Safety and Effectiveness of Sclerotherapy for Nonparasitic Splenic Cysts: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the reported safety and effectiveness of sclerotherapy for the treatment of nonparasitic splenic cysts through a systematic review and meta-analysis. MATERIALS AND METHODS: A systematic search of PubMed MEDLINE, Embase, Web of Science, and the Cochrane Library through July 2023 was performed. Studies including at least 5 patients reporting percutaneous sclerotherapy of nonparasitic splenic cysts, initial and posttreatment cyst size, clinical symptoms as well as adverse events (AEs), and recurrence rates were included. A 0-8-point scale for case reports and case series was used to assess bias. Data were analyzed using random-effects meta-analysis. RESULTS: Twenty-three of 833 citations were selected for full-text assessment, and 7 studies were included for a total of 99 patients. The methodological quality of the studies included scored 3-7. Composite analysis demonstrated 38% (95% CI, 23%-55%) rate of recurrence after treatment with significant heterogeneity; however, when assessed for a cyst size of <8 cm, recurrence dropped to 7% (95% CI, 2%-20%). Residual symptoms after treatment completion were present in 17% (95% CI, 7%-33%). Intraprocedural and postprocedural AE rates were 6% (95% CI, 3%-13%) and 6% (95% CI, 3%-12%) respectively. CONCLUSIONS: Sclerotherapy of splenic cysts seemed to be safe, with a high rate of recurrence for cysts ≥8 cm.

Mechanical Thrombectomy in Pulmonary Embolism Associated with COVID-19: A "Clotography" Gallery.

Venous thromboembolism from a "thrombotic storm"-like syndrome is a major cause of morbidity and mortality in patients with active or "recovered" COVID-19. Patients should be risk-stratified, optimally by a pulmonary embolism (PE) response team (PERT), and considered for escalation of care if found with intermediate or high-risk PE. We present a series of patients with COVID-19-associated PE and thrombotic storm with D-dimer >10 000 ng/mL who underwent successful mechanical thrombectomy for intermediate to high-risk PE. All patients had immediate improvement in hemodynamics and large amounts of thrombi were retrieved.

Outcomes of a structured inter-professional ultrasound guided vascular access workshop: a program evaluation report analyzing structure, participation and satisfaction.

This article was migrated. The article was marked as recommended. Ultrasound-guided vascular access procedures are increasingly performed, particularly in the hospital setting, by a variety of health care professionals. Adequate teaching of the skills required for these procedures is important for all clinicians conducting these procedures. We created an inter-disciplinary workshop to teach these skills to anyone interested at our institution. This was a half-day workshop that combined pre-workshop teaching materials with didactic lectures and simulation based learning, which was followed by deliberate practice. Enrollment was on a first come first serve basis. We retrospectively reviewed the enrollment and performance of this workshop at our institution over 18 months. The workshop proved equally attractive to trainees and staff. Participants spanned a variety of healthcare disciplines, with the most common being intensive care (27%) and diagnostic imaging (23%). Participants indicated high satisfaction with the workshop, with a mean score of 4.7 on a 5-point Likert scale given to measure overall satisfaction. A long-term impact survey indicated regular use of skills learned in the workshop and a perceived improvement in clinical practice. This study helps demonstrate the efficacy of this inter-professional workshop structure in helping multidisciplinary healthcare professionals acquire unique skillsets for everyday clinical practice.

Use of Vascular Ports for Long-Term Apheresis in Children.

High-flow ports have been used for apheresis in adults. The purpose of this study was to demonstrate the efficacy of ports for apheresis in children and to survey satisfaction of patients and their families with their use. A retrospective review of clinical details was combined with a prospective assessment of the experience of patients and their families. Eight patients (mean age, 10.4 y; mean weight, 35 kg) had nine ports placed for long-term apheresis. All 246 treatment sessions were completed successfully. Access difficulties occurred in eight of 246 sessions (3%). Alarms occurred in 40 of 246 sessions (16%), resulting in delays in 10 of 246 sessions (4%). A survey of early experience indicated overall satisfaction with and a preference for ports for apheresis.