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Brönnimann MP, Kulagowska J, Gebauer B, Auer TA, Collettini F, Schnapauff D, Magyar CTJ, Komarek A, Krokidis M, Heverhagen JT. Fluoroscopic-Guided vs. Multislice Computed Tomography (CT) Biopsy Mode-Guided Percutaneous Radiologic Gastrostomy (PRG)-Comparison of Interventional Parameters and Billing. Diagnostics (Basel) 2024; 14:1662. [PMID: 39125538 PMCID: PMC11312216 DOI: 10.3390/diagnostics14151662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND This study investigated and compared the efficacy, safety, radiation exposure, and financial compensation of two modalities for percutaneous radiologic gastrostomy (PRG): multislice computed tomography biopsy mode (MS-CT BM)-guided and fluoroscopy-guided (FPRG). The aim was to provide insights into optimizing radiologically assisted gastrostomy procedures. METHODS We conducted a retrospective analysis of PRG procedures performed at a single center from January 2018 to January 2024. The procedures were divided into two groups based on the imaging modality used. We compared patient demographics, intervention parameters, complication rates, and procedural times. Financial compensation was evaluated based on the tariff structure for outpatient medical services in Switzerland (TARMED). Statistical differences were determined using Fisher's exact test and the Mann-Whitney U test. RESULTS The study cohort included 133 patients: 55 with MS-CT BM-PRG and 78 with FPRG. The cohort comprised 35 women and 98 men, with a mean age of 64.59 years (±11.91). Significant differences were observed between the modalities in effective dose (MS-CT BM-PRG: 10.95 mSv ± 11.43 vs. FPRG: 0.169 mSv ± 0.21, p < 0.001) and procedural times (MS-CT BM-PRG: 41.15 min ± 16.14 vs. FPRG: 28.71 min ± 16.03, p < 0.001). Major complications were significantly more frequent with FPRG (10% vs. 0% in MS-CT BM-PRG, p = 0.039, φ = 0.214). A higher single-digit number of MS-CT BM-guided PRG was required initially to reduce procedure duration by 10 min. Financial comparison revealed that only 4% of MS-CT BM-guided PRGs achieved reimbursement equivalent to the most frequent comparable examination, according to TARMED. CONCLUSIONS Based on our experience from a retrospective, single-center study, the execution of a PRG using MS-CT BM, as opposed to FPRG, is currently justified in challenging cases despite a lower incidence of major complications. However, further well-designed prospective multicenter studies are needed to determine the efficacy, safety, and cost-effectiveness of these two modalities.
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Eisenstein D, Shukr GH, Carlow JJ, Kemp L, Yu S. Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:523-536. [PMID: 39100656 PMCID: PMC11296368 DOI: 10.2147/ceor.s437353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. Subjects and Methods This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017-2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids. Results Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA ($13,134 and $14,428) and highest for UAE ($28,214 and $19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were $2429 and $5939 for LAP-RFA, $2122 and $8368 for LM, $4410 and $11,942 for AM, and $8113 and $46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data. Conclusion In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.
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Antonello VS, Ramos SCP, Jimenez MF, Bassols FF. Early ultrasound-guided drainage of tubo-ovarian abscesses versus conservative treatment: a retrospective cross-sectional study. J Infect Dev Ctries 2024; 18:919-924. [PMID: 38990994 DOI: 10.3855/jidc.18185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/18/2023] [Indexed: 07/13/2024] Open
Abstract
OBJECTIVE To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. METHODOLOGY Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. RESULTS There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. CONCLUSIONS Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.
