Need for analgesia after percutaneous liver biopsy: a real-life experience.

OBJECTIVE: To evaluate variables affecting the need for analgesia after ultrasound-guided percutaneous liver biopsy performed on an outpatient basis. MATERIALS AND METHODS: This was a retrospective analysis of 1,042 liver biopsies performed between 2012 and 2018. The data collected included the age and sex of the patient, as well as self-reported pain in the recovery room, the pain treatment used, the indication for the biopsy, and the lobe punctured. As per the protocol of our institution, physicians would re-evaluate patients with mild pain (1-3 on a visual analog scale), prescribe analgesics for those with moderate pain (4-6 on the visual analog scale), and prescribe opioids for those with severe pain (7-10 on the visual analog scale). RESULTS: The main indications for biopsy were related to diffuse disease (in 89.9%), including the follow-up of hepatitis C (in 47.0%) and suspicion of nonalcoholic steatohepatitis (in 38.0%). Pain requiring analgesia occurred in 8.0% of procedures. Of the 485 female patients, 51 (10.5%) needed analgesia, compared with 33 (5.9%) of the 557 male patients (p < 0.05). The need for analgesia did not differ in relation to patient age, the lobe punctured, or the indication for biopsy (nodular or diffuse disease). The analgesic most commonly used was dipyrone (in 75.9%), followed by paracetamol alone (16.4%) and their combination with opioids (7.6%). CONCLUSION: Ultrasound-guided percutaneous liver biopsy is safe and well tolerated. Postprocedural pain does not correlate with the lobe punctured, patient age, or the indication for biopsy and appears to affect more women than men.

OBJETIVO: Avaliar variáveis que afetam a necessidade de analgesia após biópsia hepática guiada por ultrassonografia. MATERIAIS E MÉTODOS: Análise retrospectiva de 1042 biópsias hepáticas realizadas entre 2012 e 2018. Os dados coletados incluíram dor detectada na sala de recuperação, analgesia utilizada, indicação, lobo puncionado, idade e sexo do paciente. O protocolo institucional indicava orientações e reavaliação para dor leve (1-3, segundo a escala visual analógica), analgésicos simples para dor moderada (4-6, segundo a escala visual analógica) e opioides para dor importante (7-10, segundo a escala visual analógica). RESULTADOS: As indicações foram principalmente doença difusa (89,9%), particularmente no seguimento de hepatite C (47,0%) e suspeita de esteato-hepatite não alcoólica (38,0%). Dor com necessidade de analgesia ocorreu em 8,0% dos procedimentos. Mulheres demandaram analgesia em 10,5% das vezes e homens demandaram em 5,9% (p < 0,05). Não houve diferença estatisticamente significante na necessidade de analgesia em relação a idade, lobo hepático puncionado ou indicação por doença nodular versus difusa. O analgésico mais utilizado foi dipirona (75,9%), seguido de paracetamol (16,4%) e associação com opioides (7,6%). CONCLUSÃO: Este é um procedimento seguro e bem tolerado. Dor pós-procedimento não se correlaciona com lateralidade da biópsia, idade ou doença nodular versus difusa e parece afetar mais mulheres que homens.

Need for analgesia after percutaneous liver biopsy: a real-life experience / Necessidade de analgesia após biópsia hepática percutânea: uma experiência da vida real

