Comparing clinical outcomes of image-guided percutaneous transperitoneal and transhepatic cholecystostomy for acute cholecystitis

2020 ◽  
pp. 028418512095982
Author(s):  
Joseph R Kallini ◽  
Deven C Patel ◽  
Nikhil Linaval ◽  
Edward H Phillips ◽  
Richard J Van Allan
Keyword(s):  
Clinical Outcomes ◽  
Multivariable Analysis ◽  
Bile Leak ◽  
Acalculous Cholecystitis ◽  
Catheter Placement ◽  
Percutaneous Cholecystostomy ◽  
Post Procedure ◽  
The Mean ◽  
Calculous Cholecystitis ◽  
Mean Time

Background Percutaneous cholecystostomy is performed by interventional radiologists for patients with calculous/acalculous cholecystitis who are poor candidates for cholecystectomy. Two anatomical approaches are widely utilized: transperitoneal and transhepatic. Purpose To compare the clinical outcomes of transperitoneal and transhepatic approaches to cholecystostomy catheter placement. Material and Methods From December 2007 to August 2015, 165 consecutive patients (97 men, 68 women) underwent either transperitoneal (n = 89) or transhepatic (n = 76) cholecystostomy at a single center. Indications were calculous cholecystitis (n = 21), acalculous cholecystitis (n = 35), hydrops (n = 1), gangrenous cholecystitis (n = 1), and other cholecystitis (n = 107). The most common high-risk co-morbidities were sepsis (n = 53) and cardiac (n = 11). Outcomes were compared using univariate and multivariable analysis. Results Post-procedure outcomes included tube dislodgement (transperitoneal [n = 6] and transhepatic [n = 3], P = 0.44), bile leak (transperitoneal [n = 5], transhepatic [n = 1], P = 0.14), gallbladder hemorrhage (transperitoneal [n = 2]; transhepatic [n = 3], P = 0.52), duodenal fistula (transperitoneal [n = 0], transhepatic [n = 1], P = 0.27), repeat cholecystostomy (transperitoneal [n = 1], transhepatic [n = 3], P = 0.27), and repeat cholecystitis requiring separate admission (transperitoneal [n = 6], transhepatic [n = 10], P = 0.15). All complications were Common Terminology Criteria for Adverse Events grade <3. Twenty transperitoneal patients underwent post-procedure cholecystectomy: 13 laparoscopic, three open, and four unclear/outside records. The mean time from cholecystostomy to operation was 38 days (range 3–211 days). Twenty-three transhepatic patients underwent cholecystectomy: 14 laparoscopic, eight open, and one unclear/outside records, with the mean time from cholecystostomy being 98 days (range 0–1053 days). One transhepatic and three transperitoneal patients died during admission. Conclusion There were no significant differences in short-term complications after transperitoneal and transhepatic approaches to percutaneous cholecystostomy catheter placement.

scholarly journals Clinical Relationship between Steatocholecystitis and Gallbladder Contractility Measured by Cholescintigraphy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Chang Seok Bang ◽  
Yong Sub Lee ◽  
Jai Hoon Yoon ◽  
Youn Jeong Kim ◽  
Jin Bong Kim ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Teaching Hospital ◽  
Multivariable Analysis ◽  
Acalculous Cholecystitis ◽  
Total Serum ◽  
Total Serum Cholesterol ◽  
Gallbladder Stone ◽  
Gallbladder Contractility ◽  
Clinical Relationship ◽  
Calculous Cholecystitis

Objective.Contractility of gallbladder is known to be decreased in fatty gallbladder diseases. However, clinical estimation data about this relationship is still lacking. The aim of this study was to investigate the association between steatocholecystitis and contractility of gallbladder.Methods.Patients with cholecystitis (steatocholecystitis versus nonsteatocholecystitis) who underwent cholescintigraphy before cholecystectomy were retrospectively evaluated in a single teaching hospital of Korea. The association of steatocholecystitis with contractility of gallbladder, measured by preoperative cholescintigraphy, was assessed by univariable and multivariable analysis.Results.A total of 432 patients were finally enrolled (steatocholecystitis versus nonsteatocholecystitis; 75 versus 357, calculous versus acalculous cholecystitis; 316 versus 116). In the multivariable analysis, age (OR: 0.94, 95% CI: 0.90–0.99,P=0.01) and total serum cholesterol (OR: 1.02, 95% CI: 1.01–1.04,P=0.04) were related to steatocholecystitis in patients with acalculous cholecystitis. Only age (OR: 0.97, 95% CI: 0.94–0.99,P=0.004) was significantly related to steatocholecystitis in patients with calculous cholecystitis. However, ejection fraction of gallbladder reflecting contractility measured by cholescintigraphy was not related to steatocholecystitis irrespective of presence of gallbladder stone in patients with cholecystitis.Conclusion.Ejection fraction of gallbladder measured by cholescintigraphy cannot be used for the detection or confirmation of steatocholecystitis.

