Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience.

Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication-a small dehiscence of the anastomosis-which extended the catheter dwell time. Minor complications occurred in two cases-one small perihepatic hematoma and one segmental thrombosis of the left portal branch-neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.

Extracellular matrix metalloproteinase expression in endometrial tissue after arterial embolization of myomas.

OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.

Percutaneous access for the diagnosis of urothelial neoplasms: pictorial essay with anatomopathological correlation.

Urothelial carcinoma is a rare malignant neoplasm, accounting for only 5% to 7% of kidney tumors and 5% of urothelial tumors. During the management of urothelial carcinoma, anatomopathological evaluation is used for stratifying the tumors into different prognostic groups to aid in the evaluation of treatment results and to optimize the management of patients. Percutaneous image-guided biopsy is a safe and feasible procedure, with high sensitivity and accuracy rates. Although image-guided percutaneous biopsy of the urinary tract is a relatively uncommon procedure, it can be considered an option in selected cases or when traditional methods, such as the ureteroscopic technique, are not possible.

O carcinoma urotelial é uma neoplasia maligna rara, responsável por apenas 5% a 7% dos tumores renais e 5% dos tumores uroteliais. No manejo do carcinoma urotelial, a determinação anatomopatológica tem por objetivo estratificar os tumores em diferentes grupos prognósticos, para permitir avaliar resultados do tratamento e otimizar o gerenciamento dos pacientes. Biópsia percutânea guiada por imagem é um procedimento seguro e tecnicamente viável, com alta sensibilidade e taxa de precisão. Apesar de as biópsias percutâneas guiadas por imagem do trato urinário serem um procedimento relativamente incomum, podem ser consideradas como opção em casos selecionados ou quando os métodos tradicionais, como o a técnica ureteroscópica, não são possíveis.

Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization.

OBJECTIVE: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. MATERIALS AND METHODS: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). RESULTS: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. CONCLUSION: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

OBJETIVO: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. MATERIAIS E MÉTODOS: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. RESULTADOS: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. CONCLUSÃO: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.

What the radiologist should know about the role of interventional radiology in urology.

Interventional radiology has been constantly developing in terms of the techniques, materials, and methods of intervention. It interacts with all areas of medicine, always with the ultimate goal of ensuring the well-being of patients. Advances in imaging techniques, especially in the last two decades, have led to a paradigm shift in the field of urological imaging interventions. Many urologic diseases that were previously treated only surgically can now be effectively managed using minimally invasive image-guided techniques, often with shorter hospital stays and requiring only local anesthesia or conscious sedation.

A radiologia intervencionista vem se desenvolvendo constantemente por meio de técnicas, materiais e métodos de intervenção. Interage com todas as áreas da medicina, sempre visando, como objetivo final, o bem-estar dos pacientes. Os avanços das técnicas de imagem, especialmente nas últimas duas décadas, levaram a uma mudança de paradigma no campo das intervenções guiadas por imagens na urologia. Muitas doenças urológicas que eram tratadas somente cirurgicamente, podem agora ser manejadas efetivamente usando técnicas minimamente invasivas guiadas por imagem, muitas vezes com redução do tempo de internação e utilizando apenas anestesia local ou sedação consciente.

Evaluation of Uterine Contractility by Magnetic Resonance Imaging in Women Undergoing Embolization of Uterine Fibroids.

