endpoint of death from any cause, MI, ischaemia-drive revascularization or stent thrombosis in the 48 h following randomization occurred in significantly fewer cangrelor than clopidogrel recipients. The rate of severe or life-threatening non-coronary artery bypass graft-related, GUSTO-defined bleeding at 48 h did not significantly differ between cangrelor and clopidogrel recipients. In conclusion, intravenous cangrelor is an important new option for use in patients undergoing PCI who have not been treated with oral P2Y12 inhibitors.

  14. Cangrelor for treatment during percutaneous coronary intervention.

    PubMed

    Oestreich, Julie H; Dobesh, Paul P

    2014-03-01

    Dual antiplatelet therapy consisting of aspirin and a P2Y12-receptor antagonist is important for preventing major adverse cardiovascular events in patients managed with percutaneous coronary intervention (PCI). The current P2Y12-receptor antagonists are only available for oral administration and exhibit a delayed onset of action. Furthermore, several days are required for platelet function to return to normal following cessation of therapy. Cangrelor is an intravenous ATP analog that directly, selectively and reversibly inhibits P2Y12 receptors on platelets. A 30-μg/kg bolus dose followed by a 4-μg/kg per minute continuous infusion of cangrelor achieves peak concentration and maximal platelet inhibition within minutes of administration. Cangrelor also demonstrates a fast offset as normal platelet function is restored 1-2 h after cessation of the infusion. Three large, double-blind, randomized trials - CHAMPION PLATFORM, CHAMPION PCI and CHAMPION PHOENIX - assessed the efficacy and safety of cangrelor compared with clopidogrel (during or immediately after PCI) or placebo in the setting of PCI. In the most recent CHAMPION PHOENIX trial, cangrelor was superior to clopidogrel for preventing adverse cardiovascular events with no significant increase in major bleeding. Based on the clinical trial results combined with unique properties such as intravenous administration and fast onset and offset, cangrelor may provide benefit in certain patients undergoing PCI.

  15. Percutaneous Decommissioning of Left Ventricular Assist Device.

    PubMed

    Soon, Jia-Lin; Tan, Ju-Le; Lim, Choon-Pin; Tan, Teing-Ee; Tan, Swee-Yaw; Kerk, Ka-Lee; Sim, Kheng-Leng David; Sivathasan, Cumaraswamy

    2017-08-19

    The Left Ventricular Assist Device (LVAD) has revolutionised our treatment of advanced stage heart failure, giving debilitated patients a new lease on life. A small proportion of these LVAD patients can be bridged-to-recovery. The identification of these patients and decision to wean, however, can be challenging. The need to fully explant the device upon recovery has evolved to a minimalist approach aiming to avoid injury to the 'recovered' heart. A review of the evolution of explant strategies was performed to guide our decision to wean the LVAD in our early experience. Between 2009 and 2014, two patients in our series of 69 LVAD implants (2.9%) were successfully weaned off their LVADs. The second patient had a minimal access implantation of his HeartWare Ventricular Assist Device (HVAD, Medtronic Inc, Framingham, MA). His clinical variables and minimalist weaning strategy are described. A case of LVAD decommissioning by thrombosis of the outflow graft, using percutaneous Amplatzer Vascular Plug II without surgery is reported. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  16. Percutaneous Endoscopic Gastrostomy for Enteral Nutrition

    PubMed Central

    Nah, Yong Ho; Chae, Soo In; Song, Ju Hung; Choi, In Tae; Kim, Hyuk Je; Park, Suk; Cho, Won Sup

    1987-01-01

    From January to October, 1986, at Wonkwang University Hospital in Iri, percutaneous endoscopic gastrostomy(PEG) was attempted in 26 patients and was successful in 24. This study was designed to review the technique and to evaluate the efficacy of PEG. The mean operation time was 22 minutes (range: 14 to 42 minutes). After feeding started, early positive nitrogen balance was achieved in all patients. All gastrostomies functioned well throughout the patient’s survival with the longest functioning at 10 month. There were no procedure-related deaths, and morbidity was lower and less severe as compared with large-bore nasogastric tube feeding. Complications included minor wound infection in two patients, stomal growth in one patient, leaks around the tube in two patients, and intraperitoneal leak in one patient. No patient developed aspiration pneumonia or required laparotomy for complications from PEG. The gastrostomy tube was easily removed endoscopically when treatment was completed. Feeding via a large-bore tube increased the risk of aspiration pneumonia (72%) and the feeding cost via a small-bore tube with elemental diet exceeded that of PEG by more than tenfold. This author’s experience with these 26 patients has led to the conclusion that PEG is safe, easy to perform, and effective means of creating feeding gastrostomy without laparotomy or general anesthesia. The authors suggest that PEG be the preferred route of alimentation in those patients who are unable to swallow for prolonged periods of time. PMID:3155323

  17. Optical Coherence Tomography Guided Percutaneous Coronary Intervention.

    PubMed

    Ha, Francis J; Giblett, Joel P; Nerlekar, Nitesh; Cameron, James D; Meredith, Ian T; West, Nick E J; Brown, Adam J

    2017-08-04

    Optical coherence tomography (OCT) is an increasingly available intracoronary imaging modality that provides high-resolution imaging of coronary arteries. Its fundamental reliance on the emission and reflection of light enables rapid data acquisition without compromise of image resolution. As such, OCT can inform operators planning percutaneous coronary intervention (PCI) by accurately defining luminal geometry and detailing plaque composition. Following PCI, OCT imaging delivers a thorough assessment of the treated arterial segment and can identify specific features not always visible on alternate imaging modalities, including stent edge-related dissection, plaque tissue prolapse, incomplete stent apposition and the presence of intra-coronary thrombus. Clinical trials highlight that procedural strategy is frequently altered based on OCT findings, while concerns over final stent dimensions have been mitigated through use of a sizing protocol based on external elastic lamina dimensions in the reference arterial segment. Randomised trials are now warranted to definitively ascertain whether OCT-guidance improves clinical outcomes when utilised during PCI. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  18. Management of infectious complications in percutaneous nephrolithotomy.

    PubMed

    Negrete-Pulido, Oscar; Gutierrez-Aceves, Jorge

    2009-10-01

    Infectious complications are one of the most frequent and feared adverse medical events in percutaneous nephrolithotomy. They represent a dangerous and life-threatening condition, especially when postoperative septicemia or severe sepsis develops. In order to limit morbidity and mortality it is crucial to recognize preoperative and intraoperative risk factors that could be clear contributors to an adverse infectious event; those factors are mainly immunosuppression caused by some comorbidities, presence of urinary infection or colonization, stone characteristics, obstruction, long-lasting operation, and high intrapelvic pressure during nephrolithotomy. Close observation during the immediate and early postoperative period must be established and a high index of suspicion must be maintained to identify a major complication. The early recognition and prompt multidisciplinary management of sepsis is mandatory to optimize the final outcome. Appropriate therapy is a continuum of management of infection, ranging from adequate drainage and broad-spectrum antibiotics to aggressive fluid resuscitation and invasive monitoring with medical management in the intensive care setting until the causative agent is found and eradicated.

  19. Quality of canine spermatozoa retrieved by percutaneous epididymal sperm aspiration.

    PubMed

    Varesi, S; Vernocchi, V; Faustini, M; Luvoni, G C

    2013-02-01

    To investigate the feasibility of percutaneous epididymal sperm aspiration in dogs and whether it might provide a population of epididymal spermatozoa similar to the population that can be obtained by processing isolated epididymis caudae. Concentration and total sperm number, motility, morphology and acrosomal integrity of spermatozoa retrieved by percutaneous epididymal sperm aspiration, in vitro aspiration and mincing of the cauda of the epididymis were compared. Percutaneous epididymal sperm aspiration is a feasible procedure to retrieve a population of spermatozoa in dogs. Quality is similar to that of spermatozoa collected in vitro, although a wide variation amongst animals was observed. In case of ejaculation failure due to pathological conditions in dogs, the collection of spermatozoa from the cauda of the epididymis could be an option for providing gametes for assisted reproductive technologies. Percutaneous epididymal sperm aspiration can be used in dogs with compromised reproductive performance, in which orchiectomy cannot be performed for medical or owner reasons. Further studies aimed to investigate whether the percutaneous epididymal sperm aspiration technique might be feasible for repeated semen collection and to accurately evaluate side effects are required. © 2013 British Small Animal Veterinary Association.

  20. Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

    SciTech Connect

    Akhan, Okan Akkaya, Selçuk; Dağoğlu, Merve Gülbiz; Akpınar, Burcu; Erbahçeci, Aysun; Çiftçi, Türkmen; Köroğlu, Mert; Akıncı, Devrim

    2016-03-15

    PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

  1. Percutaneous approaches to valve repair for mitral regurgitation.

    PubMed

    Feldman, Ted; Young, Amelia

    2014-05-27

    Percutaneous therapy has emerged as an option for treatment of mitral regurgitation for selected, predominantly high-risk patients. Most of the percutaneous approaches are modifications of existing surgical approaches. Catheter-based devices mimic these surgical approaches with less procedural risk, due to their less-invasive nature. Percutaneous annuloplasty can be achieved indirectly via the coronary sinus or directly from retrograde left ventricular access. Catheter-based leaflet repair with the MitraClip (Abbott Laboratories, Abbott Park, Illinois) is accomplished with an implantable clip to mimic the surgical edge-to-edge leaflet repair technique. A large experience with MitraClip has been reported, and several other percutaneous approaches have been successfully used in smaller numbers of patients to demonstrate proof of concept, whereas others have failed and are no longer under development. There is increasing experience in both trials and practice to begin to define the clinical utility of percutaneous leaflet repair, and annuloplasty approaches are undergoing significant development. Transcatheter mitral valve replacement is still in early development.

  2. Percutaneous repair of the Achilles tendon rupture in athletic population.

    PubMed

    Ververidis, Athanasios N; Kalifis, K Georgios; Touzopoulos, Panagiotis; Drosos, Georgios I; Tilkeridis, Konstantinos E; Kazakos, Konstantinos I

    2016-03-01

    This review was designed in order to study the percutaneous repair of Achilles tendon rupture in athletic population. We present a comprehensive description of clinical, functional outcomes, complications, with emphasis on patients' level, and time of return to sports. We proceeded to a systematic search of Medline (PubMED), Cochrane, and Scopus databases using keywords "Achilles Tendon", "Percutaneous Repair", "Percutaneous suturing", "Subcutaneous repair", "Subcutaneous suturing", "Athletes", and "Athletic" to identify articles or abstracts written in English. Thirteen studies, including 670 patients, could be identified. A variety of percutaneous repair techniques were performed. Re-rupture rate was very low. The most frequent complication was sural nerve damage. Average functional outcomes were satisfying. Up to 91.4% continued practicing sports after surgery. Furthermore, 78-84% returned to the same or higher sports level. Average time of return was 18 weeks in 9 studies. Percutaneous repair of Achilles tendon rupture is an excellent perspective for athletic population. Low re-rupture rate and impressing level of return to sports allow athletes to continue their recreational activities or careers.

  3. Septic thrombophlebitis: percutaneous mechanical thrombectomy and thrombolytic therapies.

    PubMed

    Kar, Subrata; Webel, Richard

    2014-01-01

    Suppurative thrombophlebitis (Lemierre's syndrome) of the internal jugular vein is a rare and sometimes fatal complication. It commonly occurs from oropharyngeal infections, peripheral lines, complications from dental procedures, gingivitis, or central venous catheterizations. Empiric antibiotics are the initial treatment of choice followed by thrombolytics or surgical thrombectomy in refractory cases. We present a case of septic thrombophlebitis of the right internal jugular vein from a peripherally inserted central venous catheter. We also review the current percutaneous mechanical thrombectomy and thrombolytics therapies for such a rare disorder. Mechanical thrombectomy includes rotational thrombectomy or rheolytic therapies. Devices include the Amplatz thrombectomy device (Microvena), the Arrow-Trerotola Percutaneous thrombolytic device (Arrow), and the Cragg-Casteneda thrombolytic brush (Microtherapeutics). Rheolytic therapies include Angiojet, the Hydrolyzer, and the Oasis Thrombectomy System. Percutaneous mechanical thrombectomy techniques include rotational fragmentation, aspiration or suction thrombectomy, and hydrodynamic thrombectomy. AngioJet catheters may be used for percutaneous embolectomy in conjunction with pulse spray techniques, which instill thrombolytics locally. Thrombolytics include streptokinase, urokinase, and recombinant-tissue plasminogen activator. Mechanical thrombectomy combined with thrombolytics provide optimal treatment results secondary to their complementary effects. Therefore, patients who are refractory to standard medical therapy and considered poor surgical candidates may benefit from combined percutaneous mechanical thrombectomy with thrombolytics to achieve superior results if no contraindications exist for thrombolytics.