Abstract Objective: To evaluate variables affecting the need for analgesia after ultrasound-guided percutaneous liver biopsy performed on an outpatient basis. Materials and Methods: This was a retrospective analysis of 1,042 liver biopsies performed between 2012 and 2018. The data collected included the age and sex of the patient, as well as self-reported pain in the recovery room, the pain treatment used, the indication for the biopsy, and the lobe punctured. As per the protocol of our institution, physicians would re-evaluate patients with mild pain (1-3 on a visual analog scale), prescribe analgesics for those with moderate pain (4-6 on the visual analog scale), and prescribe opioids for those with severe pain (7-10 on the visual analog scale). Results: The main indications for biopsy were related to diffuse disease (in 89.9%), including the follow-up of hepatitis C (in 47.0%) and suspicion of nonalcoholic steatohepatitis (in 38.0%). Pain requiring analgesia occurred in 8.0% of procedures. Of the 485 female patients, 51 (10.5%) needed analgesia, compared with 33 (5.9%) of the 557 male patients (p < 0.05). The need for analgesia did not differ in relation to patient age, the lobe punctured, or the indication for biopsy (nodular or diffuse disease). The analgesic most commonly used was dipyrone (in 75.9%), followed by paracetamol alone (16.4%) and their combination with opioids (7.6%). Conclusion: Ultrasound-guided percutaneous liver biopsy is safe and well tolerated. Postprocedural pain does not correlate with the lobe punctured, patient age, or the indication for biopsy and appears to affect more women than men.

Resumo Objetivo: Avaliar variáveis que afetam a necessidade de analgesia após biópsia hepática guiada por ultrassonografia. Materiais e Métodos: Análise retrospectiva de 1042 biópsias hepáticas realizadas entre 2012 e 2018. Os dados coletados incluíram dor detectada na sala de recuperação, analgesia utilizada, indicação, lobo puncionado, idade e sexo do paciente. O protocolo institucional indicava orientações e reavaliação para dor leve (1-3, segundo a escala visual analógica), analgésicos simples para dor moderada (4-6, segundo a escala visual analógica) e opioides para dor importante (7-10, segundo a escala visual analógica). Resultados: As indicações foram principalmente doença difusa (89,9%), particularmente no seguimento de hepatite C (47,0%) e suspeita de esteato-hepatite não alcoólica (38,0%). Dor com necessidade de analgesia ocorreu em 8,0% dos procedimentos. Mulheres demandaram analgesia em 10,5% das vezes e homens demandaram em 5,9% (p < 0,05). Não houve diferença estatisticamente significante na necessidade de analgesia em relação a idade, lobo hepático puncionado ou indicação por doença nodular versus difusa. O analgésico mais utilizado foi dipirona (75,9%), seguido de paracetamol (16,4%) e associação com opioides (7,6%). Conclusão: Este é um procedimento seguro e bem tolerado. Dor pós-procedimento não se correlaciona com lateralidade da biópsia, idade ou doença nodular versus difusa e parece afetar mais mulheres que homens.

Endovascular Repositioning of a Central Venous Port Malposition in the Internal Thoracic Vein.

Malpositioning of a central venous port in the internal thoracic vein can be difficult to check based on single-plane (PA) chest radiographs only, and can be managed by interventional radiology. Teaching Point: Central venous port malposition in the internal thoracic vein must be detected on postero-anterior chest radiograph and can be repositioned via endovascular procedure.

Post-Traumatic Ostial Avulsion of a Polar Inferior Renal Artery Treated by Endovascular Covered Aortic Stenting.

Renovascular traumas are rare in abdominal blunt traumas, especially those involving complete avulsion of a renal artery. Their management poses a dilemma between blood flow preservation and the risks of bleeding. We present the case of a rare variant of renovascular injury, with a post traumatic ostial avulsion of a polar inferior renal artery, successfully treated percutaneously by endovascular aortic covered stenting under c-arm cone-beam computed tomography guiding.

Congenital horner syndrome with heterochromia iridis associated with ipsilateral internal carotid artery hypoplasia.

BACKGROUND: Horner syndrome (HS), also known as Claude-Bernard-Horner syndrome or oculosympathetic palsy, comprises ipsilateral ptosis, miosis, and facial anhidrosis. CASE REPORT: We report herein the case of a 67-year-old man who presented with congenital HS associated with ipsilateral hypoplasia of the internal carotid artery (ICA), as revealed by heterochromia iridis and confirmed by computed tomography (CT). CONCLUSIONS: CT evaluation of the skull base is essential to establish this diagnosis and distinguish aplasia from agenesis/hypoplasia (by the absence or hypoplasia of the carotid canal) or from acquired ICA obstruction as demonstrated by angiographic CT.