Recurrence and new tumor development after frontline intravenous chemotherapy for retinoblastoma: Risk factors and treatment results

2021 ◽  
pp. 112067212110233
Author(s):  
Ahmet Kaan Gündüz ◽  
Ibadulla Mirzayev ◽  
Handan Dinçaslan ◽  
Funda Seher Özalp Ateş
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Tumor Development ◽  
Primary Treatment ◽  
Intravenous Chemotherapy ◽  
Kaplan Meier ◽  
Risk Factors For Recurrence ◽  
The Mean ◽  
Mean Time

Purpose: To evaluate the risk factors leading to recurrence and new tumor (NT) development in patients with retinoblastoma after intravenous chemotherapy (IVC) and to review the treatment outcomes. Materials and methods: The records of 166 retinoblastoma cases (having 246 affected eyes) who underwent six-cycle IVC (vincristine, etoposide, and carboplatin) as primary treatment between October 1999 and August 2020 were reviewed retrospectively. Results: The mean ages at presentation were 9.0 (median: 8.0) and 9.2 (median: 8.5) months in cases with recurrence and NTs respectively. Recurrence was detected in 40 (16.3%) eyes, NTs in 29 (11.8%), and both recurrence/NTs in 24 (9.8%). The mean time elapsed till recurrence and NT was 10.7 months. Multivariable analysis showed that the factors predictive of recurrence were largest tumor base diameter (LTBD) >12 mm ( p = 0.039) and presence of subretinal seeds at diagnosis ( p = 0.043). Multivariable risk factors for the development of NTs were bilateral familial retinoblastoma ( p = 0.001) and presence of subretinal seeds at diagnosis ( p = 0.010). Mean follow-up was 80.1 (median: 72.5) months. By Kaplan-Meier analysis, the 1-, 3-, and 6-year recurrence and NT rates were 21.2%, 28.1%, and 28.7% and 14.9%, 22.6%, and 23.9% respectively. The most common treatment methods used for recurrent and/or NTs included cryotherapy, transpupillary thermotherapy, and intra-arterial chemotherapy. Enucleation was eventually required in 24/93 (25.8%) eyes. No patient developed metastasis. Discussion: Development of recurrence and/or NT after IVC was noted in 38% of all retinoblastoma eyes. Bilateral familial disease, LTBD >12 mm, and presence of subretinal seeds at baseline were risk factors for recurrence and NTs in this study.

Routine ileal intubation in colonoscopy does not increase the polyp detection rate: a retrospective study

2020 ◽  
Vol 58 (10) ◽  
pp. 955-959
Author(s):  
Weiyi Wang ◽  
Ke Chen ◽  
Ying Xu ◽  
Yufen Zhou ◽  
Ping Chen
Keyword(s):  
Retrospective Study ◽  
Detection Rate ◽  
Multivariable Analysis ◽  
Polyp Detection ◽  
Cecal Intubation ◽  
Abdominal Symptoms ◽  
Polyp Detection Rate ◽  
Clinical Benefits ◽  
The Mean ◽  
Mean Time

AbstractColonoscopy is effective in the prevention and screening of colorectal cancer. Whether terminal ileal (TI) intubation is required during conventional colonoscopy and whether it offers clinical benefits with respect to polyp detection rate (PDR) remain unclear. This retrospective study included patients who underwent colonoscopy at our hospital between July 1, 2018 and April 20, 2019. The positive findings and time for TI intubation were recorded. Univariate and multivariate analyses were performed to identify factors associated with PDR. There were 1675 patients with cecal intubation colonoscopy, including 994 (59 %) with TI intubation and 8 (1 %) with intestinal disease. The mean time for TI intubation was 40 seconds (3–338), and the mean time from cecal intubation to arrival at the deep part of TI mucosa was 24 seconds (2–118). The overall PDR was 27 %. On multivariable analysis, age > 50 years [95 % confidence interval (CI) 2.837–4.590], male sex (95 %CI, 0.406–0.649), presence of symptoms (abdominal symptoms vs. asymptomatic, 95 % CI, 1.146–2.468; stool changes vs. asymptomatic, 95 % CI, 1.070–1.834), and non-TI intubation (95 % CI, 1.040–1.648) were independent predictors of higher PDR. Trend analysis indicated decreasing trend of PDR among non-TI intubation group, 0–5 cm TI intubation group, and > 5 cm TI intubation group (30 % vs. 27 % vs. 24 %, respectively; p < 0.05). TI intubation is necessary to identify small bowel disease among a designated population, but it was not suggested to be routinely performed as part of colonoscopy, owing to limited positive intestinal findings, extra time requirement, and possible PDR worsening.

