Comparison of perioperative patient characteristics associated with severe bleeding after percutaneous transhepatic gallbladder intervention.

Comparison of perioperative patient characteristics associated with severe bleeding after percutaneous transhepatic gallbladder intervention.</p

Flowchart of 194 patients who underwent PTGBD or PTGBA according to the administration of antithrombotic drugs.

PTGBD: percutaneous transhepatic gallbladder drainage. PTGBA: percutaneous transhepatic gallbladder aspiration. No drug group: no prior antithrombotic therapy. Discontinuing drug group: antithrombotic drugs discontinuation. Single-drug group: single antithrombotic drug continuation. Multiple-drugs group: multiple antithrombotic drugs continuation.</p

Patient characteristics and data.

This study aimed to investigate the bleeding risk associated with percutaneous transhepatic gallbladder interventions in patients with acute cholecystitis receiving antithrombotic therapy. In this retrospective study, 194 consecutive patients who underwent percutaneous transhepatic gallbladder interventions for acute cholecystitis between April 2011 and April 2021 were enrolled. Patients were sorted into four groups: no prior antithrombotic therapy, discontinued antithrombotic drugs, single antithrombotic drug continued perioperatively, and multiple antithrombotic drugs continued perioperatively. The risk of postoperative bleeding after percutaneous transhepatic gallbladder interventions was evaluated via multivariate logistic regression analysis. Of the 116 (59.8%) patients receiving antithrombotic therapy, 32 (16.5%) discontinued antithrombotic drugs before their respective procedure, 50 (25.8%) continued a single antithrombotic drug, and 34 (17.5%) continued multiple antithrombotic drugs during the perioperative period. The rates of significant and severe bleeding were 10.3% (20/194) and 3.1% (6/194), respectively. The rate of significant bleeding was significantly higher in patients who continued multiple antithrombotic drugs than in patients who received no prior antithrombotic therapy (P = 0.006). In the multivariate logistic regression analysis, the continuation of multiple antithrombotic drugs during the perioperative period was a risk factor for significant bleeding after percutaneous transhepatic gallbladder interventions. In conclusion, the perioperative continuation of multiple antithrombotic drugs is a risk factor for postoperative bleeding after percutaneous transhepatic gallbladder interventions.</div

Risk factors associated with significant bleeding after percutaneous transhepatic gallbladder intervention.

Risk factors associated with significant bleeding after percutaneous transhepatic gallbladder intervention.</p

Risk factors associated with severe bleeding after percutaneous transhepatic gallbladder intervention.

Risk factors associated with severe bleeding after percutaneous transhepatic gallbladder intervention.</p

Comparison of significant postoperative bleeding after PTGBD or PTBGA according to the regimens of antithrombotic therapy.

NS: not significant. no drug group: no prior antithrombotic therapy. discontinuing drug group: antithrombotic drugs discontinuation. single-drug group: single antithrombotic drug continuation. multiple-drugs group: multiple antithrombotic drugs continuation.</p

Baseline characteristics of 194 patients that underwent percutaneous transhepatic gallbladder intervention.

Baseline characteristics of 194 patients that underwent percutaneous transhepatic gallbladder intervention.</p

Comparison of perioperative patient characteristics associated with significant bleeding after percutaneous transhepatic gallbladder intervention.

Comparison of perioperative patient characteristics associated with significant bleeding after percutaneous transhepatic gallbladder intervention.</p

Image_1_A case report: Dual-lead deep brain stimulation of the posterior subthalamic area and the thalamus was effective for Holmes tremor after unsuccessful focused ultrasound thalamotomy.JPEG

Holmes tremor is a symptomatic tremor that develops secondary to central nervous system disorders. Stereotactic neuromodulation is considered when the tremors are intractable. Targeting the ventral intermediate nucleus (Vim) is common; however, the outcome is often unsatisfactory, and the posterior subthalamic area (PSA) is expected as alternative target. In this study, we report the case of a patient with intractable Holmes tremor who underwent dual-lead deep brain stimulation (DBS) to stimulate multiple locations in the PSA and thalamus. The patient was a 77-year-old female who complained of severe tremor in her left upper extremity that developed one year after her right thalamic infarction. Vim-thalamotomy using focused ultrasound therapy (FUS) was initially performed but failed to control tremor. Subsequently, we performed DBS using two leads to stimulate four different structures. Accordingly, one lead was implanted with the aim of targeting the ventral oralis nucleus (Vo)/zona incerta (Zi), and the other with the aim of targeting the Vim/prelemniscal radiation (Raprl). Electrode stimulation revealed that Raprl and Zi had obvious effects. Postoperatively, the patient achieved good tremor control without any side effects, which was maintained for two years. Considering that she demonstrated resting, postural, and intention/action tremor, and Vim-thalamotomy by FUS was insufficient for tremor control, complicated pathogenesis was presumed in her symptoms including both the cerebellothalamic and the pallidothalamic pathways. Using the dual-lead DBS technique, we have more choices to adjust the stimulation at multiple sites, where different functional networks are connected. Intractable tremors, such as Holmes tremor, may have complicated pathology, therefore, modulating multiple pathological networks is necessary. We suggest that the dual-lead DBS (Vo/Raprl and Vim/Zi) presented here is safe, technically feasible, and possibly effective for the control of Holmes tremor.</p