Fluoroscopy-assisted vs fluoroless endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections: A comparative study.

INTRODUCTION: The need for fluoroscopy guidance in patients undergoing endoscopic ultrasound-guided transmural drainage (EUS-TMD) of peripancreatic fluid collections (PFCs) remains unclear. AIMS: The aim of this study was to compare general outcomes of EUS-TMD of PFCs under fluoroscopy (F) vs fluoroless (FL). METHODS: This is a comparative study with a retrospective analysis of a prospective and consecutive inclusion database at a tertiary centre, from 2009 to 2015. All patients were symptomatic pseudocyst (PSC) and walled-off pancreatic necrosis (WON). Two groups were assigned depending on availability of fluoroscopy. The groups were heterogeneous in terms of their demographic characteristics, PFCs and procedure. The main outcome measures included technical and clinical success, incidences, adverse events (AEs), and follow-up. RESULTS: Fifty EUS-TMD of PFCs from 86 EUS-guided drainages were included during the study period. Group F included 26 procedures, PSC 69.2%, WON 30.8%, metal stents 61.5% (46.1% lumen-apposing stent) and plastic stents 38.5%. Group FL included 24 procedures, PSC 37.5%, WON 62.5%, and metal stents 95.8% (lumen-apposing stents). Technical success was 100% in both groups, and clinical success was similar (F 88.5%, FL 87.5%). Technical incidences and intra-procedure AEs were only described in group F (7.6% and 11.5%, respectively) and none in group FL. Procedure time was less in group FL (8min, p=0.0341). CONCLUSIONS: Fluoroless in the EUS-TMD of PFCs does not involve more technical incidences or intra-procedure AEs. Technical and clinical success was similar in the two groups.

Comparison of ultrasound and fluoroscopic guidance for injection in CT arthrography and MR arthrography of the hip. / Comparación de las técnicas de inyección ecográfica y radioscópica en artro-TC y artro-RM de cadera.

OBJECTIVE: To evaluate the usefulness of ultrasound-guided versus fluoroscopy-guided injection in CT arthrography and MR arthrography. MATERIAL AND METHODS: We reviewed all CT arthrography and MR arthrography studies done at our center between October 1, 2014 and October 1, 2015. We analyzed 32 studies: 26 with fluoroscopic guidance and 6 with ultrasound guidance. We compared the two techniques on the following parameters: presence of sufficient contrast material in the joint, extravasation or injection of contrast material in the soft tissues (presence of contrast material in the psoas or other soft tissues), and intra-articular gas bubbles. We used SPSS V. 20 to compare the techniques with Pearson's chi-square tests. RESULTS: Contrast material was observed in soft tissues in 56.3% of ultrasound-guided injections, making 6.3% of the procedures invalid for diagnostic purposes. Extravasation of contrast material was observed in 53.8% of fluoroscopy-guided procedures, making 3.8% invalid for diagnostic purposes. Intra-articular gas was observed in 21.9% of ultrasound-guided studies and in 38.5% of fluoroscopy-guided studies. None of the differences between techniques were statistically significant at p<0.05. CONCLUSIONS: Our study shows that ultrasound is as useful as fluoroscopy for injecting contrast material for CT arthroscopy and MR arthroscopy; ultrasound has the advantage of not using ionizing radiation.

Efficacy and complications in the use of self-expanding colonic stents: an analysis of 15 years' experience.

OBJECTIVE: To analyze the efficacy and safety of the procedure for placing self-expanding stents in the colon. To evaluate the factors associated with complications. To analyze the dose of radiation delivered in the procedure. MATERIAL AND METHODS: This was a retrospective descriptive study of 478 procedures done at a single center to place self-expanding metallic stents in the colon. A total of 423 nitinol stents and 79 stainless steel stents were placed. We included all colonic obstructions, of which 446 had malignant causes and 8 had benign causes. We excluded patients with intestinal perforation, severe colonic bleeding, short life expectancy, or lesions located less than 5 cm from the anus. We collected the dosimetric data and analyzed the technical success, clinical success, and complications during follow-up. RESULTS: The procedure was a technical success in 92.26% of cases (n=441) and a clinical success in 78.45% (n=375); complications occurred during follow-up in 18.5% of cases. Complications occurred more frequently with the stainless steel stents than with the nitinol stents (OR: 3.2; 95% CI: 1.8-5.7). The mean value of the dose area product was 35 Gy*cm(2). When instead of being done by the interventional radiologist working together with an endoscopist the procedure was done exclusively by the interventional radiologist, the time under fluoroscopy (p=0.001), dose area product (p=0.029), and kinetic energy released per unit mass (p=0.001) were greater. CONCLUSION: The procedure for placing self-expanding colonic stents is efficacious and safe with an acceptable rate of complications. The doses of radiation delivered were low, and the radiation doses and time under fluoroscopy were lower when the procedure was done together with an endoscopist.

