Punción percutánea transtorácica con aguja gruesa: complicaciones y factores de riesgo inherentes al paciente / Imaging-guided Chest Biopsies with Thick Needle: Complications and Risk Factors Inherent to the Patient

Objetivo Determinar la incidencia de complicaciones con el uso de una aguja gruesa (semiautomática Trucut 18), para punción pulmonar y realizar un análisis exploratorio de las variables inherentes al paciente que probablemente puedan tener relación con el desarrollo de complicaciones. Materiales y Métodos Estudio retrospectivo de una serie de casos de pacientes sometidos a punción percutánea transtorácica (PPT) con aguja gruesa y guiada por tomografía computada (TC) para el estudio de lesiones pulmonares; se realizó un análisis univariado. Resultados Se realizaron 26 punciones, la tasa de incidencia de complicaciones fue del 38,46% en 1 año; los pacientes presentaron: neumotórax leve (n » 7), neumotórax moderado (n » 3) y hemorragia alveolar difusa (n » 1). El análisis estadístico univariado mostró una diferencia estadísticamente significativa en la edad de los pacientes que presentaron complicaciones v/s los pacientes que no presentaron complicaciones (61,18 þ/- 3,6 versus 75,1 þ/- 2,46 años, p » 0,0107). Conclusión La PPT-TC es un procedimiento con una tasa considerable de complicaciones no severas; en nuestra serie de casos, la edad fue la variable que se asoció con mayor fuerza al probable desarrollo de complicaciones.

Objective Establish the incidence of complications with the use of thick needle (Trucut 18) for pulmonary puncture and perform an exploratory analysis of the inherent variables to the patient that may be related to complication development. Materials and Methods Retrospective study of a case series of patients undergoing transthoracic percutaneous puncture (PPT) with thick needle,guided by computed tomography (CT) for the study of pulmonary lesions; a univariate and multivariate analysis was performed. Results 26 punctures were performed, the incidence rate of complications was 38.46% in 1 year: patients presented: mild pneumothorax (n » 7), moderate pneumothorax (n » 3) and diffuse alveolar hemorrhage (n » 1). The univariate statistical analysis showed a statistically significant difference in the age of the patients who presented complications v/s patients who did not present complications (61.18 þ/- 3.6 versus 75.1 þ/- 2.46 years, p » 0.0107). Conclusion PPT-CT is a procedure with a considerable rate of non-severe complications; in our case series, age was the variable that was most strongly associated with the probable development of complications.

Resultados da vertebroplastia percutânea na doença vertebral cervical / Results of percutaneous vertebroplasty in the cervical spine

A vertebroplastia percutânea (VP) consiste na injeção de polimetilmetacrilato (PMMA) no corpo vertebral para alívio da dor e estabilização vertebral, porém seu uso na região cervical é restrito. No intuito de avaliar a efetividade e a segurança da VP na região cervical (VPC), foram avaliados 75 pacientes que se submeteram à VPC (n=101) por doença maligna (n=69) ou hemangioma vertebral (n=6) no período de janeiro de 1994 a outubro de 2007. A VPC foi realizada por uma abordagem ântero-lateral guiada por fluoroscopia. A dor foi graduada por uma escala variando de 0 a 10. O seguimento clinico (período médio de 8,8 meses) foi obtido em 57 (76%) pacientes: 48 tiveram a VPC indicada para controle da dor e nove para estabilização vertebral. Os dados foram analisados de forma univariada e multivariada. A efetividade analgésica foi obtida em 37 (77,1%) dos 48 pacientes seguidos, tendo sido associada ao volume de cimento injetado (P=0,011) e ao preenchimento vertebral (P=0,007) na análise multivariada. A estabilidade vertebral foi observada em 55 (96,5%) dos 57 pacientes, não se correlacionando com as variáveis estudadas. A curva de ROC identificou o preenchimento vertebral como preditor da efetividade analgésica (P=0,008), sendo 50% o melhor ponto de corte para discriminar a maior probabilidade de efetividade analgésica (sensibilidade de 78,0% e especificidade de 62,5%). O extravasamento de cimento foi identificado em 83 (82,2%) das 101 vértebras tratadas não se correlacionando com as variáveis estudadas. As complicações clínicas foram detectadas em 13 (17,3 %) pacientes: complicações locais em 10 (13,3%) e sistêmicas em três (4%) pacientes. As complicações clínicas foram estatisticamente relacionadas à ruptura do muro posterior (P=0,026) e ao extravasamento de PMMA no plexo venoso transverso (P=0,023). A taxa de mortalidade e morbidade a longo termo foi de 1,3% (um paciente) e 1,3% (um paciente). Pode se inferir que a VPC é um procedimento efetivo e seguro...

Percutaneous vertebroplasty (PV) consists of an injection of polymethylmethacrylate (PMMA) into the vertebral body for pain relief and spinal stabilization, however reports of PV in the cervical spine (CPV) are scarce in the literature. To evaluate the effectiveness and security of CPV, we evaluated 75 patients (mean age, 51.3 years) who underwent CPV (n=101) for malignancies (n=69) and vertebral hemangiomas (n=6) between January 1994 and October 2007. CPV was performed via an antero-lateral approach, using fluoroscopic guidance. Pain intensity was scored with a scale ranging from 0 to 10. Follow-up (mean time of 8.8 months) was avaible in 57 (76 %) patients: 48 of them had CPV indicated for pain control and nine for spinal stabilization. Data were analysed by means of univariate and multivariate analysis. Pain improvement was observed in 37 (77.1%) out of 48 followed patients and was correlated in multivariate analysis with cement volume (P=0.011) and with vertebral filling (P=0.007). Spinal stabilization was observed in 55 (96.5%) of 57 followed patients and was related with none of the evaluated variables. The ROC curve identified the vertebral filling as a good predictor of pain improvement (P=0.008). The best cut-off point to discriminate pain improvement was 50% of vertebral filling (78.0% sensitivity and 62.5% specificity). In 83 (82.2%) of the 101 treated vertebral levels, at least one type of PMMA leakage was found. None of the evaluated factors were related significantly to PMMA leakage. Clinical complications were detected in 13 (17.3%) patients: local complications in 10 (13.3%) patients and systemic clinical complications in three (4.0%) patients. Posterior wall disruption (P=0.026) and transverse venous PMMA leakage (P=0.023) were significantly associated with clinical complications. Long-term morbidity and mortality rate was 1.3% (one patient) and 1.3% (one patient). CPV is a safe and efficacious procedure, but the potential for local...