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PURPOSE: The main objective of the present study is to compare the safety, technical success and diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) versus ultrasound-guided percutaneous core-needle biopsy (US-CNB) in patients with solid pancreatic lesions. METHODS: This is a retrospective study that involved all patients with a solid pancreatic lesion who underwent EUS-FNA or US-CNB between November 2019 and February 2021. Of all patients, 69 (84.1%) had inoperable malignancy, whereas 13 (15.9%) had chronic pancreatitis. Resectability status was ascertained by computed tomography. All core needle biopsies were performed by the same interventional radiologist via ultrasound guidance with an 18-gauge semi-automatic tru-cut needle. All EUS-FNA procedures were performed by the same gastroenterologist with a 27-gauge EUS-FNA needle. Technical success is defined as if the region of interest is reached and specimen taken from the pancreatic lesion. Diagnostic yield is defined as the procurement of sufficient tissue for pathological examination. RESULTS: Overall, 52 patients (mean age 58.5 ± 9.8 years) who underwent EUS-FNA and 30 patients (60.1 ± 12.1 years) who underwent US-CNB were included. Solid lesions were most commonly (61.5% in EUS-FNA and 50.0% in US-CNB groups) located in pancreatic head in both groups. Mean size of the lesions was comparable in both groups as well. The technical success was 100% in both groups. In 12 (14.6%) patients, pathology results revealed inadequate sampling (11 × in the EUS-FNA and 1 × in the US-CNB group). The diagnostic yield was significantly higher in US-CNB group than in EUS-FNA group (96.7% vs. 78.8%, respectively, p = 0.048). Of 11 patients in the EUS-FNA with inadequate sampling, pancreatic lesions were located in the pancreatic head in 7 (63.6%). No major complications were observed in neither of the groups. As a minor complication, one case of slight abdominal pain was detected in the EUS-FNA group. CONCLUSION: Based on the results of the present study, both US-CNB and EUS-FNA appeared safe; however, diagnostic yield in the US-CNB group was significantly higher.
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Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas , Humanos , Pessoa de Meia-Idade , Idoso , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Biópsia com Agulha de Grande Calibre , Estudos Retrospectivos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagemRESUMO
The aim of the study is to prepare embolic hydroxyl ethyl cellulose (HEC)-polyvinyl prolidone (PVP)-magnetic particles suitable for transcatheter arterial chemoembolization (TACE) procedures, drug delivery, and magnetic hyperthermia. Two different sizes (microsized and nanosized) of iron oxide particles were used to prepare the embolic particles to investigate the embolization and drug delivery properties. Iron oxides were linked with PVP via bridging flocculation process, then outermost layer of the linked particles was coated with HEC in order to load drugs to particles and reach size requirements for a successful TACE procedure. Size of each particle was calibrated to the range that allows easy injections through microcatheters (40-500 µm). The results showed that the size of the final embolic particles reached around 70 µm with 82 W/g specific absorption rate (SAR) values for nano-iron oxide particles and 45 µm with 77 W/g SAR values for micro-iron oxide particles, which are quite suitable for TACE applications. Furthermore, an anticancer drug doxorubicin (DOX) was successfully loaded onto these particles in order to achieve localized chemotherapy at the tumor site. Particles produced in this study, loaded DOX successfully and prolonged drug release time, performed similarly to pure DOX at higher concentration treatments against human breast cancer cell lines, were heatable under applied alternating magnetic fields. In addition, in vivo embolization studies performed using a rabbit renal embolization model, indicated that these particles were easily delivered through microcatheters and were able to embolize the target.
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Antineoplásicos , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Animais , Coelhos , Humanos , Liberação Controlada de Fármacos , Quimioembolização Terapêutica/métodos , Doxorrubicina , Imageamento por Ressonância Magnética/métodos , ÓxidosRESUMO
A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.
