Renal cell carcinoma complicating long-term dialysis: Computed tomography-guided aspiration cytology

The diagnosis of renal cell carcinoma was established by computed tomography-guided aspiration in two small solid lesions occurring in end-stage kidneys. This represents a safe means of providing more specific information about the various lesions that frequently develop in chronic hemodialysis patients: complex cysts, adenoma, and renal cell carcinoma. The proposed conservative approach of simple observation of these lesions may be altered if a precise diagnosis is obtained. Computed tomography is considered the most reliable imaging modality for evaluation and guided aspiration

Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy

Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure-related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment

Percutaneous Sclerotherapy of Lymphoceles Related to Renal Transplantation

To determine the advantages of using transcatheter sclerotherapy to treat renal allograft-related lymphoceles. Eighteen patients first seen with symptomatic lymphoceles secondary to renal transplantation were treated with povidone-iodine percutaneous sclerotherapy. Percutaneous catheters were placed by means of sonographic, computed tomographic, or combined fluoroscopic and sonographic guidance. Sclerotherapy was initiated while patients were in the hospital, and the patients then instilled povidone-iodine twice a day at home. One patient had an inadequate trial period of therapy and was not included in the analysis. Seventeen lymphoceles were adequately sclerosed. Average length of treatment was 35 days. Three lymphoceles recurred and were effectively treated percutaneously. Follow-up studies showed no recurrence 1 month to 2 years after completion of therapy. No patient needed surgery for lymphocele repair. Because of its safety and efficacy, percutaneous transcatheter sclerotherapy with povidone-iodine should be the treatment of choice in patients with lymphoceles that develop after renal transplantation

Percutaneous Catheter-directed Debridement of Infected Pancreatic Necrosis: Results in 20 Patients

To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis. Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30–120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid. All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7–32 (average, 17) episodes of debridement and stayed 0–36 days (average, 9 days) in the intensive care unit, 13–118 days (average, 42 days) on the regular floor, and spent 0–98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred. Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis

Percutaneous irreversible electroporation for the treatment of colorectal cancer liver metastases with a proposal for a new response evaluation system

To describe an initial experience with irreversible electroporation (IRE) in patients with colorectal liver metastasis (CLM). A retrospective analysis of patients undergoing IRE for the management of CLM was performed. Procedures were done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. Between March 2010 and February 2013, 29 patients underwent percutaneous ablation of 58 tumors in 36 IRE sessions. Most patients (89%) had an absolute or relative contraindication to thermal ablation. The median age was 62 years, and the median time from diagnosis to IRE was 28 months. The median number of lesions treated per patient was two, and the median tumor size was 2.7 cm. Patients had received previous chemotherapy regimens (range, 1-5 per patient). A new Metabolic Imaging And Marker Integration response evaluation criteria was used for response assessment, and was a predictor of progression-free and overall survival. The 2-year progression-free survival rate was 18% (95% confidence interval, 0%-35%), and the 2-year overall survival rate was 62% (95% confidence interval, 37%-87%). Complications included arrhythmias (n = 1) and postprocedure pain (n = 1). Both patients recovered without sequelae. Percutaneous IRE of CLM is feasible and safe. A new response evaluation system for colorectal cancer appears to be prognostic

Percutaneous Irreversible Electroporation for Downstaging and Control of Unresectable Pancreatic Adenocarcinoma

Treatment of unresectable locally advanced pancreatic cancer (LAPC) usually includes chemotherapy and/or radiation therapy in an attempt to downstage these tumors to the extent of resectability, but outcomes remain poor. Irreversible electroporation (IRE) is an ablative modality that may be useful in this population. The aim of this study was to evaluate the safety of percutaneous IRE in patients with pancreatic adenocarcinoma. IRE was performed in patients with pancreatic cancer whose tumors remained unresectable after, or who were intolerant of, standard therapy. The procedures were all done percutaneously under general anesthesia. Patients were then followed for adverse events, tumor response, and survival. Fifteen IRE procedures were performed in 14 patients (one was treated twice). Three patients had metastatic disease and 11 had LAPC. All patients had received chemotherapy previously, and 11 had received radiation. The median tumor size was 3.3 cm (range, 2.5–7 cm). Immediate and 24-hour postprocedural scans demonstrated patent vasculature in the treatment zone in all patients. Two patients underwent surgery 4 and 5 months after IRE, respectively. Both had margin-negative resections, and one had a pathologic complete response; both remain disease-free after 11 and 14 months, respectively. Complications included spontaneous pneumothorax during anesthesia (n = 1) and pancreatitis (n = 1), and both patients recovered completely. There were no deaths directly related to the procedure. All three patients with metastatic disease at IRE died from progression of their disease. Percutaneous IRE for pancreatic adenocarcinoma is feasible and safe. A prospective trial is being planned