Has fluoroless endourology (URS and PCNL) come of age? Evidence from a comprehensive literature review.

INTRODUCTION: Radiation via the use of imaging is a key tool in management of kidney stones. Simple measures are largely taken by the endourologists to implement the 'As Low As Reasonably Achievable' (ALARA) principle, including the use of fluoroless technique. We performed a scoping literature review to investigate the success and safety of fluoroless ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) procedures for the treatment of KSD. METHODS: A literature review was performed searching bibliographic databases PubMed, EMBASE and Cochrane library, and 14 full papers were included in the review in accordance with the PRISMA guidelines. RESULTS: Of the 2535 total procedures analysed, 823 were fluoroless URS vs. 556 fluoroscopic URS; and 734 fluoroless PCNL vs. 277 fluoroscopic PCNL. The SFR for fluoroless vs. fluoroscopic guided URS was 85.3% and 77%, respectively (p=0.2), while for fluoroless PCNL vs. fluoroscopic group was 83.8% and 84.6%, respectively (p=0.9). The overall Clavien-Dindo I/II and III/IV complications for fluoroless and fluoroscopic guided procedures were 3.1% (n=71) and 8.5% (n=131), and 1.7% (n=23) and 3% (n=47) respectively. Only 5 studies reported a failure of the fluoroscopic approach with a total of 30 (1.3%) failed procedures. CONCLUSION: The ALARA protocol has been implemented in endourology in numerous ways to protect both patients and healthcare workers during recent years. Fluoroless procedures for treatment of KSD are safe and effective with outcomes comparable to standard procedures and could become the new frontier of endourology in selected cases.

Efficacy and safety of fluoroless ureteroscopy and retrograde intrarenal surgery for the treatment of urolithiasis: A comparative study.

INTRODUCTION: Ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) are traditionally guided by fluoroscopy, but the risks of exposure to ionizing radiation may present a matter of concern for patients and urologists. The aim of this study was to evaluate the efficacy and safety of fluoroless URS and RIRS compared with conventional fluoroscopy-guided procedures for the treatment of ureteral and renal stones. MATERIAL AND METHODS: Patients treated with URS or RIRS for urolithiasis between August 2018 and December 2019 were retrospectively evaluated and grouped according to the use of fluoroscopy. Data was collected from individual patient records. The main outcomes were stone-free rate (SFR) and complications, compared between the fluoroscopy and fluoroless groups. A subgroup analysis by type of procedure (URS and RIRS) and a multivariate analysis to identify predictors of residual stones were conducted. RESULTS: A total of 231 patients met the inclusion criteria: 120 (51.9%) in the conventional fluoroscopy group and 111 (48.1%) in the fluoroless group. No significant differences were found between groups regarding SFR (82.5% vs 90.1%, p=.127) or postoperative complication rate (35.0% vs 31.5%, p=.675). In the subgroup analysis these variables did not present significant differences, regardless of the procedure considered. In the multivariate analysis the fluoroless technique was not an independent predictor of residual lithiasis (OR 0.991; 95% IC 0.407-2.411; p=.983), when adjusted for procedure type, stone size and stone number. CONCLUSION: URS and RIRS can be done without fluoroscopic guidance in selected cases, without affecting the efficacy or safety of the procedure.

Percutaneous cementoplasty of periprosthetic aseptic hip loosening.