  4. Outpatient 'mini' percutaneous cystolithotomy following complex lower urinary tract reconstruction.

    PubMed

    Barber, Theodore D; DaJusta, Daniel; Gargollo, Patricio C

    2013-08-01

    To present our initial experience with "mini" percutaneous cystolithotomy performed as an outpatient procedure in patients with neurogenic bladders. Over the last 6 years, patients with neurogenic bladders and bladder calculi were managed with outpatient percutaneous cystolithotomy. All but 1 had previously undergone appendicovesicostomy (APV) creation. The procedure was performed by first passing a pediatric cystoscope per APV. Once the calculi were visualized, and following bladder distention, additional bladder access was obtained by passage of either a 16F Peel-Away introducer using the Seldinger technique or a 5 mm laparoscopic trocar under direct vision. An ultrasonic lithotripter was then advanced through the percutaneous access site and stone fragmentation completed. Following procedure completion, a catheter was placed for 24 h for bladder decompression. All procedures were performed on an outpatient basis. 12 patients underwent 18 successful operations. In 1 patient, percutaneous access was unsuccessful. Mean age at surgery was 12.3 years. Mean operative time was 72 min 8 patients had undergone previous ileocystoplasty. The remainder was rendered stone free at the completion of surgery. One patient had persistent bleeding from the intravesical trocar site necessitating fulguration and an overnight stay for observation. The remainder were sent home the same day. There were no cases of urine extravasation. "Mini" percutaneous cystolithotomy is a safe, effective technique for the outpatient management of bladder calculi. Copyright © 2012. Published by Elsevier Ltd.

  5. 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

  6. 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.

  7. 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 that...

  8. Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia Using a Single-Plane, Flat Panel Detector Angiography System: Technical Note

    PubMed Central

    ARISHIMA, Hidetaka; KAWAJIRI, Satoshi; ARAI, Hiroshi; HIGASHINO, Yoshifumi; KODERA, Toshiaki; KIKUTA, Ken-ichiro

    2016-01-01

    Percutaneous treatments for trigeminal neuralgia (TN) including glycerol rhizotomy (GR), radiofrequency thermocoagulation (RT), and balloon compression (BC) are effective for patients with medical comorbidities and risk factors of microvascular decompression (MVD). These procedures are usually performed under fluoroscopy. Surgeons advance the needle to the trigeminal plexus through the foramen ovale while observing landmarks of fluoroscopic images; however, it is sometimes difficult to appropriately place the needle tip in Meckel’s cave. We present the technical details of percutaneous GR using a single-plane, flat panel detector angiography system to check the needle positioning. When the needle tip may be located near the trigeminal cistern, three-dimensional (3-D) bone images are taken with cone-beam computed tomography (CT). These images clearly show the position of the needle tip in Meckel’s cave. If it is difficult to place it through the foramen ovale, surgeons perform cone beam CT to observe the actual position of the needle tip at the skull base. After confirming the positional relation between the needle tip and foramen ovale, surgeons can advance it in the precise direction. In 10 procedures, we could place the nerve-block needle in about 14.5 minutes on average without complications. We think that our method is simple and convenient for percutaneous treatments for TN, and it may be helpful for surgeons to perform such treatments. PMID:27041633

  9. Predictors of technical success and rate of complications of image-guided percutaneous transthoracic lung needle biopsy of pulmonary tumors.

    PubMed

    Otto, Stephan; Mensel, Birger; Friedrich, Nele; Schäfer, Sophia; Mahlke, Christoph; von Bernstorff, Wolfram; Bock, Karen; Hosten, Norbert; Kühn, Jens-Peter

    2015-01-01

    To investigate predictors of technical success and complications of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of potentially malignant pulmonary tumors. From 2008 to 2009, technical success and rate of complications of CT-guided percutaneous transthoracic lung needle biopsies of patients with suspicious pulmonary tumors were retrospectively evaluated. The influence on technical success and rate of complications was assessed for intervention-related predictors (lesion diameter, length of biopsy pathway, number of pleural transgressions, and needle size) and patient-related predictors (age, gender, reduced lung function). In addition, technical success and rate of complications were compared between different interventional radiologists. One hundred thirty-eight patients underwent biopsies by 15 interventional radiologists. The overall technical success rate was 84.1% and was significantly different between interventional radiologists (range 25%-100%; p<0.01). Intervention-related and patient-related predictors did not influence the technical success rate. The overall complication rate was 59.4% with 39.1% minor complications and 21.0% major complications. The rate of complications was influenced by lesion diameter and distance of biopsy pathway. Interventional radiologist-related rates of complications were not statistically different. Technical success of percutaneous, transthoracic lung needle biopsies of pulmonary tumors is probably dependent on the interventional radiologist. In addition, lesion diameter and length of biopsy pathway are predictors of the rate of complications.

  10. Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia Using a Single-Plane, Flat Panel Detector Angiography System: Technical Note.

    PubMed

    Arishima, Hidetaka; Kawajiri, Satoshi; Arai, Hiroshi; Higashino, Yoshifumi; Kodera, Toshiaki; Kikuta, Ken-Ichiro

    2016-05-15

    Percutaneous treatments for trigeminal neuralgia (TN) including glycerol rhizotomy (GR), radiofrequency thermocoagulation (RT), and balloon compression (BC) are effective for patients with medical comorbidities and risk factors of microvascular decompression (MVD). These procedures are usually performed under fluoroscopy. Surgeons advance the needle to the trigeminal plexus through the foramen ovale while observing landmarks of fluoroscopic images; however, it is sometimes difficult to appropriately place the needle tip in Meckel's cave. We present the technical details of percutaneous GR using a single-plane, flat panel detector angiography system to check the needle positioning. When the needle tip may be located near the trigeminal cistern, three-dimensional (3-D) bone images are taken with cone-beam computed tomography (CT). These images clearly show the position of the needle tip in Meckel's cave. If it is difficult to place it through the foramen ovale, surgeons perform cone beam CT to observe the actual position of the needle tip at the skull base. After confirming the positional relation between the needle tip and foramen ovale, surgeons can advance it in the precise direction. In 10 procedures, we could place the nerve-block needle in about 14.5 minutes on average without complications. We think that our method is simple and convenient for percutaneous treatments for TN, and it may be helpful for surgeons to perform such treatments.

  11. Percutaneous thrombin embolization of a pancreatico-duodenal artery pseudoaneurysm after failing of the endovascular treatment

    PubMed Central

    Barbiero, Giulio; Battistel, Michele; Susac, Ana; Miotto, Diego

    2014-01-01

    Pancreatico-duodenal artery (PDA) pseudoaneurysms are rare vascular conditions with high mortality rates after rupture and they are frequently secondary to pancreatitis, surgery, trauma or infection. Due to the high risk of rupture and bleeding, it is mandatory to treat all pseudoaneurysms, regardless of their size or symptomatology. First option of treatment is open surgical repair, but it has high mortality rate, especially in hemodynamically unstable patients. In the recent years, percutaneous ultrasonography (US)- or computed tomography-guided thrombin injection was proposed as an alternative method for treating visceral aneurysms and pseudoaneurysms, but few reports described this therapy in case of peri-pancreatic pseudoaneurysms. We present a rare case of pseudoaneurysm of the PDA in a patient with no previous history of pancreatitis nor major surgery but with an occlusive lesion of the celiac axis. To the best of our knowledge this is the first reported case of PDA pseudoaneurysm successfully treated in emergency by single transabdominal US-guided injection of thrombin after failed attempts of percutaneous catheterization of the feeding vessel of the pseudoaneurysm. PMID:25170402

  12. Local Control of Perivascular Malignant Liver Lesions Using Percutaneous Irreversible Electroporation: Initial Experiences

    SciTech Connect

    Eller, Achim Schmid, Axel; Schmidt, Joachim; May, Matthias Brand, Michael Saake, Marc Uder, Michael Lell, Michael

    2015-02-15

    PurposeThis study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).MethodsFourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.ResultsMedium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.ConclusionsPercutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.

  13. Percutaneous Intradiscal Aspiration of a Lumbar Vacuum Disc Herniation: A Case Report

    PubMed Central

    Pak, Kevin I.; Hoffman, David C.; Herzog, Richard J.

    2010-01-01

    We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5–S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5–S1. After a failed left L5 transforaminal epidural steroid injection, the patient was brought back for a percutaneous intradiscal aspiration of the vacuum disc gas. This resulted in immediate relief for the patient. A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain. PMID:22294964

  14. [Clinical efficacy of subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws].

    PubMed

    Yuan, Cheng-song; Tang, Kang-lai; Chen, Cheng; Hu, Chao; Zhou, Bing-hua; Xu, Jian-zhong

    2013-06-04

    To explore the clinical efficacy of subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws for severe subtalar joint arthritis. A total of 88 patients with 90 feet underwent subtalar joint fusion under four different incisions from April 2008 to April 2012. There were 56 males and 32 females with a mean age of 43.7 (15-74) years. All of them were evaluated by radiography or computed tomography (CT) scan and assessed by the rating scores of visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS). Among them, 68 cases were followed up for an average of 18.5 (6-48) months. Fusion was confirmed on radiography or CT in 67 cases with a fusion rate of 98.5%. The mean duration of fusion was 13.8 (6-28) weeks, the mean VAS score decreased from 6.00 to 1.03 points (P < 0.05) and the mean AOFAS score improved from 57.0 to 80.6 points (P < 0.05) with a good-and-excellent rate of 80.8%. Subtalar joint arthrodesis with percutaneous opposite parallel cannulated screws is recommend for severe subtalar joint arthritis. Such a procedure has a high fusion rate, excellent clinical outcomes and fewer complications.

  15. Percutaneous catheter drainage of abdominal abscesses: a five-year experience.

    PubMed

    Gerzof, S G; Robbins, A H; Johnson, W C; Birkett, D H; Nabseth, D C

    1981-09-17

    We used computed tomography (CT) and ultrasonography for detection and localization of intra-abdominal abscesses. On the basis of these images, safe routes for diagnostic aspiration and percutaneous drainage were planned. Over these routes indwelling catheters were inserted to provide immediate decompression, evacuation, and continuous drainage until the abscess resolved. All patients received concomitant intravenous antibiotics. The treatment was used for 71 abscesses in 67 patients. Sixty-one abscesses (86 per cent) were satisfactorily drained. There were 11 complications (15 per cent). Six deaths were attributable to sepsis, three of which (4 per cent) were related to inadequate drainage. There was one recurrence (1 per cent) during a follow-up period ranging from one month to five years (means, 22.3 months). The mean duration of treatment was 20.2 days (range, five to 120 days). We conclude that percutaneous drainage is an effective method for treatment of abdominal abscesses and is indicated when sectional imaging demonstrates an accessible unilocular lesion.

