Pelvic abscess drainage: outcome with factors affecting the clinical success

PURPOSE:We aimed to evaluate the success and complication rates of image-guided pelvic abscess drainage with emphasis on factors affecting the clinical success.METHODS:During a 7-year period, 185 pelvic abscesses were treated in 163 patients under ultrasonography and fluoroscopy (n=140) or computed tomography (n=45) guidance with transabdominal (n=107), transvaginal (n=39), transrectal (n=21) and transgluteal (n=18) approaches. Abscess characteristics (etiology, number, size, intrastructure, microbiological content, presence of fistula), patient demographics (age, sex, presence of malignancy, primary disease, antibiotic treatments), procedure-related factors (guidance method, access route, catheter size) and their effects on clinical success, complications, and duration of catheterization were statistically analyzed. RESULTS:Technical and clinical success rates were 100% and 93.9%, respectively. Procedure-related mortality or major complications were not observed. Minor complications such as catheter dislodgement, obstruction, or kinking were detected in 6.7% of the patients. Clinical failure was observed in 10 patients (6.1%). Fistulization was observed in 14 abscesses. Fistulization extended the duration of catheter use (P < 0.001) and decreased the clinical success rate (P < 0.001). The presence of postoperative malignant, complex-multilocular abscesses, and fungus infection in the cavity extended catheter duration (P < 0.001, P = 0.018, and P = 0.007, respectively), whereas the presence of sterile abscess and endocavitary catheterization reduced the catheter duration (P = 0.009 and P = 0.011, respectively).CONCLUSION:İmage-guided pelvic abscess drainage has high clinical success and low complication rates. The only factor affecting the clinical success rate is the presence of fistula

Diagnostic accuracy and complication rates of percutaneous CT-guided coaxial needle biopsy of pulmonary lesions

PURPOSEThe aim of this retrospective study was to evaluate and compare diagnostic accuracy and complication rates of percutaneous computed tomography (CT)-guided biopsies of pulmonary lesions 10–35 mm, 35–50 mm, and >50 mm, using the coaxial biopsy technique.METHODSOver a 4-year period, 235 lung biopsies were performed using the coaxial biopsy technique with 18G semi-automated true-cut needle. There were 163 (69.4%) male and 72 (30.6%) female patients, with a mean age of 64.01±9.18 years (18–85 years). The mean lesion size was 59.6±29.3 mm. The lesions were stratified into three groups according to size: lesions 50 mm (n=140, 59.6%). Diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for all biopsies, and for each group separately, as well as the incidence of complications.RESULTSThe overall diagnostic accuracy was 95.4%, with 95.52% sensitivity, 100% specificity, 100% PPV, and 47.37% NPV. For lesions 50 mm, with 93.65% sensitivity, 100% specificity, 100% PPV, and 42.86% NPV. An adequate sample was obtained in 219 core biopsies (93.2%), while 16 biopsies (6.8%) were nondiagnostic due to necrosis (4.25%) and insufficient biopsy material (2.55%). The most frequent complication was minor pneumothorax, which was seen at a rate of 19.1%; pneumothorax requiring chest tube placement occurred in 3 patients (1.3%).CONCLUSIONDiagnostic accuracy decreased with increasing lesion size. On the other hand, complication rates were higher in smaller lesions, more distanced from the pleura

Management of single double-J stent failure in malignant ureteral obstruction: tandem ureteral stenting with less frequent stent exchange

PURPOSETo evaluate the safety and efficacy of the placement and exchange of tandem ureteral stents (TUS) under fluoroscopic guidance in the management of indwelling single double-J stent (DJS) failure in patients with malignant ureteral obstruction. We also aimed to investigate whether the generally accepted exchange period of DJSs could be extended using TUS.METHODSThis retrospective study involved 11 patients (10 female) with an age range of 27–64 years, median of 49 years, who underwent TUS (ipsilateral two 8F DJSs) placement due to indwelling single DJS failure occurring in less than 3 months. TUS exchanges were performed initially at 6-month intervals, and subsequent exchange intervals were extended to 9 and 12 months for seven patients. The interval from initial TUS placement to percutaneous nephrostomy, repeat exchange, or death was defined as the duration of stent patency.RESULTSIndwelling single DJS failure occurred during a median follow-up of 45 days (range, 35–60 days) in 14 ureters of 11 patients. TUS were successfully placed and exchanged with a technical success rate of 100% without any early major complications. Thirty-nine procedures (11 placement and 28 exchange procedures) in 55 ureters were performed. The median duration of urinary patency was significantly higher with TUS [300 days (range, 60–440 days)] compared with single DJSs [45 days (range, 35–60 days)] (P < 0.001).CONCLUSIONThe placement and exchange of TUS can be safely and effectively performed under fluoroscopic guidance. The need for frequent DJS exchange could be reduced with increased duration of stent patency using TUS

Percutaneous drainage of retroperitoneal abscesses: variables for success, failure, and recurrence