Progressive population aging and improved healthcare have led to a significant increase in patients with hip arthroplasty (HA). In this patient group, the proportion of those who require a new arthroplasty (prosthetic replacement or secondary revision of the hip), has also increased. For this subgroup of patients in whom surgical prosthetic replacement should be considered but is contraindicated, a new technique has been developed since 2010: percutaneous injection of periprosthetic cement under fluoroscopic or CT control ("femoroplasty; FMP") as an alternative and less invasive treatment compared to surgery to stabilize the HA without replacing it, with excellent results on patients' quality of life. In this brief communication, we describe our positive experience regarding FMP, which we have performed for the first time in Spain on four patients (age range between 74-83 years, 2 female and 2 male patients, 3 right HA and 1 left HA), without post-complications. We highlight both the relative simplicity of this technique, which can be incorporated into radiological intervention even in regional hospitals, and the significant clinical improvement observed in all patients. In conclusion, we hope that our experience can contribute to the increased adoption of this innovative technique within the scientific community.

Mónico Sánchez Moreno: A pioneer in radiologic technology.

Mónico Sánchez Moreno (1880-1961) was an important figure in the early years of electromedicine, rubbing elbows with world-class physicists like Nikola Tesla. Her main contribution to the field was the invention and commercialization of a portable X-ray generator, replacing the heavy transformer had been necessary to generate power with a lightweight portable device that could work with direct or alternating current at 220 or 125V. This device was easily adaptable to other applications in electromedicine, such as cauterization or disinfection. This indefatigable entrepreneur could have triumphed in America, but preferred to work toward furthering technological development in the land that she loved. Her efforts made it possible to have an affordable device made in Spain that would allow radiological examinations to be done in places where it would have been otherwise unthinkable. In conclusion, Mónico Sánchez Moreno was a self-made woman who deserves to be remembered for her pioneering role in portable radiology.

Mónico Sánchez Moreno: a pioneer in radiologic technology. / Mónico Sánchez Moreno: un pionero de la tecnología radiológica.

Mónico Sánchez Moreno (1880-1961) was an important figure in the early years of electromedicine, rubbing elbows with world-class physicists like Nikola Tesla. Her main contribution to the field was the invention and commercialization of a portable X-ray generator, replacing the heavy transformer had been necessary to generate power with a lightweight portable device that could work with direct or alternating current at 220 or 125V. This device was easily adaptable to other applications in electromedicine, such as cauterization or disinfection. This indefatigable entrepreneur could have triumphed in America, but preferred to work toward furthering technological development in the land that she loved. Her efforts made it possible to have an affordable device made in Spain that would allow radiological examinations to be done in places where it would have been otherwise unthinkable. In conclusion, Mónico Sánchez Moreno was a self-made woman who deserves to be remembered for her pioneering role in portable radiology.

How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial.

INTRODUCTION AND OBJECTIVES: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS: A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). CONCLUSION: US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.

Left ventricular pacing with a temporary pacemaker: Case report.

We report a case of temporary pacemaker lead malposition in the left ventricle crossing the interventricular septum (IVS). The majority of described cases occur due to a patent foramen ovale and are frequently incidental findings. A course across the IVS is rarely found and this complication with temporary leads is not even reported in the literature. This very rare location entails a risk of dangerous complications associated with left-to-right flow after lead removal. Echocardiography was an essential tool to diagnose the lead's course inside the heart and enabled secure removal of the lead with cardiac surgery backup.

[Videourodynamics: Current indications, technique and considerations.] / Videourodinamia: indicaciones actuales, técnicas y consideraciones.

OBJECTIVES: Describe the technique, indications and the correct interpretation given the findings in different clinical entities, and to serve as a guide for urologists, urology residents and even medical students. MATERIAL AND METHODS: A literature search was performed using Pubmed, Cochrane and Scopus database for articles and guidelines published between January 1970 and June 2020. RESULTS: Videourodynamics is a diagnostic procedure that combines the urodynamic study with simultaneous images of the lower urinary tract to assess the anatomy and function during the different phases of micturition.This study provides important information that can modify therapeutic behavior and therefore clinical outcomes of patients. CONCLUSION: The role of videourodynamics becomes more relevant nowadays in the assessment of the pathophysiology of voiding dysfunction, being the gold standard for the workup of neurogenic bladder and voiding dysfunction in young people and women and, possibly in persistent/recurrent incontinence in both men and women.

