Metastatic Parathyroid Carcinoma treated with Radiofrequency Ablation: A novel therapeutic modality

Parathyroid carcinoma (PCA), accounting for less than one per cent of all endocrine malignancies, is a rare cause of primary hyperparathyroidism. A diagnosis of parathyroid carcinoma may be challenging in the presence of localised disease and involves a histological diagnosis based on capsular, vascular, or perineural invasion or the presence of metastasis. Distant metastasis remains a rare presentation, with the lung being the most common site. Surgery remains the treatment of choice as radiotherapy and chemotherapy have proved to be of limited benefit in metastatic disease. This case reports suggests that radiofrequency ablation has the potential to be a novel and effective treatment option in these patients

A Survey on Factors Influencing the Work–Family–Health Balance of an Interventional Radiologist

Aim: Burnout and stress-related health disorders are on the rise among physicians. The aim of this study is to report the results of a survey on factors affecting the work–life balance of interventional radiologists (IR)

Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

Objective: To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. Materials and Methods: This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS) and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Results: Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula) was detected during the first angiogram in 55 patients (78.6%) and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3%) showed complete resolution and 4 patients (5.7%) died. Three patients (4.3%) underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Conclusions: Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy

Assessment of preprocedure difference in the supine and dependent transcutaneous tissue oxygenation to prognosticate pain relief, following chemical lumbar sympathectomy for critical limb ischemia in thromboangiitis obliterans

Context: Chemical lumbar sympathectomy (CLS) is performed in thromboangiitis obliterans (TAO) for relief of rest pain. Interruption of sympathetic innervation causes improvement in tissue oxygenation and is reflected in transcutaneous partial pressure of oxygen (TcPo2). There is very little data available to guide patient selection for CLS. Aims: The primary objective was to assess if preprocedure difference in TcPo2measured in supine and dependent positions on the foot correlated with relief of rest pain. The secondary objectives were to measure postprocedure TcPo2on the foot and assess preprocedure predictors of rest pain relief following sympathectomy. Settings and Design: Prospective observational study in patients undergoing CLS for TAO carried out from October 2009 to August 2014 in the Vascular Surgery Unit at Christian Medical College, Vellore. Subjects and Methods: Patients diagnosed to have TAO based on Shionoya's criteria, who were planned for a sympathectomy for rest pain, were included in the study. Statistical Analysis Used: Outcomes were compared using Mann—Whitney U-test and Wilcoxon signed-rank test. Data were entered and analyzed using SPSS 16.0 software. Results: There was a significant reduction of pain after sympathectomy (P < 0.001). There was a significant increase in TcPo2, supine to dependent position, independently before and after sympathectomy (P < 0.001). However, preprocedure difference in supine and dependent TcPo2did not correlate with the change in pain scores following sympathectomy. Conclusions: CLS provides relief of rest pain in TAO by improving tissue oxygenation. Preprocedure difference in the supine and dependent TcPo2did not correlate with pain relief

Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis

Background: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up

Standardisation of Preoperative Marking of Incompetent Perforators and Saphenopopliteal Junction on Doppler with Evaluation of “T” Technique

To standardise the preoperative marking of incompetent perforators and saphenopopliteal junction on Doppler with evaluation of “T” technique. A prospective study including 54 consecutive patients (61 lower limbs) who underwent surgery for varicose veins in 2003 and 2004 were included for preoperative marking. “T” technique is a technique of Doppler marking of an incompetent perforator, long limb of the T representing the course of the superficial vein and the junction of the T representing the site of perforator entering the deep fascia. Surgical correlation was done. The overall surgical detection rate of incompetent perforators was 199 / 220(90.5%); detection of the saphenopopliteal junction was 100%. The “T” technique of Doppler marking was found to be easy to perform and aided intraoperative detection

Computed Tomography–Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility

Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography–guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice. Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis. Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution. Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%. Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients