Clinical Application of Artificial Ascites in assisting CT-guided Percutaneous Cryoablation of Hepatic Tumors Adjacent to the Gastrointestinal Tract.

This study was to assess the safety and efficacy of artificial ascitetes in assisting CT-guided cryoablation of hepatic tumors adjacent to the gastrointestinal (GI) tract. A total of 84 patients with peripheral hepatic tumors adjacent to the GI tract, who were treated cryoablation, were included in this retrospective study. Of these 84 patients, cryoablation had been performed in 39 patients with 41 peripheral hepatic tumors. These were assisted by induction artificial ascites while 40 patients with 43 peripheral hepatic tumors underwent cryoablation without induction of ascites. The artificial ascites separation success rate, the cryoablation technique effectiveness, local tumor progression and complications were all evaluated. The results showed that the artificial ascites separation success rate for 41 hepatic tumors adjacent to the GI tract was 95% (39/41). Technique effectiveness of group I was achieved in 35 of 43 tumors (81.3%) after follow-up imaging three months after cryoablation. In group II, technique effectiveness was achieved in 39 of 41 tumors after follow-up imaging three months following cryoablation. No major complications were encountered in either of the two groups. Artificial ascites assisting in CT-guided percutaneous cryoablation is a reliable and effective method for the treatment of hepatic tumors adjacent to the GI tract, and it can achieve a fine local control of such tumors.

Computed tomography-guided catheter drainage with urokinase and ozone in management of empyema.

AIM: To retrospectively compare the outcomes of catheter drainage, urokinase and ozone in management of empyema. METHODS: Retrospective study included 209 patients (111 males and 98 females; age range 19 to 72 years) who were diagnosed with empyema. The patients were divided into 3 groups based on the therapy instituted: catheter drainage only (group I); catheter drainage and urokinase (group II); catheter drainage, urokinase and ozone (group III). Drainage was considered successful if empyema was resolved with closure of cavity, clinical symptoms were resolved, and need for any further surgical procedure was avoided. Success rate, length of stay (LOS), need for further surgery and hospital costs were compared between the three groups using the Kruskall-Wallis nonparametric test, with P < 0.05 considered significant. RESULTS: Of the 209 patients with empyema, all catheters were placed successfully under CT guidance. Sixty-three patients were treated with catheters alone (group I), 64 with catheters and urokinase (group II), and 82 with catheters, urokinase and ozone (group III). Group I, group II and group III had success rates of 62%, 83% and 95% respectively (P < 0.05). Group I and group II had statistically longer LOS (P < 0.05) and higher hospital costs (P < 0.05) compared to group III. There were statistically significant differences between the three groups when comparing patients who converted into further surgery. CONCLUSION: The combination of chest tube drainage, urokinase and ozone is a safe and effective therapeutic modality in thoracic empyema.

CT-guided sclerotherapy for simple renal cysts: value of ethanol concentration monitoring.

OBJECTIVE: The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. MATERIALS AND METHODS: Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. RESULTS: After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. CONCLUSION: Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

Effectiveness of CT-guided sclerotherapy with estimated ethanol concentration for treatment of symptomatic simple hepatic cysts.

BACKGROUND AND OBJECTIVE: The mean Hounsfield value of 99.9% ethanol did get down to -190 Hounsfield units (HU), there was a linear correlation between ethanol concentration and Hounsfield values. We aimed to evaluate whether sclerotherapy with estimated ethanol concentration was helpful in improving the success rate for treatment of symptomatic simple hepatic cysts. METHODS: Forty-five patients with 52 symptomatic simple hepatic cysts were enrolled in this study. Twenty-one patients (24 cysts, group A) were treated by sclerotherapy without estimated ethanol concentration and 24 patients (28 cysts, group B) with estimated ethanol concentration. The Chi-square test and Mann-Whitney U test were used to compare the difference in characteristics and treatment outcomes of the subjects between these two groups. RESULTS: The mean cyst size before and after treatment were 8.4cm and 2.3cm, respectively, in group A, and 8.2cm and 0.8cm, respectively, in group B. There was no significant difference in the initial size of hepatic cysts between the groups. However, the final size was significantly smaller in group B (P=0.022). The mean ethanol exposure time was 18.3minutes in group B, which was less than that in group A (P<0.001). The success rate was significantly higher in group B (96.4%) than in group A (70.8%) (P=0.03). There were no major complications in either group. CONCLUSION: CT-guided sclerotherapy with estimated ethanol concentration yields better results than those without estimated ethanol concentration in the treatment of symptomatic simple hepatic cysts.