CT-guided sacroiliac joint injection: Easy or difficult? : 53

Purpose: Fluoroscopy-guided sacroiliac joint (SIJ) injections are technically difficult to perform because of the complex anatomy with helicoidal conformation of the joint. Our study describes the procedure of CT-guided SIJ injection, its feasibility and its rate of success. Methods and materials: Retrospective study included 46 consecutive patients. The procedure was performed by 3 MSK radiologists and consisted in a puncture with a posterior approach in the inferior articular part of SIJ, then in an injection of iodinated contrast agent (1ml) with CT control of SIJ space opacification and finally in an injection of slowacting corticosteroid. The SIJ approach was noticed as correct if there was an inferior articular puncture and if the needle was in the articular space, and as impossible if there was ankylosis or osteophytosis. The study was divided in two successive periods: period 1 (4 first months) and period 2 (12 last months). Results: SIJ opacification was successful in 57% (26/46). We observed a learning curve: opacification was succeeded in 66% (23/35) and there was incorrect approach in 9% (3/35) during period 2 versus respectively 27% (3/11) and 45% (5/11) during period 1. Causes of failure were incorrect approach in 40% (6/20 too low, 2/20 too high), impossible approach in 30% (6/20) and unexplained in 30% (6/20). Mean duration of procedure was about 28 minutes. No complication occurred. Conclusion: CT guided SIJ injection is safe and successful in 66% after a training period. The success depends on SIJ correct approach and also on anatomical lesions.

Influence of operator experience on performance of ultrasound-guided percutaneous liver biopsy.

The purpose was to evaluate the influence of radiologist's experience on the diagnostic yield and complications of a percutaneous liver biopsy (PLB) method. Six hundred patients underwent an ultrasound-guided PLB by an inexperienced operator in 25.2% of cases (experience of less than 15 percutaneous liver biopsies performed alone--group I) or by an experienced operator (experience of more than 150 percutaneous liver biopsies--group II). The two groups were well-matched with respect to sex, age, percentage with viral hepatitis without histological cirrhosis, number of needle passes, history of liver biopsy and pain before the biopsy. A histological diagnosis was available in 97.3% of cases without any significant difference between the two groups ( P=0.25). However, group II samples were significantly longer and contained more portal tracts ( P=0.01). Pain was mild immediately and 6 h after the biopsy, without significant difference between both groups. Eight vasovagal reactions (five in group II) and one arteriobiliary fistula (in group II) occurred. With the method of PLB used for this study, operator's experience did not influence either the final histological diagnosis or the degree of pain suffered.

Mini invasive skeletal muscle biopsy technique with a tri-axial end cut needle.

OBJECTIVE: Skeletal Muscle Biopsy is a minor surgical procedure for the diagnosis of different neuromuscular pathological conditions and has recently gained popularity also in the research field of age-related muscular modifications and sarcopenia. Few studies focused on the application of mini-invasive muscular biopsy in both normal and pathological conditions. The aim of our study was to describe a mini invasive ultrasound-guided skeletal muscular biopsy technique in complete spinal cord injured (SCI) patients and healthy controls with a tri-axial end-cut needle. PATIENTS AND METHODS: Skeletal muscle biopsies were collected from 6 chronic SCI patients and 3 healthy controls vastus lateralis muscle with a tri-axial end cut needle (Biopince© - Angiotech). Muscle samples were stained for ATPase to determine fibers composition, moreover, gene expression of cyclooxygenase-1 (COX-1) and prostaglandin E2 receptor has been analyzed by Real Time RT-PCR. RESULTS: All the procedures were perfomed easily without failures and complications. Control tissue was macroscopically thicker than SCI one. Control specimen displayed an equal distribution of type I and type II fibers, while SCI sample displayed a prevalence of type II fibers SCI specimen displayed a significant reduction in COX-1 gene expression. This mini-invasive approach was easy, accurate and with low complication rate in performing skeletal muscle biopsy in both SCI patients and controls. CONCLUSIONS: This technique could be useful in conditions in which the overall quantity of specimen required is small like for molecular biology analysis. For histological diagnostic purposes and/or conditions in which the original tissue is already pathologically modified, this technique should be integrated with more invasive techniques.

Comparative study of two needle models in terms of deflection during inferior alveolar nerve block

Objectives: The purpose of this study is to determine the possible differences in deflection between two needles of same length and external gauge but with different internal gauges during truncal block of the inferior alveolar nerve. The initial working hypothesis was that greater deflection may be expected with larger internal gauge needles. Study design: Four clinicians subjected 346 patients to inferior alveolar nerve block and infiltrating anesthesia of the buccal nerve trajectory for the surgical or conventional extraction of the lower third molar. A nonautoaspirating syringe system with 2 types of needle was used: a standard 27-gauge x 35-mm needle with an internal gauge of 0.215 mm or an XL Monoprotect® 27-gauge x 35-mm needle with an internal gauge of 0.265 mm. The following information was systematically recorded for each patient: needle type, gender, anesthetic technique (direct or indirect truncal block) and the number of bone contacts during the procedure, the patient-extraction side, the practitioner performing the technique, and blood aspiration (either positive or negative). Results: 346 needles were used in total. 190 were standard needles (27-gauge x 35-mm needle with an internal gauge of 0.215 mm) and 156 were XL Monoprotect®. Incidence of deflection was observed in 49.1% of cases (170 needles) where 94 were standard needles and 76 XL Monoprotect®. Needle torsion ranged from 0º and 6º. Conclusions: No significant differences were recorded in terms of deflection and internal gauge, operator, patient-extraction side, the anesthetic technique involved and the number of bone contacts during the procedure

Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

Objective To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and Methods In the period from June 2011 to May 2012, seven computed tomography-guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results In all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible.

Minimally invasive approach of tubo-ovarian abscesses

PURPOSE: To evaluate the treatment outcome of tubo-ovarian abscesses managed by transvaginal ultrasound-guided aspiration.METHODS: Descriptive analysis of all patients with tubo-ovarian abscesses treated with a minimally invasive procedure, ultrasound-guided drainage, at the Department of Gynecology, Centro Hospitalar Vila Nova de Gaia/Espinho, during a period of 5 years (from June 2009 to June 2014).RESULTS:Twenty-six cases were included in the study. The mean age of the study group was 42.8 years. All patients were submitted to transvaginal ultrasound-guided aspiration and sclerosis with iodated solution, as well as received broad-spectrum intravenous antibiotics. The mean time from admission to drainage was 2.5 days. Cultures for aerobic and anaerobic pathogens were positive in 14 of the 26 cases. A complete response was noted in 23 of the 26 cases. No complications or morbidity were noted as a consequence of the drainage procedures.CONCLUSION: Minimally invasive treatment of tubo-ovarian abscesses by transvaginal ultrasound-guided drainage is an effective and safe approach.

Experimental model of intervertebral disc degeneration by needle puncture in Wistar rats

Animal models of intervertebral disc degeneration play an important role in clarifying the physiopathological mechanisms and testing novel therapeutic strategies. The objective of the present study is to describe a simple animal model of disc degeneration involving Wistar rats to be used for research studies. Disc degeneration was confirmed and classified by radiography, magnetic resonance and histological evaluation. Adult male Wistar rats were anesthetized and submitted to percutaneous disc puncture with a 20-gauge needle on levels 6-7 and 8-9 of the coccygeal vertebrae. The needle was inserted into the discs guided by fluoroscopy and its tip was positioned crossing the nucleus pulposus up to the contralateral annulus fibrosus, rotated 360° twice, and held for 30 s. To grade the severity of intervertebral disc degeneration, we measured the intervertebral disc height from radiographic images 7 and 30 days after the injury, and the signal intensity T2-weighted magnetic resonance imaging. Histological analysis was performed with hematoxylin-eosin and collagen fiber orientation using picrosirius red staining and polarized light microscopy. Imaging and histological score analyses revealed significant disc degeneration both 7 and 30 days after the lesion, without deaths or systemic complications. Interobserver histological evaluation showed significant agreement. There was a significant positive correlation between histological score and intervertebral disc height 7 and 30 days after the lesion. We conclude that the tail disc puncture method using Wistar rats is a simple, cost-effective and reproducible model for inducing disc degeneration.

Efectividad en la canalización yugular guiada por ecografía usando tres diferentes técnicas. Experimento en modelos simulados.

Introducción: El desarrollo tecnológico permite efectuar procedimientos eficientes en pacientes críticos de urgencias como canalizar vasos centrales guiados por ecografía. Éste procedimiento comparado con la técnica a ciegas ofrece ventajas como disminución de complicaciones, mejor éxito y menor tiempo de procedimiento. Hay diferentes técnicas de abordaje: transversal, longitudinal y oblicua, lo que supone diferencias en la efectividad y éxito en cada una de ellas. Materiales y métodos: Se realizó un experimento en modelos simulados con especialistas y residentes de último año de medicina de emergencias. Posterior a estandarizar los conceptos y abordajes de cada una de las técnicas, se puncionaron los modelos para determinar cuál técnica presenta mayor éxito y efectividad para canalización yugular con guía ecográfica. Resultados: El procedimiento fue efectivo en 175 réplicas (97.2%) distribuidas así: éxito 133 (73.9%), redirección 37 (20.6%) y requerimiento de segunda punción en 5 (2.8%). En la técnica transversal la efectividad fue 96.7% (n=58), en longitudinal del 100% (n=60) y en oblicua del 95.0% (n=57), (p=0.377). En residentes la efectividad fue 95.6% (n=86) y en especialistas 98.9% (n=89), (p=0.184). La distribución de éxito mostró que en los especialistas fue mayor en un 18.9% que en los residentes (p=0.004), por género los hombres tienen un éxito mayor en un 18.7% que las mujeres (p=0.009, OR=3.12, IC 95%: 1.30, 7.52). Discusión: No se encontró diferencia significativa en el uso de cualquier técnica, pero la tendencia favorece la técnica longitudinal, quien obtuvo mayor porcentaje de efectividad y éxito.