PURPOSE: To assess uterine contractility using ultrafast magnetic resonance imaging (cine MRI) before and after uterine fibroid embolization (UFE). MATERIALS AND METHODS: This is a prospective study of uterine contractility in 26 patients (age 30-41 years) undergoing UFE for symptomatic uterine fibroids. Cine MRI was performed before and 6 months after UFE. Two radiologists evaluated uterine contractility and classified it as absent, ordered, or disordered. Patients were then grouped into three distinct patterns of progression: unchanged contractility (group A), modified contractility (B), and loss of contractility (C). These findings were then confronted with factors that might have interfered with uterine contractility pattern (uterine volume, location of dominant fibroid, fibroid/myometrium index, and fibroid necrosis pattern). RESULTS: Of the 26 patients, 8 (30.7%) had no contractility before the procedure, while 18 (69.2%) exhibited some form of contractility (11 [61%] ordered, 7 [39%] disordered). All 8 patients who had no contractility at baseline exhibited contractility after UFE (5 ordered, 3 disordered). Of the 11 who had ordered contractility at baseline, 9 remained ordered and 2 lost contractility after UFE. Of the 7 with disordered contractility at baseline, 1 remained disordered, 5 progressed to ordered contractility, and 1 lost contractility. Overall, 10 patients (38%) had no change in contractility after UFE (group A), 13 (50%) had a positive change (group B), and 3 (11%) lost contractility (group C). The potential interference factors assessed had no statistically significant effect in any group. CONCLUSION: In women of reproductive age with symptomatic fibroids, uterine contractility improved significantly after UFE. LEVEL OF EVIDENCE: Level 3-non-randomized controlled cohort/follow-up study.

The role of percutaneous transhepatic biliary biopsy in the diagnosis of patients with obstructive jaundice: an initial experience.

OBJECTIVE: To evaluate the accuracy of percutaneous transhepatic biliary biopsy (PTBB) in patients with suspected biliary obstruction. MATERIALS AND METHODS: This was a retrospective analysis of 18 patients with obstructive jaundice who underwent PTBB. In each patient, three to ten fragments were collected from the lesion. The final diagnosis was confirmed in the pathology report. We also reviewed analyses of the results of laboratory tests performed before the procedure, as well as the Bismuth classification, clinical outcome, complications occurring during the procedure, access route, and materials used. RESULTS: Technical success was achieved in 100% of the PTBB procedures. Among the 18 patients clinically diagnosed with bile duct stenosis, the pathological analysis confirmed that diagnosis in 17. In one case, the pathological findings were considered false-negative. The predominant tumor was cholangiocarcinoma (seen in 50% of the cases). Sixteen of the procedures (88.9%) were performed without complications. Transient hemobilia occurred in one case, and cholangitis occurred in another. CONCLUSION: PTBB is a safe, viable, simple technique with a high rate of true-positive results for the definitive diagnosis of obstructive jaundice.

OBJETIVO: Avaliar a precisão diagnóstica da colangiobiópsia trans-hepática percutânea (CBTP) em pacientes com suspeita de obstrução biliar. MATERIAIS E MÉTODOS: Análise retrospectiva de 18 pacientes apresentando icterícia obstrutiva foram submetidos a CBTP. Em cada paciente, 3 a 10 fragmentos foram coletados da lesão. O diagnóstico final foi confirmado por relatório anatomopatológico. Adicionalmente, foram registrados a análise laboratorial antes do procedimento, a classificação de Bismuth, o desfecho clínico, as intercorrências durante o procedimento, a via de acesso e os materiais utilizados. RESULTADOS: A CBTP apresentou sucesso técnico em 100% dos casos. Dos 18 pacientes clinicamente diagnosticados com estenose biliar, 17 receberam diagnóstico patológico positivo. Em um caso os achados patológicos foram considerados falso-negativos. O colangiocarcinoma foi a neoplasia predominante (50%). Dezesseis (88,9%) procedimentos foram realizados sem intercorrências. Hemobilia transitória ocorreu em um caso e colangite em outro caso isolado. CONCLUSÃO: A CBTP é uma técnica segura, viável e simples, com alta taxa de verdadeiro-positivos para o diagnóstico definitivo de causas de icterícia obstrutiva.

Percutaneous nephrostomy versus antegrade double-J stent placement in the treatment of malignant obstructive uropathy: a cost-effectiveness analysis from the perspective of the Brazilian public health care system.

