Vascular complications related to image-guided percutaneous thermal ablation of hepatic tumors

Percutaneous thermal ablation of hepatic tumors is accepted as a safe, reliable, and cost-effective therapeutic option for treating hepatocellular carcinoma and hepatic metastases. However, operators should be familiar with the myriad of vascular and non-vascular complications that can occur post-ablation and that are described in the literature. This review will focus on the various vascular complications related to percutaneous thermal ablation of hepatic tumors and discuss strategies to avoid and manage these complications.

Use of the triple coaxial (triaxial) microcatheter system in superselective arterial embolisation for complex interventional cases: an initial experience with the system.

LEARNING OBJECTIVE: To share our experience in utilising the triple coaxial (triaxial) system in superselective cannulation of arteries for complex embolisation procedures. BACKGROUND: Percutaneous transcatheter selective embolisation is widely performed for a myriad of oncologic (e.g., trans-arterial chemo- or radio-embolisation) and non-oncologic (e.g., for embolisation of bleeding and benign conditions such as uterine fibroid and benign prostate hyperplasia) purposes. The cornerstone of such embolisation procedures is to achieve superselective cannulation of the arterial supply to the tumour/organ, preventing the complication of non-target embolisation. However, a multitude of factors, such as complex vascular anatomy, can pose challenges to achieving this goal. CLINICAL FINDINGS/PROCEDURAL DETAILS: The triaxial system utilises two smaller microcatheters telescoped through each other over a microwire. We have adopted the triaxial system for specific cases due to its perceived superior torquability and trackability compared to the conventional coaxial system, in which superselective cannulation is anticipated to be challenging. The triaxial system is also favourable in situations where the inner microcatheter needs to be "sacrificed" after administering the embolics (e.g., after administering radioisotopes in radioembolisation, N-butyl cyanoacrylate [NBCA] glue or ethylene-vinyl alcohol copolymer [EvOH] Onyx). Through a case series with procedural details such as fluoroscopic time, contrast administered, etc., we hope to illustrate the utility and efficacy of the triaxial system as well as present pitfalls in its usage. CONCLUSION: The triaxial system appears to be a valuable system for certain complex embolisation procedures and could be better suited than the conventional coaxial systems in these specific circumstances.

A Rare but Noteworthy Diagnosis for "Lumps in the Groin" During Pregnancy: Round Ligament Varices.

BACKGROUND Round ligament varices (RLVs) are a rare entity that occurs almost only in pregnancy. Given its rarity and perhaps the lack of its awareness, it is not surprising that RLVs are often an overlooked differential diagnosis for inguinal swelling. Furthermore, this is aggravated by the fact that the clinical findings of RLVs on physical examination are usually non-specific and indistinguishable from the other more common causes of groin swelling. CASE REPORT A 35-year-old Asian woman, gravidity 1 parity 0 presented at 26 weeks of gestation with a painless right inguinal lump. She was given a provisional diagnosis of "inguinal hernia." Ultrasonography and color Doppler of the right inguinal lump showed echo-free tubular structures within the right inguinal canal, which became more prominent with Valsalva maneuver and demonstrated vascularity on color Doppler with a venous flow pattern, compatible with RLV. The patient was therefore reassured and treated conservatively. The symptoms spontaneously resolved after a few weeks postpartum. CONCLUSIONS With this case, we hope to increase the awareness of round ligament varices as an important differential diagnosis for an inguinal lump in pregnancy, and highlight the potential difficulty in making the diagnosis clinically. Ultrasonography can serve as a crucial investigation for the prompt and precise diagnosis of RLV, but more importantly, can be a safer alternative to invasive surgical exploration.

Interventional Radiology Procedures for COVID-19 Patients: How we Do it.

With astonishing speed, COVID-19 has become a global pandemic. As it is uncertain when the pandemic will be controlled, it is crucial for procedurists of all stripes to be familiar and confident in performing procedures for COVID-19 patients to prevent intra-hospital infection. In this article, we will detail our approach on how to perform interventional procedures for COVID-19 patients at the bedside in the isolation room and with the patient transferred to the interventional radiology centre. These workflows have been developed in conjunction with multiple other stakeholders within our hospital, drawing from valuable lessons we have learnt from the SARS outbreak of 2003.

An Evaluation of the National Malaria Surveillance System of Bhutan, 2006-2012 as It Approaches the Goal of Malaria Elimination.