  16. In silico prediction of percutaneous absorption and disposition kinetics of chemicals.

    PubMed

    Chen, Longjian; Han, Lujia; Saib, Ouarda; Lian, Guoping

    2015-05-01

    To develop in-silico model for predicting percutaneous absorption and disposition kinetics of chemicals in skin layers so as to facilitate the design of transdermal drug delivery systems and skin care products, and risk assessment of occupational or consumer exposure. A general-purpose computer model for simulating skin permeation, absorption and disposition kinetics in the stratum corneum, viable dermis and dermis has been developed. Equations have been proposed for determining the partition and diffusion properties of chemicals by considering molecular partition, binding and mobility in skin layers. In vitro skin penetration data of 12 chemicals was used to validate the model. The observed and simulated permeation and disposition in skin layers were compared for 12 tested chemicals. For most tested chemicals, the experimental and model results are in good agreement with the coefficient of determination >0.80 and relative root mean squared error <1.20. The disposition kinetic parameters of the maximum concentration and the area under the curve in the viable epidermis and dermis initially increased with hydrophobicity, but reached maxima and then decreased with further increase of hydrophobicity. By considering skin physiological structure and composition, the partition and diffusion properties of chemicals in skin layers are determined. This allows in-silico simulation of percutaneous permeation, absorption and disposition kinetics of wide chemical space. The model produced results in good agreement with experimental data of 12 chemicals, suggesting a much improved framework to support transdermal delivery of drug and cosmetic actives as well as integrated risk assessment.

  17. Long-term follow-up of large symptomatic hepatic cysts treated by percutaneous ethanol sclerotherapy.

    PubMed

    Jang, Se Young; Park, Soo Young; Tak, Won Young; Kweon, Young Oh; Ryeom, Hunkyu

    2016-10-01

    As a minimally invasive treatment, ethanol sclerotherapy has been used for large symptomatic hepatic cysts, but there are not many long-term reports on treatment outcomes and safety. To evaluate the long-term outcomes of percutaneous ethanol sclerotherapy in patients with large symptomatic hepatic cysts. This study included 43 symptomatic, enlarging hepatic cysts in 42 patients who had undergone ethanol sclerotherapy from 2003 to 2013 and were followed up for >1 year. The treatment outcomes were evaluated in terms of the reduction of cyst size and resolution of symptoms. The patients were followed up for a mean period of 33 months with either ultrasound or computed tomography examination. Thirty-nine hepatic cysts (91%) were successfully treated with ethanol sclerotherapy, showing resolution of symptoms and remarkable reduction in cyst volume. Eight hepatic cysts (19%) disappeared completely, and 31 hepatic cysts (72%) decreased in size during the follow-up period. The mean diameter of the cysts decreased from 12.5 ± 4.4 cm to 3.8 ± 3.4 cm during follow-up. There were no immediate serious complications related to the procedure. There were four cases (9%) of treatment failure requiring subsequent surgical procedures. Percutaneous ethanol sclerotherapy can be considered as an effective first-line treatment for large symptomatic hepatic cysts. © The Foundation Acta Radiologica 2016.

  18. Immediate weight bearing after modified percutaneous Achilles tendon repair.

    PubMed

    Patel, Vishal C; Chandrakant, Vishal; Lozano-Calderon, Santiago; McWilliam, James

    2012-12-01

    Controversy exists regarding postoperative treatment of Achilles tendon repair. The purpose of this study was to evaluate the results of immediate weight bearing following modified percutaneous Achilles tendon repair using readily available materials. Fifty-two patients who were treated at a single center from 2000 to 2009 underwent percutaneous Achilles tendon repair by a single surgeon and were allowed immediate weight bearing. They were followed for on average of 2 years postoperatively and evaluated with functional and subjective outcomes. The average American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 96 points (range, 81 to 100), with 95% confidence interval ranging from 89.1 to 102.9. Subjective evaluation demonstrated that 47 patients (90%) were able to return to a desired level of activity, with an overall complication rate of 11.5%. Immediate weight bearing after percutaneous Achilles tendon repair had a low overall complication rate with good clinical and functional outcomes.

  19. 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

  20. Radiostereometric analysis for monitoring percutaneous physiodesis. A preliminary study.

    PubMed

    Lauge-Pedersen, H; Hägglund, G; Johnsson, R

    2006-11-01

    Percutaneous physiodesis is an established technique for treating mild leg-length discrepancy and problems of expected extreme height. Angular deformities resulting from incomplete physeal arrest have been reported, and little is known about the time interval from percutaneous physiodesis to actual physeal arrest. This procedure was carried out in ten children, six with leg-length discrepancy and four with expected extreme height. Radiostereometric analysis was used to determine the three-dimensional dynamics of growth retardation. Errors of measurement of translation were less than 0.05 mm and of rotation less than 0.06 degrees. Physeal arrest was obtained in all but one child within 12 weeks after physiodesis and no clinically-relevant angular deformities occurred. This is a suitable method for following up patients after percutaneous physiodesis. Incomplete physeal arrest can be detected at an early stage and the procedure repeated before corrective osteotomy is required.

  1. [Use of percutaneous anesthesia in cardiac pacemaker implantation].

    PubMed

    Trigano, J A; Paganelli, F; Taramasco, V; Levy, S; Lorec, A M; Blin, O; Bruguerolle, B

    Assess the efficacy of an anesthesic cream for pacemaker implantations. Percutaneous anesthesia was studied in a series of permanent pacemaker transvenous implantations. The anesthesic cream composed of a mixture of lidocaine and prilocaine was applied precisely over operative areas after marking the skin. Percutaneous anesthesia should be applied 2 hours before entering the operating room. This percutaneous local anesthesia was perfectly effective for simple replacement procedures. At first implantations, it was used alone in 4 out of 10 cases while intradermal injections were needed to anesthetize the deep layers in the other patients. Serum concentrations indicate very low levels which are tolerated very well. Alone or combined with lidocaine infiltration, the use of an anesthesic cream is safe and effective in transvenous pacemaker surgery.

  2. Percutaneous peritoneovenous shunt positioning: technique and preliminary results.

    PubMed

    Orsi, Franco; Grasso, Rosario Francesco; Bonomo, Guido; Monti, Cinzia; Marinucci, Irene; Bellomi, Massimo

    2002-05-01

    Nine peritoneovenous shunts were positioned by percutaneous technique in seven patients with advanced malignancy causing severe refractory ascites, and in two patients with hepatic cirrhosis (one with hepatocarcinoma). In all patients the shunts were percutaneously placed through the subclavian vein in the angiographic suite under digital fluoroscopic guide. No complications directly related to the procedure occurred. The shunt was successfully positioned in all patients in 60 min average time. No patient showed symptoms related to pulmonary overload or to disseminated intravascular coagulation. All patients had a significant improvement of the objective symptoms related to ascites such as respiratory symptoms, dyspepsia, and functional impairment to evacuation describing an improvement of their quality of life. Maximum shunt patency was 273 days. Percutaneous placement of peritoneovenous shunt is a safe, fast, and inexpensive procedure, extremely useful in resolution of refractory ascites, reducing symptoms, and allowing effective palliation, with a great improvement in quality of life.

  3. CT guided percutaneous needle biopsy of the chest: initial experience

    PubMed Central

    Lazguet, Younes; Maarouf, Rachid; Karrou, Marouan; Skiker, Imane; Alloubi, Ihsan

    2016-01-01

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015. Diagnosis was achieved in 18 patients (75%), negative results were found in 3 patients (12,5%). Biopsy was repeated in these cases with two positive results. Complications were seen in 7 patients (29%), Hemoptysis in 5 patients (20%), Pneumothorax in 1 patient (4,1%) and vaso-vagal shock in 1 patient (4,1%). CT Guided Percutaneous Needle Biopsy of the Chest is a safe, minimally invasive procedure with high sensitivity, specificity and accuracy for diagnosis of lung lesions. PMID:27347300

  4. Complications of percutaneous thoracostomy in neonates and infants.

    PubMed

    Reed, R C; Waters, B L; Siebert, J R

    2016-04-01

    Percutaneous thoracostomy tubes are widely used in neonates, infants and children. The technique has a low complication rate. Lung perforation by a pigtail catheter is described in a single case report. This is a multi-center case series of neonates and infants who experienced thoracic organ injury following percutaneous chest tube placement between 2006 and 2015. Eleven patients had chest tube-related thoracic organ injury. In six, tubes were placed during resuscitation. Gestational ages ranged from 24+6 weeks to term. Most of the chest tubes were pigtail catheters, and the most common injury was lung lobe perforation. Pericardium and mediastinum were also sites of injury. Some patients had small pleural effusions, with no other complications identified. Thoracic organ injury by percutaneous catheters may be more common than previously appreciated. Clinical and radiological findings are non-specific, and the diagnosis may not be apparent until autopsy.

  5. Percutaneous dilatational tracheostomy following total artificial heart implantation.

    PubMed

    Spiliopoulos, Sotirios; Dimitriou, Alexandros Merkourios; Serrano, Maria Rosario; Guersoy, Dilek; Autschbach, Ruediger; Goetzenich, Andreas; Koerfer, Reiner; Tenderich, Gero

    2015-07-01

    Coagulation disorders and an immune-altered state are common among total artificial heart patients. In this context, we sought to evaluate the safety of percutaneous dilatational tracheostomy in cases of prolonged need for mechanical ventilatory support. We retrospectively analysed the charts of 11 total artificial heart patients who received percutaneous dilatational tracheostomy. We focused on early and late complications. We observed no major complications and no procedure-related deaths. Early minor complications included venous oozing (45.4%) and one case of local infection. Late complications, including subglottic stenosis, stomal infection or infections of the lower respiratory tract, were not observed. In conclusion, percutaneous dilatational tracheostomy in total artificial heart patients is safe. Considering the well-known benefits of early tracheotomy over prolonged translaryngeal intubation, we advocate early timing of therapy in cases of prolonged mechanical ventilation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. [Percutaneous tracheostomy in intensive care medicine - Update 2012].

    PubMed

    Kunz, Tina; Strametz, Reinhard; Gründling, Matthias; Byhahn, Christian

    2012-10-01

    Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation. To date, there is no evidence of the optimal timing of the procedure. The Ciaglia Blue Rhino technique is the most common technique and, as any other techniques of percutaneous tracheostomy, is performed under general anaesthesia and with continuous bronchoscopic control. The recently introduced Ciaglia Blue Dolphin technique is based on radial dilatation with a fluid-filled high pressure balloon. Provided that specific contraindications are observed (e.g. difficult tracheal intubation, inability to identify anatomic landmarks, severe coagulopathy etc.), all techniques have low complication rates. The use of ultrasound may further enhance perioperative safety. Finally it must be noted that percutaneous tracheostomy is an elective procedure that requires informed consent from the patient or an attorney of law.

  7. Use of intraoperative isocentric C-arm 3D fluoroscopy for sextant percutaneous pedicle screw placement: case report and review of the literature.

    PubMed

    Acosta, Frank L; Thompson, Timothy L; Campbell, Stacey; Weinstein, Philip R; Ames, Christopher P

    2005-01-01

    Three-dimensional (3D) fluoroscopy-based image guidance system using an isocentric C-arm (Iso-C) fluoroscope was shown to be as effective as computed tomography-based systems in guiding the accurate percutaneous placement of lumbar pedicle screws in cadavers. To date, however, no description is available of the intraoperative use of 3D fluoroscopy to guide lumbar pedicle screw placement in an actual spinal fusion procedure. We report a case in which isocentric 3D fluoroscopic images, along with image-guidance software, were used to guide the placement of percutaneous pedicle screws for fusion in a patient with degenerative spondylolisthesis. Operating room of a large academic medical center during the placement of percutaneous pedicle screws in a patient with degenerative spondylolisthesis. A percutaneous dynamic reference array was attached to the L3 spinous process. A satisfactory image set was obtained and automatically registered. The L4 and L5 pedicles were localized, and pedicle holes were then cannulated, drilled and tapped. A screw was then inserted using the Sextant system for percutaneous pedicle screws. In this manner, bilateral pedicle screws were inserted into the L4-L5 pedicles. All steps of pedicle cannulation were performed under Iso-C 3D image guidance. A postoperative computed tomography scan showed accurate placement of all pedicle screws. The patient experienced an improvement in leg pain with no new neurologic deficits. The present case is the first case to demonstrate the intraoperative use of a 3D fluoroscopy-based image-guidance system for accurate navigation during lumbar pedicle screw placement.