OBJECTIVE: To compare two percutaneous techniques used in the treatment of malignant obstructive uropathy-antegrade double-J stent placement (JJ stenting) and percutaneous nephrostomy-in terms of their cost-effectiveness, from the perspective of the Brazilian public health care system. MATERIALS AND METHODS: In this cost-effectiveness analysis, we employed decision-analytic modeling. We calculated material costs from 2017 factory prices listed by the Brazilian Pharmaceutical Market Regulatory Board (for medications) and published in the journal Revista Simpro (for medical devices). Procedure-related costs were evaluated, as were the rates of technical and clinical success. Those measures were then used as inputs for a cost-effectiveness analysis comparing the two procedures. RESULTS: The sample comprised 41 patients, of whom 16 underwent antegrade JJ stenting (26 procedures) and 10 underwent percutaneous nephrostomy (15 procedures). Patient records, radiology reports, and expense reports of the interventional radiology department of the public hospital where the study was conducted were analyzed retrospectively. There were no significant complications: one patient had low back pain, and one had a transient retroperitoneal hematoma. The mean procedure time was 24 min, and clinical success (improvement in serum creatinine and resolution of hydronephrosis) was achieved in 97.5% of the cases. The average cost of JJ stenting was significantly lower than was that of percutaneous nephrostomy (US$164.10 vs. US$552.20). CONCLUSION: In the absence of any clinical contraindications, antegrade JJ stenting is a suitable alternative to both percutaneous nephrostomy and retrograde stenting in patients with dilated renal collecting systems secondary to malignant ureteral obstruction, providing significant cost savings and high success rates.

OBJETIVO: Comparar a relação custo-efetividade de duas técnicas percutâneas utilizadas no tratamento da uropatia obstrutiva maligna - inserção anterógrada de cateter duplo J (JJ) versus nefrostomia percutânea - sob a perspectiva do sistema de saúde pública brasileira. MATERIAIS E MÉTODOS: Nesta análise de custo-efetividade por modelo analítico de decisão, os custos de material foram calculados a partir dos preços de fábrica de 2017 listados pela Câmara Brasileira de Regulamentação de Medicamentos (para medicamentos) e publicados na Revista Simpro (para dispositivos médicos). Custos relacionados ao procedimento e taxas de sucesso técnico e clínico foram avaliados. Essas medidas foram então usadas como insumos para uma análise de custo-efetividade comparando os dois procedimentos. RESULTADOS: A amostra foi composta de 41 pacientes, dos quais 16 foram submetidos a 26 procedimentos de inserção anterógrada de JJ e 10 foram submetidos a 15 nefrostomias percutâneas. Registros de pacientes, relatórios de radiologia e relatórios de despesas do serviço de radiologia intervencionista do hospital onde o estudo foi conduzido foram analisados retrospectivamente. Não houve complicações significativas: um paciente apresentou lombalgia e um apresentou hematoma retroperitonial transitório. O tempo médio de procedimento foi 24 minutos e o sucesso clínico (melhora da creatinina sérica e resolução da hidronefrose) foi alcançado em 97,5% dos casos. O custo médio da inserção de JJ (US$ 164.10) foi significativamente menor do que o da nefrostomia percutânea (US$ 552.20). CONCLUSÃO: Na ausência de qualquer contraindicação clínica, a inserção anterógrada de JJ é uma alternativa adequada à nefrostomia percutânea e inserção retrógrada em pacientes com sistema coletor renal dilatado secundário a obstrução maligna, proporcionando economia significativa e altas taxas de sucesso.

Impact of uterine contractility on quality of life of women undergoing uterine fibroid embolization.

