Percutaneous discectomy under CT and fluoroscopy guidance: an international multicentric study.

PURPOSE: To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment. METHODS: A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure. RESULTS: Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers. CONCLUSION: APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.

Percutaneous drainage treatment of traumatic pancreatic rupture with pancreatic transection

Management of traumatic pancreatic pseudocyst associated with pancreatic duct laceration is controversial. Surgical therapy has been clasically considered the treatment of choice for those pseudocysts. However, several authors have published good results with percutaneous drainage. Percutaneous drainage can be performed easily, with minimal complication and may facilitate the resolution of a pseudocyst.We present a case of a 16-year-old boy who sustained blunt abdominal trauma in a vehicle accident. A large pancreatic pseudocyst developed, with complete disruption of the main pancreatic duct. Percutaneous drainage under ultrasound guidance was performed and was associated with the administration of octreotide (to inhibit exocrine pancreatic secretion). The drainage flow decreased gradually until ceasing, and the pseudocyst disappeared(AU)

El manejo de pseudoquistes pancreáticos de origen traumático asociados con el desgarro del conducto pancreático es polémico. Tradicionalmente, el abordaje de elección para dichos pseudoquistes ha sido el tratamiento quirúrgico. No obstante, varios autores han publicado buenos resultados con el drenaje percutáneo. El drenaje percutáneo se puede realizar de forma sencilla, con mínimas complicaciones y podría ayuda a resolver el pseudoquiste. Presentamos el caso de un joven de 16 años que sufrió traumatismo abdominal contuso en un accidente de coche. Se desarrolló un pseudoquiste pancreático de grandes dimensiones que causó trastorno absoluto del conducto pancreático principal. Se realizó drenaje percutáneo bajo vigilancia ecográfica junto con la administración de octreótida para inhibir la secreción exocrina del páncreas. El flujo del drenaje descendió de forma gradual hasta su cese completo y la desaparición del pseudoquiste (AU)

Percutaneous drainage treatment of traumatic pancreatic rupture with pancreatic transection.

Management of traumatic pancreatic pseudocyst associated with pancreatic duct laceration is controversial. Surgical therapy has been clasically considered the treatment of choice for those pseudocysts. However, several authors have published good results with percutaneous drainage. Percutaneous drainage can be performed easily, with minimal complication and may facilitate the resolution of a pseudocyst. We present a case of a 16-year-old boy who sustained blunt abdominal trauma in a vehicle accident. A large pancreatic pseudocyst developed, with complete disruption of the main pancreatic duct. Percutaneous drainage under ultrasound guidance was performed and was associated with the administration of octreotide (to inhibit exocrine pancreatic secretion). The drainage flow decreased gradually until ceasing, and the pseudocyst disappeared.

Drenaje percutáneo transgástrico de seudoquistes pancreáticos, también en los de origen traumático / Transgastric percutaneous drainage of pancreatic pseudocysts: also of use in traumatic pseudocysts

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