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Duva MA, Del Valle JB, Savluk L, Borensztein MA. [Percutaneous radiofrequency ablation of osteoid osteoma: results from 9 years of experience in a third-level center.]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2024; 81:336-352. [PMID: 38941221 DOI: 10.31053/1853.0605.v81.n2.42451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/29/2023] [Indexed: 06/30/2024] Open
Abstract
Introduction Osteoid osteoma is a benign bone tumor that accounts for roughly 2-3% of primary bone tumors and up to 10-12% of benigns bone neoplasms. It is most commonly seen in young adults, and shows male predominance. Over the last years, minimally invasive thermal ablation techniques such as radiofrequency ablation have gained popularity over classical surgery. In this study we evaluate results and complications of CT guided osteoid osteoma radiofrequency ablation. Materials and methods In this retrospective cohort study all patients that were diagnosed with osteoid osteoma and treated using radiofrequency ablation between January 2014 and December 2022 were included. Pain was assessed using Visual Analog Scale (VAS) pre and post procedure. Technical success was established as positioning of the radiofrequency electrode in the nidus. Primary clinical success was defined as absence of pain after one radiofrequency session. All patients that required a second radiofrequency ablation were included in the overall clinical success group. Results During the studied period, 61 osteoid osteoma radiofrequency ablations were performed. Fiftyseven of them were included in this study, 32 were men and 25 female. Pre procedure median pain was 9 according to VAS score. Only 23 patients were treated as outpatient, the rest stayed in hospital for 24 hours. Median follow up time was 21,7 months (SD 8,3). Biopsy was performed in 52 patients. Technical success was accomplished in 57 patients (100%). Primary clinical success was 80,7% (46 patients). Those who continued with pain or had recurrence after a symptoms free period (11 patients), were treated with a second radiofrequency ablation, achieving an overall success rate of 94,7%. Only one patient suffered a minor complication (1,7%). Conclusion CT guided osteoid osteoma radiofrequency ablation is a safe, effective and low complication rate procedure, that can be performed on an outpatient basis. We believe it should be considered as a first line treatment option for osteoid osteoma.
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Scharll Y, Radojicic N, Laimer G, Schullian P, Bale R. Puncture Accuracy of Robot-Assisted CT-Based Punctures in Interventional Radiology: An Ex Vivo Study. Diagnostics (Basel) 2024; 14:1371. [PMID: 39001261 PMCID: PMC11241553 DOI: 10.3390/diagnostics14131371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES The purpose of this study was to assess the performance of an optically tracked robot for computed-tomography (CT)-guided needle placements in a phantom study. METHODS In total, 240 needle punctures were carried out with the help of an optically tracked robotic device (Micromate) based on CT image datasets at three different slice thicknesses (1, 3, and 5 mm). Conically shaped targets inside a gelatin-filled plexiglass phantom were punctured. The target positioning error between the planned and actual needle trajectory was assessed by measuring the lateral positioning error (ND) between the target and the puncture needle and the Euclidean distance (ED) between the needle tip and target in control CTs. RESULTS The mean ND and ED for the thinnest CT slice thickness were 1.34 mm (SD ± 0.82) and 2.1 mm (SD ± 0.75), respectively. There was no significant impact of target depth on targeting accuracy for ND (p = 0.094) or ED (p = 0.187). The mean duration for the planning of one trajectory and for needle positioning were 42 s (SD ± 4) and 64 s (SD ± 7), respectively. CONCLUSIONS In this ex vivo study, the robotic targeting device yielded satisfactory accuracy results at CT slice thicknesses of 1 and 3 mm. This technology may be particularly useful in interventions where the accurate placement of needle-like instruments is required.
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Sun G, Wang J, Zhang B, Zheng N. Case report: Management of liver cancer complicated by gastric varices rupture and bleeding: transjugular intrahepatic portosystemic shunt utilizing the mesenteric venous pathway. Front Med (Lausanne) 2024; 11:1388584. [PMID: 38962741 PMCID: PMC11220234 DOI: 10.3389/fmed.2024.1388584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024] Open
Abstract
To avoid recurrent variceal bleeding, transjugular intrahepatic portosystemic shunt (TIPS) in conjunction with variceal embolization is considered to be an effective strategy. However, due to changes in conditions and variations in the patient's state, individuals undergoing TIPS may face challenges and limitations during procedures. The transjugular technique and combined transsplenic portal venous recanalization (PVR) with TIPS were not effective in this case due to a blocked portal vein and a previous splenectomy. With an abdominal incision, we successfully punctured the mesenteric venous system and navigated the occluded segment of the portal vein through the mesenteric approach. TIPS was then performed under balloon guidance. This study aims to explore the management of risks and complications during surgical operations and propose multiple preoperative surgical techniques to improve the success rate of the procedure.