PURPOSEWe aimed to evaluate the success and failure rates and minor and major complications of percutaneous drainage of retroperitoneal abscesses.METHODSBetween 1990 and 2010, percutaneously drained 170 retroperitoneal abscesses in 150 patients (83 males, 67 females, median age 44.2 years, age range, 1–86 years) were included retrospectively. Percutaneous drainage of retroperitoneal abscesses was performed under the guidance of ultrasonography and fluoroscopy or computed tomography. Six abscesses were drained via single needle aspiration whereas 164 abscesses were drained via catheters of 6–14 F calibre using the Seldinger technique.RESULTSWhen all retroperitoneal abscesses are considered, success rates were found as follows: 75.3% cure (128/170), 7.7% temporization (13/170), 4.1% palliation (7/170). Failure rate was 12.9% (22/170). Recurrence rate was 10.6% (18/170), and 13 of the recurred abscesses were treated via second session percutaneous drainage. Mortality rate was 2.7% (4/150).CONCLUSIONPercutaneous drainage is the first treatment option for retroperitoneal abscesses due to procedural reliability, elimination of need for general anesthesia, better tolerability, and lower morbidity and mortality rates compared with the surgical methods. High cure, temporization, or palliation rates can be obtained via imaging-guided percutaneous drainage for all retroperitoneal abscesses with a safe access route

Percutaneous management of complicated parapneumonic effusion and empyema after surgical tube thoracostomy failure in children: a retrospective study

PurposeWe aimed to evaluate the results of percutaneous management of complicated parapneumonic effusions (PPE) and empyema after surgical tube thoracostomy failure in children.MethodsA total of 84 children treated percutaneously after surgical tube thoracostomy failure between 2004 and 2019 were included to this retrospective study. Technical success was defined as appropriate placement of the drainage catheter. Clinical success was defined as complete resolution of infection both clinically and radiologically. Management protocol included imaging-guided pigtail catheter insertion, fibrinolytic therapy, serial ultrasonographic evaluation, catheter manipulations as necessary (revision, exchange, or upsizing), and appropriate antibiotherapy. All patients were followed up at least 6 months.ResultsTechnical success rate was 100%. Unilateral single, unilateral double, and bilateral catheter insertions were performed in 73, 9, and 2 patients, respectively. Inserted catheter sizes ranged from 8 F to 16 F. Streptokinase, urokinase, and tissue plasminogen activator were used as fibrinolytic agent in 29 (34%), 14 (17%), and 41 (49%) patients, respectively. In order to maintain effective drainage, 42 additional procedures (catheter exchange, revision, reposition, or additional catheter placement) were performed in 20 patients (24%). Clinical success was achieved in 83 of 84 patients (99%). Median catheter duration was 8 days (4–32 days). Median hospital stay during percutaneous management was 11.5 days (7–45 days). Factors affecting the median catheter duration were the presence of necrotizing pneumonia (p < 0.001) and bronchopleural fistulae (p < 0.001).ConclusionPercutaneous imaging-guided catheterization with fibrinolytic therapy should be the method of choice in pediatric complicated PPE and empyema patients with surgical tube thoracostomy failure. Percutaneous treatment is useful in avoiding more aggressive surgical options

A novel technique for the non-surgical management of inadvertent bowel catheterization during percutaneous abscess drainage: a technical note

Percutaneous abscess drainage-related inadvertent bowel catheterization is an undesired complication that requires treatment. In two cases without signs of peritonitis that we examined, it was possible to achieve successful abscess drainage, and to treat abscess-related inadvertent bowel catheterization by using a novel technique without surgery

How to Reduce the Risk for Complications?

Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments.publishersversionpublishe

Epidemiological factors associated with human cystic echinococcosis: a semi-structured questionnaire from a large population-based ultrasound cross-sectional study in eastern Europe and Turkey

[Background] Cystic echinococcosis (CE) is a neglected parasitic zoonosis prioritized by the WHO for control. Several studies have investigated potential risk factors for CE through questionnaires, mostly carried out on small samples, providing contrasting results. We present the analysis of risk factor questionnaires administered to participants to a large CE prevalence study conducted in Bulgaria, Romania and Turkey.[Methods] A semi-structured questionnaire was administered to 24,687 people from rural Bulgaria, Romania and Turkey. CE cases were defined as individuals with abdominal CE cysts detected by ultrasound. Variables associated with CE at P < 0.20 in bivariate analysis were included into a multivariable logistic model, with a random effect to account for clustering at village level. Adjusted odds ratios (AOR) with 95% CI were used to describe the strength of associations. Data were weighted to reflect the relative distribution of the rural population in the study area by country, age group and sex.[Results] Valid records from 22,027 people were analyzed. According to the main occupation in the past 20 years, “housewife” (AOR: 3.11; 95% CI: 1.51–6.41) and “retired” (AOR: 2.88; 95% CI: 1.09–7.65) showed significantly higher odds of being infected compared to non-agricultural workers. “Having relatives with CE” (AOR: 4.18; 95% CI: 1.77–9.88) was also associated with higher odds of infection. Interestingly, dog-related and food/water-related factors were not associated with infection.[Conclusions] Our results point toward infection being acquired in a “domestic” rural environment and support the view that CE should be considered more a “soil-transmitted” than a “food-borne” infection. This result helps delineating the dynamics of infection transmission and has practical implications in the design of specific studies to shed light on actual sources of infection and inform control campaigns.The research leading to these results received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under the project HERACLES, grant agreement no. 602051.Peer reviewe

Primum Non Nocere in interventional oncology for liver cancer: How to reduce the risk for complications?

: Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments