The value of angio-CT system on splanchnic nerve neurolysis

PURPOSEWe aimed to evaluate the effectiveness and safety of splanchnic nerve neurolysis (SNN) with angio-CT, a hybrid system combining computed tomography (CT) with X-ray fluoroscopy.METHODSThirty-three SNN procedures with angio-CT performed in 30 patients with severe epigastric cancer pain (11 males and 19 females; median age, 57 years; age range, 19–79 years) between January 2010 and July 2017 were retrospectively evaluated. The primary endpoints were the technical success and adverse event rates. The secondary endpoints included the clinical success rate, defined as a reduction in the numerical rating scale for pain score or a decrease in the consumption of analgesics on day 1 and at 1–2 weeks after the procedure; procedure time; the number of needle punctures; amount of ethanol required; and the distribution of contrast medium in the retrocrural space. These endpoints were compared with previous studies that did not employ the angio-CT system.RESULTSThe technical success rate was 96.97%. There were two procedure-related adverse events (one retroperitoneal hemorrhage, one pneumothorax). The clinical success rates on day 1 and at 1–2 weeks after the procedure were 84.38% and 87.5%, respectively. The median procedure time was 60 minutes. The median number of needles used was 2. The median amount of ethanol used was 20 mL. CONCLUSIONSNN under angio-CT is safe and effective, with excellent technical and clinical success rates and acceptable adverse event rates. These results are comparable with previous studies that did not involve angio-CT. However, the use of angio-CT allows for easier needle positioning and an earlier response to complications compared with conventional methods

Real-world effectiveness and safety analysis of carfilzomib-lenalidomide-dexamethasone and carfilzomib-dexamethasone in relapsed/refractory multiple myeloma: a multicenter retrospective analysis

Background: Little is known about the real-world survival benefits and safety profiles of carfilzomib-lenalidomide-dexamethasone (KRd) and carfilzomib-dexamethasone (Kd). Methods: We performed a retrospective analysis to evaluate their efficacy and safety in 157 patients registered in the Kansai Myeloma Forum database. Results: A total of 107 patients received KRd. Before KRd, 99% of patients had received bortezomib (54% were refractory disease), and 82% had received lenalidomide (57% were refractory disease). The overall response rate (ORR) was 68.2%. The median progression-free survival (PFS) and overall survival (OS) were 8.8 and 29.3 months, respectively. Multivariate analysis showed that reduction of the carfilzomib dose and non-IgG M protein were significantly associated with lower PFS and reduction of the carfilzomib dose and refractoriness to prior bortezomib-based regimens were significantly associated with lower OS. A total of 50 patients received Kd. Before Kd, 96% of patients had received bortezomib (54% were refractory disease). The ORR was 62.0%. The median PFS and OS were 7.1 and 20.9 months, respectively. Based on the multivariate analysis, reduction of the carfilzomib dose and International Staging System Stage III (ISS III) were significantly associated with lower PFS. Grade III or higher adverse events were observed in 48% of KRd cases and 54% of Kd cases. Cardiovascular events, cytopenia, and infections were frequent, and 4 KRd patients died due to heart failure, arrhythmia, cerebral hemorrhage, and pneumonia. Conclusion: Our analysis showed that an adequate dose of carfilzomib is important for achieving the best survival benefits in a real-world setting. Adverse effects after KRd and Kd therapy should also be considered

Endoluminal Cooling of the Esophagus during Percutaneous Thermal Ablation for Juxtaesophageal Liver Neoplasm: Two Cases

Thermal injury to the surrounding hollow organs should be avoided during thermal ablation therapy. Although this type of injury is rare, severe complications, such as perforation or stricture, have been reported. Despite the development of various adjunctive thermoprotection techniques, there are a few reports of their use for protecting the esophagus during liver ablation therapy. Endoluminal irrigation is a well-known technique for protecting hollow organs, such as the biliary tract, renal pelvis, ureter, and rectum; however, it is used infrequently for avoiding thermal injury to the esophagus. There may be hesitation in treating juxtaesophageal liver tumors with conventional ultrasound-guided ablation because the location restricts the ultrasonic window due to the poor visibility. We successfully treated two consecutive cases of juxtaesophageal liver tumor with computed tomography-guided ablation by applying endoluminal irrigation and cooling via a 12-French nasal feeding tube placed in the lower esophagus

Percutaneous Transhepatic Biopsy for Extrahepatic Lesions

Purpose The purpose was to assess the diagnostic accuracy and safety of percutaneous transhepatic biopsy for extrahepatic lesions. Materials and Methods Between January 2008 and December 2019, 26 patients (17 men and 9 women; median age, 60 years) underwent percutaneous transhepatic needle biopsy for extrahepatic lesions at our institution. Transhepatic biopsy was deemed appropriate compared with other biopsy routes or methods (i.e., endoscopic or surgical). The lesions were in the porta hepatis (n = 9), retroperitoneum (n = 6), right adrenal gland (n = 4), right kidney (n = 3), lesser omentum (n = 2), duodenum (n = 1), pleura (n = 1), and inferior vena cava (n = 1). The median maximal diameter of the lesions was 45.5 mm (range, 18–148 mm). Core-needle biopsy was performed in all patients. Eighteen-gauge and 21-G needles were used in 25 and one patient, respectively. Ultrasound was used for biopsy in 21 patients, and CT fluoroscopy was used in five patients. Postbiopsy tract embolization was performed in three patients. Technical success and diagnostic accuracy of the biopsy were evaluated. Complications were recorded using the systemic inflammation response (SIR) criteria. Results The pathological results of biopsy were carcinoma (n = 10), lymphoma (n = 9), and other diagnoses (n = 7). Technical success was obtained in all patients. The accurate diagnosis was achieved in 24 of the 26 patients (92.3%). A major complication, a bladder tamponade, was observed in one patient (3.8%) after biopsy of a right kidney lesion. A hematoma caused by iatrogenic renal injury likely obstructed the bladder outlet. Minor complications were observed in three patients (11.5%). Conclusions Percutaneous transhepatic biopsy for extrahepatic lesions is feasible with acceptable safety