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Patel PA, Muñoz FG. Interventional oncology in children: Where are we now? J Med Imaging Radiat Oncol 2024. [PMID: 38874327 DOI: 10.1111/1754-9485.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Paediatric Interventional Oncology (IO) lags behind adult IO due to a scarcity of specific outcome data. The suboptimal way to evolve this field is relying heavily on adult experiences. The distinct tumour types prevalent in children, such as extracranial germ cell tumours, sarcomas, and neuroblastoma, differ strongly from those found in adults, presenting a completely different biological behaviour. Compounding this challenge, paediatric interventional radiology often employs adapted or off-label techniques, potentially compromising optimal outcomes. This review outlines the present indications for interventional radiology in paediatric cancer, from biopsy to supportive care, including complication management. It emphasises the role of locoregional approaches, and explores the status of common paediatric oncological diseases, highlighting areas where IO has made progress identifying potential opportunities for future advancements in this evolving field.
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Vano E, Fernández-Soto JM, Sánchez-Casanueva RM, Ten Morón JI. Improving a regional project on diagnostic reference levels for interventional procedures (OPRIPALC) with the support of a dose management system for the protection of patients and staff. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:021520. [PMID: 38834050 DOI: 10.1088/1361-6498/ad53d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Interventional radiology is a clinical practice with important benefits for patients, but which involves high radiation doses. The optimisation of radiation protection (RP) for paediatric interventional cardiology is a priority for both patients and staff. The use of diagnostic reference levels (DRLs) has been proposed by the International Commission on Radiological Protection to improve RP in imaging procedures. Dose management systems (DMSs) allow the automatic collection of dosimetric, geometric and technical data to assist the optimisation process, with a continuous audit of the procedures, generating alerts to implement corrective actions when necessary. Patient dose indicators may be analysed individually and for different radiation events (fluoroscopy and cine runs). Occupational doses per procedure may be analysed (if electronic dosimeters are available) and linked with patient doses for an integrated approach to RP. Regional optimisation programmes require data collection and processing from several countries to set and periodically update the DRLs. Patient data is anonymised, and each participating hospital has access to their data in a central computer server. Using DMSs may be one of the best ways to support these programs in the collection and analysis of data, raising alerts about high patient and occupational doses and suggesting optimisation actions.
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Mondardini MC, Pezzato S, Meneghini L, Agostiniani R, De Cassai A, D'Errico I, Minardi C, Sagredini R, Sbaraglia F, Testoni C, Toni F, Vason M, Amigoni A. Procedural sedation and analgesia in pediatric diagnostic and interventional radiology: An expert DELPHI consensus document developed by the ITALIAN scientific society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI). Paediatr Anaesth 2024. [PMID: 38808388 DOI: 10.1111/pan.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Children undergoing diagnostic and interventional radiology procedures often require sedation to achieve immobility and analgesia if the procedure is painful. In the past decades, leading scientific organizations have developed evidence-based guidelines for procedural sedation and analgesia in children outside of the operating room. Their recommendations are being applied to procedural sedation in radiology. However, some questions remain open regarding specific aspects contextualized to the radiology setting, such as elective prone sedation, the urgency of the procedure, when venous access or airway protection is required, and others. AIMS To address the unresolved issues of procedural sedation and analgesia in pediatric diagnostic and interventional radiology. METHODS An expert panel of pediatricians, pediatric anesthesiologists, intensivists, and neuroradiologists selected topics representative of current controversies and formulated research questions. Statements were developed by reviewing the literature for new evidence, comparing expertise and experience, and expressing opinions. Panelists' agreement with the statements was collected anonymously using the DELPHI method. RESULTS Twelve evidence-based or expert opinion incorporate are presented, considering risks, benefits, and applicability. CONCLUSIONS This consensus document, developed by a multidisciplinary panel of experts involved in the field, provides statements to improve the quality of decision-making practice in procedural sedation and analgesia in pediatric radiology.
