Percutaneous transhepatic biliary puncture simulator: a cord network prototype.

BACKGROUND: The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. METHODS: An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. RESULTS: After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants' evaluations showed positive results, with increased user confidence and skills transferability after the training session. CONCLUSIONS: This proposed simulator can be an effective tool to improve a trainee's confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. TRIAL REGISTRATION: Retrospectively registered.

Interventional radiology workflow during the COVID-19 pandemic: recommendations of the Swiss Society of Vascular and Interventional Radiology.

Given the importance of continuum in providing services and exigence of protecting health care professionals during this period, the Swiss Society of Vascular and Interventional Radiology (SSVIR) is releasing guidance for interventional radiologists as preparedness to manage COVID-19 patients, the workflow of non-COVID-19 patients and optimize interactions with other healthcare professionals.

Endometriotic Mass After Hysterectomy in a 61 Year Old Post-menopausal Woman: A Case Report and Update.

Endometriosis is a common, hormone-dependent gynecologic disease. Undiagnosed in large proportion of women, managing therapies depend on the impact of quality of life and includes hormonal treatment and pelvic surgery. Less likely endometriosis can occur in post-menopausal women. Malignant transformation of endometriosis is a rare but well-described process, most of time occurring in the ovary, and justifies the practitioner not to underestimate this pathology. We present a case of a 61 year old woman with a symptomatic endometriotic pelvic mass, status post hysterectomy, with no history of endometriosis diagnosed beforehand.

Two-step procedure for complicated appendicitis with perityphlitic abscess formation.

PRINCIPLES: Optimal management of perforated appendicitis with perityphlitic phlegmon or abscess formation is controversial. The aim of the study was to assess the outcome after a two-step procedure to treat patients with perityphlitic abscess formation. METHODS: We retrospectively assessed prospectively collected data from a single-centre database that included adult patients who had appendicitis and perityphlitic abscess (>=3 cm) but no generalised peritonitis, and were treated in 2007-2015. Patients underwent a two-step procedure that comprised antibiotic treatment and drainage when technically feasible (step 1) followed by interval appendectomy (step 2). We evaluated treatment modalities, complications and outcomes. RESULTS: Out of a total of 1480 patients with appendicitis, 15 patients presented with perityphlitic abscess. In addition to antibiotic treatment, computed tomography-guided drainage was performed in 12 of these cases. Step 1 and 2 hospital stays were (median, range) 7 days (5­14 days) and 2 days (2­12 days), respectively. One patient's abscess recurred after 2 months, associated with new onset appendicitis and perforation. Another patient underwent reoperation after interval appendectomy for suspected postoperative peritonitis. CONCLUSION: This two-step procedure for appendicitis with appendicular abscess was highly successful (100%) with a low rate of complications (13%). In the view of a potentially increased rate of appendicular neoplasm in combination with abscess formation, the role of interval appendectomy has to be evaluated in larger trials.

A prospective study of percutaneous balloon kyphoplasty with calcium phosphate cement in traumatic vertebral fractures: 10-year results.

STUDY DESIGN: This is a prospective study to investigate the clinical and radiological results 10 years after percutaneous balloon kyphoplasty and cement augmentation with calcium phosphate cement (CPC) in traumatic vertebral fractures type A. OBJECTIVES: Evaluation of a 10-year follow-up with radiological and computed tomography results, calculated by 2 independent radiologists, VAS, Roland Morris score, Oswestry Disability Index (ODI) score and Denis work scale and clinical examination in patients with traumatic compression fractures type A, who were treated with a balloon kyphoplasty with CPC (Calcibon™ from Biomed). METHODS: In this study, we evaluated 21 patients (8 female and 13 male) clinically and radiologically 10 years postoperative and compared them with the same group of 28 patients we operated between August 2002 and August 2003 for traumatic vertebral fractures type A with balloon kyphoplasty and CPC. Over the 10 years, 7 patients were lost to follow-up. 3 of them were not clinically impaired but did not want to participate in the study and 4 patients were untraceable. All 21 patients underwent standard X-ray (standing) and a CT. We measured the volume of the cement, the resorption the last 10 years and the disc height in the CT and the segmental and vertebral kyphosis angle in the X-ray and compared them with the X-ray (standing) and CT done directly postoperatively. To assess the pain level we used the VAS, ODI score, Roland Morris score and the Denis work scale and compared them with the same scores we recorded in the past. RESULTS: The VAS score demonstrated an increase over time from a mean of 1 (0-5) at the 2-year follow-up to 2.3 (0-8) at the 10-year follow-up. The Roland Morris disability score also increased over time from 2 (0-8) 2 years postoperative to a mean of 3.6 (0-18) at the 10 years follow-up. We recognized no complications and no reoperations were necessary. We recognized an increase of the median value for the vertebral kyphosis angle about 1° (0°-4°) (p < 0.0001). The median value of the disc height diminution over the 10 years was 0.7 mm (0-3.9) (p < 0.0001). For the anterior wall of the fractured VB the decrease of the median value was about 1 mm (0-3) (p < 0.0001) and for the posterior wall it was 0 mm (0-2) (p < 0.0039). So the beck index decreased from 0.80 (0.65-0.97) to 0.77 (0.62-0.97) at the 10-year follow-up, which means a decrease of the median value of 0.03 (0-0.07) (p < 0.0039). We noticed a median value for the cement volume of 4.2 cc (2.0-8.6) postoperative and at the 10-year follow-up of 3.2 cc (1.3-7.8), which means a resorption of the cement volume about 22.9 % (0.8-55.5 %) (p < 0.0001). CONCLUSIONS: In our 10-year follow-up, we did not recognize any high loss of correction of the vertebral and segmental kyphosis angle. We also did not recognize a high diminution of the disc height without degeneration of the disc over the last 10 years. There was a partial resorption of the cement but not as much as we expected with variable bone formation. In summary, the long follow-up about 10 years of kyphoplasty show us very good clinical and radiological results and in our opinion we consider this to be a treatment option for traumatic selected vertebral type A fractures also in young patients.

Epidermoid cyst of the spleen.

We report the case of a patient with a palpable mass and abdominal pain in the left upper quadrant. A physical examination revealed tenderness in this region. An ultrasound performed initially showed a large cystic structure. A CT examination revealed a large cyst originating in the spleen with loculations in its upper part and focal calcification in the wall. On MRI, the cystic mass showed high signal on T1-weighted and T2-weighted images. The carbohydrate antigen 19-9 (CA 19-9) was measured at 88 U/ml (standard <37.1 mUI/l). According to the imaging examinations and laboratory tests performed, it was impossible to determine if the splenic cyst was parasitic or non-parasitic. Given the most important risks of complications encountered in parasitic cysts, it was decided to treat this splenic cyst as a parasitic cyst. For this reason, an elective laparoscopic splenectomy with preoperative embolisation of the splenic artery was performed. The histological diagnosis was a primary epidermoid splenic cyst with inner lining epithelial cells.