Optimal Techniques for EUS-Guided Fine-Needle Aspiration of Pancreatic Solid Masses at Facilities without On-Site Cytopathology: Results from Two Prospective Randomised Trials

Background: EUS-guided fine-needle aspiration (EUS-FNA) has emerged as the primary modality for the cytologic diagnosis of pancreatic solid masses. The aim of this study is to determine whether technical factors including suction (S), non-suction (NS), capillary sampling with stylet slow-pull (CSSS), and the number of needle actuations (to-and-fro needle movements) may affect the accuracy of EUS-FNA for pancreatic solid masses at facilities without on-site cytopathology. Methods: The diagnostic yield of malignancy, blood contamination and cellularity at each sample acquired from EUS-FNA with or without S and different numbers of actuation (10, 15 and 20) were measured (study I). The optimal actuation number was determined and a head-to-head comparison trial between S and CSSS was performed (study II). Results: In study I, significant blood contamination was seen using S with 20 compared with 15 actuations (p = 0.002). Diagnostic yield of malignancy was not significantly different between 10, 15, and 20 actuations with S, whereas it was statistically higher for 15 actuations compared with 10 actuations with NS (p = 0.001). In study II, no difference was noted in diagnostic yield with 15 actuations between S and CSSS (88% vs. 90%, p = 0.74). Conclusions: Increasing actuation in NS resulted in a better diagnostic yield for EUS-FNA without significant blood contamination, whereas increasing actuation in S did not change the diagnostic yield of EUS-FNA while causing significant blood contamination. With 15 actuations, the diagnostic yield was comparable between S and CSSS.

Ophthalmic Segment Aneurysms: Surgical Treatment and Outcomes

Background Surgical treatment of ophthalmic segment aneurysms (OSAs) remain challenging because of complex anatomy surrounding the aneurysm and entails extensive drilling of anterior clinoid process to define proximal neck of the aneurysm and carotid exposure in the neck for proximal control. Materials and Methods Authors present a retrospective analysis of 36 aneurysms in 35 patients with OSAs operated surgically by first author. Surgical clipping was done for the aneurysms as primary modality of treatment along with wrapping and trapping as required. Results Commonest age group was 40 to 60 years with female preponderance of 3:1. Maximum (23) patients presented with subarachnoid hemorrhage (WFNS Gr 1), followed by asymptomatic patients (six). There were 18 small, 14 large, and four giant aneurysms, 15 dorsal wall, 17 ventral wall, three proximal posterior wall, and one blister aneurysm. Good outcome, as measured by Glasgow Outcome Score (GOS) was achieved in 29 patients. Conclusion OSAs are technically demanding aneurysms, but with due diligence to surgical principles, good outcomes may be obtained.

Dual pigtail intervention in acute necrotising pancreatitis

Acute pancreatitis has multiple aetiologies. Acute pancreatitis is divided into interstitial oedematous pancreatitis or necrotizing pancre­atitis based on morphology. According to the revised Atlanta classification necrotizing pancreatitis is further sub­divided into acute necrotic collec­tion if the disease develops within 4 weeks or walled-off necrosis if the disease develops after 4 weeks.We report a case of 40years male, with acute pancreatitis for 1 month, presenting with decreased appetite, loss of weight, and tremors of extremities. CT featured active necrotizing pancreatitis with peripancreatic necrosis, collections, and superadded infection which was drained by percutaneous pigtail catheter.Percutaneous pigtail insertion controls the symptoms and this procedure is effective in the management of patients with necrotizing pancreatitis. It serves as definitive or intermediate therapy to surgical necrosectomy in patients who are unfit for surgery. Percutaneous pigtail insertion can be done following a peritoneal or retroperitoneal approach, both approaches have different advantages and it is the choice of the radiologist and the location of the residual collections. The disadvantages are duct leak and it needs multiple check CT’s but in well trained and experienced hands the disadvantages are minimized. Percutaneous pigtail insertion is an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery. It can prevent life-threatening complications and it can be considered as a primary modality in treating a patient with walled-off necrosis.Percutaneous pigtail insertion an alternative approach in the management of necrotizing pancreatitis when the patient is seriously ill or unfit for surgery can be considered as the primary modality of choice in treating patients with walled-off necrosis of the pancreas.

Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment

Purpose: To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. Methods: This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): <28 (n = 7), 28–30 (n = 11), >30 (n = 10). BW (in grams): <1000 (n = 8), 1000–1200 (n = 10), >1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32–34 (n = 18), >34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. Results: The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were <28 weeks of GA (one eye) and 28–30 weeks (two eyes). One baby (one eye) was <1000 gm and the other (two eyes) was >1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). Conclusion: In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones.