BACKGROUND: Although changes in uterine contractility pattern after uterine fibroid embolization (UFE) has already been assessed by cine magnetic resonance imaging (MRI), their impact on quality of life outcomes has not been evaluated. The purpose of this study was to evaluate the impact of uterine contractility on the quality of life of women undergoing UFE measured by the Uterine Fibroid Symptom and Quality of Life questionnaire (UFS-QOL). RESULTS: A total of 26 patients were included. MRI scans were acquired 30-7 days before and 6 months after UFE for all patients. The UFS-QOL was applied in person on first MRI exam day and 1 year after UFE and the outcomes were analyzed according to the groups of evolution pattern of uterine contractility: Group A: Unchanged Uterine Contractility Pattern, 38%; Group B: Favorable Modified Uterine Contractility Pattern, 50%; and Group C: Loss of Uterine Contractility, 11%. All UFE patients presented a reduction in the mean score for symptoms and increase in mean scores on quality of life. All patients in this cohort presented a reduction in mean symptom score and increase in the mean score of quality of life subscales. Group A had more relevant complaints regarding their sense of self-confidence; Group B presented worse sexual function scores before UFE, which improved after UFE compared to Group A. CONCLUSIONS: Significant improvement in symptoms, quality of life, and uterine contractility was observed after UFE in women of reproductive age with symptomatic fibroids. Functional uterine contractility seems to have a positive impact on quality of life and sexual function in this population. LEVEL OF EVIDENCE: Level 3, Non-randomized controlled cohort/follow-up study.

Functional magnetic resonance imaging for clinical evaluation of uterine contractility.

Uterine contractility out of the gestational phase, during the menstrual cycle and the habitual functional variations of the organ, this is one of the responsible mechanisms for reproduction and fertility, due to its direct action in the mechanisms conducting the spermatozoa to the ovule and in the decidual implantation. Pathologies such as uterine leiomyoma, endometriosis, adenomyosis, polycystic ovarian syndrome, as well as the use of intrauterine devices and oral contraceptives, may alter a functionality of uterine contractility. Thus, magnetic resonance imaging with ultrafast sequences provides a dynamic evaluation (cine-MRI) and thus the correlation of uterine contractility quality in patients with current infertility or pathologies.

The value of percutaneous transhepatic treatment of biliary strictures following pediatric liver transplantation.

OBJECTIVE: To evaluate the percutaneous transhepatic approach to the treatment of biliary strictures in pediatric patients undergoing liver transplantation. MATERIALS AND METHODS: This was a retrospective study of data obtained from the medical records, laboratory reports, and imaging examination reports of pediatric liver transplant recipients who underwent percutaneous transhepatic cholangiography, because of clinical suspicion of biliary strictures, between 1st September 2012 and 31 May 2015. Data were collected for 12 patients, 7 of whom were found to have biliary strictures. RESULTS: In the 7 patients with biliary strictures, a total of 21 procedures were carried out: 2 patients (28.6%) underwent the procedure twice; 3 (42.8%) underwent the procedure three times; and 2 (28.6%) underwent the procedure four times. Therefore, the mean number of procedures per patient was 3 (range, 2-4), and the average interval between them was 2.9 months (range, 0.8-9.1 months). The drainage tube remained in place for a mean of 5.8 months (range, 3.1-12.6 months). One patient presented with a major complication, hemobilia, which was treated with endovascular embolization. Clinical success was achieved in all 7 patients, and the mean follow-up after drain removal was 15.4 months (range, 5.3-26.7 months). CONCLUSION: The percutaneous transhepatic approach to treating biliary strictures in pediatric liver transplant recipients proved safe, with high rates of technical and clinical success, as well as a low rate of complications.

