[Takotsubo syndrome post percutaneous puncture of liver cyst: a case report].
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Takotsubo综合征（TTS）又称为应激性心肌病，常继发于严重的情绪或躯体（创伤、重症疾病等）应激。该文报道1例继发于肝囊肿穿刺术后的TTS患者，提示常规医疗操作后甚至无明确诱因情况下出现突发胸痛、气喘、晕厥的患者，在排除急性冠状动脉综合征等常见病因后需结合心电图、心肌酶学、超声心动图和造影等排除TTS可能。.To assess the feasibility of percutaneous microwave ablation in the treatment of diffuse adenomyosis.With a mean age of 39.2 years old, 16 patients with symptomatic adenomyosis underwent percutaneous microwave ablation (PMA). The symptoms included severe dysmenorrheal and anemia. The definite diagnosis was made by magnetic resonance (MR) imaging. Two microwave therapeutic antennas were inserted into the myometrium with adenomyosis. The microwave emission was seized when the ablated zone was over half of the total lesion. The complications, side effects and early therapeutic effects were observed during the period of treatment and at 3 and 6 months post-treatment.The average ablation duration was 700 s. The average ablated area was 72% (range: 60% - 80%). None of the patients developed complications during and after ablation. Fifteen patients had normal menstrual onset during the month of receiving ablation and one case at Day 30. The amount of menstrual bleeding was less than that before treatment. Dysmenorrhea disappeared after treatment in 13 cases, relieved markedly in 2 and no improvement in 1. The endometrial ectopic growth was not observed after treatment.The early clinical efficacy of PMA under ultrasound guidance is definite in the treatment of adenomyosis. The symptoms may be eliminated or effectively relieved after treatment. Easy to perform, minimal invasive and safe, the procedure of PMA is an effective therapeutic modality for adenomyosis with the preservation of uterus.
Adenomyosis
Microwave ablation
Therapeutic effect
Endometrial ablation
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Aneurysmal Bone Cyst
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While each of the available femoral arterial sealing devices claims equivalent safety to manual compression following invasive cardiac procedures, these claims are based on small, underpowered studies. Our aim was to increase the ability to detect a clinically meaningful difference by performing a meta-analysis.We identified studies via Medline and manual searches and selected studies that were prospective, randomized clinical trials for inclusion. Pooling of data was performed by calculation of the Mantel-Haenszel odds ratio (OR) and the variance of the OR was estimated using the method of Robins, Greenland and Breslow.Sixteen studies enrolling 5,048 patients were included in the analysis. The pooled OR was 0.89 (95% confidence interval, 0.86-0.91), indicating a significant decrease in risk by devices. Excluding hematomas from the endpoint resulted in a concordant result. Angio-Seal was associated with a significant reduction in risk (OR, 0.51) and Perclose had a neutral result (OR, 1.0), whereas Vasoseal had an increased risk of complications (OR, 1.18).Overall, sealing devices may be associated with a reduction in risk of complications following invasive coronary procedures, but significant differences may exist among individual devices. These potential differences need to be explored in randomized, controlled clinical trials.
Vascular closure device
Cardiac catheterization
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In spite of recent progress, treatment for liver echinococcal cysts is still far from satisfying. In recent years, percutaneous drainage has been increasingly used for this purpose and it has been shown to be an effective alternative to surgery and chemotherapy alone. This technique is known as PAIR, from Puncture, Aspiration, Injection (of a scolecidal agent), Reaspiration: here we present our experience and the state of the art of PAIR. Patients from Italy and Turkana (Kenya), harbouring 233 Gharbi type I, II and III echinococcal cysts were successfully treated with PAIR: it was performed according to protocols established at the Division of Infectious and Tropical Diseases, IRCCS--Policlinico S. Matteo, University of Pavia. In Italy, one relapse was recorded, four years after the procedure; the patient was treated again with PAIR; no cases of anaphylactic shock or peritoneal dissemination were observed in a follow-up of 10 years; only 10 minor complications (biliary fistula, urticarioid reaction, abscessualization of the cyst, anaphylactoid reactions) were reported. Long-term results indicate that in Gharbi type I, II and III echinococcal cysts, and in developing countries, in particular, PAIR is a first choice method for the treatment of abdominal localizations of this disease.
