Utilidad de la anestesia local del plexo periprostático en el control del dolor en las biopsias prostáticas guiadas con ecografía / Utility of local anestesia of the periprostatic plexus in the control of the pain in the ultrasound-guided prostate biopsy

Objetivo: La anestesia del plexo periprostático (APP) no es práctica habitual durante la biopsia prostática (BP).Muchos pacientes deben someterse a una segunda, o más, BP por sospecha de carcinoma. El dolor influye en la repetición de la misma pues determina que muchos pacientes rechacen el procedimiento o que éste deba realizarse en quirófano bajo anestesia. Nuestro objetivo fue valorar la utilidad de la APP en la supresión del dolor producido durante la realización de la BP así como la aceptación del procedimiento realizado en estas condiciones. Material y métodos: De octubre del 2002 a junio del 2003 planteamos un trabajo prospectivo con casos y controles en el que incluimos aleatoriamente 275 pacientes de dos centros para BP. En el primer centro se incluyeron 101 varones a los que no se les realizó APP, mientras que en el segundo fueron 174 los pacientes sometidos a BP tras APP. Usamos hasta 10 ml de lidocaína al 2% diluida al 50% administrada mediante una aguja fina del calibre 22. Al final del procedimiento se invitó al paciente a rellenar un cuestionario de satisfacción y evaluación del dolor. Resultados: En el grupo de pacientes del segundo centro se obtuvieron valores medios significativamente inferiores (p<0,005, IC 95%) en la valoración cuantitativa del dolor, que en el grupo del primer centro (1,24±0,4 vs. 2,5±1,1).Respecto a la posibilidad, si fuese necesario, de repetir la BP, a ninguno de los pacientes del segundo centro le importaría, mientras que el 10% del primer centro no la repetirían o la aceptarían sólo bajo anestesia. No se produjeron complicaciones atribuibles a la APP. Conclusión: La APP es una técnica segura que reduce significativamente el dolor durante la BP, mejorando la aceptación de la misma (AU)

Objetive: Periprostatic plexus anesthesia (PPA) is not current practice during prostate ultrasound-guided biopsy (PB). Many patients must undergo a second or more PB if a prostate carcinoma is suspected. Due to pain, many patients reject the procedure, or it has to be performed with general anesthesia. Our objective was to evaluate the utility of PPA to eliminate the pain caused by PB, as well as the acceptance of the procedure under these conditions. Patients and Methods: Between october 2002 and june 2003 we designed a randomized prospective study with 275 patients that were seen in 2 different hospitals and required PB. In the 1st group we included 101 males who underwent PB without PA. In the other group, 174 male patients submitted PB after PPA were included. 10 cc lidocaine, 2% diluted 50% was injected with a 22g needle. At the end of the procedure, patients were asked to fill in a questionnaire about their satisfaction and degree of pain felt. Results: In the second group of patients we obtained significantly inferior values (p<0.005, IC 95%) in the quantitative evaluation of pain compared with the first group (1.24±0.4 vs. 2.5 ±1.1). Ask per the possibility of repeating PB if it were necessary, none of the patients in the 2nd group would object, whereas 10% in the 1st group would not have the biopsy repeated or would only accept it if it was done with general anesthesia. No complications due to PPA were found. Conclusion: PPA is a safe procedure that significantly reduces pain during PB, improving its acquiescence among patients (AU)

[Utility of local anesthesia of the periprostatic plexus in the control of the pain in the ultrasound-guided prostate biopsy]. / Utilidad de la anestesia local del plexo periprostático en el control del dolor en las biopsias prostáticas guiadas con ecografía.

OBJECTIVE: Periprostatic plexus anesthesia (PPA) is not current practice during prostate ultrasound-guided biopsy (PB). Many patients must undergo a second or more PB if a prostate carcinoma is suspected. Due to pain, many patients reject the procedure, or it has to be performed with general anesthesia. Our objective was to evaluate the utility of PPA to eliminate the pain caused by PB, as well as the acceptance of the procedure under these conditions. PATIENTS AND METHODS: Between october 2002 and june 2003 we designed a randomized prospective study with 275 patients that were seen in 2 different hospitals and required PB. In the 1st group we included 101 males who underwent PB without PA. In the other group, 174 male patients submitted PB after PPA were included. 10 cc lidocaine, 2% diluted 50% was injected with a 22g needle. At the end of the procedure, patients were asked to fill in a questionnaire about their satisfaction and degree of pain felt. RESULTS: In the second group of patients we obtained significantly inferior values (p < 0.005, IC 95%) in the quantitative evaluation of pain compared with the first group (1.24 +/- 0.4 vs. 2.5 +/- 1.1). Ask per the possibility of repeating PB if it were necessary, none of the patients in the 2nd group would object, whereas 10% in the 1st group would not have the biopsy repeated or would only accept it if it was done with general anesthesia. No complications due to PPA were found. CONCLUSION: PPA is a safe procedure that significantly reduces pain during PB, improving its acquiescence among patients.