scholarly journals Clinical outcomes following intravitreal methotrexate for primary vitreoretinal lymphoma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Casey L. Anthony ◽  
J. Clay Bavinger ◽  
Jessica G. Shantha ◽  
Ghazala D. O’Keefe ◽  
William A. Pearce ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Clinical Outcomes ◽  
Systemic Chemotherapy ◽  
Cns Lymphoma ◽  
Primary Vitreoretinal Lymphoma ◽  
Vitreoretinal Lymphoma ◽  
Intravitreal Treatment ◽  
The Mean ◽  
Mean Time

Abstract Purpose To describe the visual acuity and anatomic outcomes of intravitreal methotrexate (MTX) for the treatment of primary vitreoretinal lymphoma (PVRL). Methods Single-center retrospective case series of patients with a diagnosis of PVRL treated with intravitreal MTX. Patient records were reviewed for demographic information, ocular exam findings, and treatment regimens including number of MTX injections. Clinical outcomes recorded included visual acuity (VA), time to partial (PR) or complete response (CR), disease-free survival, time to relapse, and any CNS progression. Results Ten eyes of 7 patients (4 male, 6 female) were reviewed. The mean age ± standard deviation (SD) was 70 ± 12 years. Five patients had prior or concomitant diagnosis of primary CNS lymphoma with a history of systemic chemotherapy including MTX. Three eyes (30%) exhibited isolated vitreous involvement, four (40%) had subretinal lesions, and three (30%) presented with both vitreous and subretinal disease. Mean initial logMAR VA was 0.38 ± 0.52 (Snellen visual equivalent 20/50), while mean final logMAR VA ± SD was 0.34 ± 0.27 (Snellen visual equivalent 20/40) with a mean follow-up time of 26 months (Range, 3–49 months). Patients received an average of 6 intravitreal MTX injections (Range 1–10) over the course of treatment. Two patients received concomitant systemic chemotherapy. Mean time to either PR or CR was 57 days, and 6 eyes (60%) exhibited regression with no relapse after local treatment. For the 4 eyes that eventually relapsed, the mean time ± SD to first relapse was 193 days ± 155 days, and one eye experienced a second relapse. Two of 3 patients with subretinal disease showed complete regression with extended follow-up of 1 and 4 years following treatment with less than 3 doses of intravitreal MTX. One patient with PVRL developed CNS lymphoma during the study period. VA remained stable overall between the initial treatment visit, 3, 6, and 12-months (P > 0.05 for paired comparisons of VA over time). Conclusions Intravitreal methotrexate was well-tolerated and led to local disease response in the majority of patients at approximately 2 months after initiation of treatment of intraocular lymphoma. Further studies on the efficacy of intravitreal treatment alone versus combined systemic and intravitreal treatment are warranted.

Abstract WP29: Early U.S. Experience with the Trevo Retriever Device: A Multi-Center Analysis

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Michael J Alexander ◽  
Erol Veznedaroglu ◽  
Lei Feng ◽  
Gary Duckwiler ◽  
Adnan Siddiqui ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Results ◽  
Technical Success ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Clinical Exam ◽  
Post Procedure ◽  
The Mean ◽  
Number Of Passes ◽  
Mean Time

