Computed tomography-guided catheter drainage with urokinase and ozone in management of empyema

AIM To retrospectively compare the outcomes of catheter drainage,urokinase and ozone in management of empyema.METHODS Retrospective study included 209 patients(111 males and 98 females; age range 19 to 72 years) who were diagnosed with empyema.The patients were divided into 3 groups based on the therapy instituted: catheter drainage only(group I); catheter drainage and urokinase(group II); catheter drainage,urokinase and ozone(group III).Drainage was considered successful if empyema was resolved with closure of cavity,clinical symptoms were resolved,and need for any further surgical procedure was avoided.Success rate,length of stay(LOS),need for further surgery and hospital costs were compared between the three groups using the Kruskall-Wallis nonparametric test,with P < 0.05 considered significant.RESULTS Of the 209 patients with empyema,all catheters were placed successfully under CT guidance.Sixty-three patients were treated with catheters alone(group I),64 with catheters and urokinase(group II),and 82 with catheters,urokinase and ozone(group III).Group I,group II and group III had success rates of 62%,83% and 95% respectively(P < 0.05).Group I and groupII had statistically longer LOS(P < 0.05) and higher hospital costs(P < 0.05) compared to group III.There were statistically significant differences between the three groups when comparing patients who converted into further surgery.CONCLUSION The combination of chest tube drainage,urokinase and ozone is a safe and effective therapeutic modality in thoracic empyema.

Computed tomography-guided radiofrequency ablation of the retained iodized oil after simultaneous combination with transarterial embolization in small recurrent or residual hepatocellular carcinoma

Objective:To assess the clinical efficacy and safety of transarterial embolization(TAE)in simultaneous combination with computed tomography(CT)-guided radiofrequency ablation(RFA)for recurrent or residual hepatocellular carcinoma(HCC),and to determine the risk factors influencing local tumor progression following this procedure.Methods:One hundred eighteen patients with recurrent or residual HCC(tumor size,10–30 mm)underwent RFA.During the 19-month follow-up,59 patients received RFA only(RFA group),and the remaining 59 received RFA immediately after TAE(TAE+RFA group).All patients were followed up to observe the short-term therapeutic effects and complications.The cumulative local tumor progression rates in both groups were calculated using unpaired Student’s t tests and the Kaplan-Meier method.Results:The rate of major complications was 5.08%in the TAE+RFA group and 3.39%in the RFA group.The overall response rate was 96.61%in the TAE+RFA group and 79.66%in the RFA group(P=0.008).The disease control rate was significantly higher in the TAE+RFA group than in the RFA group(94.92%vs.79.66%,P=0.024).The median time to local tumor progression was 4.8 months in the RFA group and 9.6 months in the TAE+RFA group.The cumulative local tumor progression rate at 1 year was 10.60%in the RFA group and 23.60%in the TAE+RFA group(P=0.016).Conclusion:TAE in simultaneous combination with CT-guided RFA was effective and safe against recurrent or residual HCC.Local tumor progression can be minimized by the complete ablation of targeted iodized oil deposits after simultaneous TAE.

Computed Tomography-Guided Virtual Stereotactic Puncture and Catheter Drainage for a Brainstem Pontine Hemorrhage: A Case Report

Background: Patients with severe hypertensive brainstem hemorrhages have poor prognoses if they only receive conservative medical management. In contrast, aggressive operative interventions may decrease the morbidity and mortality in such patients. These operative treatments include craniotomy for evacuation of the hematoma, stereotactic positioning, and neuronavigational-guided hemorrhage puncture and drainage. Here, we report a novel and relatively simple procedure to achieve satisfactory outcomes in a patient with a brainstem pontine hemorrhage. Case Presentation: A 53-year-old man who was diagnosed with brainstem pontine hemorrhage. On hospital day 6, he underwent CT-guided, virtual stereotactic puncture and catheter drainage of this brainstem pontine hemorrhage. Medical treatments were continued after this procedure. On postoperative day 16 (hospital day 22), the patient was discharged from the hospital, awake and able to answer questions appropriately. Muscle strengths were grades V and IV for the left and right extremities, respectively. The patient was continued with active rehabilitation and achieved a Barthel index of 85 points at one month after the percutaneous drainage procedure. Conclusion: CT-guided, virtual stereotactic percutaneous transcranial puncture and catheter drainage for brainstem pontine hemorrhages has obvious potential advantages and offers a possible alternative to achieve the best outcomes with minimal operative trauma compared to open microcraniotomy.