  8. Development Of an Experimental Animal Model For Lower Back Pain By Percutaneous Injury-Induced Lumbar Facet Joint Osteoarthritis

    PubMed Central

    Kim, Jae-Sung; Ahmadinia, Kasra; Li, Xin; Hamilton, John L; Andrews, Steven; Haralampus, Chris A.; Xiao, Guozhi; Sohn, Hong-Moon; You, Jae-Won; Seo, Yo-Seob; Stein, Gary S.; Wijnen, Andre J Van; Kim, Su-Gwan; Im, Hee-Jeong

    2015-01-01

    We report generation and characterization of pain-related behavior in a minimally-invasive facet joint degeneration (FJD) animal model in rats. FJD was produced by a non-open percutaneous puncture-induced injury on the right lumbar FJs at three consecutive levels. Pressure hyperalgesia in the lower back was assessed by measuring the vocalization response to pressure from a force transducer. After hyperalgesia was established, pathological changes in lumbar FJs and alterations of intervertebral foramen size were assessed by histological and imaging analyses. To investigate treatment options for lumber FJ osteoarthritis-induced pain, animals with established hyperalgesia were administered with analgesic drugs, such as morphine, a selective COX-2 inhibitor, a non-steroidal anti-inflammatory drug (NSAID) (ketorolac), or pregabalin. Effects were assessed by behavioral pain responses. One week after percutaneous puncture-induced injury of the lumbar FJs, ipsilateral primary pressure hyperalgesia developed and was maintained for at least 12 weeks without foraminal stenosis. Animals showed decreased spontaneous activity, but no secondary hyperalgesia in the hind paws. Histopathological and microfocus X-ray computed tomography analyses demonstrated that the percutaneous puncture injury resulted in osteoarthritis-like structural changes in the FJs cartilage and subchondral bone. Pressure hyperalgesia was completely reversed by morphine. The administration of celecoxib produced moderate pain reduction with no statistical significance while the administration of ketorolac and pregabalin produced no analgesic effect on FJ osteoarthritis-induced back pain. Our animal model of non-open percutanous puncture-induced injury of the lumbar FJs in rats shows similar characteristics of low back pain produced by human facet arthropathy. PMID:25858171

  9. 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

  10. Percutaneous management of cyanosis in Fontan patients using Amplatzer occluders.

    PubMed

    Masura, Jozef; Bordacova, Lucia; Borodacova, Lucia; Tittel, Peter; Berden, Pavel; Podnar, Tomaz

    2008-05-01

    To determine causes of cyanosis and to evaluate percutaneous management of cyanosis in a group of consecutive Fontan patients. A variety of communications allow a right-to-left shunt in Fontan circulation causing cyanosis and these communications are amenable to percutaneous closure. Between November 1997 and November 2007, 45 consecutive patients ranging in age from 2.5 to 26 years (median 8 years) with Fontan circulation and cyanosis underwent cardiac catheterization and percutaneous closure of superfluous communications using different types of Amplatzer occluders. Altogether, 51 communications were detected and 50 of them were closed. In 5 patients (11.1%), multiple communications were present and were closed. Fenestration was detected in 37 of 41 patients (90.2%) after total cavopulmonary connection and all were closed by Amplatzer septal occluders. Five venous collaterals were revealed in 3 of 41 patients (7.3%) with total cavopulmonary anastomosis and were closed by Amplatzer vascular plugs. In 3 patients, lateral tunnel leaks were detected and were closed by Amplatzer PFO occluders. In 4 patients after Kawashima operation, 3 major pulmonary arterio-venous malformations and single venous collateral contributed to the cyanosis and all were closed using Amplatzer vascular plugs. Different communications cause cyanosis in Fontan patients. Progressive decline of percutaneous oxygen saturation is suggestive of development of venous collaterals or pulmonary arteriovenous malformations. Superfluous communications are amenable to percutaneous closure using various types of Amplatzer occluders. A novel use of an Amplatzer PFO occluder for the percutaneous closure of a lateral tunnel leak is described. 2008 Wiley-Liss, Inc.

  11. 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

  12. 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

  13. Double-orifice mitral valve treated by percutaneous balloon valvuloplasty.

    PubMed

    Varghese, Thomas George; Revankar, Vinod Raghunath; Papanna, Monica; Srinivasan, Harshini

    2016-07-01

    Double-orifice mitral valve is an rare anomaly characterized by a mitral valve with a single fibrous annulus and 2 orifices that open into the left ventricle. It is often associated with other congenital anomalies, most commonly atrioventricular canal defects, and rarely associated with a stenotic or regurgitant mitral valve. A patient who was diagnosed with congenital double-orifice mitral valve with severe mitral stenosis was treated successfully by percutaneous balloon mitral valvotomy rather than the conventional open surgical approach, demonstrating the utility of percutaneous correction of this anomaly.

  14. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy.

    PubMed

    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.

  15. 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.

  16. [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.

  17. Management of hypertension in patients during percutaneous dialysis access interventions.

    PubMed

    Gandhi, Bhavika V; Patel, Tejas B; Costanzo, Eric J; Masud, Avais; Mehandru, Sushil; Salman, Loay

    2017-09-11

    Not infrequently, interventionalists are faced with a patient with increased blood pressure who is about to undergo a dialysis access intervention such as tunneled hemodialysis catheter, percutaneous balloon angioplasty, or declotting procedure for a clotted arteriovenous access. This can frequently create a dilemma as functional dialysis access is needed to provide dialysis therapy and delaying treatment could result in a life-threatening situation, particularly in the presence of hyperkalemia. This article investigates hypertension in patients undergoing percutaneous dialysis access interventions and provides guidance to their management.

  18. 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.

  19. Percutaneous imaging-guided cryoablation for lung cancer

    PubMed Central

    Zhang, Yi-Shi; Niu, Li-Zhi; Zhan, Ke; Li, Zhong-Hai; Huang, Yu-Gang; Yang, Yi; Chen, Ji-Bing

    2016-01-01

    Percutaneous cryoablation under imaging guidance has been proved to be a safe and effective method for ablation and debulking of tumors, providing radical cure or palliation, as the case may be, for patients with different stages of disease. The local control rate is high with cryoablation, and the complications are usually controllable, making it a reasonable choice in lung cancer treatment. In this paper the technique and mechanism of action of cryoablation are summarized, and studies performed on the application of percutaneous cryoablation in various stages of lung cancer are reviewed. Its emerging application in the treatment of pure ground-glass nodules (GGNs) is also introduced. PMID:28066673

  20. Superior Mesenteric Artery Syndrome Treated with Percutaneous Radiologic Gastrojejunostomy.

    PubMed

    Choi, Jeong Woo; Lee, Ju Young; Cho, Hyeon Geun

    2016-06-25

    Superior mesenteric artery (SMA) syndrome is a rare condition that must be differentiated from other gastrointestinal diseases manifesting as upper abdominal pain, nausea, or vomiting. The description of SMA syndrome is compression of the third portion of the duodenum by the SMA and the abdominal aorta. SMA syndrome is managed with nasoenteral nutrition or surgical strategies such as laparoscopic duodenojejunostomy. However, SMA syndrome treated using enteral nutrition by percuta-neous radiologic gastrojejunostomy has not been reported. Here, we report our experience of successfully managing a case of SMA syndrome with percutaneous radiologic gastrojejunostomy.

  1. Percutaneous imaging-guided cryoablation for lung cancer.

    PubMed

    Zhang, Yi-Shi; Niu, Li-Zhi; Zhan, Ke; Li, Zhong-Hai; Huang, Yu-Gang; Yang, Yi; Chen, Ji-Bing; Xu, Ke-Cheng

    2016-10-01

    Percutaneous cryoablation under imaging guidance has been proved to be a safe and effective method for ablation and debulking of tumors, providing radical cure or palliation, as the case may be, for patients with different stages of disease. The local control rate is high with cryoablation, and the complications are usually controllable, making it a reasonable choice in lung cancer treatment. In this paper the technique and mechanism of action of cryoablation are summarized, and studies performed on the application of percutaneous cryoablation in various stages of lung cancer are reviewed. Its emerging application in the treatment of pure ground-glass nodules (GGNs) is also introduced.

  2. Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization.

    PubMed

    Kang, Dong Hun; Park, Ji Won; Jeon, Eui Yong; Kim, Sung Eun; Kim, Jong Hyeok; Kwon, Young Seok; Park, Seung Ah; Park, Choong Kee

    2015-11-01

    Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.

  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. Percutaneous epicardial ablation in ventricular arrhythmias.

    PubMed

    Galvão Santos, Pedro; Cavaco, Diogo; Adragão, Pedro; Scanavacca, Mauricio; Reis Santos, Katya; Belo Morgado, Francisco; Carmo, Pedro; Costa, Francisco; Bernardo, Ricardo; Nunes, Manuela; Abecasis, Miguel; Neves, José; Mendes, Miguel

    2014-05-01

    Reentrant circuits of ventricular tachycardia may involve not only the endocardium but also the epicardium. Epicardial ablation can be useful in these situations. The aim of this study was to assess efficacy, safety and complications in a series of consecutive patients who underwent ablation of ventricular tachycardia with epicardial mapping. The study included all patients undergoing ventricular tachycardia ablation with epicardial mapping from 2004 to 2012. Of a total of 95 ablations, an epicardial approach was attempted in nine patients, eight male, mean age 58±12 years. Endocardial mapping was performed in all patients previously or simultaneously. The etiology of the arrhythmia was non-ischemic in eight patients and ischemic in one. We compared the number of events in the six months prior to the epicardial procedure and six months after. Percutaneous epicardial access was achieved in eight patients. In one case it was not possible due to the presence of adhesions. In none of the patients was the procedure repeated and there were no major complications during hospitalization. In a mean follow-up of 3.5±1.2 years, one patient suffered stroke; there were no other medium-to-long-term complications and the number of ventricular tachycardia episodes was reduced in all patients after ablation. Epicardial radiofrequency ablation of ventricular tachycardia was effective in reducing morbidity in eight patients, with a low risk of complications in the short and medium-to-long term. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Percutaneous penetration enhancers in cigarette mainstream smoke.

    PubMed

    Smith, Carr J; Perfetti, Thomas A; Garg, Rajni; Martin, Patricia; Hansch, Corwin

    2004-01-01

    Percutaneous penetration enhancers (PPEs) are chemicals used to enhance the transdermal delivery of drugs. Fifty-eight of the approximately 150 PPEs used for the transdermal delivery of drugs have been reported in cigarette mainstream smoke (MS). MS is a complex aerosol of minute liquid droplets (termed the particulate phase) suspended within a mixture of gases (CO(2), CO, NO(x), etc.) and semi-volatile compounds. The gases and many of the semi-volatiles are termed the vapor phase. Twenty-nine of the 58 PPEs have been identified in MS vapor phase, 15 in the particulate phase and 14 in both the vapor and particulate phases. There is a tendency for MS PPEs to be hydrophobic, with 40 of the 58 compounds (69%) being either hydrophobic or strongly hydrophobic, and only 24% being hydrophilic. Many of the 4800 known constituents of MS are hydrophilic and would not be expected to readily cross cell membranes or penetrate tissue when delivered as single compounds. The in vivo effect on biological activity of the juxtaposition within the cigarette smoke aerosol of the large number of hydrophilic constituents with the 58 PPEs is currently unknown. As an initial step in understanding this potential complex interaction, the 58 PPEs in MS have been identified and a number of molecular parameters related to the ability to penetrate tissue have been calculated, including MS concentration, measured and calculated base ten logarithm of the octanol-water partition coefficient (Mlog P and Clog P), molecular volume (MgVol) and calculated molar refractivity (CMR).