Introduction: The Trevo Retriever device (Stryker Neurovascular, Mountain View, CA) received FDA clearance as a 510K device in August 2012 for clot retrieval in acute ischemic stroke within eight hours of symptom onset. This study is an early look at the initial U.S. experience with the device following FDA clearance, examining the clinical results of the some of the first cases performed in the U.S. Methods: This was a retrospective analysis of prospectively collected clinical data from the early U.S. experience using the Trevo Retriever device. All physician operators were in-serviced on the use of the device and technique prior to first clinical use. Of the first patients treated, 6 were MCA occlusions, and 1 ICA occlusion. Four of the patients received intravenous tPA prior to their intervention, the remaining three patients did not did not qualify for IV tPA. The mean NIHSS pre-procedure was 19. Results: The Trevo device could be delivered across the intraluminal clot in all seven cases. There was a 100% success rate in revascularization of the target territory as judged by TICI score 2b or 3. One case resulted in an ACA embolus that was successfully revascularized. There was an average of 2.0 passes of the device to achieve this revascularization rate (range 1-4), with 71% of the cases needing 1 or 2 passes, and the remaining 3 or 4 passes. The mean time from femoral access to revascularization was 44 minutes (range 18-93 minutes, median 31 minutes). The average clot length was 11 mm. The clot was characterized as soft/friable in 2 cases, intermediate/rubbery in 3 cases, and hard/fibrous in 2 cases. The 24 hour post-procedure NIHSS was improved in 86% of the patients treated, and the mean NIHSS at 24 hours was 10 (range 0-27). Five of the seven patients had an improvement on the NIHSS of 9 points or greater. Conclusions: The technical success rate, as measured by a TICI score of 2b or 3, was excellent (100%) in this initial U.S. experience. With a high revascularization rate and a few number of passes, this shortened the endovascular revascularization time, and resulted in improved clinical exam in 6 of the 7 patients within 24 hours post-procedure.

scholarly journals Transradial approach for acute stroke intervention: technical procedure and clinical outcomes

2019 ◽  
Vol 5 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Omaditya Khanna ◽  
Nikolaos Mouchtouris ◽  
Ahmad Sweid ◽  
Nohra Chalouhi ◽  
Ritam Ghosh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Clinical Outcomes ◽  
Radial Artery ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Transradial Approach ◽  
Technical Procedure ◽  
The Mean ◽  
Vessel Dissection ◽  
Mean Time

Background and purposeRadial artery catheterisation is an alternate route of access that has recently started to gain more widespread use for neuroendovascular procedures, including acute stroke intervention. In this small case series, we present our institution’s outcomes in patients undergoing acute stroke interventions via transradial access.Materials and methodsWe present a retrospective study of 15 patients who underwent acute stroke intervention via radial artery access. We analyse these patients’ periprocedural and clinical outcomes after undergoing mechanical thrombectomy.ResultsA total of 15 consecutive patients were included in the study (9 males and 6 females), and all patients were able to successfully undergo mechanical thrombectomy via radial artery access. The mean time of arterial puncture to reperfusion was 50±28 min (range: 15–104). A TICI 2b/3 revascularisation was achieved in 13/15 patients (87%); a TICI 1 and TICI 2a outcome was achieved on the other two patients. One patient incurred an iatrogenic vessel dissection during the procedure. Eight of out 15 patients (53%) had favourable mRS (0–3) at the time of discharge from the hospital.ConclusionRadial artery catheterisation is technically feasible for performing acute stroke interventions with favourable time to revascularisation and good overall clinical outcomes.

scholarly journals Meniscal Repair: Failure rate and clinical outcomes with minimum two years follow-up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0019
Author(s):  
Juan Pablo Zicaro ◽  
Carlos Yacuzzi ◽  
Nicolas Garrido ◽  
Ignacio Garcia-Mansilla ◽  
Matias Costa-Paz
Keyword(s):  
Clinical Outcomes ◽  
Failure Rate ◽  
Meniscal Repair ◽  
Posterior Horn ◽  
Return To Sports ◽  
Before And After ◽  
The Mean ◽  
Mean Time ◽  
Bucket Handle