Experimental Computed Tomography-guided Vena Cava Puncture in Pigs for Percutaneous Brachytherapy of Middle Mediastinal Lymph Node Metastases

Background： Percutaneous brachytherapy is a valuable method for the treatment of lung cancer and mediastinal lymph nodes metastasis. However, in some of the metastatic lymph nodes in the middle mediastinum, the percutaneous approach cannot be used safely due to possible damage to surrounding anatomical structures. We established an animal model （group of 12 pigs） to assess the safety and feasibility of computed tomography （CT）-guided vena cava puncture. Methods： Under CT guidance, an 18G needle was used to puncture the anterior wall of the anterior vena cava （AVC） in 12 pigs. The 18G needle was chosen as it is similar in size to the needles employed for clinical application in brachytherapy. The incidence of complications and vital signs was monitored during the procedure. Thoracotomy was performed to remove AVC specimens, which were analyzed for histological evidence of vessel wall damage and repair. Results： Following postoperative enhanced CT, two animals were found to have a small pneumothorax （one being hemopneumothorax）. The intraoperative oxygen saturation of both animals was not significantly decreased and was maintained at 93-100%. No animals developed mediastinal hematoma. Preoperative, intraoperative, and postoperative changes in blood pressure, heart rate, hemoglobin, and blood oxygen saturation were not significant. Histological evaluation of AVC specimens showed that by 7 days following the procedure, the endothelial layer was smooth with notable scar repair in the muscularis layer. Conclusions： CT performed after the procedure and histological preparations confirmed the safety of the procedure. This indicates that percutaneous brachytherapy for metastatic middle mediastinal lymph nodes can be carried out via the superior vena cava.

Successful steroid treatment for acute fibrinous and organizing pneumonia: A case report

BACKGROUND Since the acute fibrinous and organizing pneumonia(AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no standard therapy for this disease and the treatment methods remain controversial. Both steroid and immunosuppressive agents, such as cyclophosphamide or mycophenolate mofetil, have been reported to be effective in some studies, but with many side effects, especially in patients of advanced age. CASE SUMMARY We herein report an 81-year-old female patient who was admitted to our hospital due to dry cough, and breathlessness for 1 mo. She was treated with broadspectrum antibiotics and anti-fungal therapy, but without improvement in both symptoms and radiological findings, and her respiratory status worsened, and she required bed rest almost the whole day. Computed tomography-guided percutaneous needle lung biopsy was performed and histopathology examination confirmed the diagnosis of AFOP. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications. CONCLUSION We conclude that complete remission of AFOP can be achieved by steroid monotherapy in patients of advanced age.

Treatment of portal vein tumor thrombus using ^(125)Iodine seed implantation brachytherapy

We reported two cases of liver metastasis with portal vein tumor thrombus that developed after liver transplantation for hepato cellular carcinoma (HCC). Both the patients were women aged 43 and 55 years, who had liver metastasis and portal vein tumor thrombus formation after liver transplantations for HCC.

Fatal left atrial air embolism as a complication of percutaneous transthoracic lung biopsy:A case report

BACKGROUND Computed tomography(CT)-guided percutaneous lung biopsy is a common protocol in the context of diagnostic thoracic oncology,but entails a risk of complications including systematic air embolism(SAE).While SAE is often well tolerated,it can be difficult to treat and may result in rapid mortality in some cases.CASE SUMMARY We report a rare case of left atrial SAE in a 71-year-old woman who underwent a CT-guided lung biopsy of a pulmonary nodule in the posterior basal segment of the right lower lobe.Shortly following needle extraction,she experienced a mild cough,hemoptysis,rapid-onset unconsciousness,and cardiopulmonary arrest.Cardiopulmonary resuscitation was immediately performed,but the patient died 40 min after the procedure.A closer review of collected CT scans revealed the presence of a large volume of air within the left atrium.CONCLUSION Although SAE is generally well tolerated and asymptomatic,interventional radiologists must be aware of the risk of fatal outcomes and establish appropriate emergency management protocols.In this report,the characteristics,mechanisms,and treatment recommendations associated with SAE are discussed in an effort to improve the survival of affected patients.