OBJETIVO: Describir la técnica, las indicaciones y la correcta interpretación dados los hallazgos en diferentes entidades clínicas, y servir como guía para urólogos, residentes de urología e incluso estudiantes de medicina.MATERIAL Y MÉTODO: Se realizó una revisión bibliográfica internacional de artículos o guías en las bases de datos PubMed, Cochrane y Scopus entre enero de 1970 y junio de 2020. RESULTADOS: La videourodinamia es un procedimiento diagnóstico que integra el estudio urodinámico con imágenes simultáneas del tracto urinario inferior para evaluar la anatomía y la función durante las diferentes fases de micción. Este estudio aporta información relevante que puede modificar la conducta terapéutica y por ende los desenlaces clínicos de los pacientes.CONCLUSIÓN: El papel de la videourodinamia cada vez toma más relevancia en la evaluación de la fisiopatología de la disfunción miccional, siendo incluso el patrón de oro para el estudio de disfunción vesical neurogénica y trastornos del vaciado en jóvenes y mujeres y, posiblemente la incontinencia recidivada tanto en hombres como en mujeres.

Radiation dose during fluoroscopically guided central venous access device insertion: retrospective observational study. / Dosis de radiación durante la inserción guiada por fluoroscopia de un dispositivo de acceso venoso central: un estudio observacional retrospectivo.

INTRODUCTION: Central venous access devices (CVAD) are used to deliver intravenous therapy to the bloodstream. CVAD insertion is sometimes fluoroscopically guided and thus associated with radiation dose to both the patient and the staff members within the room. The objective of this study is to assess the radiation dose to the patient through a retrospective audit and directly measure the exposure to staff members in simulated procedures. A secondary objective is to evaluate the radiation exposure to the staff and patients when utilising fluoroscopic pulse rate of 7.5 pps and 4 pps. MATERIAL AND METHODS: A retrospective audit of patients undergoing Permcath and Hickman line insertions was conducted. The patients were grouped by the pulse rate used for the duration of the study; 4 pulses per second (pps) (n=24) and 7.5 pps (n=33). A STEP OD-2 monitor and PMMA was used in a simulated environment to estimate the radiation exposure to locations that a Radiologist, Nurse and Radiographer would be standing during the procedures using the average procedure details collected in the retrospective audit. Measurements were conducted at heights to reflect a whole body estimate and an estimate to the lens of the eye. RESULTS: The results show that the median dose area product (DAP) for CVAD insertion is 0.7Gy.cm2 and 0.3Gy.cm2 for procedures done at 7.5 pps and 4 pps, respectively. This corresponded to an effective dose of 0.22 mSv and 0.1 mSv. The radiologist, nurse and radiographer were exposed to a whole-body shielded dose of 0.36µSv, 0.1µSv and 0.05µSv when 7.5 pps was utilised and 0.13µSv, 0.03µSv and 0.02µSv when 4 pps was used. The exposure to the head of radiologist, nurse and radiographer was 2.1µSv, 1.4µSv, and 0.6µSv in the 7.5 pps studies and 0.7µSv, 0.5µSv, and 0.2µSv when 4pps was used. CONCLUSION: The patient effective dose was estimated to be 0.1-0.22 mSv depending on the fluoroscopic pulse rate utilised during CVAD insertions. Additionally, The radiologist, nurse and radiographer whole body and lens exposure was estimated in a simulated setting. In all cases, there was a statistically significant dose reduction when the lower fluoroscopic pulse rate was used. Thus, where possible, consideration should be given to utilising a lower pulse rate during CVAD insertions to reduce the exposure to both staff and patients.

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success. / Eficiencia de la cirugía intrarenal retrograda sin radiación en niños y evaluación de los factores que afectan el éxito quirúrgico.

OBJECTIVE: To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed. RESULTS: Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05). CONCLUSION: RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.