Unusual vanishing interstitial lymphatic "pearls" in a patient presenting with extensive interstitial and mediastinal MDCT features of acute cardiogenic failure related to bradycardia and mitral regurgitation.

Thoracic multidetector computed tomography-MDCT-was simultaneously performed during emergency abdominal CT in a patient presenting with abdominal pain and acute cardiogenic edema related to sick sinus syndrome and mitral prolapse with regurgitation. A constellation of severe but completely reversible interstitial and mediastinal features was found comprising pleural effusions, diffuse alveolar ground glass, thickening of the bronchial walls and septal lines, hazy infiltration of the mediastinal fat, and enlarged lymphatic nodes. Multiple atypical hypodense nodular "pearls" were also found. These oval shape or fusiform pearls were distributed along the thickened septal lines and disappeared completely after treatment. The hypothesis of transient lymphatic ectasia or lakes is proposed for these never previously described abnormalities.

Spontaneous (atraumatic) splenic rupture complicating anticoagulant treatment for splenic infarction.

We report the case of a 61-year-old male patient who suffered a spontaneous (atraumatic) splenic rupture (SSR) following splenic infarction treated by heparin anticoagulation. Splenic rupture precipitated by thrombolytic or anticoagulant therapy has been reported and putatively attributed to unrecognized micro-traumatisms i.e. after resuscitation manoeuvres, leading to massive bleeding upon anticoagulation and secondary splenic rupture. Nevertheless, SSR resulting from splenic infarction and anticoagulation has not been described.

Controversies about effects of low-kilovoltage MDCT acquisition on Agatston calcium scoring.

Recent articles have advocated the possibility of obtaining Agatston coronary calcium scoring at 100 kVp by using a single adapted elevated calcium threshold. To evaluate the influence of kilovoltage potential protocols on the Agatston score, we acquired successive scans of a calcium scoring phantom at 4 levels of kilovoltage potential (80, 100, 120, and 140 kVp, 55 mAs) and measured semiautomatically the individual and the total Agatston score of 6 inserts (of 5-mm and 3-mm diameter) containing hydroxyapatite at different concentrations (800, 400, 200 mg/cm(3)). Our results showed that Agatston scores obtained at various low-kilovoltage potential protocols can be highly overestimated in some particular cases. At 80 kVp, for example, mean measured Agatston score was multiplied by a factor from 1.06 (5-mm highest density insert) to 2.67 (3-mm lowest density insert) compared with the Agatston scores performed at 120 kVp. Indeed in the one hand, reducing kilovoltage potential in multidetector CT acquisitions increase the CT density of coronary calcifications that can be measured on the reconstructed images. On the other hand, Agatston score is a multi-threshold measurement (with a step weighting function). Consequently low kilovoltage potential can lead to overweight some calcifications scores. For these reasons, Agatston score with low kilovoltage potential acquisition cannot be reliably adapted by a unique recalibration of the standard calcium attenuation threshold of 130 HU and requires a standardized CT acquisition protocol at 120 kVp. Alternatives to performing low-dose coronary artery calcium scans are either using coronary calcium scans with reduced tube current (low mAs) at 120 kVp with the iterative reconstructions or using mass/volume scoring (not influenced by kilovoltage potential variations). Finally, we emphasized that incorrect Agatston score evaluation may have important clinical, financial, and health care implications.

Multiorgan developmental anomalies presenting as a variation of the serpentine-like syndrome: cervical fusion and brachioesophagus with intrathoracic stomach and malposition of duodenopancreas and spleen.

Congenital brachioesophagus with secondary intrathoracic stomach is an extremely rare condition. In association with rachischisis, the latter condition has been described recently as "serpentine-like syndrome." We report here a unique case of a male infant with normal karyotype from healthy nonconsanguinous parents, presenting with a complex malformative syndrome combining ultrashort brachioesophagus with intrathoracic stomach, duodenum, pancreas, and spleen associated with short neck because of posterior fusion and scoliosis. This case report details aspects of diagnostic and management of this unusual clinical presentation and includes a review of the literature.