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1.
Intern Med J ; 53(8): 1390-1399, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-35675149

RESUMO

BACKGROUND: Computed tomography-guided transthoracic biopsy (CT-TTB) is the 'gold standard' biopsy for lung nodules. Radial-endobronchial ultrasound (R-EBUS) bronchoscopy is another recommended biopsy but carries a lower diagnostic yield. Addition of cryobiopsy with R-EBUS (Cryo-Radial) has shown promising results. There are no studies comparing CT-TTB with Cryo-Radial biopsy. AIM: The co-primary aims were the diagnostic yeild and safety. The secondary aim: ability to test epidermal growth factor receptor (EGFR). METHODS: A randomised controlled, multicentre exploratory study was conducted at three tertiary hospitals. Patients with nodules >1 cm on CT of the chest were randomised to CT-TTB or Cryo-Radial. With Cryo-Radial, patients had 1-3 cryo-biopsies in addition to at least one R-EBUS biopsy through the 2.6 mm guide sheath. RESULTS: Forty-eight patients were randomised: 22 to CT-TTB and 26 to Cryo-Radial. Sixteen in the CT-TTB and 20 in the Cryo-Radial received the allocated biopsy. The diagnostic yield was CT-TTB 93.8% (15/16) versus Cryo-Radial 85% (17/20) P = 0.61 and the odds ratio was 0.37. For 5/13 (38%), a diagnosis was solely made on cryobiopsy. Eleven (78%) of 14 in CT-TTB versus 7/10 (70%) Cryo-Radial were suitable for EGFR testing P = 0.66, with odds ratio 0.63. Pneumothorax occurrence was 44% (7/16) in CT-TTB versus 4.2% (1/24) in Cryo-Radial. Two (12.5%) of 16 CT-TTB required chest drain insertion. CONCLUSION: Cryo-Radial is comparable in diagnostic yield and ability to perform EGFR testing with a significantly lower risk of pneumothorax, compared with CT-TTB. Cryo-Radial has the additional advantage of mediastinal staging during the same procedure with Linear-EBUS and is a promising first-line tool in the diagnostic method of lung cancer.


Assuntos
Neoplasias Pulmonares , Pneumotórax , Humanos , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Estudos Retrospectivos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Biópsia/efeitos adversos , Biópsia/métodos , Tomografia Computadorizada por Raios X/métodos , Endossonografia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos
2.
Intern Med J ; 48(12): 1524-1528, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30517990

RESUMO

Large volume paracentesis is effective in relieving the symptoms of malignant ascites, but frequent procedures are often required. Permanent peritoneal ports are an alternative to repeated procedures. We describe our experience with the use of peritoneal ports in patients at Middlemore Hospital (Auckland, New Zealand) who had a port inserted for the drainage of malignant ascites. Twenty-eight ports were inserted in 26 patients and accessed a total of 257 times with acceptably low rates of complications including cellulitis, peritonitis and wound dehiscence.


Assuntos
Paracentese , Cavidade Peritoneal , Complicações Pós-Operatórias , Ascite/diagnóstico , Ascite/etiologia , Ascite/cirurgia , Líquido Ascítico/patologia , Cateteres de Demora , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Nova Zelândia , Avaliação de Processos e Resultados em Cuidados de Saúde , Paracentese/efeitos adversos , Paracentese/métodos , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/patologia , Cavidade Peritoneal/cirurgia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Dispositivos de Acesso Vascular
4.
J Vasc Interv Radiol ; 25(6): 895-903, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24630750

RESUMO

PURPOSE: A previous clinical trial showed that radiologic insertion of first peritoneal dialysis (PD) catheters by modified Seldinger technique is noninferior to laparoscopic surgery in patients at low risk in a clinical trial setting. The present cohort study was performed to confirm clinical effectiveness of radiologic insertion in everyday practice, including insertion in patients with expanded eligibility criteria and by fellows in training. MATERIALS AND METHODS: Between 2004 and 2009, 286 PD catheters were inserted in 249 patients, 133 with fluoroscopic guidance in the radiology department and 153 by laparoscopic surgery. Survival analyses were performed with the primary outcome of complication-free catheter survival and secondary outcomes of overall catheter survival and patient survival. Outcomes were assessed at last follow-up, as long as 365 days after PD catheter insertion. RESULTS: In the radiologic group, unadjusted 365-day complication-free catheter, overall catheter, and patient survival rates were 22.6%, 81.2%, and 82.7%, respectively, compared with 22.9% (P = .52), 76.5% (P = .4), and 92.8% (P = .01), respectively, in the laparoscopic group. Frequencies of individual complications were similar between groups. Adjusting for patient age, comorbidity, and previous PD catheter, the hazard ratio (HR) for catheter complications by radiologic versus laparoscopic insertion is 0.90 (95% confidence interval [CI], 0.62-1.31); the HR for overall catheter survival is 1.25 (95% CI, 0.59-2.65); and that for death is 2.47 (95% CI, 0.84-7.3). CONCLUSIONS: Radiologic PD catheter insertion is a clinically effective alternative to laparoscopic surgery, although there was poorer long-term survival with radiologic catheter placement, possibly because of preferential selection of radiologic insertion for more frail patients.