INTRODUCTION: Bhutan is progressing toward malaria elimination. The purpose of this evaluation was to assess the ability of the surveillance system from 2006 to 2012 to meet the objectives of the Bhutan Vector-borne Disease Control Program (VDCP) and to highlight priorities requiring attention as the nation transitions to elimination. METHODS: The evaluation was conducted using the Center for Disease Control guidelines for evaluating public health surveillance systems. Data sources included a search of publically available literature, VDCP program data, and interviews with malaria surveillance personnel. Blood slide quality assurance and control through formal assessment of slide preparation and measures of between-reader correlation were performed. RESULTS: Total malaria cases declined from 2006 to 2012. The average slide positivity rate decreased from 3.4% in 2006 to 0.2% in 2012. The proportion of non-residents in all cases increased to its highest value of 22.6% in 2012, and significant clustering in the border regions of India was noted, with Sarpang accounting for more cases than any other district from 2009 onward. Case detection was almost exclusively passive, but flexibility and sensitivity was demonstrated by the later addition of active case detection and specification of imported and locally acquired cases. Spatial data were limited to the village level, not allowing identification of transmission hotspots. For blood smears, statistical measures of between-reader agreement and predictive value were not computed. Blood smear quality was suboptimal by at least one criterion in over half of evaluated smears. Timeliness in reporting of cases was on a weekly to monthly basis, and did not meet the WHO goal of immediate notification. CONCLUSION: As of 2012, the national malaria surveillance system demonstrated flexibility, representativeness, simplicity, and stability. The full potential for data analysis was not yet realized. Attaining the goal of malaria elimination will require system function enhancement through increased and more accurate case detection and rapid investigation, improved health worker training and accountability, focally targeted response measures, and, in particular, the challenge of finding re-introductions of infections from India. Many such measure have been undertaken or planned as part of the next phase of the Bhutan's National Strategic Plan.

The pterygopalatine fossa: imaging anatomy, communications, and pathology revisited.

UNLABELLED: The pterygopalatine fossa (PPF) is a small, clinically inaccessible, fat-filled space located in the deep face that serves as a major neurovascular crossroad between the oral cavity, nasal cavity, nasopharynx, orbit, masticator space, and the middle cranial fossa. Due to its inherent complex location and connections, it can potentially act as a natural conduit for the spread of inflammatory and neoplastic diseases across the various deep spaces in the head and neck. This review aims to acquaint the reader with the imaging anatomy of the PPF, its important communications, and to identify some major pathological conditions that can involve the PPF, especially in conditions where its involvement can have serious diagnostic and therapeutic implications, such as in perineural tumour spread. TEACHING POINTS: • The PPF is a small neurovascular junction in the deep face with important to-and-fro connections. • Awareness of anatomy of the PPF and its communications helps to simplify imaging of its pathology. • Perineural tumour spread is clinically the most important pathology in this region.

Soil carbon and nitrogen stocks in forests along an altitudinal gradient in the eastern Himalayas and a meta-analysis of global data.

High-altitude soils potentially store a large pool of carbon (C) and nitrogen (N). The assessment of total C and N stocks in soils is vital to understanding the C and N dynamics in terrestrial ecosystems. In this study, we examined effects of altitude and forest composition on soil C and N along a transect from 317 to 3300 m a.s.l. in the eastern Himalayas. We used meta-analysis to establish the context for our results on the effects of altitude on soil C, including variation with depth. Total C and N contents of soils significantly increased with altitude, but decreased with soil depth. Carbon and N were similarly correlated with altitude and temperature, and temperature was seemingly the main driver of soil C along the altitudinal gradient. Altitude accounted for 73% of the variation in C and 47% of the variation in N stocks. Soil pH and cation exchange capacity were correlated with both soil C and N stocks. Increases in soil C and N stocks were related to forest composition, forest basal area as well as quantity of leaf litter that were in turn influenced by altitude and temperature. Concentrations of C in foliage increased by 2.1% for every 1000 m rise in altitude, while that in leaf litter increased by 2.3%.

Role of bilateral inferior petrosal sinus sampling (BIPSS) in the diagnosis of Cushing's disease in a patient with double superior vena cava.

Cushing's syndrome is known to have a wide spectrum of clinical presentation with debilitating consequences and morbidity if not diagnosed and treated in time. Sometimes the diagnosis of Cushing's syndrome can be challenging to the endocrinologist, especially when the usual battery of biochemical tests and advanced cross-sectional imaging is negative or inconclusive. We described a case in which the use of bilateral inferior petrosal sinus sampling (BIPSS) was conclusive albeit being technically challenging (due to a rare incidental finding of double superior vena cava) and invasive in nature.