Valor diagnóstico de segundas biopsias prostáticas en varones de riesgo. Estudio estratificado por valor de PSA / Diagnostic value of the second prostate biopsies in males of risk. Study stratified by value of PSA

OBJETIVO: Valorar el rendimiento diagnóstico de la segunda biopsia prostática (BP). PACIENTES Y MÉTODOS: Un total de 116 varones con BP previa de benignidad fueron sometidos a 2 o más BP por sextantes guiadas con ultrasonidos (US). Los criterios de inclusión fueron: BP previa sospechosa (PIN), PSA elevado, TR o US sospechoso.RESULTADOS: El tiempo medio transcurrido entre la primera y siguiente biopsia fue de 13 ± 11 meses. Se obtuvieron 35 malignas y 4 premalignas en las segundas biopsias realizadas, lo que da un rendimiento diagnóstico global del 33,6%. Cuando estratificamos por valor de PSA, obtenemos que con PSA 10 ng/ml, de 34,6%. CONCLUSIÓN: La repetición de la biopsia seriada de próstata en pacientes de riesgo, mejora el rendimiento diagnóstico y elimina los falsos negativos de carcinoma. prostático

OBJETIVE: To value the diagnostic yield of the second prostate biopsy (BP). PATIENTS AND METHODS: To 116 males with BP previous to kindliness surrendered to 2 or more BP for sextants guided with ultrasounds (US). The criteria of inclusion were: BP previous suspicious (PIN), high PSA, TR or suspicious US. RESULTS: The average time passed between the first and following biopsy was 13 ± 11 months. 35 malignant and 4 premalignant ones were obtained in the second realized biopsies, which gives a diagnostic global yield of 33.6%. When we stratify for value of PSA, we obtain that with PSA 10 ng/ml of 34,6%. CONCLUSION: The repetition of the serial biopsy of prostate in patients of risk, improves the diagnostic yield and eliminates the false negatives of prostate carcinoma

[Diagnostic value of the second prostate biopsies in males of risk. Study stratified by value of PSA]. / Valor diagnóstico de segundas biopsias prostáticas en varones de riesgo. Estudio estratificado por valor de PSA.

OBJECTIVE: [corrected] To value the diagnostic yield of the second prostate biopsy (BP). PATIENTS AND METHODS: To 116 males with BP previous to kindliness surrendered to 2 or more BP for sextants guided with ultrasounds (US). The criteria of inclusion were: BP previous suspicious (PIN), high PSA, TR or suspicious US. RESULTS: The average time passed between the first and following biopsy was 13 +/- 11 months. 35 malignant and 4 premalignant ones were obtained in the second realized biopsies, which gives a diagnostic global yield of 33.6%. When we stratify for value of PSA, we obtain that with PSA <4 ng/ml the yield was 23%, for PSA 4-10 ng/ml the yield was 32% and for PSA >10 ng/ml of 34.6%. CONCLUSION: The repetition of the serial biopsy of prostate in patients of risk, improves the diagnostic yield and eliminates the false negatives of prostate carcinoma.

Sonographically guided percutaneous biopsy of gastrointestinal tract lesions.

