Variceal and Nonvariceal Upper Gastrointestinal Bleeding Refractory to Endoscopic Management: Indications and Role of Interventional Radiology.

For over 60 years, diagnostic and interventional radiology have been heavily involved in the evaluation and treatment of patients presenting with gastrointestinal bleeding. For patients who present with upper GI bleeding and have a contraindication to endoscopy or have an unsuccessful attempt at endoscopy for identifying or controlling the bleeding, interventional radiology is often consulted for evaluation and consideration of catheter-based intervention.

Educational Value of an Intern-Directed Vascular Access Team at a Community Teaching Hospital.

To gain additional experience in ultrasound-guided procedures, interventional radiology (IR)-bound surgical preliminary interns at an urban community hospital established a difficult intravenous access (DIVA) consult service. This study evaluates the efficacy, safety, and educational value for such a team. The first year of DIVA team results were followed from May 2019 to April 2020. The value of the experience for IR-bound residents vs. categorical general surgery residents (GS) was compared. 239 patients were evaluated by the DIVA team for a total of 4.3 consults per week. General surgery residents performed an additional estimated 2.5 consults per week. For IR residents, 218/230 (94.8%) PIV and 8/9 (88.9%) midline attempts were successful. There were no technical complications that required additional procedural interventions. All residents found educational value in participating in DIVA team. Residents designated to enter IR found participating in the DIVA team to be significantly more beneficial for overall educational value learning identification/access of vessels under ultrasound guidance (P < .01). Interventional radiology residents had a higher mean number of procedures (average 60 vs. 24) before diminishing educational value was noted (P < .05). 100% of GS and IR residents noted that upon entering PGY 2 they felt more adept than their peers at performing ultrasound-guided vascular access and all believed their experience working with DIVA team would benefit them throughout their careers. Establishment of an intern-directed difficult IV access team is beneficial to resident education as well as patient care. Monitoring of case load to avoid service over education is recommended.

Percutaneous Access of the Modified Hutson Loop for Retrograde Cholangiography, Endoscopy, and Biliary Interventions.

PURPOSE: The purpose of this study was to present the institutional experience of performing endoscopy, cholangiography, and biliary interventions through the modified Hutson loop by interventional radiology. MATERIALS AND METHODS: A total of 61 of 64 modified Hutson loop access procedures were successful. This single-center retrospective study included 61 successful procedures of biliary interventions using existing modified Hutson loops (surgically affixed subcutaneous jejunal limb adjacent to biliary anastomosis or anastomoses) for diagnostic or therapeutic purposes in 21 patients. Seventeen of 21 patients (81%) had undergone liver transplantation. Indications included biliary strictures (n = 18) and biliary leaks (n = 3). The clinical success and complications were evaluated. RESULTS: There were 3 of 26 modified Hutson loop retrograde biliary intervention failures (12%) before introduction of endoscopy and no failures (0 of 38 [0%]) subsequently (P = .06). Endoscopy or cholangioscopy was performed in 19 procedures by interventional radiologists. Retrograde biliary interventions included diagnostic cholangiography (n = 26), cholangioplasty (n = 25), stent placement (n = 29), stent retrieval (n = 25), and biliary drainage catheter placement (n = 5). No procedure-related mortality occurred. There was 1 major complication (duodenal perforation) (1.6%) and 12 minor complications (19%). In the 9 patients undergoing therapeutic interventions for biliary strictures, there was a significant decrease in median alkaline phosphatase (288.5 to 174.5 U/L; P = .03). There was a trend toward decrease in median bilirubin levels (1.7 to 1 mg/dL; P = .06) at 1 month post-intervention. CONCLUSIONS: The modified Hutson loop provided interventional radiologists a safe and effective alternative access to manage biliary complications in patients with biliary-enteric anastomoses. Introduction of the endoscope in interventional radiology has improved the success rate of these procedures.

Parainfluenza Virus in Hospitalized Adults: A 7-Year Retrospective Study.

Background: Parainfluenza virus (PIV) is a cause of respiratory tract infection in children and the immunocompromised population, but its clinical manifestations, impact, and outcomes in hospitalized adults are not well studied. Methods: This retrospective study included adults (≥18 years old) admitted to Northwestern Memorial Hospital or Prentice Women's Hospital (both in Chicago, Illinois) between 1 August 2009 and 31 July 2016 with a positive molecular test result for PIV. Epidemiologic, clinical, and outcomes data were collected from the enterprise data warehouse and patient electronic health records after institutional review board approval. Descriptive statistics were used to summarize the data. Results: A total of 550 adults with a positive molecular test for PIV were identified. Differences in seasonality, clinical presentation, and prevalence between the different PIV serotypes (PIV-1, PIV-2, and PIV-3) were identified. The most common signs/symptoms were cough (88%), productive sputum (55%), fever (63%), and dyspnea (49%). Of the patients administered antibiotics, 349 (79.6%) had no confirmed bacterial infection throughout their hospitalization. The average length of hospitalization was 7.7 days. Presence of bacterial coinfection (P = .01), fungal coinfection (P < .01), decreased body mass index (P = .03), and increased respiratory rate (P < .01) were associated with significant differences in mortality rates. Conclusions: PIV infection is associated with substantial morbidity in hospitalized adults. Such data will be useful in understanding the impact on epidemiology and outcomes if a PIV-specific vaccine becomes available. Furthermore, this highlights the need for novel preventive and therapeutic approaches to PIV infection.

Parainfluenza Virus in the Hospitalized Adult.

Parainfluenza virus (PIV) is a negative-sense single-stranded RNA virus in the Paramyxoviridae family. There are 4 serotypes that follow seasonal patterns with varying rates of infection for each serotype. PIV is an established cause of disease and death in the pediatric and immunocompromised populations, and its impact on the hospitalized adult is becoming more apparent with the increased use of multiplex molecular assays in the clinical setting. The clinical presentation of PIV in hospitalized adults varies widely and includes upper respiratory tract infections, severe lower respiratory tract infections, and exacerbations of underlying disease; 0.2%-11.5% of hospitalized patients with pneumonia have been found to have PIV infection. Currently no licensed treatment is available for PIV infection. Ribavirin has been used, but case studies show no impact on mortality rates. DAS181, an inhaled sialidase, is undergoing clinical development for the treatment of PIV in adults and children.