Percutaneous radiofrequency ablation of spinal osteoid osteoma under CT guidance.

OBJECTIVE: Osteoid osteoma (OO) accounts for approximately 10-12% of all benign bone tumours and 3% of all bone tumours. Spinal involvement appears in 10-25% of all cases. The purpose of this study was to evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation in the treatment of spinal OOs and report our experience. METHODS: 13 patients suffering from spinal OO and treated at the authors' institution using CT-guided RF ablation were retrospectively evaluated. The RF probe was introduced through a 11-G Jamshidi(®) needle, and the lesion was heated at 90°C for 6 min. RESULTS: All procedures were considered technically successful as the correct positioning of the probe was proven by CT. 11 of the 13 patients reported pain relief after RF ablation. In two cases, RF ablation was repeated 1 month after the first procedure. Pain relief was achieved in both cases after the second procedure. No recurrence was reported throughout the follow-up. No complications like skin burn, soft-tissue haematoma, infection, vessel damage or neurological deficit were reported. CONCLUSION: This study demonstrates that CT-guided percutaneous RF ablation is a safe and effective method for the treatment of spinal OOs. ADVANCES IN KNOWLEDGE: The data of this study support the efficacy and safety of the recently applied CT-guided percutaneous RF ablation technique for the treatment of spinal OOs.

Electrocardiographic changes in elderly patients during endoscopic retrograde cholangiopancreatography.

BACKGROUND: Cardiorespiratory complications may occur during gastrointestinal endoscopy, and elderly people seem to be more vulnerable to these complications during endoscopic procedures involving the manipulation of abdominal viscera. OBJECTIVES: To determine the incidence of cardiac arrhythmias, changes in oxygen saturation, heart rate and blood pressure during endoscopic retrograde cholangiopancreatography (ERCP) via Holter monitoring in elderly patients older than 70 years of age. METHODS: Holter monitoring and 12-lead electrocardiograms were performed in 30 elderly patients undergoing ERCP and in 30 control subjects undergoing routine chest, abdomen, bone and upper gastrointestinal small bowel follow-through studies. A computerized nontriggered template system was used to analyze the electrocardiograms qualitatively and quantitatively. Arrhythmias, cardiac axis, conduction defects, pauses, ST segment changes, ectopic beats, oxygen desaturation and changes in blood pressure and rate-pressure product were evaluated. RESULTS: Increased heart rate, ST segment changes resulting from myocardial ischemia, oxygen desaturation and transient atrial and ventricular ectopic beats were frequent during ERCP compared with the control group. In one patient, transient left bundle branch block developed and this was attributed to pre-existing hypertension with cardiomegaly. One patient developed ventricular tachycardia and one other sinus bradycardia, but this was attributed to sick sinus syndrome. CONCLUSIONS: Transient myocardial ischemia and various cardiac arrhythmias are frequent in elderly patients undergoing ERCP. Appropriate noninvasive monitoring seems to be justified during this procedure.