OBJETIVO: Investigar los factores que afectan el éxito quirúrgico y la duración de la cirugía retrógrada intrarenal sin fluoroscopia en niños. El objetivo de este estudio fue demostrar la eficacia de la cirugía retrógrada intrarenal sin fluorosocopia en el tratamiento de litiasis en niños. MÉTODOS: Todos los procedimientos de cirugía retrógrada intrarenal fueron realizados en pacientes pediátricos en nuestra clínica entre agosto 2013 y enero 2017. Estudiamos 52 casos pediátricos con 1 litiasis en 1 riñón y recibieron una sesión. Marcamos el sistema colector renal y la litiasis se definió según ese marcaje. El tamaño y la localización de la piedra, colocación preoperatoria del doble J, la vaina de acceso y la tasa de éxito quirúrgico fueron reportadas. Los efectos de estos factores en el éxito quirúrgico y la duración de las cirugías fueron analizados. RESULTADOS: Cada paciente recibió cirugía retrógrada una vez. De éstos 52 pacientes pediátricos, 23 (44%) tenían entre 0 y 5 años (grupo 1), 12 (25%) entre 6 y 11 años (grupo 2), 16 (31%) entre11 y 17 años (Grupo 3). El éxito quirúrgico en cada grupo fue de 65%, 77% y 81% respectivamente (73% en general). El éxito quirúrgico se vió afectado sólo por el tamaño de la litiasis (p<0,01). La duración de las cirugías se vió afectada por el tamaño de la litiasis, localización de la litiasis, dilatación pasiva del uréter, y uso de la vaina de acceso (p<0,05).CONCLUSIÓN: La cirugía intrarenal retrógrada es segura y efectiva en el tratamiento de litiasis intrarenales en el paciente pediátrico. Altas tasas de éxito se consiguen con el mapeo renal sin fluoroscopia.

Fusion imaging in interventional cardiology.

The number and complexity of percutaneous interventions for the treatment of structural heart disease has increased in clinical practice in parallel with the development of new imaging technologies, in order to render these interventions safer and more accurate. Complementary imaging modalities are commonly used, but they require additional mental reconstruction and effort by the interventional team. The concept of fusion imaging, where two different modalities are fused in real time and on a single monitor, aims to solve these limitations. This is an important tool to guide percutaneous interventions, enabling a good visualization of catheters, guidewires and devices employed, with enhanced spatial resolution and anatomical definition. It also allows the marking of anatomical reference points of interest for the procedure. Some studies show decreased procedural time and total radiation dose with fusion imaging; however, there is a need to obtain data with more robust scientific methodology to assess the impact of this technology in clinical practice. The aim of this review is to describe the concept and basic principles of fusion imaging, its main clinical applications and some considerations about the promising future of this imaging technology.

Current status of radiological protection in endourological procedures in Spain. / Estado actual de la protección radiológica en procedimientos endourológicos en España.

OBJECTIVE: To discover the extent of training in radiological protection (RP) of Spanish urologists who perform endourological procedures, and to analyse the use of on ionising radiation control and protection measures. MATERIAL AND METHODS: A survey conducted through the Plataforma de Investigación de Estudios Multicéntricos (PIEM) (Multicentre Study Research Platform) on the 1,894 associates of the Spanish Association of Urology, between April and October 2015. The questionnaire comprised 21 questions on endourological activity undertaken, RP training, and the use of protective measures, and personal dosimetry. Seventeen percent responded, and 238 surveys were eventually validated for study. RESULTS: Sixty-three percent of the respondents had received no type of RP training, 25% had first level accreditation, and only 12% second level. Fifty-seven percent, 27%, and 2% of the urologists used flap, wrist and crystalline dosimetry respectively. Use of radiation protection measures was insufficient. Fifty-three percent of the urologists at greatest risk of exposure had had no training in RP, 30% did not use flap dosimetry, and 40% used neither an apron or thyroid collar during the endourological procedures. CONCLUSIONS: RP training, dosis monitoring, and the use of ionising radiation protective measures are insufficient, even by practitioners most exposed to radiation. It is essential that these serious shortcomings in RP are corrected, at the level of the individual, in urology departments, scientific societies, and the health authorities.

Retrograde intrarenal surgery without fluoroscopy: Is it possible? A randomized prospective study, an extraordinary experience. / Cirugía retrógrada intrarrenal sin fluoroscopia: ¿es posible? Estudio prospectivo aleatorizado, una experiencia extraordinaria.