OBJETIVO: Demonstrar o valor da abordagem transparieto-hepática no tratamento de estenoses biliares em pacientes pediátricos submetidos a transplante de fígado. MATERIAIS E MÉTODOS: Estudo retrospectivo com revisão de prontuários, exames laboratoriais e de imagem dos pacientes pediá­tricos submetidos a transplante hepático. Foram incluídos pacientes com suspeita de estenose de vias biliares que realizaram colangiografia transparieto-hepática para diagnóstico, entre 1º de setembro de 2012 e 31 maio de 2015. Os dados de 12 pacientes foram coletados, dos quais 7 apresentaram estenose de vias biliares. RESULTADOS: No total foram realizados 21 procedimentos: 2 pacientes realizaram dois procedimentos (28,6%), 3 pacientes realizaram três procedimentos (42,8%) e 2 pacientes realizaram quatro procedimentos (28,6%). A média de procedimentos por paciente foi 3 (variação: 2­4) e o intervalo médio entre os procedimentos foi 2,9 meses (variação: 0,8­9,1 meses). A permanência média do dreno foi 5,8 meses (variação: 3,1­12,6 meses). Uma paciente apresentou hemobilia com instabilidade hemodinâmica, tratada com sucesso por via endovascular. O sucesso clínico foi alcançado nos 7 pacientes e o seguimento médio após retirada do dreno foi 15,4 meses (variação: 5,3­26,7 meses). CONCLUSÃO: A abordagem transparieto-hepática das estenoses biliares em crianças submetidas a transplante de fígado demonstrou ser tratamento eficaz, com baixo índice de complicações.

Long-term results of oversized balloon dilation for benign anastomotic biliary strictures: initial two-center experience

Abstract Objective: To describe, assess the feasibility of, and quantify the long-term patency achieved with percutaneous transhepatic biliary dilation using the anastomotic biliary stricture (ABS) oversized balloon dilation technique as a single-step procedure for the treatment of benign anastomotic biliary strictures following hepatobiliary surgery. Materials and Methods: This was a retrospective, two-center study including 16 consecutive cases of symptomatic benign biliary-enteric strictures. After assessment of the diameter of the bile duct by computed tomography or magnetic resonance imaging, the strictures were dilated with oversized balloons (40-50% larger than the bile duct diameter) and an external biliary-enteric drain was placed. After drain removal, clinical symptoms and laboratory test results were evaluated every three months, whereas follow-up magnetic resonance imaging was performed at 30 days out and follow-up computed tomography was performed at 6 and 12 months out. Results: The mean follow-up time was 31.8 ± 8.15 months. Kaplan-Meier-estimated 1-, 2-, and 3-year patency rates were 88.2%, 82.4%, and 82.4%, respectively. There was one major complication—a small dehiscence of the anastomosis—which extended the catheter dwell time. Minor complications occurred in two cases—one small perihepatic hematoma and one segmental thrombosis of the left portal branch—neither of which required further intervention. Conclusion: The single-step ABS oversized balloon dilation technique is a feasible treatment for benign anastomotic biliary-enteric strictures. The technique appears to be associated with high rates of long-term clinical success and patency.

Resumo Objetivo: Descrever o procedimento, avaliar a viabilidade e perviedade em longo prazo da dilatação biliar trans-hepática percutânea usando a técnica de dilatação por balão superdimensionado para o tratamento em uma única etapa de estenose biliar anastomótica benigna após cirurgia hepatobiliar. Materiais e Métodos: Este estudo retrospectivo de dois centros incluiu 16 casos consecutivos de estenoses bilioentéricas benignas sintomáticas. A dilatação das estenoses com superdimensionamento do balão de 40-50% foi realizada após avaliação pré-procedimento do diâmetro do ducto biliar por tomografia computadorizada ou ressonância magnética e um dreno externo foi colocado. Os sintomas clínicos e exames laboratoriais foram avaliados a cada três meses após a remoção do dreno, enquanto o acompanhamento radiológico foi realizado com ressonância magnética em 30 dias e tomografia computadorizada em 6 e 12 meses. Resultados: O tempo médio de seguimento foi de 31,8 ± 8,15 meses. As estimativas de perviedade em um, dois e três anos foram 88,2%, 82,4% e 82,4%; respectivamente. Houve uma complicação importante, com pequena deiscência da anastomose biliodigestiva, que exigiu prolongamento do tempo de permanência do dreno externo. Complicações menores ocorreram em dois casos, um pequeno hematoma peri-hepático e uma trombose segmentar do ramo portal esquerdo e nenhum deles necessitou de intervenção adicional. Conclusão: A técnica de dilatação com balão superdimensionado para o tratamento de estenoses biliares anastomóticas benignas foi viável para o tratamento de estenoses anastomóticas bilioentéricas benignas. A técnica parece estar associada a altas taxas de perviedade e de sucesso clínico no longo prazo.