Anaphylactic shock
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Appropriateness criteria
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Report the successful treatment of iatrogenic pseudoaneurysm of the brachial artery with the percutaneous ultrasonographically guided thrombin injection (PUGTI).The pseudoaneurysm was caused by an accidental puncture into a native brachial artery instead of the venous side of an arteriovenous fistula during hemodialysis. The aneurysmal sac had a large size with a short neck, vulnerable to intra-arterial thrombosis and distal artery embolization during the thrombin glue injection.This procedure was secured by using color duplex ultrasonography (CDU) for the accurate positioning of the needle and the assessment of the optimal dosage of the injected bovine thrombin. After the procedure, an elastic compression was applied at the injection site to prevent the reentry of blood flow into the aneurysmal sac. The flow in the aneurysmal sac completely disappeared in seven days after the treatment. The 4-month follow-up demonstrated the complete resolution of the aneurysmal sac.Percutaneous injection of bovine thrombin under ultrasound guidance is possible as one of the minimal invasive procedures to treat the pseudoaneurysm of the extremity artery.
Pseudoaneurysm
Brachial artery
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From September 1987 through May 1988, 86 patients (62 men and 24 women) underwent percutaneous laser-assisted balloon angioplasty, and 2 patients (1 man and 1 woman) underwent laser-assisted balloon angioplasty via cutdowns, in our free-standing catheterization laboratory. The patients' ages ranged from 36 to 81 years. One hundred limbs were treated; each had at least 1 total occlusion, and many had multiple significant occlusions (greater than 50%). Vascular access was attained via the common femoral artery in 62 limbs, via the popliteal artery in 34 limbs, and via a posterior tibial artery cutdown in 4 limbs. In all, 232 lesions were treated either by percutaneous laser-assisted balloon angioplasty (172 lesions) or by balloon angioplasty alone (60 lesions). Technical success was defined as "recanalization and dilation of the occluded arterial segment, resulting in a recognizable improvement in pulse that persisted until hospital discharge." The technical success/attempt ratios for the 172 laser-assisted treatments were as follows: iliac artery, 11/17 (64.7%); common femoral artery, 8/9 (88.9%); superficial femoral artery, 62/80 (77.5%); popliteal artery, 25/30 (83.3%); peroneal artery, 14/16 (87.5%); anterior tibial artery, 6/7 (85.7%); and posterior tibial artery, 9/13 (69.2%). Technical failure occurred in 25 limbs. Failure was not related to sex, age, approach artery, or diabetes, but it was related to the indication of impending limb loss (p < 0.01), previous vascular surgery (p < 0.01), amputation (p < 0.01), and lesion length of 20 cm or greater. Clinical success was defined as "clinical improvement in symptoms, with persistence of an improved pulse at follow-up." Recurrence was observed in 10 limbs. Recurrence was not related to sex, age, approach artery, diabetes, or lesion length, but it was related to the indication of impending limb loss (p < 0.05); to the fact that the patient was a cigarette smoker at the time of the procedure (p < 0.02); and (inversely) to the number of tibial vessels that remained patent post-intervention. Five patients required emergency surgery after laser-assisted angioplasty, but no limb amputation has been necessary. Minor complications included perforation (16 cases), hematoma formation (6 cases), dissection (3 cases), hemorrhage (1 case), hives (1 case), and fracture of the laser probe (1 case). We conclude that percutaneous laser-assisted balloon angioplasty can be safely accomplished in a free-standing laboratory and that the procedure is reasonably successful in patients with totally occluded lower-extremity arteries.
Posterior tibial artery
Popliteal artery
Anterior tibial artery
Peroneal Artery
Balloon dilation
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Uncomplicated bilateral percutaneous subclavian venous sampling for parathormone estimation was performed preoperatively in 10 patients with primary hyperparathyroidism. In 7 cases there was correlation of the higher parathormone level with the side of the parathyroid tumour subsequently found at operation. In conjunction with the "Tibblin strategy of unilateral parathyroidectomy" (1) a dual approach is suggested that may provide a simple, accurate method of treating patients with hyperparathyroidism.
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Urinary incontinence is one of the most frequent diseases in female urology. There are hundreds of therapeutic opportunities without sure outcomes, because of lack of the etiologic cause. Transurethral injection has good results in around of the 60% of the cases with minimal invasivity, good patients compliance, ripetitivity of the method. From 1993 to 1997 we treated 44 ladies with urinary incontinence due to low pressure of closure of the sphincter: 13 patients (29.55%) disease free, 17 (38.64%) meliorate.
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A prospective study of percutaneous laser assisted thermal angioplasty for superficial femoral and proximal popliteal artery occlusions was performed on 93 consecutive patients with a mean length of occluded segment of 7.6 cm. Technical success was achieved in 78 patients (84%). Subsequent patency or occlusion has been confirmed by duplex ultrasound scanning or arteriography. The crude patency rate for successfully recanalised vessels was 48% during a mean follow-up period of 18 months. Subsequent femoropopliteal bypass or amputation was required in 20% of these patients. Factors predictive of reocclusion were a length of occluded segment greater than 8 cm (p = 0.05) and less than two patent vessels below the knee (p = 0.005).
Popliteal artery
Superficial femoral artery
Duplex scanning
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