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Umapathy S, Miller M, Chen YT. Novel Ultrasound-Guided Radiofrequency Ablation of the Epicondylar Branch of the Posterior Cutaneous Nerve of the Forearm for Recalcitrant Lateral Epicondylosis. Cureus 2024; 16:e61222. [PMID: 38939254 PMCID: PMC11210423 DOI: 10.7759/cureus.61222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
This report describes a novel technique for the treatment of recalcitrant lateral epicondylosis (LE) by radiofrequency ablation (RFA) of the epicondylar branch of the posterior cutaneous nerve of the forearm (PCNF-BrEpi). Here, we describe two patients suffering from recalcitrant LE who were treated with ultrasound-guided RFA of the PCNF-BrEpi in the outpatient pain clinic setting. Patient follow-up was made at eight weeks, five months, and seven months. Numerical pain rating (NPR) for pain and Upper Extremity Functional Index-15 (UEFI-15) were obtained at baseline and at each of the follow-ups. Both patients reported significant improvement in their pain and function quickly. RFA may be a viable treatment option for recalcitrant LE. Larger comparative trials and further investigation are needed to establish results in comparison to conventional treatments and to validate RFA as a treatment option in recalcitrant LE.
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Mull HJ, Foster MV, Higgins MCSS, Sturgeon DJ, Hederstedt K, Bart N, Lamkin RP, Sullivan BA, Ayeni C, Branch-Elliman W, Malloy PC. Development and Validation of an Electronic Adverse Event Model for Patient Safety Surveillance in Interventional Radiology. J Am Coll Radiol 2024; 21:752-766. [PMID: 38157954 PMCID: PMC11257375 DOI: 10.1016/j.jacr.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Comprehensive adverse event (AE) surveillance programs in interventional radiology (IR) are rare. Our aim was to develop and validate a retrospective electronic surveillance model to identify outpatient IR procedures that are likely to have an AE, to support patient safety and quality improvement. METHODS We identified outpatient IR procedures performed in the period from October 2017 to September 2019 from the Veterans Health Administration (n = 135,283) and applied electronic triggers based on posyprocedure care to flag cases with a potential AE. From the trigger-flagged cases, we randomly sampled n = 1,500 for chart review to identify AEs. We also randomly sampled n = 600 from the unflagged cases. Chart-reviewed cases were merged with patient, procedure, and facility factors to estimate a mixed-effects logistic regression model designed to predict whether an AE occurred. Using model fit and criterion validity, we determined the best predicted probability threshold to identify cases with a likely AE. We reviewed a random sample of 200 cases above the threshold and 100 cases from below the threshold from October 2019 to March 2020 (n = 20,849) for model validation. RESULTS In our development sample of mostly trigger-flagged cases, 444 of 2,096 cases (21.8%) had an AE. The optimal predicted probability threshold for a likely AE from our surveillance model was >50%, with positive predictive value of 68.9%, sensitivity of 38.3%, and specificity of 95.3%. In validation, chart-reviewed cases with AE probability >50% had a positive predictive value of 63% (n = 203). For the period from October 2017 to March 2020, the model identified approximately 70 IR cases per month that were likely to have an AE. CONCLUSIONS This electronic trigger-based approach to AE surveillance could be used for patient-safety reporting and quality review.