Assuntos
Cateterismo/métodos , Falência Renal Crônica/terapia , Laparoscopia/métodos , Diálise Peritoneal/métodos , Radiografia Intervencionista/métodos , Idoso , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/mortalidade , Cateteres de Demora , Intervalo Livre de Doença , Feminino , Fluoroscopia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Laparoscopia/efeitos adversos , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/instrumentação , Diálise Peritoneal/mortalidade , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/mortalidade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
N Z Med J ; 136(1571): 65-72, 2023 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-36893396

RESUMO

AIM: Historically, both acute and chronic vertebral compression fractures (VCF) have been managed with vertebral augmentation procedures such as percutaneous vertebroplasty (VP). Recently, however, the trend has shifted to manage VCF pharmacotherapeutically. This study aims to determine if VP is effective for managing pain related to acute VCF (≤12 weeks). METHOD: This study retrospectively surveyed 8 of 15 patients that underwent VP at Middlemore Hospital between 2018 and 2021. All had VCF aged ≤12 weeks, and presence of increased bone marrow signal on magnetic resonance imaging (MRI). The survey reviewed pain levels (via numeric score), opiate analgesia dispensation, and mobility levels pre- and post-procedure. RESULTS: Results showed post-procedure improvement in pain levels in 75% of individuals, which were maintained over the two- and four-week marks. There was an improvement in mobility in 75% of patients at 4 weeks, and 66% had decreased dispensation or complete cessation of opioid analgesia 4 weeks post procedure. CONCLUSION: This study shows that VP correlates with overall improvement in pain scores, opiate use and mobility in the sample group with VCF aged ≤12 weeks. Hopefully the results of this study will encourage physicians to consider vertebroplasty as a method of achieving adequate analgesia in this demographic of patients.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Humanos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Estudos Retrospectivos , Nova Zelândia , Dor , Vertebroplastia/métodos , Resultado do Tratamento
7.
Nephrol Dial Transplant ; 27(11): 4196-204, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22810376

RESUMO

BACKGROUND: The success of peritoneal dialysis (PD) is dependent on timely and adequate PD catheter access. In many centres, including our own, PD catheter insertion technique has evolved by laparoscopic surgery. An alternative method of catheter insertion is performed by radiologists using a percutaneous modified Seldinger technique under fluoroscopic guidance. However, there are no clinical trials comparing these two methods of catheter insertion. METHODS: From 1 April 1999 to 30 August 2004, we randomly assigned 113 pre-dialysis patients to receive PD catheter insertion using fluoroscopic guidance under local anaesthesia by radiologists or insertion using laparoscopy under general anaesthesia by a surgeon. The primary endpoint was the occurrence of dialysis catheter complications (complication-free catheter survival) by Day 365, a composite endpoint that included complications secondary to mechanical and infectious causes. Secondary endpoints were the occurrence of catheter removal (overall catheter survival) and death from any cause (patient survival) by Day 365, procedure pain, procedure time, procedure room utilization time, length of inpatient admission and direct hospital costs. Results were analysed by univariate and multivariate methods and by Kaplan-Meier survival curves. RESULTS: Complication-free catheter survival was significantly higher at 42.5% [95% confidence interval (CI) 29.3-55] in the radiological group compared with 18.1% (95% CI 8.9-29.8) in the laparoscopic group (P-value = 0.03). Excess complications in the laparoscopic group included peritonitis, peritoneal dialysate leaks and umbilical herniae. One-year overall catheter survival and 1-year subject survival were not different between the groups. Hospital costs were significantly higher in the laparoscopic group by almost a factor of two. CONCLUSIONS: Radiological insertion of first PD catheters using fluoroscopy is a clinically non-inferior and cost-effective alternative to surgical laparoscopic insertion.


Assuntos
Cateterismo/métodos , Fluoroscopia/métodos , Falência Renal Crônica/terapia , Laparoscopia/métodos , Diálise Peritoneal/métodos , Idoso , Cateterismo/efeitos adversos , Cateterismo/mortalidade , Remoção de Dispositivo , Feminino , Fluoroscopia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/mortalidade , Análise de Sobrevida , Resultado do Tratamento
8.
J Med Imaging Radiat Oncol ; 65(3): 309-316, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33665957