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Anestesia Epidural/efeitos adversos , Hematoma/complicações , Paralisia/etiologia , Complicações Pós-Operatórias , Prostatectomia , Transtornos de Sensação/etiologia , Idoso , Hematoma/etiologia , Humanos , Masculino , Espaço RetroperitonealRESUMO
STUDY OBJECTIVE: To determine the efficacy of ultrasound-guided thoracic paravertebral block intraoperatively and 24 hours postoperatively in patients undergoing donor nephrectomy. DESIGN: Prospective randomized controlled study. SETTING: Private foundation university hospital; November 2014 to June 2015. PATIENTS: Thirty-two patients undergoing donor nephrectomy (exclusion criteria: coagulation disorders, allergy to local anesthetics, and unwillingness to participate). The final study population comprised 30 patients (15 male, 15 female) randomly assigned to either Group P (paravertebral block, n=14) or Group M (morphine, n=16). INTERVENTIONS: In Group P, a unilateral paravertebral catheter was inserted 1 day preoperatively; on the day of surgery, a single-level unilateral paravertebral block was administered through the catheter before general anesthesia. Infusion of bupivacaine continued intraoperatively and postoperatively. Patients in Group M received only general anesthesia, and morphine patient-controlled analgesia was begun postoperatively. MEASUREMENTS: Intraoperative analgesic and anesthetic requirement, postoperative numerical rating scale pain scores, additional analgesic consumption during the postoperative period, and incidence of complications related to thoracic paravertebral block (TPVB) like pleural puncture, pneumothorax, epidural spread, injection into the subarachnoid space, intravascular injection, and Horner's syndrome and rate of opioid related adverse reactions like nausea and vomiting, itching, constipation, and respiratory depression. RESULTS: Intraoperative remifentanil consumption was significantly higher in Group M, and postoperative morphine consumption was significantly lower in Group P (P<.001). During the first 24 hours postoperatively, the mean numerical rating scale pain scores were similar and there were no significant differences between the 2 groups. There were no statistically significant differences in the additional analgesic consumption and rate of adverse reactions between the 2 groups. We didn't detect any complication related to TPVB in group P. CONCLUSIONS: Continuous thoracic paravertebral block provides good intraoperative stability with a low anesthetic requirement and reduces postoperative morphine consumption for up to 24 hours. Ultrasound guided technique enhanced the safety of TPVB and provides analgesia without major complications.
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Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Cuidados Intraoperatórios/métodos , Nefrectomia/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Adulto , Idoso , Pontos de Referência Anatômicos , Anestesia Geral , Bupivacaína/administração & dosagem , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Piperidinas/administração & dosagem , Estudos Prospectivos , Remifentanil , Nervos Torácicos/efeitos dos fármacos , Vértebras Torácicas , Coleta de Tecidos e Órgãos/efeitos adversos , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
BACKGROUND: To assess the effectiveness of the current vesicoureteral reflux (VUR) grading system according to the international classification of VUR (ICVUR) and to evaluate whether VUR grading accuracy could be improved by renal ultrasonography (RU) according to the Society for Fetal Urology (SFU) grading system. OBJECTIVES: Therefore, this study assessed the accuracy of the current VCUG staging system by assessing inter-rater reliability among pediatric radiologists and urologists; it also evaluated whether accuracy is increased by RU without consensus (with respect to VCUG grading). METHODS: Four pediatric urologists and four pediatric radiologists independently graded 120 voiding cystourethrograms (VCUGs). Middle VUR grades were divided into the following three groups: VUR consensus grade III (group 1), VUR consensus grade IV (group 3), and VUR non-consensus grades III and IV (group 2). All groups were compared with respect to hydronephrosis grade using RU. RESULTS: The intraclass correlation coefficient (ICC) values ranging from 0.86 to 0.89 reflected good reliability. The lowest agreement was associated with middle grades (III and IV). A marked difference in sensitivity was observed between groups 1 and 3 (35% and 95%, respectively, P < 0.05), indexed by SFU hydronephrosis grade, suggesting that VCUG cases in group 2 (n = 16 at SFU 0 or 1) could be accepted as grade III, and SFU scores of 2, 3, or 4 could be considered grade IV. CONCLUSIONS: Inter-rater accuracy could be improved at middle grades using renal ultrasonography (USG), which could promote communication between different specialists.