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Hadid-Beurrier L, Geryes BH, Jean-Pierre A, Gaudin PA, Feghali JA. Clinical benchmarking of a commercial software for skin dose estimation in cardiac, abdominal, and neurology interventional procedures. Med Phys 2024; 51:3687-3697. [PMID: 38277471 DOI: 10.1002/mp.16956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Radiation exposure from interventional radiology (IR) could lead to potential risk of skin injury in patients. Several dose monitoring software like radiation dose monitor (RDM) were developed to estimate the patient skin dose (PSD) distribution in IR. PURPOSE This study benchmarked the accuracy of RDM software in estimating PSD as compared to GafChromic film baseline in-vivo measurements on patients during cardiac, abdominal, and neurology IR procedures. METHODS The prospective study conducted in four IR departments included 81 IR procedures (25 cardiac, 31 abdominal, and 25 neurology procedures) on three angiographic systems. PSD and field geometry were measured by placing GafChromic film under the patient's back. Statistical analyses were performed to compare the software estimation and film measurement results in terms of PSD and geometric accuracy. RESULTS Median values of measured/calculated PSD were 1140/1005, 591/655.9, and 538/409.7 mGy for neurology, cardiac, and abdominal procedures, respectively. For all angiographic systems, the median (InterQuartile Range, IQR) difference between calculated and measured PSD was -10.2% (-21.8%-5.7%) for neurology, -4.5% (-19.5%-15.5%) for cardiac, and -21.9% (-38.7%--3.6%) for abdominal IR procedures. These differences were not significant for all procedures (p > 0.05). Discrepancies increased up to -82% in lower dose regions where the measurement uncertainties are higher. Regarding the geometric accuracy, RDM correctly reproduced the skin dose map and estimated PSD area dimensions closely matched those registered on films with a median (IQR) difference of 0 cm (-1-0.8 cm). CONCLUSIONS RDM is proved to be a useful solution for the estimation of PSD and skin dose distribution during abdominal, cardiac and neurology IR procedures despite a geometry phantom which is not specific to the latter type of IR procedures.
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Yang F, Du Y, Yuan C, Han L, Zhao Y, Xie Y, Peng W. Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy. Am J Transl Res 2024; 16:1018-1028. [PMID: 38586110 PMCID: PMC10994798 DOI: 10.62347/rxrn7802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA). METHODS Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO2), arteriovenous oxygen difference (AVDO2), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured. RESULTS The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO2 was significantly higher in the SGB group, while AVDO2 and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05). CONCLUSION SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.
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Winters KD, Byrne J, Eckholm N, Atayee RS, Furnish T. Palliation of Intractable Cancer-Related Pain With Low-Dose Epidural Bupivacaine. J Palliat Med 2024; 27:434-437. [PMID: 37610860 DOI: 10.1089/jpm.2023.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Introduction: Patients with advanced cancer nearing end of life often present with complex multifactorial pain. Although epidural analgesia is routinely used in inpatient hospital settings for targeted pain control, there is scant description in the literature of the use of low-dose epidural analgesia for relief of cancer-related pain at end of life. In this study, we present a case of difficult to control cancer-related rectal and pelvic pain in a patient who responded well in her last days of life to a low-dose bupivacaine epidural. Case Description: A 66-year-old woman presented for inpatient hospital admission for pain control from home hospice with intractable cancer-related pain from metastatic colorectal adenocarcinoma marked by extensive erosive lesions extending from the anterior perineum to the posterior rectum, with rectovaginal fistula. The patient reported poor tolerance of medications and described spiritual beliefs (based in Buddhism) that caused her and her family to prioritize maintaining a lucid, clear mind above nearly all else while seeking symptom management. The patient was so debilitated by pain at the time of presentation that she was bedbound in a quadruped position. Case Management and Outcome: After 2 weeks of poor pain control in the hospital with multiple failed attempts at palliation-including bilateral pudendal block, as well as opioids and other routine, but potentially sedating or deliriogenic, medications to treat her pain-the patient permitted administration of a low-dose bupivacaine epidural that significantly reduced her pain and allowed the patient to remain clear-headed up until the time of her death. Twenty-three days after admission, and 5 days after initiation of low-dose bupivacaine epidural for pain control, the patient died peacefully in the hospital. Conclusion: Low-dose epidural analgesia for cancer-related pain at end of life from malignancy involving the pelvis-perineum, rectum, or vagina-may be a viable option for patients, particularly those who wish to avoid the risk of somnolence or confusion from systemic opioids and other analgesics.