  6. 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

  7. Two Cases of Lethal Complications Following Ultrasound-Guided Percutaneous Fine-Needle Biopsy of the Liver

    SciTech Connect

    Drinkovic, Ivan; Brkljacic, Boris

    1996-09-15

    Two cases with lethal complications are reported among 1750 ultrasound (US)-guided percutaneous fine-needle liver biopsies performed in our department. The first patient had angiosarcoma of the liver which was not suspected after computed tomography (CT) and US studies had been performed. The other patient had hepatocellular carcinoma in advanced hepatic cirrhosis. Death was due to bleeding in both cases. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in either case. Normal liver tissue was interposed in the needle track between the liver capsule and the lesions which were targeted.

  8. Percutaneous Transhepatic Duodenal Drainage as an Alternative Approach in Afferent Loop Obstruction with Secondary Obstructive Jaundice in Recurrent Gastric Cancer

    SciTech Connect

    Yao, N.-S.; Wu, C.-W.; Tiu, Chui-Mei; Liu, Jacqueline M.; Whang-Peng, Jacqueline; Chen, L.-T.

    1998-07-15

    Two cases are reported of chronic, partial afferent loop obstruction with resultant obstructive jaundice in recurrent gastric cancer. The diagnosis was made by characteristic clinical presentations, abdominal computed tomography, and cholescintigraphy. Percutaneous transhepatic duodenal drainage (PTDD) provided effective palliation for both afferent loop obstruction and biliary stasis. We conclude that cholescintigraphy is of value in making the diagnosis of partial afferent loop obstruction and in differentiating the cause of obstructive jaundice in such patients, and PTDD provides palliation for those patients in whom surgical intervention is not feasible.

  9. Side-wire technique for percutaneous pulmonary balloon valvuloplasty.

    PubMed

    Cay, Serkan; Atak, Ramazan

    2011-07-01

    On occasion during percutaneous pulmonary balloon valvuloplasty, a small balloon may slip into the pulmonary artery when dilating a stenotic pulmonary valve. In order to stabilize the balloon should a larger balloon size not be available, a side wire can be used without changing the original balloon.

  10. Use of Stone Cone minimizes stone migration during percutaneous nephrolithotomy.

    PubMed

    Springhart, W Patrick; Tan, Yeh Hong; Albala, David M; Perelman, Jason; Teichman, Joel M; Preminger, Glenn M

    2006-05-01

    We describe a simple and effective method using the Stone Cone to prevent migration of stone fragments into the ureter during percutaneous nephrolithotomy. This maneuver may reduce the need for antegrade ureteroscopy to remove residual fragments, thereby saving time and obviating the need for placement of an occlusion balloon.

  11. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention.

    PubMed

    ten Berg, Jurriën M; Plokker, HW Thijs; Verheugt, Freek WA

    2001-01-01

    Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  12. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention

    PubMed Central

    ten Berg, Jurriën M; Plokker, HW Thijs; Verheugt, Freek WA

    2001-01-01

    Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used. PMID:11806786

  13. Percutaneous Ablation of an Internal Iliac Aneurysm Using Tissue Adhesive

    SciTech Connect

    Owen, Richard J.T.; Jackson, Ralph; Loose, Henry W.; Lees, Timothy A.; Dunlop, Paul; Rose, John D.G.

    2000-09-15

    We report the percutaneous injection of tissue adhesive (Tisseal, Immuno, Vienna, Austria) to ablate a 12-cm internal iliac aneurysm. The complex history of this lesion included previous surgery for a ruptured aortic aneurysm, attempted repair of the internal iliac aneurysm, and several embolization procedures. These factors precluded further open repair or transcatheter techniques and dictated the choice of a more direct approach.

  14. Osteoid osteoma of the cuboid managed by percutaneous radiofrequency ablation.

    PubMed

    Chakraverty, Julian; Al-Mokhtar, Namir; James, Steven L

    2014-01-01

    We present details of a case of osteoid osteoma of the tarsal cuboid bone. Osteoid osteoma arising in the foot is not very common, and localization in the cuboid is rare. To our knowledge, this is the first case of osteoid osteoma of the cuboid bone treated successfully by percutaneous radiofrequency ablation.

  15. Correction of angular deformities of the knee by percutaneous hemiepiphysiodesis.

    PubMed

    Inan, Muharrem; Chan, Gilbert; Bowen, J Richard

    2007-03-01

    Predicting patients' remaining angular growth and timing for hemiepiphysiodesis are crucial for correcting coronal plane knee deformities in children. We asked whether the Angular Deformity Versus Growth Remaining Chart predicted correction of coronal angular deformities of the knee in children. Serial orthoroentgenograms and the predictive chart were used to time percutaneous hemiepiphysiodesis, and the children were followed until skeletal maturity. Twenty-five consecutive children (35 extremities) with a mean skeletal age of 13 years (range, 9.6-16 years) had percutaneous hemiepiphysiodeses as described by Bowen and Johnson, and were followed up until skeletal maturity. At skeletal maturity, correction of varus and valgus coronal plane deformities were within 2 degrees (range, 0 degrees - 6 degrees) of the predicted value. The maximum limb-length discrepancy resulting from the procedure was 1.5 cm. The only complication was failure of a physeal bar formation hemiepiphysiodesis; this was treated successfully with a repeat percutaneous hemiepiphysiodesis. The percutaneous hemiepiphysiodesis is effective and has a low complication rate. Angular correction and timing for hemiepiphysiodesis can be predicted by using the Angular Deformity Versus Growth Remaining Chart in children with coronal plain knee deformities.

  16. Gastric Wall Dissection as a Complication of Percutaneous Gastrostomy

    SciTech Connect

    Reimer, Wolfgang; Farres, Maria Teresa; Lammer, Johannes

    1996-04-15

    A percutaneous gastrostomy (PG) was complicated by gastric wall dissection and partial tube malposition. It occurred after tangential puncture along the greater curvature of the stomach which was performed in order to avoid an enlarged left lobe of the liver. To prevent this complication we recommend not using hydrophilic guidewires during PG.

  17. Pneumoperitoneum with Subcutaneous Emphysema after Percutaneous Endoscopic Gastrostomy

    PubMed Central

    Karip, Bora; Ozcabi, Yetkin; Ağca, Birol; Alahdab, Yesim; Memisoglu, Kemal

    2014-01-01

    Percutaneous endoscopic gastrostomy is a safe way for enteral nutrition in selected patients. Generally, complications of this procedure are very rare but due to patients general health condition, delayed diagnosis and treatment of complications can be life threatening. In this study, we present a PEG-related massive pneumoperitoneum and subcutaneous emphysema in a patient with neuro-Behçet. PMID:25120935

  18. Clinical outcome after percutaneous flexor tenotomy in forefoot surgery.

    PubMed

    Debarge, Romain; Philippot, Rémy; Viola, Jérémy; Besse, Jean Luc

    2009-10-01

    The aim of this study was to evaluate the outcome of the percutaneous flexor tenotomy. We compared the results of two groups. The first group included 23 patients who underwent forefoot surgery without percutaneous flexor tenotomy, and the second group included 50 patients who underwent the same procedure combined with percutaneous flexor tenotomy for claw toe deformities, secondary to shortening metatarsal Scarf osteotomy. The average follow-up was 11.6 months. Three algoneurodystrophies were noted. No delayed wound healing was observed. Functional dissatisfaction rate (18% vs.17.4%) and toe pulp contact defect (12% vs. 8.7%) were not significantly different in the two groups. Toe grasping defect rate (10% vs. 4.3%) was superior in the tenotomy group. Five recurring claw toe deformities of the second toe were noted in the tenotomy group. Percutaneous flexor tenotomy is a simple, rapid, and efficient method to correct reducible secondary claw toe deformities. However, despite a significant postoperative loss of toe grasping function, no patient reported major dissatisfaction.

  19. CT-guided percutaneous biopsies of head and neck masses

    SciTech Connect

    Gatenby, R.A.; Mulhern, C.B. Jr.; Strawitz, J.

    1983-03-01

    Six patients underwent CT-guided percutaneous pharyngeal or laryngeal biopsies. A retromandibular approach was used in five of these patients. Accurate cytologic information was obtained in all six cases, and no complications were encountered. This technique can be helpful in certain clinical settings.

  20. Stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage.

    PubMed

    Ergun, T; Akin, A; Lakadamyali, H

    2011-01-01

    Xanthogranulomatous pyelonephritis (XPN) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma. Its standard therapy consists of total or partial nephrectomy. A case of stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage is presented in this paper.

  1. [Percutaneous nephropexy in the treatment of renal ptosis].

    PubMed

    Castillo Rodríguez, M; Larrea Masvidal, E; Hernández Silverio, D; Carauna Valdes-Gómez, A; Labrada Rodríguez, M V; Cuesta Megias, T

    1999-04-01

    Surgical fixation of ptotic kidneys has been utilized since the late nineties of the last century and more than 170 techniques have been described in the literature, all of which are by open surgery. The efficacy of a new percutaneous nephropexy procedure is described herein. The technique basically consists in the fixation of the organ in its normal position by fibrous ligation created by a nephrostomy (preferably loop nephrostomy) and a nephropyeloureteral catheter inserted percutaneously. Our technique of percutaneous nephropexy was performed in 15 female patients with marked right renal ptosis, a long history of pain, which was complicated by lithiasis in the same kidney in 5 cases, and in whom medical treatment had repeatedly failed. At 6-14 months' follow-up, all of the patients are asymptomatic with negative urological cultures, no calculi, kidney in normal position and ureter corrected. The results demonstrate that our percutaneous nephropexy technique is an effective alternative treatment for the old and unresolved problem of renal ptosis.

  2. 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.

  3. 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

  4. 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.

  5. Percutaneous tibial nerve stimulation for patients with faecal incontinence.

    PubMed

    Allison, Marion

    Percutaneous tibial nerve stimulation (PTNS) is a new, non-invasive treatment for faecal incontinence. It is given in an outpatient setting and has few side effects. An increasing number of studies confirm its efficacy. This article discusses the procedure, reports early experiences of using PTNS at one centre in the UK and considers cost effectiveness.

  6. 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.

  7. Delayed rupture of renal artery after renal percutaneous transluminal angioplasty

    SciTech Connect

    Puijlaert, C.B.A.J.; Mali, W.P.; Rosenbusch, G.; van Straalen, A.M.; Klinge, J.; Feldberg, M.A.M.

    1986-06-01

    Two cases are reported in which rupture of the renal artery occurred many hours after renal percutaneous transluminal angioplasty. Delayed rupture can be recognized by the angiographic appearance and by the presence of persistent flank pain. The typical angiographic finding is a poorly defined zone of contrast medium at the site of perforation.

  8. Percutaneous coronary intervention in nonagenarians: pros and cons

    PubMed Central

    Biondi Zoccai, Giuseppe; Abbate, Antonio; D'Ascenzo, Fabrizio; Presutti, Davide; Peruzzi, Mariangela; Cavarretta, Elena; Marullo, Antonino G.M.; Lotrionte, Marzia; Frati, Giacomo

    2013-01-01

    Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians. PMID:23610578

  9. 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.

  10. Right Atrial Clot Formation Early after Percutaneous Mitral Balloon Valvuloplasty

    PubMed Central

    Ateş, Ahmet Hakan; Aksakal, Aytekin; Yücel, Huriye; Atasoy Günaydın, İlksen; Ekbul, Adem; Yaman, Mehmet

    2016-01-01

    Mitral balloon valvuloplasty which has been used for the treatment of rheumatic mitral stenosis (MS) for several decades can cause serious complications. Herein, we presented right atrial clot formation early after percutaneous mitral balloon valvuloplasty which was treated successfully with unfractioned heparin infusion. PMID:28105049

  11. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  12. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  13. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  14. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  15. 21 CFR 870.1310 - Vessel dilator for percutaneous catheterization.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vessel dilator for percutaneous catheterization. 870.1310 Section 870.1310 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1310...

  16. 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.

  17. 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.

  18. Percutaneous management of postoperative duodenal stump leakage with foley catheter.

    PubMed

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

    2013-10-01

    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. 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. 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. 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.

  19. [Primary percutaneous coronary interventions in Iceland].