Objectives The purpose of our study was to evaluate the clinical outcomes and failure rate of a series of patients who underwent meniscal repair with a minimum two-years of follow-up. Methods We retrospectively reviewed patients treated with meniscal repair between 2004 and 2016. We included patients with at least 2 years of follow-up. Surgical details such as the affected menisci, type of rupture and meniscal repair technique used were analyzed. Clinical and functional outcomes were evaluated using Lysholm and IKDC scores. Patients were studied with x-rays and magnetic resonance imaging (MRI). We analyzed the failure rate (defined as a re-rupture that required surgery). We compared failure rate for isolated meniscal repair vs associated with Anterior cruciate ligament reconstruction (ACLR). Also we compared patients operated before and after 2014. Results One hundred sixty nine patients were operated during that period of time. Ten patients did not meet inclusion criteria and forty were lost in follow-up. Out of the 119 patients evaluated, 35 had bucket-handle lesions, 25 tears in the posterior horn treated with all inside sutures and 59 body and posterior horn lesions treated with a combined suture technique. The mean postoperative Lysholm score was 85 (SD 14) and IKDC 70 (SD 10). The mean return to sports time was 8 months (range 2-19). An MRI was performed in 71 patients. The overall failure rate was 21% (24 /119) at a mean time of 20 months (range 2-60 months) and 26% (9/35) for bucket-handle lesions at a mean time of 21 months (range 2-60 months). Failure rate for the 48 isolated lesions was 20% at a mean of 23 months and 19% for 70 associated to ACLR at a mean of 17 months (p=0.53). Isolated bucket-handle lesions had failure rate of 27% at a mean of 27 months and when associated to ACLR this was 23% at a mean of 12 months (p=1.0) Overall failure rate for patients treated before 2014 was 27% (18/67) and 12% after 2014 (6/52) (p=0.03). For bucket-handle lesions before 2014 was 36% (8/23) and 8% after 2014 (1/12) (p=0.03). Isolated bucket-handle lesions failure rate was 45% (5/11) before 2014 and 0% (0/7) after 2014 (p=0.01) and when associated to ACLR, it was 25% (3/12) before 2014 and 20% (1/5) after 2014 (p=0.09). Conclusion Overall failure rate of our series was 21%. We found no differences between isolated lesions and associated to ACLR. There was a statistically significant difference regarding failure rate results for those operated before and after 2014. This might be the result of an improvement in the surgical devices, modifications in the technique and the number of sutures for each procedure.

Role of percutaneous cholecystostomy for acute acalculous cholecystitis: clinical outcomes of 271 patients

2017 ◽  
Vol 28 (4) ◽  
pp. 1449-1455 ◽  
Author(s):  
Seung Yeon Noh ◽  
Dong Il Gwon ◽  
Gi-Young Ko ◽  
Hyun-Ki Yoon ◽  
Kyu-Bo Sung
Keyword(s):  
Clinical Outcomes ◽  
Acalculous Cholecystitis ◽  
Acute Acalculous Cholecystitis ◽  
Percutaneous Cholecystostomy

scholarly journals Outcomes of Percutaneous Cholecystostomy

2012 ◽  
Vol 1 (1) ◽  
pp. 20-23
Author(s):  
Rahul J Anand ◽  
Laurie Punch ◽  
Amy C Sisley ◽  
Steven b Johnson ◽  
Matthew Lissauer
Keyword(s):  
Acute Cholecystitis ◽  
Retrospective Chart Review ◽  
Acalculous Cholecystitis ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Acute Calculous Cholecystitis ◽  
Open Operation ◽  
Biliary Pathology ◽  
Emergency Cholecystectomy ◽  
Calculous Cholecystitis

ABSTRACT Objective Emergency cholecystectomy in patients with severe comorbidities carries up to 30% mortality. Percutaneous cholecystostomy (PC) is accepted as acute management in these patients. This study evaluated outcomes of PC and the need for subsequent cholecystectomy. Methods Retrospective chart review evaluated all patients undergoing PC between June 1, 2005 and January 1, 2010. Results Fifty four patients underwent PC. Indications included acute calculous cholecystitis (44%), acalculous cholecystitis (33%) and other (22%). Twelve patients had PC related complications. Seventeen patients underwent CCY 144 ± 133 days after PC placement. 71% of those procedures were converted to open operation. 15% of patients had PC tube removed successfully without cholecystectomy, 62 ± 53 days after PC. Fifteen patients died in hospital after PC, four likely related to biliary pathology. Patients who underwent subsequent cholecystectomy were more likely to have had a diagnosis of acute cholecystitis (71% vs 33%, p < 0.05). Patients with a diagnosis of acalculous cholecystitis trended toward a higher likelihood of death compared to acute cholecystitis (8 of 18, 44% vs 4 of 24, 17%, p = 0.08). Conclusion PC can be definitive treatment in a minority of patients with acalculous cholecystitis and severe comorbidities. Interval cholecystectomy carries a high complication rate. How to cite this article Ferrada PA, Anand RJ, Punch L, Sisley AC, Johnson SB, Lissauer M . Outcomes of Percutaneous Cholecystostomy. Panam J Trauma Critical Care Emerg Surg 2012;1(1):20-23.

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