RESUMO

Low thyroid cancer mortality worldwide has not been altered by decades of increasing radiological, pathological and surgical intervention for thyroid nodules. Ultrasound-based risk stratification of thyroid nodules, such as TIRADS, has been introduced to reduce intervention for the 'global epidemic' of thyroid cancer 'overdiagnosis'. This article illustrates the use of TIRADS at a New Zealand tertiary centre, during its introduction, with all nodules undergoing fine-needle aspiration biopsy (FNAB) correlated with clinical referral priority and cytological Bethesda score. The correlation between TIRADS and Bethesda score was not significant but cytology had a strong association with clinical priority. Accuracy of TIRADS was poor though the risk of malignancy for TIRADS 5 nodules was 5.1 times those rated as TIRADS 3. After TIRADS was introduced, there was no significant trend in the proportion of malignant nodules diagnosed by FNAB. Despite an incomplete TIRADS programme, the ACR targets of malignancy rates were achieved. The number of patients, as well as the number of nodules per patient, referred for FNAB continues to rise. Changing papillary thyroid cancer nomenclature and other control measures by health policymakers, such as adjustments to payment systems, may be justified. Radiologists are wasting precious health resources that can be better deployed. The use of TIRADS is expensive and a symptom of health policy failure. Clear recommendations from professional societies to not report incidental small thyroid nodules may be a useful start. Whether TIRADS merits continuing use and promotion should be further investigated.


Assuntos
Epidemias , Neoplasias da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Uso Excessivo dos Serviços de Saúde , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia
11.
N Z Med J ; 120(1251): U2467, 2007 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-17384695

RESUMO

INTRODUCTION: With endoluminal stent graft (ESG) repair of abdominal aortic aneurysms (AAA) becoming more common, the morphological boundaries are constantly being pushed in deciding which patients to offer this mode of surgical management. In our tertiary hospital we have a relatively strict morphological selection as well as a multidisciplinary team that provides a good platform for performing endoluminal AAA repair. METHOD: A retrospective audit of patients undergoing elective endoluminal AAA repair at Middlemore Hospital (Otahuhu, Auckland, New Zealand) between 1999 and 2005 was performed; 40 patients were identified during this period and all records were reviewed. Prior to surgery, all patients had CT aortography with 3D-reconstruction, and each case was discussed at a multidisciplinary team meeting (vascular surgeons and interventional radiologists present). Patients less than 65 years of age were excluded from this endoluminal assessment. A strict morphological selection criteria was applied and adhered to. RESULTS: Forty patients underwent elective endoluminal AAA repair between 1999 and 2005--5:1 male:female ratio and mean age 73.4 years. Fifty percent of patients had a history of ischaemic heart disease, 48% had known hypertension, 33% had known pulmonary disease, 12% had known diabetes mellitus, while a previous stroke, chronic renal failure, and current smokers respectively accounted for 18%. The American Society of Anaesthesiology (ASA) classification was used to assess patient fitness for surgery. Eighty percent of patients in this study had an ASA of III, 15% had an ASA of II, and the remaining patients had an ASA of IV. These figures are similar to Australian audit data (audit undertaken by ASERNIP-S). Morphology AAA showed mean diameter AAA of 5.2 cm (4.3?6.7 cm). Most AAA were fusiform (fusiform 90% vs saccular 10%). All grafts were of Zenith Cook type bifurcated grafts. There were 2 endoleaks (5%)--type II endoleaks that were sealed with endovascular therapy; 2 patients returned to theatre for embolic complications with good postoperative result; and 1 patient died due to myocardial infarction (MI) postprocedure (mortality 2.5%). Primary technical success was 95% and secondary technical success 100%. There were no conversions to open surgery and no procedural-related deaths. CONCLUSION: This audit from Middlemore Hospital shows good results can be achieved using strict morphological selection criteria and a multidisciplinary approach to treatment for ESG of AAA.


Assuntos
Angioplastia/estatística & dados numéricos , Aneurisma da Aorta Abdominal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angioplastia/instrumentação , Angioplastia/métodos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Aortografia , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Auditoria Médica , Nova Zelândia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Stents , Análise de Sobrevida , Resultado do Tratamento
12.
N Z Med J ; 117(1203): U1101, 2004 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-15477925

RESUMO

AIMS: To describe our initial experience with percutaneous vertebroplasty in a New Zealand teaching hospital setting. METHODS: Five patients suffering osteoporotic vertebral fractures were treated with percutaneous vertebroplasty. RESULTS: Three patients experienced improvement in pain after the procedure. The other two experienced documented improvement in mobility. There were no significant complications. DISCUSSION: This small series shows that percutaneous vertebroplasty has been successfully performed in a New Zealand teaching hospital. The definitive role of this technique in the management of patients with osteoporotic fractures remains to be determined.


Assuntos
Fraturas Espontâneas/terapia , Vértebras Lombares/lesões , Osteoporose/complicações , Polimetil Metacrilato , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Cimentos Ósseos , Fraturas Espontâneas/diagnóstico , Humanos , Injeções Espinhais , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Procedimentos Ortopédicos , Radiografia , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Resultado do Tratamento
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