Success Rate of Intra-articular Sacroiliac Joint Injection: Fluoroscopy vs Ultrasound Guidance-A Cadaveric Study.

BACKGROUND: Given the unacceptably high miss rates of non-image-guided injections into the sacroiliac joint, either fluoroscopy or ultrasound is recommended for guidance. The real success rate of both techniques was assessed by cadaver dissection. METHODS: Twenty bodies donated to science (40 joints: 15 female and 5 male) were investigated bilaterally. Fluoroscopy and a lower ultrasound-guided approach were performed in 10 bodies each. Conditions during puncture, the subjective feeling of the needle being intra-articular, and, for fluoroscopic guidance, the intra-articular spread of the contrast were assessed. First, 0.5 cc of Iopamidol was injected, followed by 2 mL of red-colored latex. The spread was investigated by dissection via anterior opening of the sacroiliac joint and the dorsal ligaments. RESULTS: Ultrasound guidance was used in 1/20 (5%, 95% CI = 0.9-23.6%) intra-articular injections. In 19/20 (95%, 95% CI = 0.9-23.6%) cases, latex spread in the interosseous sacroiliac ligament was used. Conditions of structural visibility were classified as good in 11/20 (55%, 95% CI = 34.2-74.2%) cases, puncture condition as good in 16/20 (80%, 95% CI = 58.4-91.9%) cases, and subjective feeling of the needle being intra-articular was present in 10/20 (50%, 95% CI = 34.2-74.2%) cases. Fluoroscopy showed an intra-articular injection in 10/20 (50%, 95% CI = 34.2-74.2%) cases. The structure visibility in fluoroscopy was good in 9/20 (45%, 95% CI = 25.8-65.8%), puncture conditions good in 8/20 (40%, 95% CI = 21.9-61.3%), intra-articular contrast spread visible in 10/20 (50%, 95% CI = 34.2-74.2%), and subjective feeling of being intra-articular was present in 17/20 (85%, 95% CI = 64.0-94.8%) cases. CONCLUSIONS: Fluoroscopy clearly showed a higher success rate of intra-articular sacroiliac joint injection.

Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project.

BACKGROUND AND STUDY AIM: In a quality assessment project for endoscopic retrograde cholangiopancreatography (ERCP), initiated in 2006 by the Austrian Society of Gastroenterology and Hepatology, benchmark data were collected on a voluntary basis. Results from the individual participating centers, both academic and community-based, were compared with pooled benchmark data, with the intention that individual problems should be identified and corrected in order to improve patient care in Austria. Success and complication rates in nonselected patients were evaluated, especially with regard to case volume. METHODS: In Austria, with a population of 8 million, 140 sites are registered for ERCP, and it is estimated that up to 15 000 procedures are done annually. Of these sites, 28 participated in the "Benchmarking ERCP" project during the first year, reporting on 3132 procedures, or 22 % of the total number. RESULTS: The overall complication rate in nonselected patients was 12.6 %, consisting of post-ERCP pancreatitis (5.1 %), bleeding (3.7 %), cholangitis (1.9 %), cardiopulmonary complications (0.9 %), and perforation (0.5 %); procedure-related mortality was 0.1 %. The overall therapeutic and diagnostic target was achieved in 84.8 %. High case volume (endoscopists performing > 50 vs. < 50 ERCPs per year; 21 vs. 68 endoscopists) was associated with significantly higher success (86.9 % vs. 80.3 %, P < 0.001) and lower overall complication rates (10.2 % vs. 13.6 %, P = 0.007); significance was not reached for all subgroups of complications. CONCLUSION: Success and complication rates for ERCP in Austria are comparable to those reported elsewhere. In our study, endoscopists with a case volume exceeding 50 ERCPs per year had higher success and lower overall complication rates.

Surficial geology of the Chicxulub impact crater, Yucatan, Mexico.

The Chicxulub impact crater in northwestern Yucatan, Mexico is the primary candidate for the proposed impact that caused mass extinctions at the end of the Cretaceous Period. The crater is buried by up to a kilometer of Tertiary sediment and the most prominent surface expression is a ring of sink holes, known locally as cenotes, mapped with Landsat imagery. This 165 +/- 5 km diameter Cenote Ring demarcates a boundary between unfractured limestones inside the ring, and fractured limestones outside. The boundary forms a barrier to lateral ground water migration, resulting in increased flows, dissolution, and collapse thus forming the cenotes. The subsurface geology indicates that the fracturing that created the Cenote Ring is related to slumping in the rim of the buried crater, differential thicknesses in the rocks overlying the crater, or solution collapse within porous impact deposits. The Cenote Ring provides the most accurate position of the Chicxulub crater's center, and the associated faults, fractures, and stratigraphy indicate that the crater may be approximately 240 km in diameter.