OBJECTIVES: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. MATERIAL AND METHODS: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2groups were compared. RESULTS: There were no statistically significant differences between the 2groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. CONCLUSION: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure.

Clinical outcomes before and after videofluoroscopic swallow study in children 24 months of age or younger / Desfechos clínicos antes e depois da videofluoroscopia da deglutição em crianças com 24 meses de idade ou menos

ABSTRACT Objective: To evaluate the combined impact of videofluoroscopic swallow study (VFSS) and therapeutic feeding and swallowing interventions on clinical outcomes in children with oropharyngeal dysphagia (OPD). Methods: This was an uncontrolled longitudinal analytical study in which OPD patients were evaluated before and after VFSS. Children ≤ 24 months of age diagnosed with OPD in a clinical setting and undergoing VFSS for investigation and management of OPD were included in the study. The study participants received therapeutic feeding and swallowing interventions after having undergone VFSS, being followed at an outpatient clinic for pediatric dysphagia in order to monitor feeding and swallowing difficulties. Respiratory and feeding outcomes were compared before and after VFSS. Results: Penetration/aspiration events were observed in 61% of the VFSSs (n = 72), and therapeutic feeding and swallowing interventions were recommended for 97% of the study participants. After the VFSS, there was a reduction in the odds of receiving antibiotic therapy (OR = 0.007) and in the duration of antibiotic therapy (p = 0.014), as well as in the odds of being admitted to hospital (p = 0.024) and in the length of hospital stay (p = 0.025). A combination of oral and enteral feeding became more common than oral or enteral feeding alone (p = 0.002). Conclusions: A high proportion of participants exhibited penetration/aspiration on VFSS. Therapeutic feeding and swallowing interventions following a VFSS appear to be associated with reduced respiratory morbidity in this population.

RESUMO Objetivo: Avaliar o impacto conjunto da videofluoroscopia da deglutição (VFD) e intervenções terapêuticas de alimentação e deglutição nos desfechos clínicos em crianças com disfagia orofaríngea (DOF). Métodos: Trata-se de um estudo analítico longitudinal não controlado em que pacientes com DOF foram avaliados antes e depois da VFD. Foram incluídas no estudo crianças com idade ≤ 24 meses e diagnóstico clínico de DOF, submetidas à VFD para a investigação e manejo da DOF. Os participantes do estudo receberam intervenções terapêuticas de alimentação e deglutição após terem sido submetidos à VFD, sendo então acompanhados em um ambulatório de disfagia pediátrica para o monitoramento das dificuldades de alimentação e deglutição. Os desfechos respiratórios e alimentares foram comparados antes e depois da VFD. Resultados: Eventos de penetração/aspiração foram observados em 61% das VFD (n = 72), e intervenções terapêuticas de alimentação e deglutição foram recomendadas a 97% dos participantes do estudo. Após a VFD, houve uma redução das chances de receber antibioticoterapia (OR = 0,007) e da duração da antibioticoterapia (p = 0,014), bem como das chances de internação hospitalar (p = 0,024) e do tempo de internação (p = 0,025). A alimentação por via oral e enteral em conjunto tornou-se mais comum do que a alimentação exclusivamente por via oral ou enteral (p = 0,002). Conclusões: Houve alta proporção de crianças que apresentaram penetração/aspiração na VFD. As intervenções terapêuticas de alimentação e deglutição após a VFD parecem estar associadas à redução da morbidade respiratória nessa população.