Extracellular matrix metalloproteinase expression in endometrial tissue after arterial embolization of myomas

OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.

Interventional radiology and endovascular surgery in the treatment of ectopic pregnancies.

The advent of interventional radiology enabled remarkable advances in diagnosis and treatment of several situations in obstetrics and gynecology. In the field of obstetrics, these advances include temporary occlusion of the iliac arteries to the management of placenta accreta and/or prior, arteriovenous fistulas after embolization of uterine curettage and management of ectopic uterine and extra-uterine pregnancies. The non-tubal ectopic pregnancy, either cervical, abdominal, ovarian or in a cesarean scar, often represents major therapeutic challenge, especially when exists a desire to maintain fertility. Despite the systemic methotrexate therapy and surgical resection of the ectopic gestational sac be the most used therapeutic options, the interventionist approach of non-tubal ectopic pregnancies, direct injection of methotrexate in the gestational sac and intra-arterial chemoembolization of uterine arteries constitute in the currently literature viable, safe, effective modalities with low morbidity, shorter hospital stay, and rapid clinical recovery. Because of little variety of materials used, and the increase in training of specialists in the area, the radiological intervention as a treatment option in ectopic pregnancies is financially viable and present considerable accessibility in the world and at most of Brazilian medical centers.

Percutaneous access for the diagnosis of urothelial neoplasms: pictorial essay with anatomopathological correlation / Acesso percutâneo no diagnóstico de neoplasias uroteliais: ensaio iconográfico com correlação anatomopatológica

Abstract Urothelial carcinoma is a rare malignant neoplasm, accounting for only 5% to 7% of kidney tumors and 5% of urothelial tumors. During the management of urothelial carcinoma, anatomopathological evaluation is used for stratifying the tumors into different prognostic groups to aid in the evaluation of treatment results and to optimize the management of patients. Percutaneous image-guided biopsy is a safe and feasible procedure, with high sensitivity and accuracy rates. Although image-guided percutaneous biopsy of the urinary tract is a relatively uncommon procedure, it can be considered an option in selected cases or when traditional methods, such as the ureteroscopic technique, are not possible.

Resumo O carcinoma urotelial é uma neoplasia maligna rara, responsável por apenas 5% a 7% dos tumores renais e 5% dos tumores uroteliais. No manejo do carcinoma urotelial, a determinação anatomopatológica tem por objetivo estratificar os tumores em diferentes grupos prognósticos, para permitir avaliar resultados do tratamento e otimizar o gerenciamento dos pacientes. Biópsia percutânea guiada por imagem é um procedimento seguro e tecnicamente viável, com alta sensibilidade e taxa de precisão. Apesar de as biópsias percutâneas guiadas por imagem do trato urinário serem um procedimento relativamente incomum, podem ser consideradas como opção em casos selecionados ou quando os métodos tradicionais, como o a técnica ureteroscópica, não são possíveis.

Hemorrhagic complications after percutaneous nephrolithotomy: angiographic diagnosis and management by transcatheter arterial embolization / Complicações hemorrágicas após nefrolitotripsia percutânea: diagnóstico angiográfico e tratamento por embolização arterial transcateter

Abstract Objective: To identify the main hemorrhagic complications after percutaneous nephrolithotomy, as well as the results obtained with transcatheter arterial embolization (TAE) at an interventional radiology center. Materials and Methods: This was a retrospective analysis of patients undergoing TAE for the treatment of hemorrhagic complications after percutaneous nephrolithotomy. All patients underwent computed tomography angiography (CTA). Results: We evaluated a total of nine patients. At emergency department readmission, the most common symptom was macroscopic hematuria, which was seen in five patients. Three patients had an isolated pseudoaneurysm, two had a pseudoaneurysm together with active bleeding (perirenal hematoma), and one had a pseudoaneurysm together with arteriocalyceal fistula. Arteriovenous fistula was diagnosed in three patients and was not seen in combination with other vascular lesions. We did not identify arteriocalyceal fistula in isolation. Five patients underwent TAE with 6 × 15 mm and 6 × 20 mm microcoils. Four patients underwent TAE with n-butyl-2-cyanoacrylate and ethiodized oil. Follow-up CTAs revealed no complications. Conclusion: Because of its high diagnostic accuracy, CTA provides the interventional radiologist with valuable data for individualized therapeutic planning. The TAE procedure is safe and effective. It can therefore be used as a first-line treatment for hemorrhagic complications resulting from percutaneous renal procedures.

Resumo Objetivo: Demonstrar as principais complicações hemorrágicas após nefrolitotripsia percutânea, bem como os resultados após o tratamento por embolização arterial transcateter (EAT) em um centro de radiologia intervencionista. Materiais e Métodos: Coleta e análise de dados retrospectivos de pacientes submetidos a EAT por complicações hemorrágicas após nefrolitotripsia percutânea. Resultados: O sintoma mais comum foi hematúria macroscópica, presente em cinco pacientes no momento da readmissão ao pronto-socorro, e nestes pacientes identificamos três pseudoaneurismas isolados, dois casos de combinação de pseudoaneurisma e sangramento ativo (hematoma perirrenal) e um caso de associação de pseudoaneurisma e fístula arteriocalicinal. Fístula arteriovenosa foi diagnosticada em três pacientes, não sendo observada em associação com outras lesões vasculares. Não identificamos fístula arteriocalicinal isolada, somente associada a pseudoaneurisma. Cinco pacientes foram submetidos a embolização por micromolas 6 × 15 mm e 6 × 20 mm. Quatro pacientes foram submetidos a embolização por Histoacryl e Lipiodol. Não observamos complicações pela angiotomografia computadorizada de controle. Conclusão: A angiotomografia computadorizada apresenta alta acurácia diagnóstica e guarnece o radiologista intervencionista de dados para um planejamento terapêutico individualizado. EAT é um procedimento seguro e eficaz e pode ser utilizado como primeira linha para o tratamento de complicações hemorrágicas resultantes de procedimentos percutâneos renais.

Transcatheter arterial embolization for unresectable symptomatic giant hepatic hemangiomas: single-center experience using a lipiodol-ethanol mixture.

OBJECTIVE: The present article is aimed at reporting the author's experience with transcatheter arterial embolization using a lipiodol-ethanol mixture in three cases of unresectable symptomatic giant hepatic hemangiomas. MATERIALS AND METHODS: The cases of three patients with giant unresectable symptomatic hepatic hemangiomas embolized in the period 2009-2010 were retrospectively reviewed. In all the cases, transarterial embolization was performed with an ethanol-lipiodol mixture. RESULTS: Symptoms regression and quality of life improvement were observed in all the cases. No complications were observed and all the patients were discharged within 12 hours after the procedure. CONCLUSION: Transcatheter arterial embolization using ethanol mixed with lipiodol was a safe and effective treatment for symptomatic giant hepatic hemangiomas in this small series of patients.

OBJETIVO: Este estudo teve como objetivo relatar a experiência dos autores de embolização arterial transcateter com o uso de uma mistura de lipiodol e etanol em três casos de hemangiomas hepáticos gigantes sintomáticos e não ressecáveis. MATERIAIS E MÉTODOS: Três hemangiomas hepáticos gigantes sintomáticos e não ressecáveis em três pacientes foram embolizados com o uso de uma mistura transarterial de etanol e lipiodol. RESULTADOS: A regressão dos sintomas e a melhora na qualidade de vida foram observadas em todos os casos. Nenhuma complicação foi encontrada e todos os pacientes receberam alta em até 12 horas após o procedimento. CONCLUSÃO: O etanol misturado com o lipiodol foi um tratamento eficaz e seguro para hemangiomas hepáticos gigantes sintomáticos nesta pequena série de pacientes.