Solitary splenic tuberculosis:A case report

BACKGROUND Solitary splenic tuberculosis(TB) is unusual and rarely reported.Whether splenic TB is best treated surgically is still controversial.We describe a 73-year-old man with solitary splenic TB and no extrapulmonary TB.CASE SUMMARY We report the case of a 73-year-old man with solitary splenic TB who complained of emaciation and fatigue.Abdominal computed tomography(CT) images suggested a splenic space-occupying lesion.We then performed a CT-guided splenic biopsy.The postoperative pathological examination revealed splenic TB.The patient took quadruple anti-TB medication.After 1 year,the patient recovered his normal weight and had no feeling of fatigue,and the splenic lesion had shrunk significantly.CONCLUSION If patients receive combined,appropriate,regular,full-time anti-TB treatment,solitary splenic TB may be cured.

Pulmonary benign metastasizing leiomyoma: A case report and review of the literature

BACKGROUND Pulmonary benign metastatic leiomyoma(PBML),which is very rare,is a type of benign metastatic leiomyoma(BML).Here,we report a case of PBML,finally diagnosed through multidisciplinary team(MDT)discussions,and provide a literature review of the disease.CASE SUMMARY A 55-year old asymptomatic woman was found to have bilateral multiple lung nodules on a chest high-resolution computed tomography(HRCT)scan.Her medical history included total hysterectomy for uterine leiomyoma.The patient was diagnosed with PBML,on the basis of her clinical history,imaging manifestations,and computed tomography(CT)-guided percutaneous lung puncture biopsy,via MDT discussions.As the patient was asymptomatic,she received long-term monitoring without treatment.A follow-up of chest HRCT after 6 mo showed that the PBML lung nodules were stable and there was no progression.CONCLUSION For patients with a medical history of hysterectomy and uterine leiomyoma with lung nodules on chest CT,PBML should be considered during diagnosis based on the clinical history,imaging manifestations,CT-guided percutaneous lung puncture biopsy,and MDT discussions.

Ciliated hepatic foregut cyst with high intra-cystic carbohydrate antigen 19-9 level

A ciliated hepatic foregut cyst (CHFC) is a rare foregut developmental malformation usually diagnosed in adulthood. Five percent of reported cases of CHFC transform into squamous cell carcinoma. We report the presentation, evaluation, and surgical management of a symptomatic 45-year-old male found to have a 6.2 cm CHFC. Contrast tomography-guided fine-needle aspiration demonstrated columnar, ciliated epithelium consistent with the histologic diagnosis of CHFC. The intracystic levels of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) were extremely high (978118 U/mL and 973 &#x003bc;g/L, respectively). Histologically, the wall of the cyst showed characteristic pseudopapillae lined with a ciliated stratified columnar epithelium, underlying smooth muscle, an outer fibrous layer and no atypia. Immunohistochemistry for CA19-9 and CEA was positive. This is the first case report of a CHFC in which levels of CA 19-9 and CEA were measured. Our findings suggest that a large sized multilocular cyst and elevated cyst CA19-9 and CEA levels do not exclude a CHFC from consideration in the diagnosis. CHFCs should be included in the differential diagnosis of hepatic lesions. Accurate diagnosis of a CHFC is necessary given its potential for malignant transformation, and surgical excision is recommended.

Brachytherapy in cancer cervix: Time to move ahead from point A?

Brachytherapy forms an integral part of the radiation therapy in cancer cervix. The dose prescription for intracavitary brachytherapy(ICBT) in cancer cervix is based on Tod and Meredith's point A and has been in practice since 1938. This was proposed at a time when accessibility to imaging technology and dose computation facilities was limited. The concept has been in practice worldwide for more than half a century and has been the fulcrum of all ICBT treatments, strategies and outcome measures. The method is simple and can be adapted by all centres practicing ICBT in cancer cervix. However, with the widespread availability of imaging techniques, clinical use of different dose-rates, availability of a host of applicators fabricated with image compatible materials, radiobiological implications of dose equivalence and its impact on tumour and organs at risk; more and more weight is being laid down on individualised image based brachytherapy. Thus, computed tomography, magnetic-resonance imaging and even positron emission computerized tomographyalong with brachytherapy treatment planning system are being increasingly adopted with promising outcomes. The present article reviews the evolution of dose prescription concepts in ICBT in cancer cervix and brings forward the need for image based brachytherapy to evaluate clinical outcomes. As is evident, a gradual transition from "point" based brachytherapy to "profile" based image guided brachytherapy is gaining widespread acceptance for dose prescription, reporting and outcome evaluation in the clinical practice of ICBT in cancer cervix.