    PubMed

    Libungan, Berglind Gerda; Eyjolfsson, Kristjan; Thorgeirsson, Gudmundur

    2008-02-01

    Acute coronary angiography with primary percutaneous coronary intervention (PCI), if executed with sufficient expertise and without undue delay, is the best therapy for patients with ST-elevation myocardial infarction (STEMI). At Landspitali-University Hospital 24 hour on-call service has been provided since December the 1st 2003. This hospital is the single center for all coronary catherizations in Iceland. This report is a review of this service during the first year. Retrospective review was carried out of all hospital records and PCI worksheets of those who had an acute coronary angiography from December 1st 2003 until November 30th 2004. A total of 124 patients were investigated with acute coronary angiography, 94 men (76%) and 30 women (24%). The average age of men was 61 years (range 19 to 85 years) and women 67 years (range 38 to 84 years). The primary indication for acute coronary angiograpy was STEMI (83%), 8% non ST-elevation myocardial infarction (NSTEMI) and for the remaining 9% the procedure was performed for other reasons. Eleven patients (9%) suffered cardiac arrest prior to angiography and ten (8%) were in cardiogenic shock upon arrival to the hospital. The mean door-to-needle time was 47 minutes for all STEMI patients. In 76% of the cases the procedure started within 60 minutes and in 91% within the recommended 90 minutes. Mean hospital stay was 5 (1/2) days. Total mortality was 7% (9 patients). Of those 9 patients 5 were in cardiogenic shock at the arrival to the hospital and 4 had suffered cardiac arrest. The mortality rate among those who were neither in cardiogenic shock upon admission nor having suffered cardiac arrest was 1,7% (2 patients). During follow up for 15-27 months nine of the patients needed CABG and nine needed a repeat PCI. The experience of a 24 hour on-call service at Landspitali-University Hospital to carry out primary PCI for all patients in Iceland with STEMI proved excellent during its first year, with a short door

  20. Percutaneous osteosynthesis of Galeazzi fracture-dislocation.

    PubMed

    Gadegone, Wasudeo M; Salphale, Yogesh; Magarkar, Ds

    2010-10-01

    A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ). The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation. We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years). Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist. In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results. Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the medullary canal and anchorage they gain in the radial diaphysis. Elastic nailing

  1. Percutaneous osteosynthesis of Galeazzi fracture-dislocation

    PubMed Central

    Gadegone, Wasudeo M; Salphale, Yogesh; Magarkar, DS

    2010-01-01

    Background: A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radio-ulnar joint (DRUJ). The conventional surgical technique of nailing does not give enough stability and open reduction, internal fixation with the plate is associated with numerous complications. The stacked nailing for the management of these injuries provides adequate stability, maintains the relationship of the DRUJ and promotes uneventful union by closed technique. The purpose of this study is to evaluate the results of simple, user-friendly, low cost elastic stacked nailing for the management of Galeazzi fracture dislocation. Materials and Methods: We treated 22 young adults with fresh Galeazzi fracture-dislocation of the forearm, from January 2004 to January 2008, by percutaneous fixation of fracture by stacked elastic nailing at our institute. There were 19 males and three females and the age group ranged from 20-56 years (average 35 years). Surgery was performed within 48 to 72 hours under the guidance of image intensifier. Medullary cavity was filled with two elastic titanium nails having unequal lengths and diameter. One nail acts as a reduction nail and the other acts as a stabilizing nail. The results were evaluated using Mikic criteria based on union, alignment, relationship of the DRUJ, and movements at the inferior radio ulnar joint, elbow and wrist. Results: In six cases, following radiological union, nails in the radius were extracted between six to nine months after operation because of discomfort complained by the patient at site of insertion. After one year follow-up, 18 patients had excellent, four had fair results. Conclusion: Closed reduction and internal fixation of Galeazzi fracture by two elastic rods re-establishes the normal relationship of the fractured fragments and the DRUJ without repair of the ligaments. The stability is achieved by the flexibility and elasticity of the nails, crowding of the medullary canal and

  2. Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

    SciTech Connect

    Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A. Sugimura, Kazuro

    2006-12-15

    A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy.

  3. 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.

  4. Symptomatic Middle Cerebral Artery Stenosis Treated by Percutaneous Transluminal Angioplasty: Improvement of Cerebrovascular Reserves

    PubMed Central

    Abe, A.; Ueda, T.; Ueda, M.; Nogoshi, S.; Nishiyama, Y.; Katayama, Y.

    2012-01-01

    Summary This study evaluated the recoveries of cerebrovascular reserves (CVR) after applying percutaneous transluminal angioplasty (PTA) to patients with symptomatic middle cerebral artery (MCA) stenosis of varying severity. The patients were submitted to single photon emission computed tomography (SPECT) to obtain their regional cerebral blood flows at resting stage (rCBFrest) and acetazolamide-challenged CBF in five regions of interest (ROIs), including the MCA, on the ipsilateral and contralateral sides of the hemisphere. rCVR values were then calculated from these CBF data to evaluate the CVR recoveries after PTA treatment. When the PTA effects were statistically analyzed of the patients dichotomized into more severe (n=9) and less severe (n=5) groups, distinctly significant ROI-specific PTA effectiveness was observed for CVR rather than CBF values in the patients of the severer group. PMID:22681739

  5. Hepatic Encephalopathy due to Congenital Multiple Intrahepatic Portosystemic Venous Shunts Successfully Treated by Percutaneous Transhepatic Obliteration

    PubMed Central

    Takenaga, Shinsuke; Narita, Kenichi; Matsui, Yo; Fukuda, Kunihiko

    2016-01-01

    Hepatic encephalopathy due to intrahepatic portosystemic venous shunts (IPSVS) in a non-cirrhotic condition is rare. Here we report a rare case of a patient with congenital multiple IPSVS successfully treated by percutaneous transhepatic obliteration. The patient was a 67-year-old woman who presented to our hospital with progressive episodes of consciousness disorder and vomiting. Laboratory tests revealed hyperammonemia (192.0 μg/dL), and computed tomography revealed multiple IPSVS in both lobes. There was no evidence of underlying liver disease or hepatic trauma. Transcatheter embolization for IPSVS was performed because conservative therapy was not sufficiently effective. After endovascular shunt closure, hepatic encephalopathy improved. The serum ammonia level normalized during the 5-year follow-up period. Thus, transcatheter embolization may be an effective therapy for patients with symptomatic and refractory IPSVS. Careful follow-up is necessary for portal hypertension-related complications after transcatheter embolization for IPSVS. PMID:27990104

  6. Pressure monitoring inside Meckel's cave during percutaneous microcompression of gasserian ganglion.

    PubMed

    Zanusso, M; Curri, D; Landi, A; Colombo, F; Volpin, L; Cervellini, P

    1991-01-01

    During percutaneous microcompression of the gasserian ganglion for the relief of trigeminal neuralgia, a computerized technique for monitoring the pressure inside Meckel's cave was employed in 22 patients. A dedicated transducer connected to a computer records the balloon inflation pressure. Its variations are discernible within tenths of a bar and are plotted in relation to time. The intraoperative pressure inside Meckel's cave is from 0.9 to 2.4 bars. When pressure was low, there was recurrence of pain. The highest values of pressure (1.9-2.4 bars) were observed in most of the patients suffering from untoward side effects. The clinical results seem to be influenced by the level of the intraoperative intracavitary pressure.

  7. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

    PubMed Central

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho; de Menezes, Marcos Roberto

    2016-01-01

    OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks. PMID:27759849

  8. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders.

    PubMed

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho; Menezes, Marcos Roberto de

    2016-10-01

    To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

  9. Lumbar nerve rootlet entrapment by an iatrogenically spliced percutaneous intra-thecal lumbar cerebrospinal fluid catheter.

    PubMed

    Yue, James J; Castro, Carlos A; Scott, David

    2015-01-01

    Complications associated with the use of percutaneous intra-thecal lumbar indwelling spinal catheters include infection, hematoma, neurologic dysfunction, and persistent undesired retention among others. A case of iatrogenic splicing associated with neurologic dysfunction with the use of a percutaneous intra-thecal indwelling spinal catheter is presented in this study. Single case study review. Review of case materials indicate Y pattern splicing/fragmentation of an indwelling intra-thecal catheter causing neurologic dysfunction and resistance to removal during attempted removal. Pain and weakness were evident soon after insertion of the catheter and were amplified with attempted catheter removal. Computed tomography revealed a double dot sign on axial view and a Y appearance on sagittal view. Surgical findings revealed entrapment of nerve rootlets in the axilla of the spliced catheter. Splicing/fragmentation causing neurologic dysfunction as well as catheter retention is described as a potential complication of intra-thecal indwelling cerebrospinal fluid catheters. A symptom of fragmentation of a catheter may include neurologic dysfunction including pain and weakness of a lumbar nerve root. If resistance is experienced upon attempted catheter removal, with or without associated neurologic dysfunction, further attempts at removal should not be attempted. In those cases in which pain and/or lumbar weakness are evident post catheter placement and/or following attempted removal, computed tomography should be performed. If fragmentation of a catheter is evident on CT scan, spinal surgical consultation should be obtained. Recommended spinal surgical intervention includes an open durotomy and visualization of catheter fragments and nerve rootlets and removal of catheter fragments. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. [Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series].

    PubMed

    Li, X Y; He, H Y; Tang, X; Wang, R; Zhang, C Y; Wang, S Q; Sun, B; Tong, Z H

    2017-09-12

    Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Results: The 87 patients consisted of 61 males and 26 females. The average age was (47±16)years (range 15-82 years ). Fifty-six patients were given ECMO therapy because of acute respiratory distress syndrome(ARDS), and 16 were treated as a bridge for lung transplantation and 15 for other causes. Eighty-one cases were given VV-ECMO support, and 6 cases were given VA-ECMO support. The most commonly used cannulas were 15-17 F arterial cannulas and 21-23 F venous cannulas. Preinsertion ultrasound was performed in 62 patients (71%) . Bedside chest radiography was used to help adjust the position of the end of the cannula in 11 patients (13%). Percutaneous catheterization was successful in 85 cases (97%) , while it failed in 2 female patients due to thick subcutaneous fat layer, and open surgical approach was used. Percutaneous femoral artery collateral circulation was established by ourselves in 5 cases. One patient with femoral artery catheterization without collateral circulation had gangrene of limbs. The complications included 9 cases of catheter site hemorrhage, 4 catheter-related bloodstream infection and 1 pulmonary embolism during ECMO weaning. Conclusion: Percutaneous catheterization for ECMO can be performed with a high rate of success and a low rate of complications.

  11. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

    PubMed Central

    Mahesha, Kanthila

    2017-01-01

    Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. Materials and Methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab's criteria, visual analog scale, and Oswestry Disability Index. Results: The mean followup period was 2 years (range 18 months - 3 years). Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations. PMID:28216749

  12. Percutaneous tricuspid valve replacement in congenital and acquired heart disease.

    PubMed

    Roberts, Philip A; Boudjemline, Younes; Cheatham, John P; Eicken, Andreas; Ewert, Peter; McElhinney, Doff B; Hill, Sharon L; Berger, Felix; Khan, Danyal; Schranz, Dietmar; Hess, John; Ezekowitz, Michael D; Celermajer, David; Zahn, Evan

    2011-07-05

    This study sought to describe the first human series of percutaneous tricuspid valve replacements in patients with congenital or acquired tricuspid valve (TV) disease. Percutaneous transcatheter heart valve replacement of the ventriculoarterial (aortic, pulmonary) valves is established. Although there are isolated reports of transcatheter atrioventricular heart valve replacement (hybrid and percutaneous), this procedure has been less frequently described; we are aware of no series describing this procedure for TV disease. We approached institutions with significant experience with the Melody percutaneous pulmonary valve (Medtronic, Inc., Minneapolis, Minnesota) to collect data where this valve had been implanted in the tricuspid position. Clinical and procedural data were gathered for 15 patients. Indications for intervention included severe hemodynamic compromise and perceived high surgical risk; all had prior TV surgery and significant stenosis and/or regurgitation of a bioprosthetic TV or a right atrium-to-right ventricle conduit. Procedural success was achieved in all 15 patients. In patients with predominantly stenosis, mean tricuspid gradient was reduced from 12.9 to 3.9 mm Hg (p < 0.01). In all patients, tricuspid regurgitation was reduced to mild or none. New York Heart Association functional class improved in 12 patients. The only major procedural complication was of third-degree heart block requiring pacemaker insertion in 1 patient. One patient developed endocarditis 2 months after implant, and 1 patient with pre-procedural multiorgan failure did not improve and died 20 days after the procedure. The remaining patients have well-functioning Melody valves in the TV position a median of 4 months after implantation. In selected cases, patients with prior TV surgery may be candidates for percutaneous TV replacement. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Web-based VR training simulator for percutaneous rhizotomy.

