Percutaneous retrieval of a large peripherally inserted central catheter remnant from the pulmonary arteries.
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To describe a novel indication for a method through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screwsfixation in the treatment of lumbar tuberculosis (TB) in an elderly patient, and its clinical efficacy and feasibility. Lumbar TB is a destructive form of TB. Antituberculous treatment should be started as early as possible. In some circumstances, however, surgical debridement with or without stabilization of the spine appears to be beneficial and may be recommended. Surgeries through the approach of anterior or posterior are still challenging and often involve some complications.The case is a 68-year-old female who was misdiagnosed as simple vertebral compression fracture and underwent L1 and L2 percutaneous vertebroplasty in another hospital 7 years ago. He complained of lumbosacral pain for 1 month this time. Magnetic resonance imaging (MRI) and computed tomography (CT) showed intervertebral space in L1/2 was seriously damaged like TB.Lumbar tuberculosis INTERVENTIONS:: Antitubercular drugs, mini-invasive debridement with XLIF in combination with percutaneous pedicle screwsfixation was performed. This patient was followed up for 12 months.No obvious complication occurred during the operation and the wound healed well. Oswestry Disability Index (ODI: 56 vs 22) and visual analog scale (VAS: 4 vs 0) score significantly decreased atfinal follow-up of 12 months. Obvious recovery of kyphosis angle was found postoperatively (post: 14.8° vs pre: 33.5°). No recurrent infection occurred at the last follow-up.Mini-invasive surgery by debridement through XLIF and percutaneous pedicle screwsfixation may be an effective and innovative treatment method for lumbar TB in the elderly.
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Interquartile range
Single Center
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Debridement (dental)
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Objective:To compare the therapeutic effectiveness of catheter drainage and needle aspiration in percutaneous treat- ment of liver abscesses.Methods:Thirty-three patients underwent catheter drainage and eighty seven patients underwent needle aspiration,patients were followed up to assess the outcome of the percutaneous treatment,including time for fever to subside, time for leucocytosis to become normalized,length of hospitalization,and complications.All patients were treated with intrave- nous antibiotics simultaneously.Results:Needle aspiration was as effective and safe as catheter drainage in treatment of liver abscess.Conclusion:This study suggests that catheter drainage and needle aspiration have same therapeutic effectiveness in treatment of liver abscess.
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The authors percutaneously placed 45 catheters for peritoneal dialysis in 32 patients, aged 31-83 years, in a radiology department. In all patients, the procedure was modified by use of the Hawkins needle, and in response to the high frequency of extrusion of the proximal cuff, the deep cuff of the 16th and each subsequent catheter was sutured to the rectus muscle or fascia. After 17 catheters were placed, the catheter was modified with a permanent bend, or "U" neck, between the two cuffs, which were then thickened. All procedures were performed with use of local anesthesia, and all catheters were successfully placed. Acute complications included bowel perforation associated with peritonitis in one patient (2%). Delayed complications included cuff extrusion in nine patients (20%), obstruction in nine patients (20%), and peritonitis requiring removal of the catheter in three patients (7%). This study shows the feasibility of percutaneous placement of peritoneal dialysis catheters by radiologists despite the need for improved technique and equipment.
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Dialysis catheter
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We present an analysis of 48 patients with pyogenic liver abscess (PLA) that were treated according to a protocol between 1975 and 1993. In this period, 35 patients with PLA were treated by surgical drainage (SD). The indication for surgical treatment of the abscess were patients in septic conditions, underlying intra-abdominal surgical disease and the failure/contraindication of other therapeutic methods. Thirty-one patients were submitted to surgical treatment as the initial procedure and four patients unsuccessfully treated by percutaneous drainage, underwent SD.The surgical approach was indicated in patients with severe disease and presented 91.5% of good results, and a mortality rate of 8.5%.These results suggest that surgical treatment is a good alternative as a first step not only for the treatment of the primary cause of the abscess but also in septic patients with severe disease where a delay in adequate drainage, frequent in percutaneous management, can lead to high morbidity and mortality rates.
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pyogenic liver abscess
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Objective
To discuss the feasibility, the advantages and disadvantages, the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis.
Methods
All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed. There are 11 male and female cases separately, with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months. Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases. The data of these patients were complete, and all patients had been followed up for more than 36 months. The clinical and radiographic results were recorded and analyzed.
Results
In this group, 22 patients were followed-up for 41.9±2.5 months(36-48 months). The spinal kyphosis was not improved 3 months after surgery (t=0.3546, P=0.7029), but the amount of blood loss (30.5±7.9 ml) was less in the operation, the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short. No recurrence and no internal fixation failure was found after long term follow-up. Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5%) except one. The neuralgia was relieved, and the spinal cord injury was recovered to ASIA E. The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation, and patients’ life quality in the early period after operation was excellent. The incidence of complications was low (9.0%) , and the patients were satisfied with the treatment process.
Conclusion
It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation, which could be a powerful supplement to other therapeutic measures, and is worthy of further research and development.
Key words:
Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Endoscopy; Spinal fusion
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Debridement (dental)
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Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.
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Open surgery
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