Ultrasound-guided lumbar puncture for nusinersen administration in spinal muscular atrophy patients.

BACKGROUND AND PURPOSE: The purpose was to report the results of ultrasound-guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines. METHODS: Eighteen SMA patients (five children, five adolescents and eight adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound-guided lumbar puncture. Ultrasound was performed with a 3.5 MHz transducer to guide a 22 gauge × 15 mm needle, which was placed in the posterior lumbar space following a parasagittal interlaminar approach. RESULTS: Twelve patients had undergone spinal instrumentation (nine growing rods and three spinal fusion) whilst the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescents and 50% of adult patients. In two of the unsuccessfully treated patients, computed tomography and fluoroscopy-guided transforaminal lumbar punctures were also tried without success. After a median follow-up of 14 months, only few adverse events, mostly mild, were observed. CONCLUSION: The ultrasound-guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines and could be considered the first option in them.

Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada / Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies

Objetivo: La utilización de un tapón de hidrogel reduce el número de neumotórax y la necesidad de tubos de drenaje pleural en las biopsias de pulmón guiadas por tomografía computarizada. Realizamos un estudio de coste-efectividad sobre su uso. Material y métodos: Se analizaron 171 biopsias de pulmón divididas en tres grupos: grupo 1 (n=22): punción aspirativa con aguja fina (PAAF) sin tapón de hidrogel; grupo 2 (n=89): PAAF con tapón, y grupo 3 (n=60): PAAF más biopsia con aguja gruesa (BAG) con tapón. Se calcularon costes totales (directos e indirectos) de los tres grupos. Se analizó el porcentaje de diagnósticos correctos, las ratios medias e incrementales y la opción más coste-efectiva. Resultados: Costes totales: grupo 1 = 1.261,28 + 52,65 = 1.313,93 Euros, grupo 2 = 1.201,36 + 67,25 = 1.268,61 euros, grupo 3 = 1.220,22 + 47,20 = 1.267,42 Euros. Porcentaje de diagnósticos correctos: grupo 1 = 77,3%, grupo 2 = 85,4% y grupo 3 = 95% (p = 0,04). Ratio medio de coste-efectividad: grupo 1 = 16,99, grupo 2 = 14,85 y grupo 3=13,34. Conclusiones: El grupo 3 fue la opción dominante, con la menor ratio media, lo cual demuestra que, en las biopsias de pulmón guiadas por TC, la opción más coste-efectiva es la realización de una PAAF y una BAG con la utilización del tapón de hidrogel deshidratado al final del procedimiento

Objective: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. Material and methods: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. Results: Total costs: Group 1 = 1,261.28 + 52.65 = euros 1,313.93; Group 2 = 1,201.36 + 67.25 = Euros 1,268.61; Group 3 = 1,220.22 + 47.20 = Euros 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. Conclusions: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure

Cost-effectiveness of hydrogel plugs in CT-guided lung biopsies. / Estudio de coste-efectividad sobre la utilización de un tapón de hidrogel en las biopsias pulmonares guiadas por tomografía computarizada.

OBJECTIVE: Using a hydrogel plug decreases the number of cases of pneumothorax and reduces the need for pleural drainage tubes in CT-guided lung biopsies. We aimed to analyze the cost-effectiveness of using hydrogel plugs. MATERIAL AND METHODS: We analyzed 171 lung biopsies divided into three groups: Group 1 (n=22): fine-needle aspiration cytology (FNAC) without hydrogel plugs; Group 2 (n=89): FNAC with hydrogel plugs; and Group 3 (n=60): FNAC plus core-needle biopsy (CNB) with hydrogel plugs. We calculated the total costs (direct and indirect) in the three groups. We analyzed the percentage of correct diagnoses, the average and incremental rations, and the most cost-effective option. RESULTS: Total costs: Group 1 = 1,261.28 + 52.65 = € 1,313.93; Group 2 = 1,201.36 + 67.25 = € 1,268.61; Group 3 = 1,220.22 + 47.20 = € 1,267.42. Percentage of correct diagnoses: Group 1 = 77.3%, Group 2 = 85.4%, and Group 3 = 95% (p = 0.04). Average cost-effectiveness ratio: Group 1 = 16.99; Group 2 = 14.85; and Group 3 = 13.34. CONCLUSIONS: Group 3 was the best option, with the lowest average cost-effectiveness ratio; therefore, the most cost-effective approach is to do FNAC and CNB using a dehydrated hydrogel plug at the end of the procedure.