    PubMed

    Li, Y; Brodlie, K; Phillips, N

    2000-01-01

    Virtual Reality offers great potential for surgical training--yet is typically limited by the dedicated and expensive equipment required. Web-based VR has the potential to offer a much cheaper alternative, in which simulations of fundamental techniques are downloaded from a server to run within a web browser. The equipment requirement is modest--an Internet-connected PC or small workstation--and the simulation can be accessed worldwide. In a collaboration between computer scientists and neurosurgeons, we have studied the use of web-based VR to train neurosurgeons in Percutaneous Rhizotomy--a treatment for the intractable facial pain which occurs in trigeminal neuralgia. This involves the insertion of a needle so as to puncture the foramen ovale, and lesion the nerve. Our simulation uses VRML to provide a 3D visualization environment, but the work immediately exposes a key limitation of VRML for surgical simulation. VRML does not support collision detection between objects--only between viewpoint and object. Thus collision between needle and skull cannot be detected and fed back to the trainee. We have developed a novel solution in which the training simulation has linked views: a normal view, plus a view as seen from the tip of the needle. Collision detection is captured in the needle view, and fed back to the viewer. A happy consequence of this approach has been the chance to aid the trainee with this additional view from needle tip, which helps locate the foramen ovale. The technology to achieve this is Java software communicating with the VRML worlds through the External Authoring Interface (EAI). The training simulator is available on the Web, with accompanying tutorial on its use. A major advantage of web-based VR is that the techniques generalize to a whole range of surgical simulations. Thus we have been able to use exactly the same approach as described above for neurosurgery, to develop a shoulder arthroscopy simulator--where again collision detection, and

  14. DNA double-strand breaks after percutaneous transluminal angioplasty.

    PubMed

    Geisel, Dominik; Heverhagen, Johannes T; Kalinowski, Marc; Wagner, Hans-Joachim

    2008-09-01

    To determine exemplarily the amount of DNA damage and the repair kinetics after interventional radiologic procedures by using visualization of foci of the phosphorylated form of the H2AX histone variant (gammaH2AX) to quantify DNA double-strand breaks (DSBs) at percutaneous transluminal angioplasty (PTA) of the lower limb arteries. After local ethics committee approval and written informed consent were obtained, five patients (two women, three men; mean age, 64.4 years; age range, 45-76 years) scheduled for computed tomography (CT) and 20 patients (six women, 14 men; mean age, 68.5 years; age range, 53-85 years) scheduled for PTA of lower limb arteries were prospectively entered into the study. Blood samples were taken before the first exposure to ionizing radiation and 5 minutes, 1 hour, 6 hours, and 24 hours after the last exposure. Additional samples were taken from the irradiated limb (femoral vein) of three patients who underwent PTA--before the first radiation exposure, 5 and 10 minutes after the first exposure, and 5 minutes after the last exposure. Lymphocytes were isolated, fixed, and stained with anti-gammaH2AX antibody, and gammaH2AX focus yields were determined with fluorescence microscopy. Data were analyzed with linear regression and two-sample F tests. Mean increase in number of gammaH2AX foci after CT (7.78 per 1 Gy x cm) depended linearly on dose-length product (r = 0.997). Number of foci reached background levels within 24 hours. Mean numbers of gammaH2AX foci per cell increased by factors of 4.08-20.67 in blood samples taken 5 minutes after PTA compared with mean numbers of foci before PTA. Mean radiation dose increase, 6.56/(10 Gy x cm(2)), depended linearly on dose-area product (r = 0.993). Maximal focus yield in cells taken directly from the irradiated limb was higher than that in cells from the systemic circulation (by mean factor of 1.46). Data showed compromised DSB repair capacity after PTA (P < .05). Mean number of foci at 24 hours (0

  15. Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention.

    PubMed

    Gemma, Daniele; Moreno Gómez, Raúl; Fernández de Bobadilla, Jaime; Galeote García, Guillermo; López Fernandez, Teresa; López-Mínguez, Jose R; López-Sendón, José L

    2016-11-01

    Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Percutaneous trans-hepatic bilateral biliary stenting in Bismuth IV malignant obstruction

    PubMed Central

    Karnabatidis, Dimitrios; Spiliopoulos, Stavros; Katsakiori, Paraskevi; Romanos, Odissefs; Katsanos, Konstantinos; Siablis, Dimitrios

    2013-01-01

    AIM: To investigate the clinical efficiency of percutaneous trans-hepatic bilateral biliary metallic stenting for the management of Bismuth IV malignant obstructive disease. METHODS: Our hospital’s database was searched for all patients suffering from the inoperable malignant biliary obstruction Bismuth IV, and treated with percutaneous bilateral trans-hepatic placement of self-expandable nitinol stents. The indication for percutaneous stenting was an inoperable, malignant, symptomatic, biliary obstruction. An un-correctable coagulation disorder was the only absolute contra-indication for treatment. Bismuth grading was performed using magnetic resonance cholangiopancreatography. Computed tomography evaluation of the lesion and the dilatation status of the biliary tree was always performed prior to the procedure. All procedures were performed under conscious sedation. A single trans-hepatic track technique was preferred (T-configuration stenting) and a second, contra-lateral trans-hepatic track (Y-configuration stenting) was used only in cases of inability to access the contra-lateral lobe using a single track technique. The study’s primary endpoints were clinical success, defined as a decrease in bilirubin levels within 10 d and patient survival rates. Secondary endpoints included peri-procedural complications, primary and secondary patency rates. RESULTS: A total of 35 patients (18 female, 51.4%) with a mean age 69 ± 13 years (range 33-88) were included in the study. The procedures were performed between March 2000 and June 2008 and mean time follow-up was 13.5 ± 22.0 mo (range 0-96). The underlying malignant disease was cholangiocarcinoma (n = 10), hepatocellular carcinoma (n = 9), pancreatic carcinoma (n = 5), gastric cancer (n = 2), bile duct tumor (n = 2), colorectal cancer (n = 2), gallbladder carcinoma (n = 2), lung cancer (n = 1), breast cancer (n = 1) or non-Hodgkin lymphoma (n = 1). In all cases, various self-expandable bare metal stents with

  17. Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series.

    PubMed

    Tsuang, Fon-Yih; Chen, Chia-Hsien; Kuo, Yi-Jie; Tseng, Wei-Lung; Chen, Yuan-Shen; Lin, Chin-Jung; Liao, Chun-Jen; Lin, Feng-Huei; Chiang, Chang-Jung

    2017-09-01

    Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy. A technical report (a retrospective and prospective case series) was carried out. Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample. We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions. In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral

  18. Retained Double J Stent with Huge Renal and Bladder Calculi Extracted by Percutaneous Nephrolithotomy and Percutaneous Cystolitholapaxy in a Single Encounter.

    PubMed

    Nerli, Rajendra B; Patil, Shivagouda M; Magdum, Prasad; Sharma, Vikas; Ghagane, Shridhar; Hiremath, Murigendra B; Dixit, Neeraj

    2017-01-01

    We report a case of retained Double J ureteral stent with huge, multiple calculi at both ends in a 10-year-old female child. The renal and bladder calculi were managed by percutaneous nephrolithotomy and percutaneous cystolitholapaxy in a single sitting.

  19. [Clinical applications of computed tomography coronary angiography].

    PubMed

    Bastarrika, G; Schoepf, U J

    2009-01-01

    The clinical applications of computed tomography coronary angiography (CTCA) are constantly evolving. Initially employed to quantify coronary artery calcification, multidetector CT also makes it possible to evaluate the anatomy and anatomical variations of coronary circulation, rule out coronary disease, and follow up surgical and percutaneous revascularization procedures. Moreover, CTCA may potentially be useful to quantify ventricular function, characterize non-calcified atherosclerotic plaques, and analyze myocardial perfusion and viability, providing anatomical, morphological, and functional information in patients with suspected ischemic heart disease.

  20. 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

  1. [Microsurgical resection of lumbar intraspinal tumors through paraspinal approach using percutaneous tubular retractor system].

    PubMed

    Chunmei, Chen; Gangfeng, Cai; Rui, Wang; Weiqiang, Zhang; Yan, Chen; Feng, Li; Chunhua, Wang; Fan, Wang; Zhijie, Chen; Songsheng, Shi; Weizhong, Yang

    2015-04-07

    To evaluate the clinical outcomes and operative techniques of microsurgical resection of lumbar intraspinal tumors through paraspinal approach by percutaneous tubular retractor system. A retrospective study was conducted to analyze 21 patients with lumbar intraspinal tumors between November 2011 and February 2014, including Schwannoma (n = 19) and meningioma (n = 2) without lumbar instability on preoperative images. The length of tumors was 0.6-2.0 cm. Tracheal intubation anesthesia was performed prior to microsurgery using percutaneous tubular retractor system through paraspinal approach. Operative duration, blood loss volume, postoperative wound pain duration and hospital stay were analyzed. Creatine phosphokinase (CPK-MM) level was recorded at 1 day preoperatively, 1 day, 3 days and 5 days postoperatively. The scores of Japanese Orthopedic Association (JOA) and visual analog scale (VAS) were analyzed at 1 day preoperatively, 1, 3, 5 days and 6 months postoperatively to evaluate the function status of spinal cord. Computed tomography ( CT) three-dimensional reconstruction of lumbar vertebrae was performed at 1 week postoperatively. Magnetic resonance imaging ( MRI) plain scan and enhanced scan of lumbar vertebrae were conducted preoperatively, 1 week and 6 months postoperatively. Complete removal of tumors was achieved in all patients without the injuries of spinal cord or nerve root. Postoperative scores of JOA and VAS improved versus preoperative ones (P < 0.05). Level of CPK-MM increased 1 day postoperatively and declined to preoperative level at 5 days postoperatively. And th difference was not statistically significant (P < 0.05). Neither residual tumor nor tumor recurrence was detected by MRI plain and enhanced scans. No postoperative spinal instability was identified by CT three-dimensional reconstruction. And no spinal deformity occurred during a follow-up period of 6-28 months. Microsurgical resection of lumbar intraspinal tumors using percutaneous

  2. The comparison of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts.

    PubMed

    Yonguc, Tarik; Sen, Volkan; Aydogdu, Ozgu; Bozkurt, Ibrahim Halil; Yarimoglu, Serkan; Polat, Salih

