Percutaneous transhepatic balloon dilatation of benign biliary strictures.

Between February 1981 and June 1984, 15 patients with benign biliary strictures were treated with percutaneous transhepatic balloon dilatation. Three of these patients had received liver transplants. The treatment began with a course of balloon dilatation therapy, after which a stent catheter was left across the stricture. Six weeks later, after duct patency had been shown by cholangiography, the stent catheter was removed from all but two patients, both of whom had intrahepatic sclerosing cholangitis. After this procedure, six patients (40%), including two liver-transplant patients, were stricture-free after one treatment for periods ranging from 27 to 56 months, and were considered to be treatment successes. Nine patients (60%) suffered stricture recurrences. In eight of these patients, the stricture was heralded by symptoms of either cholangitis or jaundice; in one patient, who was on permanent catheter drainage, the stricture was discovered only on follow-up cholangiography. All successfully treated patients had only one stricture, while all patients with more than one stricture suffered recurrences. Our data also suggest a greater responsiveness for anastomotic strictures than for non-anastomotic strictures. Of the patients with recurrences, five had symptom-free intervals of 23 months or more (up to 31 months). The fact that strictures recurred after such long periods of time underscores the importance of long-term follow-up. In view of the number of patients helped, the favorable experience with post-liver-transplantation strictures, and the lack of any major complications in our series, percutaneous biliary balloon dilatation offers a viable alternative to surgical management of benign biliary strictures

Easy drainage of presacral abscess

Presacral region is one of the difficult regions for drainage of abscess as the approaches described for this carry a lot of morbidities. Transpedicular approach is described for the drainage of presacral abscess. Further, tuberculous abscess as a cause of cauda equina syndrome is reported. Patient had complete neurological recovery within weeks of drainage of abscess. Transpedicular drainage of presacral abscess is a safer option for recently developed neurological deficit. Late presentation may need anterior approach, which is associated with increased morbidity

Computed Tomography-guided fine-needle aspiration and tissue-core biopsy of bone lesions in small animals

Nell'uomo, la biopsia TC-guidata a mano libera è un metodo accurato per ottenere dei campioni di tessuto. Ci sono pochi lavori di questa tecnica in medicina veterinaria. Nel presente studio, 21 cani e 2 gatti sono stati sottoposti a biopsia TC-guidata (17 animali) o ago aspirato fine TC-guidato (6 animali) di lesioni ossee. Due delle 17 biospie sono state anche sottoposta ad esame colturale. Tutte le 17 biospie erano diagnostiche (accuratezza 100%). Cinque dei sei aghi aspirati fini erano diagnostici (accuratezza 83.3%). L'accuratezza totale era 95.7%. In un aspirato, la qualità citologica è stata considerata insufficiente in quanto conteneva solo sangue. Non si sono evidenziate complicazioni maggiori. Sono state diagnosticate 14 lesioni neoplastiche, 2 infezioni, e 6 lesioni benigne. L'esame TC dopo somministrazione di mezzo di cotnrasto endovenoso ha aggiunto informazioni utili per evitare grossi vasi e per biopsare tessuto vitale. La bipsia e l'ago aspirato fine TC-guidati a mano libera sembra essere una tecnica sicura e molto accurata per la diagnosi di patologie ossee nei piccoli animaliIn humans, free-hand computed tomography (CT)-guided biopsy is an accurate method to obtain a tissue sample. There are only a few reports of this technique in veterinary medicine. In the present study, 21 dogs and two cats underwent a free-hand CT-guided tissue-core biopsy (17 animals) or fine-needle aspiration (six animals) of a bone lesion. Two out of 17 tissue-core samples were also cultured. All 17 tissue-core biopsy samples were diagnostic (accuracy of 100%). Five out of six aspirates were diagnostic (accuracy of 83.3%). The overall accuracy was 95.7%. In one aspirate, cytologic quality was insufficient containing only blood. No major complications were encountered. Fourteen neoplastic, two infectious and six benign lesions were diagnosed. CT examination after intravenous contrast medium added useful information to avoid large vessels and to biopsy-viable tissue. Free-hand CT-guided tissue-core biopsy and aspiration appears to be a safe and very accurate procedure for use in the diagnosis of bone-associated diseases in small animal