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Yaxley J, Wilkinson C, Davidson-West S, Mantha M. Clavicular hook: Cuffed haemodialysis catheter insertion using a paramedian tunnel in patients with recurrent tip migration. J Vasc Access 2024; 25:669-672. [PMID: 36401348 DOI: 10.1177/11297298221138334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Tunnelled, cuffed central venous catheters are commonly used for the provision of haemodialysis. Internal jugular vein catheters are generally tunnelled subcutaneously to the anterolateral chest wall. However, the lateral subcutaneous tract may increase the risk of catheter migration, particularly in the setting of obesity or large breast tissue. Catheter tip migration is an important cause of catheter failure. We describe two cases in which a paramedian tunnel was fashioned in patients experiencing recurrent catheter migration.
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Lee D, Carrera EJ, Hagens R, Yeung G, Garvan CW, Rothman MS, Akuthota V. Serum cortisol level to screen for significant hypothalamic-pituitary-adrenal axis suppression in patients receiving multiple steroid injections. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:97-103. [PMID: 37819765 DOI: 10.1093/pm/pnad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Morning serum cortisol level (mSCL) is a practical screening tool for hypothalamic-pituitary-adrenal (HPA) axis suppression and has been used to assess for duration of cortisol deficiency after epidural and peripheral glucocorticoid injections. More evidence is needed to establish the utility of mSCL in patients undergoing repeat injections with increasing cumulative glucocorticoid equivalent dose (CGED) that could place them at higher risk of HPA axis suppression. OBJECTIVES To estimate the prevalence of spine injection candidates with significant HPA axis suppression (sigAS), to understand the correlation between 12 months of CGED and the presence of sigAS based on the timing of mSCL collection after the most recent glucocorticoid injection (within 6 weeks or between 6 weeks and 12 months), and to investigate demographic and clinical factors relating to sigAS. METHODS Retrospective chart review of patients scheduled for spine injection who had an associated mSCL and documented histories of prior glucocorticoid injections. The steroid name, dose, type, and procedure location were recorded for each injection that occurred within 12 months before mSCL. CGED was calculated from standard glucocorticoid equivalent conversion factors. RESULTS SigAS was present in 7.8% to 22% of the analysis cohorts. There was no association found between CGED and sigAS regardless of timing of mSCL. There was a trend toward lower mSCL and sigAS with increasing CGED. There were no significant relationships found between sigAS and overall demographic or clinical factors. CONCLUSIONS A 3-fold reduction in the rate of sigAS was noted 6 weeks after the most recent steroid injection. Using mSCL provides a template to investigate the impact of CGED and the best timing for mSCL collection in order to define a more practical guideline to identify patients at higher risk of sigAS earlier and plan for future spine injections.
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Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
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Laney D, Ferral H, Fairchild A, Üstünsöz B. Techniques for portal vein targeting during a transjugular intrahepatic portosystemic shunt. Diagn Interv Radiol 2024; 30:42-47. [PMID: 36994881 PMCID: PMC10773176 DOI: 10.4274/dir.2022.221539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/14/2022] [Indexed: 01/15/2023]
Abstract
A transjugular intrahepatic portosystemic shunt (TIPS) is one of the most challenging procedures in interventional radiology. Hepatic and portal venous anatomy can be highly variable, and access to the portal vein, which can be quite difficult even for experienced surgeons, is the most critical step in a TIPS. Although there are multiple techniques to achieve a portal venous puncture, each access technique carries a unique set of risks and benefits. Thus, knowledge of these assistive techniques will add to the resources available to the surgeon when planning and subsequently performing a TIPS and, ultimately, increase the likelihood of a safe and successful procedure.