OBJECTIVE: Our objective was to evaluate the role and safety of sonographically guided percutaneous biopsy in the diagnosis of digestive tract lesions when the lesions are not suitable to biopsy by endoscopy and safely reachable by sonography. MATERIALS AND METHODS: We performed 42 biopsies in 41 patients (age range, 14-81 years; mean age, 57.5 years). We performed biopsies with real-time sonographic guidance using graded compression, with a 3.5-5-MHz microconvex transducer. In 39 biopsies, core specimens were obtained with an 18-gauge automatic needle gun; fine-needle aspiration biopsy was obtained in 28 patients with a 22-gauge needle and in the other four patients with a 21-gauge needle. In the remaining three patients, a coaxial technique with 20- and 22-gauge needles for cytology was used. RESULTS: In 40 (95.2%) of 42 core biopsies performed, a specific diagnosis was obtained. A positive diagnosis was obtained in 16 (45.7%) of 35 fine-needle aspirations. The lesions were located from the pharynx to the sigmoid colon. Twenty-eight patients had malignant lesions, and 13 had benign lesions. Only one serious complication, bile peritonitis, was observed. CONCLUSION: Percutaneous biopsy with sonographic guidance can be used safely and efficiently to diagnose digestive tract lesions that can be visualized on sonography and are not accessible endoscopically.

[Echography-guided percutaneous biopsy of pleural lesions and effusions]. / Biopsia percutánea de lesiones y derrames pleurales dirigida por ecografía.

Our experience in the use of ultrasonic echography (UE) is exposed as a guide for directing small lesions and pleural effusions percutaneous lesions with an unknown grounds. We have done pleural percutaneous biopsy using UE as guide in 45 patients. The needle diameter ranges between 17 and 19.5 G. Lesions were benign for 16 patients and malignant for 29. The right result was obtained in 93% of the cases. There were not complications. We conclude that echography-directed pleural biopsy presents an excellent diagnostic profitability, it improves the results obtained with blind biopsy with Cope's needle and it must precede thoracoscopy by means of its less aggressiveness.

Characterization of solid liver lesions with color and pulsed Doppler imaging.

BACKGROUND: To assess the usefulness of color Doppler and duplex sonography in the characterization of solid liver lesions. METHODS: We performed color Doppler and duplex sonography on 106 solid hepatic lesions. With color Doppler, we evaluated the aspect and distribution of tumoral vessels. The pulsed Doppler parameters considered were only those showing the highest systolic peak velocity values. RESULTS: Intratumoral color and pulsed Doppler signals were obtained in 81% (59/73) of malignant tumors (p < 0. 0001) but only in 18% (6/33) of benign tumors. Ninety-six percent (45/47) of the lesions with arterial intratumoral and peritumoral signals were malignant, whereas 4% were benign (p < 0.0001). Only eight (11%) malignant lesions had intratumoral venous signal vis-a-vis 23 (70%) benign. Twelve cases showing intratumoral venous Doppler signal as a single finding were benign. No statistically significant differences were observed in the quantitative parameters recorded by pulsed Doppler (Student t test, p < 0.05), there having been a clear overlapping in the values obtained in benign and malignant lesions. CONCLUSIONS: (a) The type of signal (arterial or venous) and its distribution detected by color and pulsed Doppler is more helpful than the assessment of the spectral quantitative parameters obtained by pulsed Doppler. (b) The presence of intratumoral venous flow remarkably suggests benignancy. (c) The presence of both intra- and peritumoral arterial flow in the same lesion strongly suggests malignancy.

Eosinophilic gastroenteritis: percutaneous biopsy under ultrasound guidance.

Eosinophilic gastroenteritis (EG) is an unusual disorder that is characterized by diffuse or scattered eosinophilic infiltration of the digestive tract. The diagnosis is based on histology obtained by capsule, endoscopic, laparoscopic, or laparotomy biopsy. The eosinophilic infiltration produces thickening of the small bowel wall that can be observed by using sonography. The appearance produces the pseudokidney sign that can be used to guide biopsy. We report the first case of EG diagnosed by percutaneous biopsy under ultrasound guidance.

Infected intraabdominal hematomas: percutaneous drainage.

Percutaneous drainage of infected intraabdominal hematomas has often been contraindicated due to its greater number of complications. The results of percutaneous drainage of infected localized hematomas in five cases are described, two in the lesser sac and three in the right subphrenic space. The catheter size ranged from 8.4 to 24 French. Mean maintenance time of the drainage was 37 days. Drainage tube obstruction occurred in three patients, in two of whom the drainage tube had to be changed for one with a broader gauge. Hematomas were completely resolved in all the cases. We describe our experience with one patient in whom we used intracavitary urokinase who showed successful results. Percutaneous drainage is not contraindicated in the management of infected hematomas, although the drainage tube must be closely controlled; drainage time may be longer than in other types of abscesses.