Relationship between follicle size and ultrasound-guided transvaginal oocyte recovery

We evaluated the relationship between follicle size and oocyte recovery (OR) using ultrasound-guided follicle aspiration. Thirty Holstein cows were subjected to OR without gonadotrophic therapy. Oocytes were recovered two to four times from each cow in a total of 67 aspiration sessions, Ovarian follicles with diameters less than or equal to4 mm and >4 mm were aspirated in separated groups. Recovered oocytes from each group were kept separate and submitted to in vitro maturation, fertilization, and culture to the blastocyst stage. A total of 430 follicles were aspirated, of which 154 (35.8%) were from follicles >4 mm and 276 (64.2%) were from follicles less than or equal to4 mm. Seventy-seven oocytes (50%) were recovered from follicles >4 mm and 200 (72.2%) were from follicles less than or equal to4 mm. Nineteen blastocysts were obtained from follicles >4 mm, whereas 45 blastocysts were obtained from follicles less than or equal to4 mm. Recovery rate was greater (P < 0.01) in follicles less than or equal to4 mm, Oocyte quality, cleavage rate and blastocyst development did not differ between different follicle sizes. Routine aspiration of small follicles (less than or equal to4 mm) could increase the number of oocytes available for in vitro development. (C) 2001 Elsevier B.V. B.V. All rights reserved.

Luteal Function and Follicular Growth Following Follicular Aspiration During the Peri-Luteolysis Period in Bos indicus and Crossbred Cattle

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Simulation-based ultrasound-guided central venous cannulation training program

PURPOSE: To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.METHODS: This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.RESULTS: It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.CONCLUSION: A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.

Aspectos da dinâmica, seleção e maturação folicular em éguas pônei

O presente trabalho envolveu três experimentos: Influência da imunização passiva contra estradiol (E2) e a aspiração do maior folículo (F1) no momento do desvio folicular esperado, sobre a ocorrência do desvio folicular observado. Também foi objetivo verificar o efeito desses tratamentos sobre o perfil de hormônio folículo estimulante (FSH), hormônio luteinizante (LH) e inibina total circulante. Para tanto, os animais foram imunizados com dose única de soro anti-E2 (G anti-E2) ou o F1 foi aspirado no momento do desvio esperado (GAF1). O plasma sangüíneo foi obtido no período pré e póstratamento. O intervalo entre o dia da aplicação do soro (desvio esperado) e o dia da detecção do desvio foi em média o mesmo para o G anti-E2 e controle. No GAF1, a eliminação do maior folículo provocou atraso no momento da detecção do desvio folicular entre o segundo (F2) e o terceiro (F3) maior folículo, comparado ao controle. Em ambos os tratamentos o perfil de FSH, LH e inibina total foi similar ao controle. O experimento 2 tratou de um projeto piloto visando dominar a técnica de colheita de fluido dos grandes folículos ovarianos por meio de punção com agulha fina e o efeito desse procedimento sobre o folículo e às concentrações hormonais. Foram utilizados dois grupos de animais, G1 o folículo foi mantido intacto (controle) e G2 foi utilizada uma punção folicular quando o maior folículo atingiu diâmetro ~35 mm. Ultrasonografia ovariana foi realizada desde o ínicio da detecção de um folículo ~25mm, seguindo até a detecção da ovulação. O terceiro experimento objetivou verificar a influência de gonadotrofina coriônica humana (hCG) em folículos de 30 ou 35mm sobre as concentrações de hormônios esteróides e fatores intrafoliculares. A colheita do fluido folicular foi realizada imediatamente antes e 30 horas após a aplicação... (Resumo completo, clicar acesso eletrônico abaixo)

Contribution in the diagnosis of ultrasonography perinephric pseudocyst uriniferous in a feline - case report

The renal pseudocysts are accumulations of fluid unilateral or bilateral perirenal location, contained in a capsule without epithelium, a characteristic that distinguishes them from true renal cysts. The capsule itself may have originated in the renal capsule or a localized inflammatory reaction. The nature of the fluid can vary, but the presence of ooze found the most common, but they are also called pseudocysts accumulations of urine, blood and lymph. The most frequently observed clinical sign is abdominal distention. However these nonspecific signs may be related to chronic kidney disease and azotemia that may develop before or after the formation of this lesion. The abdominal ultrasound is less invasive and allows you to diagnose this change more easily, also allowing the collection of fluid guided percutaneous and submit it to cytological, biochemical and bacteriological in order to obtain information about its nature. This paper aims to describe a case of perinephric pseudocyst in a cat uriniferous, highlighting the contribution ultrasound as a diagnostic method complementary quick and noninvasive, allowing evaluation of the architecture of the renal parenchyma, differentiation of cortex and spinal cord as well as detect changes in size and shape of it, aiming for better planning in clinical surgery.

Bloqueio pericoal guiado por ultrassom: ensaio clínico randonizado

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)