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Aim. Vesicoureteral reflux (VUR) is one of the most common conditions seen in pediatric urology. Fortunately, there are many treatment options for this disorder. The grading system for VUR varies among doctors, and the literature on its reliability is sparse. Here, we assessed the effectiveness of the current VUR grading system. Methods. A series of 40 voiding cystourethrogram (VCUG) studies were selected. Four pediatric urologists (PU) and four pediatric radiologists (PR) independently graded each VCUG and then agreed on a uniform interpretation. For statistical analysis the intraclass correlation coefficient (ICC) was applied to assess interrater agreement. Results. ICC values ranging from 0.82 to 0.88 reflected the strong reliability of VCUG for grading cases of VUR among pediatric urologists and radiologists as separate groups, and the reliability between the two groups was also good, as indicated by an ICC of 0.89. Despite the high ICC, disagreement existed between raters; the lowest agreement was associated with middle grades (III and IV). Conclusions. The interrater reliability of the international grading system for VUR was high but imperfect. Thus, grading differences at middle grades can profoundly influence the type of treatment pursued.
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PURPOSE: We aimed to assess the technical feasibility of targeted endovenous treatment of Giacomini vein insufficiency (GVI)-associated varicose disease and report our early results. METHODS: We retrospectively screened 335 patients with varicose disease who underwent endovenous laser ablation from September 2011 to January 2013, and determined 17 patients who underwent Giacomini vein ablation. Using a targeted endovenous treatment approach considering the reflux pattern, all healthy great saphenous veins (GSV) or vein segments were preserved while all insufficient veins (Giacomini vein, perforator veins, small saphenous vein, anterior accessory GSV, major tributary veins, or incompetent segments of the GSV) were ablated. Treatment success was analysed using Doppler findings and clinical assessment scores before and after treatment. RESULTS: Targeted endovenous treatment was technically successful in all cases. Seven GSVs were preserved totally and three GSVs were preserved partially (10/17, 58%), with no major complications. Clinical assessment scores and Doppler findings were improved in all cases. CONCLUSION: Targeted endovenous treatment of GVI-associated varicose disease is safe and effective. In majority of GVI cases saphenous vein can be preserved using this approach.
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Veia Femoral/cirurgia , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/patologia , Humanos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Veia Safena/diagnóstico por imagem , Veia Safena/patologia , Escleroterapia/métodos , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Varizes/diagnóstico por imagem , Varizes/patologia , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/patologiaRESUMO
In the differential diagnosis of perineal cystic lesions, a wide range of lesions can be considered, but perineal epidermoid cyst is rare. We present a case of perineal epidermoid cyst, a man with a complaint of painless perianal mass who appeared at the general surgery clinic. Ultrasonographic and conventional magnetic resonance imaging (MRI) findings are noted along with the diffusion-weighted MRI findings. To our knowledge, there has been no specific study in the literature up to now focusing on the value of diffusion-weighted MRI findings in the differential diagnosis of perineal cystic lesions; this technique may be useful.
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A 51-year-old man developed anorexia, dizziness, nausea, vomiting, and weight loss. He had orthostatic hypotension, hyponatremia, hyperkalemia, and hypocortisolemia, and the diagnosis of adrenal insufficiency was made. Magnetic resonance imaging (MRI) showed asymmetrically enlarged adrenal glands. Biopsy of a hypoechoic, enlarged, inguinal lymph node showed caseating granulomas. Lumbar MRI showed vertebral body height loss and abnormal signal in L1 and L2; vertebral biopsy showed chronic, necrotic, caseating granulomatous inflammation consistent with tuberculous osteomyelitis. Clinical improvement occurred with isoniazid, rifampicin, pyrazinamide, and corticosteroids. The differential diagnosis of adrenal insufficiency should include tuberculosis, especially in geographic regions where tuberculosis is endemic.