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Im H, Oh SY, Lim L, Lee H, Kwon J, Ryu HG. Timing of prophylactic antibiotics administration and suspected systemic infection after percutaneous biliary intervention. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:34-41. [PMID: 37792597 DOI: 10.1002/jhbp.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND/PURPOSE Prophylactic antibiotics administration before percutaneous biliary intervention (PBI) is currently recommended, but the underlying evidence is mostly extrapolated from prophylactic antibiotics before surgery. The aim of this study was to evaluate the impact of prophylactic antibiotics administration timing on the incidence of suspected systemic infection after PBI. METHODS The incidence of suspected systemic infection after PBI was compared in patients who received prophylactic antibiotics at four different time intervals between antibiotics administration and skin puncture for PBI. Suspected post-intervention systemic infection was assessed according to predetermined clinical criteria. RESULTS There were 98 (21.6%) suspected systemic infections after 454 PBIs in 404 patients. There were significant differences among the four groups in the incidence of suspected systemic infection after the intervention (p = .020). Fever was the most common sign of suspected systemic infection. Administration of prophylactic antibiotics more than an hour before PBI was identified as an independent risk factor of suspected systemic infection after adjusting for other relevant factors (adjusted odds ratio = 10.54; 95% confidence interval, 1.40-78.86). CONCLUSIONS The incidence of suspected systemic infection after the PBI was significantly lower when prophylactic antibiotics were administered within an hour before the intervention.
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Papalexis N, Ponti F, Masi PD, Peta G, Savarese LG, Miceli M, Facchini G, Spinnato P. Transpedicular Contrast-enhanced CT-guided biopsy of the body and dens of the axis avoiding the trans-oral approach: Technical report and literature review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:118-122. [PMID: 38644913 PMCID: PMC11029103 DOI: 10.4103/jcvjs.jcvjs_183_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 04/23/2024] Open
Abstract
This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients.
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Velarde-Acosta K, Moscoso Ramirez JY, Rojas P, Baltodano-Arellano R. Acute left anterior descending artery occlusion after IVUS leading to urgent percutaneous coronary intervention complicated with coronary perforation: Case report. JRSM Cardiovasc Dis 2024; 13:20480040241248924. [PMID: 38736704 PMCID: PMC11082483 DOI: 10.1177/20480040241248924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Intravascular ultrasonography (IVUS) has become an important complementary tool in interventional cardiology, both for preprocedural planning and for optimizing the performance of percutaneous coronary intervention (PCI). However, this tool is not free of potential complications, because of that it is essential to be aware of them and their management. Over time, new uses of IVUS have emerged, and it is currently a potential tool for predicting the risk of coronary perforation. Case report We present the clinical case of a 51-year-old male patient who was admitted in the context of post-infarction angina. During coronary angiography, the patient presented with two acute complications, one of them associated with IVUS and the other associated with severe coronary calcification that predisposed to coronary perforation. Both complications were successfully treated. Conclusion IVUS, although a very useful imaging tool before and during PCI, is not without risk. The overall rate of complications with certain or possible relation to IVUS is 3.9%. Vascular spasm is the most frequent complication and acute vascular occlusion, with the need for emergency coronary artery by-pass grafting, the least frequent. On the other hand, IVUS can predict the risk of developing other complications, such as coronary perforation, by means of the C-CAT sign. Knowledge of the possible complications during PCI and the rapid procedure of the hemodynamic team allows adequate management of these potentially fatal complications.