Bloqueo del plexo hipogástrico superior para manejo de dolor pélvico crónico no oncológico: efectividad y seguridad / Superior hypogastric plexus block for the management of non-oncological chronic pelvic pain: effectiveness and safety

Introducción: El dolor pélvico crónico es un problema ginecológico común, incapacitante y que afecta a la calidad de vida. Se estima la prevalencia hasta del 26,6 % a nivel mundial y en el 30 % de los casos no tienen un desencadenante claro. Dentro del manejo analgésico se propone el uso de intervencionismo como herramienta de control efectivo; para eso se analizan los casos recolectados en el Instituto Colombiano del Dolor (Incodol) con el objetivo de determinar la efectividad y la seguridad del procedimiento.Materiales y métodos: En este estudio retrospectivo descriptivo, se analizaron 100 pacientes a los que se les realizó bloqueo del plexo hipogástrico superior guiado por fluoroscopia. Se obtuvo datos de dolor percibido y requerimiento de analgésicos a los 0, 1, 3 y 6 meses después el bloqueo, y se registraron las complicaciones como sangrado, infección, lesión neurológica, dolor persistente y toxicidad. La percepción del dolor se analizó mediante el modelo lineal generalizado con efectos mixtos para medidas repetidas.Resultados: Todos los pacientes presentaron dolor de tipo visceral con una percepción media basal de 8,4 (SD = 1,5). El dolor percibido presentó disminución clínicamente relevante (> 50 %) del 45 %, 36 % y 23 % para cada periodo y el descenso del requerimiento analgésico a los 1, 3 y 6 meses fueron de 20 %, 19 % y 9 %, respectivamente. Para el sexto mes percepción del dolor fue estadísticamente significativa, siendo mayor en quienes disminuyeron el requerimiento de analgésicos (-5,2; IC 95 %: -6,7, -3,8). No se registraron complicaciones.Conclusiones: Se documenta la reducción estadísticamente significativa a los seis meses en la media del dolor percibido en pacientes con bloqueo del plexo hipogástrico superior guiado por fluoroscopia, sin registrarse complicaciones asociadas. Se considera benéfico en términos de reducción del dolor desde la perspectiva de puntos absolutos con respecto al valor basal de EVA...(AU)

Introduction: Chronic pelvic pain is a common, disabling gynecological problem that affects patient’s quality of life. Its prevalence is estimated to be up to 26.6 % worldwide and in 30 % of the cases there’s no clear trigger. Within the analgesic management, the use of interventionism is proposed as an effective tool, for this reason the cases collected in the Colombian Institute of Pain (Incodol) are analyzed to determine the effectiveness and safety of the procedure.Materials and methods: In this retrospective descriptive study, 100 patients with superior hypogastric plexus block guided by fluoroscopy were analyzed. Data on pain perception and analgesic requirements were obtained at 0, 1, 3, and 6 months after the block, and complications such as bleeding, infection, neurological injury, persistent pain, and toxicity were recorded. Pain perception was analyzed using the generalized linear model with mixed effects for repeated measures.Results: All patients presented visceral pain with a mean baseline perception of 8.4 (SD = 1.5). The perceived pain presented a clinically relevant decrease (> 50 %) of 45 %, 36 % and 23 % for each period and the decrease in analgesic requirement at 1, 3 and 6 months was 20 %, 19 % and 9 % respectively; For the sixth month, the reduction of pain perception was statistically significant, being higher in those who reduced the need for analgesics (-5.2; 95 % CI: -6.7, -3.8). No complications were recorded.Conclusions: The statistically significant reduction at six months in the mean of perceived pain in patients with fluoroscopy-guided superior hypogastric plexus block is documented, without registering associated complications. It is considered beneficial in terms of pain reduction from the perspective of absolute points with respect to baseline VAS value. The safety results give rise to consider it as a complementary and/or rescue technique in selected populations.(AU)

Fluoroscopia por tomografia computadorizada - biópsia percutânea guiada de nódulos pulmonares ≤ 10 mm: análise retrospectiva de procedimentos realizados no período de pandemia de COVID-19 / Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic

Resumo Objetivo: Avaliar o desempenho diagnóstico da biópsia pulmonar percutânea transtorácica (BPPT) guiada por fluoroscopia associada a tomografia computadorizada (FTC) em nódulos pulmonares ≤ 10 mm no período de pandemia de COVID-19. Materiais e Métodos: No período de 1º de janeiro de 2020 a 30 de abril de 2022, 359 BPPTs guiadas por FTC foram realizadas em um centro terciário de radiologia intervencionista. As lesões pulmonares mediam entre 2 mm e 108 mm. Dessas 359 BPPTs, 27 (7,5%) foram realizadas com agulha 18G em nódulos de 2 mm a 10 mm. Resultados: Das 27 BPPTs realizadas nos nódulos ≤ 10 mm, quatro lesões tinham dimensões menores que 5 mm e 23 lesões mediam entre 5 e 10 mm. Sensibilidade e acurácia diagnóstica das BPPTs guiadas por FTC foram de 100% e 92,3%, respectivamente. A dose média de radiação ionizante para os pacientes durante o procedimento de BPPT guiada por FTC foi de 581,33 mGy*cm, variando de 303 a 1129 mGy*cm. A média de tempo dos procedimentos de biópsia foi de 6,6 minutos, variando de 2 a 12 minutos. Nas 27 BPPTs, nenhuma complicação maior foi descrita. Conclusão: A BBPT guiada por FTC resultou em alto rendimento diagnóstico e baixas taxas de complicações.

Abstract Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.

Efficacy of full-endoscopic interlaminar and transforaminal discectomy for lumber disc herniation / Eficácia da discectomia interlaminar e transforaminal totalmente endoscópica na hérnia de disco lombar

ABSTRACT A previous study has reported the therapeutic effects of interlaminar/transforaminal approaches under full-endoscopic visualization to treat L5-S1 lumber disc herniation (LDH). However, the comparison of interlaminar/transforaminal approaches to treat other segments of LDH remains unclear. Objective: To evaluate the clinical efficacy of full-endoscopic interlaminar and transforaminal lumbar discectomy to treat LDH. Methods: A total of 93 patients with LDH who underwent fully-endoscopic lumbar interlaminar/transforaminal discectomy were retrospectively collected. Patients were divided into a Transforaminal group (n=41) and an Interlaminar group (n=52). Clinical efficacy was evaluated by visual analogue scale (VAS), the Oswestry disability index (ODI), and the modified MacNab scoring system. Results: Of the 93 patients, involving segments in LDH referred to L3-4, L4-5, and L5-S1. The fluoroscopy times in the Interlaminar group were smaller than that of the Transforaminal group. We found no obvious significances between the Transforaminal and Interlaminar groups regarding operation time, incision length, postoperative landing time, hospitalization, and incision healing time. Postoperative VAS and ODI scores notably improved at follow-up. Besides, almost 90% LDH patients achieved excellent/good outcomes. Conclusion: The full-endoscopic visualization technique via interlaminar and transforaminal approaches safely and effectively treat LDH. Level of Evidence III, Retrospective Study.

RESUMO Um estudo anterior relatou os efeitos terapêuticos das abordagens interlaminar/transforaminal sob visualização totalmente endoscópica para tratar a hérnia de disco lombar (HDL) L5-S1. No entanto, a comparação das abordagens interlaminar/transforaminal para o tratamento de outros segmentos de HDL permanece pouco clara. Objetivo: Avaliar a eficácia clínica da discectomia lombar interlaminar e transforaminal totalmente endoscópica no tratamento da HDL. Métodos: Foram recolhidos retrospetivamente 93 pacientes com HDL submetidos a discectomia lombar interlaminar/transforaminal totalmente endoscópica. Os pacientes foram divididos em um grupo transforaminal (n=41) e um grupo interlaminar (n=52). A eficácia clínica foi avaliada através da escala visual analógica (EVA), do índice Oswestry de incapacidade (ODI) e do sistema de pontuação de MacNab modificado. Resultados: Dos 93 pacientes, os segmentos envolvidos na HDL referiam-se a L3-4, L4-5 e L5-S1. Os tempos de fluoroscopia no grupo Interlaminar foram menores do que no grupo Transforaminal. Não encontramos significâncias óbvias entre os grupos Transforaminal e Interlaminar em relação ao tempo de operação, comprimento da incisão, tempo de pós-operatório, hospitalização e tempo de cicatrização da incisão. As pontuações EVA e ODI pós-operatórias melhoraram notavelmente no acompanhamento. Além disso, quase 90% dos pacientes com HDL obtiveram resultados excelentes/bons. Conclusão: A técnica de visualização totalmente endoscópica através de abordagens interlaminar e transforaminal trata a HDL de forma segura e eficaz. Nível de Evidência III, Estudo Retrospectivo.