    2015-04-01

    To compare the efficacy and safety of percutaneous ethanol and polidocanol sclerotherapy in the management of simple renal cysts. Between 2008 and 2013, symptomatic Bosniak type I renal cysts with a diameter larger than 5 cm in ultrasonography (US) or computed tomography were included in the study and divided into two groups. Group 1 patients were treated by US-guided percutaneous polidocanol sclerotherapy, and group 2 patients were treated by US-guided percutaneous ethanol sclerotherapy. The pre-operative and postoperative US findings were documented to compare the cyst recurrence and the reduction in cyst size. Success was defined as complete or partial: as >90% reduction or 50-90% reduction in cyst size, respectively. Failure was defined as <50% reduction in cyst size. The success rates of two groups were compared. Intraoperative pain was assessed using a visual analog scale (VAS) just after the operation. The median follow-up period was 36 months (range 12-76) in group 1 and 39 months (range 10-78) in group 2. Group 1 consists of 86 patients with 89 simple renal cysts, and group 2 consists of 57 patients with 57 simple renal cysts. Anatomical success was documented in 49 (55.1%) and 48 (84.2%) cysts in groups 1 and 2, respectively (p < 0.001). Clinical success was seen in 56 (65.1%) and 43 (75.4%) patients in groups 1 and 2, respectively. Major complication was detected in only one patient in group 2 (aseptic psoas abscess), and there was not any major complication in group 1. Minor complications had occurred in ten patients in group 2 (microscopic hematuria in six patients and fever and nausea in four patients) and in eight patients in group 1 (microscopic hematuria in six patients and fever and nausea in two patients). The mean VAS scores were 21 ± 1.04 and 4.26 ± 1.99 in ethanol and polidocanol groups, respectively (p < 0.001). Ethanol was found to be significantly painful, compared to polidocanol in the sclerotherapy of simple renal cysts. Although the

  3. Evaluation of skin damage caused by percutaneous absorption enhancers using fractal analysis.

    PubMed

    Obata, Y; Sesumi, T; Takayama, K; Isowa, K; Grosh, S; Wick, S; Sitz, R; Nagai, T

    2000-04-01

    Fractal analysis of the cross-sectional morphology of rat skin was conducted to evaluate pathologic changes evoked by percutaneous absorption enhancers. Male hairless rats (WBN/Ht-ILA), 8 weeks old, weighing 160 to 180 g were used. Under anesthetization, glass cells (10-mm inner diameter) were attached to the rats' abdomens, and test solutions containing various mixtures of the percutaneous absorption enhancers, sodium lauryl sulfate, isopropanol, 2-methyl-1-butanol, and sodium myristate were applied. Six hours after application, the solutions were removed and the abdominal skin was excised. Skin cross sections were analyzed with a charge-coupled device (CCD) camera. Image data taken by the CCD camera were fed into a desktop digital computer; then the fractal dimension of each skin cross section was determined on the basis of the box-counting algorithm. A pathologic study was also performed on the skin treated with the test solution. All sections of skin were examined with an optical photo microscope. Pathologic findings were classified into five levels. The total irritation score (TIS) was defined as the summation of damage levels in all regions. Only with the administration of hydrogel containing 2-methyl-1-butanol or sodium lauryl sulfate were positive values of TIS observed. However, the TIS values were independent of the concentration of these components. The most severe skin damage was evoked by application of sodium lauryl sulfate. Noticeable skin damage was also seen with 2-methyl-1-butanol. No irritation to the skin resulted from treatment with isopropanol or sodium myristate. When test solution containing sodium lauryl sulfate was applied to the skin, a remarkable increment in fractal dimensions was noted. This may suggest that the structure of the skin was greatly compromised as a result of sodium lauryl sulfate application. Although no change in fractal dimension was observed as a result of application of the test solution containing only 25

  4. 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

  5. Metabolism of propranolol during percutaneous absorption in human skin.

    PubMed

    Ademola, J I; Chow, C A; Wester, R C; Maibach, H I

    1993-08-01

    This in vitro study evaluated the extent of the absorption and metabolism of propranolol in human skin from four sources. Between 10.4 +/- 3.1 and 36.6 +/- 2.6% of the applied dose was absorbed; however, only a small portion (between 4.1 +/- 0.9 and 16.1 +/- 1.3%) of the dose permeated through the skin. Naphthoxyacetic acid formed during percutaneous absorption was located in the skin supernate. 4'-Hydroxypropranol was formed during percutaneous absorption and by skin microsomes. In addition, the microsomes biotransformed propranolol to norpropranolol. The retention of some of the absorbed drug and metabolites in the skin could explain the low plasma concentration and irritation observed following topical application of propranolol.

  6. Percutaneous transcatheter aortic valve replacement: first transfemoral implant in Asia.

    PubMed

    Chiam, P T; Koh, T H; Chao, V T; Lee, C Y; See Tho, V Y; Tan, S Y; Lim, S T; Hwang, N C; Sin, Y K; Chua, Y L

    2009-05-01

    Surgical aortic valve replacement (AVR) is the standard of care for patients with symptomatic severe aortic stenosis (AS), providing relief of symptoms and prolonging survival. However, many patients are either denied or not offered surgery due to high surgical risk or non-operability for open AVR. The technology of percutaneous aortic valve implantation emerged in 2002, and has since evolved rapidly with satisfactory results. Currently, almost all the procedures are performed predominantly in Europe and North America. The first-in-Asia percutaneous transcatheter aortic valve implantation via the transfemoral route is described. A 77-year-old man with symptomatic severe AS and at high surgical risk was successfully treated, with sustained clinical improvement and satisfactory haemodynamic results at 30-day follow-up.

  7. 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.

  8. [Percutaneous transluminal angioplasty in vascular by-passes].

    PubMed

    Rodríguez, J E; Fernández Guinea, O; López, V; Suárez Pereiro, M J; Reimunde, E; Cosío, J M; Barreiro, A

    1993-01-01

    Results from 21 cases of percutaneous transluminal angioplasties as a treatment of stenosed vascular by-pass from 16 patients, are presented. The technique took place in 10 cases at the aorto-femoral area, in others 10 cases at the popliteal-femoral area and, in the last one, at the carotid-subclavian area. Preliminary results were successful in all cases (100%). Follow-up showed a better long-term results at the aorto-femoral level. Considering the satisfactory results and also considering that, in case of negative results or re-stenosis, other surgical techniques could be performed, we conclude that the percutaneous transluminal angioplasty should be the first treatment for such of injuries.

  9. High-density percutaneous chronic connector for neural prosthetics

    DOEpatents

    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. Percutaneous mitral valve repair with MitraClip.

    PubMed

    Cilingiroğlu, Mehmet; Salinger, Michael

    2012-03-01

    Over the last decade, several technologies have been developed for percutaneous repair of the mitral valve for patients with severe mitral regurgitation (MR) and at high-risk for the traditional open-heart mitral valve repair or replacement. Among them, MitraClip has emerged as the only clinically safe and effective method for percutaneous mitral valve repair. It is adapted from the surgical technique that was initially described by Dr. Alfieri and his group by placement of a suture approximating the edges of the mitral leaflets at the origin of the MR jet, leading to creation of so-called bow-tie or double orifice with significant reduction in the MR jet. Here, we review the details of the technology, its procedural perspective as well as currently available data for its safety and effectiveness on a case-based report.

  11. 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.

  12. Percutaneous tibial nerve stimulation: the Urgent PC device.

    PubMed

    van Balken, Michael R

    2007-09-01

    Lower urinary tract disorders, with its main representative the overactive bladder, are an increasing problem that impact patients' quality of life tremendously. Neuromodulative treatment may fill the gap between conservative measures and invasive surgery. Percutaneous tibial nerve stimulation (Urgent PC) is a neuromodulation technique that is minimally invasive and easy to perform. Stimulation is carried out in 12 weekly sessions of 30 min each, through a percutaneously placed needle cephalad to the medial malleolus. Success can be obtained in approximately two-thirds of patients, but the therapy has the disadvantage of the necessity of maintenance therapy. The development of a small implantable device may be the future next step in the evolution of the technique.

  13. Percutaneous tibial nerve stimulation and sacral neuromodulation: an update.

    PubMed

    Gupta, Priyanka; Ehlert, Michael J; Sirls, Larry T; Peters, Kenneth M

    2015-02-01

    Neuromodulation is an important treatment modality for a variety of pelvic floor disorders. Percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) are currently the two approved methods for delivering this therapy. Percutaneous tibial nerve stimulation is a minimally invasive office-based procedure that has shown efficacy in the treatment of overactive bladder, fecal incontinence, and pelvic pain. It has the advantage of minimal side effects but is limited by the need for patients to make weekly office visits to receive the series of treatments. Sacral neuromodulation uses an implanted device that stimulates the S3 nerve root and can improve symptoms of overactive bladder, non-obstructive urinary retention, fecal incontinence, and pelvic pain. This paper will review the most recent literature regarding this topic and discuss their advantages and limitations and recent innovations in their use.

  14. 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

  15. Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

    PubMed Central

    Zhang, Ji; Gu, Yi-feng; Li, Ming-hua

    2008-01-01

    Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient. PMID:19039277

  16. 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.

  17. [Percutaneous nephrostomy in emergencies. Report of 42 cases].

    PubMed

    Dassouli, B; Benlemlih, A; Joual, A; Debbagh, A; Skali, K; Bennani, S; el Mrini, M; Benjelloun, S

    2001-11-01

    Through this work we are going to demonstrate the interest and the contribution of the percutaneous nephrostomy in obstructive anuria and in pyonephrosis. It is a retrospective study concerning 42 cases. The average age of the patients is 50 years (19-80 years). The sex-ratio is 26 men for 16 women. The nephrostomy was realized in first intention or after failure of ascent stent on 33 patients for an obstructive anuria and nine patients for a pyonephrosis. Improvement of the renal function was noted in 100% of obstructive with anuria and apyrexy in every case of pyonephrosis. No major complication arose during the realization of the nephrostomy. The long-term prognostic depends on the etiology. The percutaneous nephrostomy constitutes a saving, effective and temporary solution in the strategy of the coverage of obstructive anuria and pyonephrosis.

  18. Hemostatic Plug: Novel Technique for Closure of Percutaneous Nephrostomy Tract

    PubMed Central

    Cicic, Arman; Jump, Roger W.; Davalos, Julio G.

    2015-01-01

    Abstract Percutaneous nephrolithotomy (PCNL) is a standard treatment for patients with large or complex kidney stones. The procedure has traditionally included postoperative placement of a nephrostomy tube to allow for drainage and possible reentry. This practice was first implemented after complications incurred after tubeless PCNL in a small patient population. Recently, tubeless PCNL has reemerged as a viable option for selected patients, resulting in decreased pain and analgesic use, shorter hospitalization, quicker return to normal activity, and decreased urine extravasation. Gelatin matrix sealants are occasionally used in nephrostomy tract closure. Techniques for delivery of these agents have been ill described, and placement may be performed with varying results. We present a literature review comparing tubeless PCNL to its traditional variant with indications for use of each, as well as a comparison of agents used in closure. Finally, we outline a novel, reproducible technique for closure of the dilated percutaneous renal access tract. PMID:25157538

  19. Radiation dose to personnel during percutaneous renal calculus removal

    SciTech Connect

    Bush, W.H.; Jones, D.; Brannen, G.E.

    1985-12-01

    Radiation dose to the radiologist and other personnel was measured during 102 procedures for percutaneous removal of renal calculi from the upper collecting system. A mobile C-arm image intensifier was used to guide entrance to the kidney and stone removal. Average fluoroscopy time was 25 min. Exposure to personnel was monitored by quartz-fiber dosimeters at the collar level above the lead apron. Average radiation dose to the radiologist was 10 mrem (0.10 mSv) per case; to the surgical nurse, 4 mrem (0.04 mSv) per case; to the radiologic technologist, 4 mrem (0.04 mSv) per case; and to the anesthesiologist, 3 mrem (0.03 mSv) per case. Radiation dose to the uroradiologic team during percutaneous nephrostolithotomy is similar to that from other interventional fluoroscopic procedures and is within acceptable limits for both physicians and assisting personnel.

  20. Percutaneous absorption of crotamiton in man following single and multiple dosing.

    PubMed

    Dika, E; Tosti, A; Goldovsky, M; Wester, R; Maibach, H I

    2006-01-01

    Crotamiton is a topical drug used in the treatment of scabies and pruritus. We determined its percutaneous absorption following single and multiple dosing in normal skin. We used in vivo measurement of percutaneous absorption of [14C] crotamiton in a multidose regimen by measuring urinary excretion and liquid scintillation counting in three groups of four healthy volunteers. The Feldmann urinary excretion method was utilized to ascertain percutaneous absorption. Our results showed that tape stripping does not increase percutaneous absorption of crotamiton; upon repeated application.