Soft-Tip Stylet and Saline Instillation Technique: Making Difficult Percutaneous CT-Guided Biopsies Possible

Finding a safe needle path during percutaneous computed tomography-guided biopsy is sometimes difficult due to concern for injuring a vital structure. Saline instillation technique has been used to displace the structure out of the way. Another useful tool is a soft-tip stylet. A soft-tip also referred as blunt-tip stylet for the introducer cannula is provided with some coaxial biopsy sets in additional to standard sharp-tip stylet. While the sharp-tip stylet is fitted with introducer cannula for piercing skin, muscle, and fascia, a soft-tip stylet may be used for avoiding injury to structures like vessels and bowel loops especially while advancing introducer cannula through fatty tissue. Additionally, it is also useful for avoiding injury to nerves and giving pleural anesthesia. Although its use has been described in medical literature, many radiologists are still not utilizing this tool to its full potential. In this educational exhibit, various applications of soft-tip stylet and saline instillation technique have been depicted using representative cases.

Post Laparoscopy Pain Reduction Project I (POLYPREP I): Intraperitoneal Normal Saline Instillation—A Randomised Controlled Trial

Objectives: To evaluate the effect of intraperitoneal normal saline instillation (INSI) of 15 mL/kg body weight at the end of a gynaecological laparoscopic procedure on postoperative pain. Design: Randomised controlled trial. Setting: Teaching/University Hospital in Kuala Lumpur, Malaysia. Participants: Patients aged 18-55 years, with American Society of Anaesthesiologists (ASA) classification I–II, scheduled for an elective gynaecological laparoscopic procedure for a benign cause.Intervention: The patients were randomly allocated to two groups. In the intervention group, 15 mL/kg body weight of normal saline was instilled intraperitoneally, while the control group received the conventional combination of open laparoscopic trocar valves with gentle abdominal pressure to remove the retained carbon dioxide. Main outcome measures: The primary outcomes were the mean pain score for the shoulder and upper abdominal pain at 24 h, 48 h, and 72 h postoperatively. Results: A total of 68 women completed the study, including 34 women in each group. There was no difference in the shoulder pain score at 24 h, 48 h, and 72 h postoperatively. However, a significant improvement in the upper abdominal pain score after 42 h (95% confidence interval (CI) 0.34-1.52, p=0.019) and 72 h (95% CI 0.19-0.26, p=0.007) postoperatively were observed. Conclusions: INSI of 15 mL/kg body weight does not lower postoperative shoulder pain compared to no fluid instillation. A modest pain score improvement was observed in the upper abdominal area at 42 h and 72 h after surgery. An INSI of up to 30 mL/kg body weight may be required to eliminate shoulder pain. Care must be taken before administering a higher amount of INSI, considering the potential risk of peritoneal adhesions. Clinical Registration: ISRCTN Identifier: 87898051 (Date: 26 June 2019) https://doi.org/10.1186/ISRCTN87898051

TO COMPARE THE EFFECTIVENESS OF EXTRA-AMNIOTIC SALINE INSTILLATION THROUGH FOLEY CATHETER PRIOR TO ORAL MISOPROSTOL WITH ORAL MISOPROSTOL ALONE IN INDUCING LABOUR IN PREGNANCIES >28 WEEKS WITH INTRAUTERINE FOETAL DEATH- A RANDOMIZED CONTROLLED TRIAL AT TE

Background: The present study aims to compare the results of EASI followed by oral misoprostol and oral misoprostol alone for induction of labour in pregnancies of more than 28 weeks with intrauterine foetal death. Methods: The present observational and prospective study is an attempt to compare the efficacy of extra-amniotic saline instillation with Foley catheter prior to oral misoprostol and oral misoprostol alone in induction of labour of pregnancies more than 28 weeks with intrauterine fetal death. Results: Most of the cases delivered vaginally in both study groups. The mean induction delivery time in group I was higher than group II and the results were statistically significant on comparing both groups. In group I, 78% cases were delivered within 24 hours whereas in group II 96% cases delivered within 24 hours of induction. There was no significant difference in the mean number of required misoprostol in both groups (p>0.05). Need of supplementation with oxytocin was more in group I as compared to group II and the p value is significant (p<0.01). Mean birth weight in group I was 2.25±0.75 kg and in group II was 2.27±0.77 kg. Maximum number of babies had birth weight between 1.52-2.50 kg with 44% in group I and 40% in group II (p>0.05). Only 4 cases had uterine tachysystole and only 1case had postpartum pyrexia. Very few complications were recorded in both the study groups (p>0.05). Conclusion: We concluded that oral misoprostol tablet alone is more effective at inducing and setting up the active labour in pregnancies of >28 weeks with intrauterine foetal death than EASI followed by oral misoprostol. It is inexpensive, has a long shelf life, can be easily stored at room temperature and patient remains ambulatory after induction with oral misoprostol. Oral misoprostol alone seems to have an edge over extra-amniotic saline instillation followed by oral misoprostol in all aspects. Keywords: Misoprostol, Extra-amniotic saline, Induction of labour.

Comparison of saline instillation sonography with trans vaginal sonography in abnormal uterine bleeding: a prospective study

Background: Abnormal vaginal bleeding may be caused by an extensive spectrum of disorders, both gynecologic and non-gynecologic. Diagnostic accuracy of abnormal uterine bleeding is important for the management. Trans vaginal sonography (TVS) is one of the commonest investigation used for the diagnosis, but the diagnosis is not always accurate for all clinical conditions. Saline instillation sonography (SIS) has been shown to improve the diagnosis. Authors aimed to compare the TVS and SIS diagnosis with the final histopathological diagnosis.Methods: Seventy-five patients with the complained of abnormal uterine bleeding attending outpatient department of a tertiary care institute were enrolled for the study. Trans vaginal sonography (TVS) and saline instillation sonography (SIS) was done on outpatient basis. The diagnosis was compared with final histopathological diagnosis, in term of diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value.Results: Seventy-five patients who were enrolled for the study. Sixty-four patients underwent surgery and final histopathological diagnosis was established. Four patients SIS was not possible, data was analysed for sixty patients.Conclusions: In SIS abnormal uterus diagnosis confidence was significantly improved (p value 0.001) when compared to TVS. The diagnosis of submucous myoma significantly improved (p=0.015) by SIS when compared to TVS. There was no significant difference between TVS and SIS diagnosis of Myoma remote from the endometrium (p=0.522), Adenomyosis (p=1), Focal endometrial abnormality (p=0.654) and Diffuse endometrial abnormality (p=1). The SIS sensitivity, specificity, PPV and NPV were either improved or same, when compare to TVS for all the diagnosis except for the diagnosis of focal endometrial abnormality.