The Role of HRCT chest in COVID-19 Pneumonia

COVID-19 pneumonia is a recently identified lung infection, the hazardous factor of this pneumonia is pandemic dissemination of infection by corona virus. Due to its high mortality and morbidity it has become a threat to the human life. As pneumonia is the commonest manifestation chest x-ray becomes the primary modality of investigation however many symptomatic patients do not have a positive chest X-ray findings hence, HRCT is used as primary modality for both screening as well as a diagnosing COVID-19 pneumonia. It has been observed that in many situations RT-PCR test are negative or inconclusive but the HRCT in such cases is useful and conclusive. Aim of the article is to highlight the role of HRCT in diagnosing COVID-19 pneumonia and providing proper guidance to the Clinicians for assessing the response and therapeutic purpose for covid19 pneumonia. recently, HRCT score have also been used to provide the clinicians an idea about the Prognosis of this disease progress.

Treatment of Nonthrombotic Iliac Vein Lesions

Nonthrombotic iliac vein lesions (NIVLs) most frequently result from extrinsic compression of various segments of the common or external iliac vein. Patients develop symptoms associated with chronic venous insufficiency (CVI); female patients may develop symptoms of pelvic venous disease. Given that iliac vein compression can be clinically silent, a thorough history and physical examination is mandatory to exclude other causes of a patient's symptoms. Venous duplex ultrasound, insufficiency examinations, and axial imaging are most commonly used to assess for the presence of a NIVL. Catheter venography and intravascular ultrasound (IVUS) are the mainstay for invasive assessment of NIVLs and planning prior to stent placement. IVUS in particular has become the primary modality by which NIVLs are evaluated; recent evidence has clarified the lesion threshold for stent placement, which is indicated in patients with moderate to severe symptoms. In appropriately selected patients, stent placement results in improved pain, swelling, quality of life, and, when present, healing of venous stasis ulcers. Stent patency is well preserved in the majority of cases, with a low incidence of clinically driven need for reintervention. In this article, we will discuss the clinical features, workup, endovascular management, and treatment outcomes of NIVL.

Pelatihan Proteksi dan Keselamatan Radiasi Sebagai Dasar Penguatan Kompetensi Bagi Pekerja Radiasi di RSUD KRMT Wongsonegoro Semarang

Radiology installation is one of the supporting elements in a hospital whose primary function is to establish a diagnosis. Following its function, there are modalities of both ionizing and non-ionizing radiation. Understanding a primary modality that uses ionizing radiation is necessary to create patient safety. Several other health workers participate in carrying out a radiology modality using both ionizing and non-ionizing aircraft modalities. Relates to the use of radiology equipment in other installations, for example, urological surgery installations held by urological surgeons, orthopedic surgeons in central surgical facilities, neurosurgeons specializing in the use of surgical support C arms, heart and vascular specialists. Blood in the catheterization laboratory installation, as well as the supporting nurses in each of these rooms. Understanding radiation and the basics of protection to ensure the safety and security of radiation protection or radiation hazards that the use of these modalities may cause. Keywords: modality, radiation hazard

Open versus laparoscopic cholecystectomy: a comparative study on patient parameters

Background: The advent of laparoscopic surgeries have heralded a giant leap for minimally invasive surgeries and are now being used as a primary modality due to its various benefits. The use of laparoscopic surgeries has been limited only by patient related factors and in certain scenarios by lack of infrastructure availability. The present study aimed to provide a comparative review of the traditional and minimally invasive modalities.Methods: The study employed a comparative prospective randomized study model with 100 subjects divided in two groups based on modality employed. The operative and post-operative parameters were noted and presented.Results: The study displayed that the advent of post-operative complications as well as hospital stay duration was higher in traditional laparoscopic cholecystectomy cases.Conclusions: The study reiterated the long known fact that laparoscopic surgeries in gall stones is favorable from the patient perspective but is riddled with unavailability due to financial and infrastructure based concerns.

Anticoagulation in COVID-19: current concepts and controversies

Rising incidence of thromboembolism secondary to COVID-19 has become a global concern, with several surveys reporting increased mortality rates. Thrombogenic potential of the SARS-CoV-2 virus has been hypothesised to originate from its ability to produce an exaggerated inflammatory response leading to endothelial dysfunction. Anticoagulants have remained the primary modality of treatment of thromboembolism for decades. However, there is no universal consensus regarding the timing, dosage and duration of anticoagulation in COVID-19 as well as need for postdischarge prophylaxis. This article seeks to review the present guidelines and recommendations as well as the ongoing trials on use of anticoagulants in COVID-19, identify discrepancies between all these, and provide a comprehensive strategy regarding usage of these drugs in the current pandemic.