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Jaubert O, Montalt‐Tordera J, Knight D, Arridge S, Steeden J, Muthurangu V. HyperSLICE: HyperBand optimized spiral for low-latency interactive cardiac examination. Magn Reson Med 2024; 91:266-279. [PMID: 37799087 PMCID: PMC10953456 DOI: 10.1002/mrm.29855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Interactive cardiac MRI is used for fast scan planning and MR-guided interventions. However, the requirement for real-time acquisition and near-real-time visualization constrains the achievable spatio-temporal resolution. This study aims to improve interactive imaging resolution through optimization of undersampled spiral sampling and leveraging of deep learning for low-latency reconstruction (deep artifact suppression). METHODS A variable density spiral trajectory was parametrized and optimized via HyperBand to provide the best candidate trajectory for rapid deep artifact suppression. Training data consisted of 692 breath-held CINEs. The developed interactive sequence was tested in simulations and prospectively in 13 subjects (10 for image evaluation, 2 during catheterization, 1 during exercise). In the prospective study, the optimized framework-HyperSLICE- was compared with conventional Cartesian real-time and breath-hold CINE imaging in terms quantitative and qualitative image metrics. Statistical differences were tested using Friedman chi-squared tests with post hoc Nemenyi test (p < 0.05). RESULTS In simulations the normalized RMS error, peak SNR, structural similarity, and Laplacian energy were all statistically significantly higher using optimized spiral compared to radial and uniform spiral sampling, particularly after scan plan changes (structural similarity: 0.71 vs. 0.45 and 0.43). Prospectively, HyperSLICE enabled a higher spatial and temporal resolution than conventional Cartesian real-time imaging. The pipeline was demonstrated in patients during catheter pull back, showing sufficiently fast reconstruction for interactive imaging. CONCLUSION HyperSLICE enables high spatial and temporal resolution interactive imaging. Optimizing the spiral sampling enabled better overall image quality and superior handling of image transitions compared with radial and uniform spiral trajectories.
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Lee AJ, Campbell T, Ceraolo CA, Saxton A, Quarrier SO, Bandari J. The Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures. UROLOGY PRACTICE 2024; 11:228-235. [PMID: 37903750 DOI: 10.1097/upj.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time. METHODS The Centers for Medicare & Medicaid Services Physician/Procedure Summary data from 2010 to 2021 were utilized to examine uroradiology Current Procedural Terminology codes billed by urologists, radiologists, and APPs. Percent of total reimbursement and higher volume procedure count (after excluding providers with <11 procedures by per year) by each provider field was calculated and analyzed for changes in distribution from 2010 to 2021. RESULTS There were significant changes in all procedures when examining procedure reimbursement distribution in 2010 to 2021 (P < .001). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were significant changes in proportion in all procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation. CONCLUSIONS Uroradiology procedures have seen shifts in the distribution of which provider type performs each procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes.
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Carrasco M, Cabrito TMS, Montalbano MJ, Hołda MK, Walocha J, Tubbs RS, Loukas M. Cardiac ventricular false tendons: A meta-analysis. Clin Anat 2024; 37:114-129. [PMID: 37819143 DOI: 10.1002/ca.24116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
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Zhuang M, Lin Y, Wu S, Lu M, Jiang Z, Wei T, Wang L, Wang S, Zou J, He Y. Ultrasound-guided percutaneous thermal ablation of parotid tumors: experience from two-centers. Int J Hyperthermia 2023; 41:2290924. [PMID: 38159559 DOI: 10.1080/02656736.2023.2290924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Objective: To evaluate the efficacy and feasibility of ultrasound-guided percutaneous thermal ablation (TA) for treating benign parotid tumors.Methods: Patients with benign parotid tumors who underwent ultrasound-guided microwave ablation (MWA) or radiofrequency ablation (RFA) between January 2020 and March 2023 were included in this retrospective study. Change in tumor size (maximum diameter, tumor volume(V), volume reduction rate (VRR)) and cosmetic score (CS) were evaluated during a one-year follow-up period. We also recorded the incidence of any complications associated with TA.Results: A total of 23 patients (13 males and 10 females; median age 65 years, range 5-91 years) were included. The mean VRR at 1, 3, 6, and 12 months after TA was 37.03%±10.23%, 56.52%±8.76%, 82.28%±7.89%, and 89.39%±6.45%, respectively. Mean CS also changed from 3.39 ± 0.66 to 1.75 ± 0.93 (p < 0.001) by the end of follow-up time. Subgroup analysis showed that tumors with smaller initial maximum diameter had a faster CS reduction rate than those with larger initial diameter. The incidence of facial nerve dysfunction was 8.70%.Conclusion: Ultrasound-guided percutaneous TA is an effective and safe treatment option for patients with benign parotid tumors.
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