Percutaneous catheter biliary decompression

Percutaneous catheter biliary decompression was performed in 42 patients with obstructive jaundice. Internal drainage was accomplished in 27 patients (64.3%), and external drainage in 15 patients (35.7%). Serum bilirubin levels decreased at a mean rate of 1.4 mg/dl/day. Tissue diagnosis was obtained by percutaneous aspiration biopsy in nine patients (21.4%). Complications occurred in 10 patients (23.8%): septic shock, two; bilious pleural effusion, one; hepatic subcapsular hematoma, one; sepsis, six. There was one death related to the procedure. The catheter management problems encountered included pain, catheter dislodgement or migration, lumen occlusion, and external bile leakage.     

经皮激光椎间盘减压术治疗颈椎椎间盘突出症

目的 探讨经皮激光椎间盘减压术在治疗颈椎椎间盘突出症的应用.方法 应用SLT30半导体激光治疗仪,在C型臂X线机引导下,选择颈部前外侧经气管、食管与颈动脉鞘之间入路,用穿刺针插入椎间隙中心,然后插入光导纤维,激光输出能量为500～1 000 J.结果 共治疗32例患者,有效率为87.5%,无一例出现感染及其他严重并发症.结论 经皮激光椎间盘减压术具有创伤小、痛苦少、安全性高、恢复快等特点,是治疗颈椎椎间盘突出症的有效方法之一.     

Percutaneous cecostomy for decompression of the massively distended cecum

Massive dilatation of the cecum developed in an elderly man following admission for an acute episode of upper gastrointestinal hemorrhage complicated by myocardial infarction, ventricular fibrillation, and pulmonary edema. A diagnosis of pseudo-obstruction was made. After an unsuccessful attempt at colonoscopy, percutaneous cecostomy was performed under computed tomographic guidance, using trocar technique. The cecal distention resolved and did not recur. Percutaneous cecostomy is an alternative to colonoscopy and to surgical cecostomy in the treatment of massive cecal distention.     

Percutaneous laser disc decompression for lumbar discogenic radicular pain

PurposeThe aim of our study was to directly evaluate the effectiveness of percutaneous laser disc decompression (PLDD) for treatment of lumbar discogenic radicular pain.Materials and methodsFrom June 2006 through July 2009, 205 patients with contained disc herniation demonstrated on computed tomography (CT) or magnetic resonance, concordance between the radicular pain and the nerve root compressed by the herniated disc, neurological findings referring to a single nerve root and no improvement after conservative therapy for a minimum of six weeks were enrolled. All patients were treated with PLDD under CT guidance and local anaesthesia. Follow-up was scheduled at 1, 2 days, 3, 6 months. Subsequent follow-ups at 12, 24 and 36 months were carried out through visits or by telephone. Clinical outcome was quantified using the MacNab criteria.ResultsThe age of patients ranged from 27 to 78 years (mean 58 ± 11 years). The levels of involvement were 18 cases at L3-L4, 123 cases at L4-L5 and 64 cases at L5-S1. Using the MacNab criteria, the results were as follows: 67% (n = 137) showed a good outcome and 9% (n = 18) a fair outcome. There were no serious complications in our series.ConclusionPLDD is effective treatment for lumbar discogenic radicular pain, associated with only minimal discomfort to the patient. This minimally invasive technique is a valid alternative for those patients not responding to conservative medical treatment, allowing in many cases to obviate the need of spine surgery.     

经皮内镜下责任节段减压治疗多节段腰椎退变疾病的效果

 目的 探讨多节段腰椎退变疾病的责任节段判定及经皮内镜减压的治疗效果。方法 回顾性分析2015-01至2018-12解放军总医院第三医学中心骨三科及北京电力医院骨二科诊疗的53例多节段腰椎退变疾病患者。术前先采用症状、体征和影像学分析相结合的方法来明确责任节段,若无法通过此法明确责任节段,则采用选择神经根封闭明确责任节段,然后将所有明确责任节段的患者采用经皮内镜下责任节段减压治疗。详细记录每例手术的时间、并发症发生情况、术中出血量,使用疼痛视觉模拟评分(VAS)评定手术前后的腰腿痛变化情况,改良MacNab标准评定疗效,Oswestry功能障碍指数(ODI)评价腰椎功能。结果 21例可通过症状、体征和影像学分析以确定责任节段。32例行选择神经根封闭,其中,2例未明确责任节段,未纳入研究,其余30例明确了责任节段,其准确性在减压手术中也得到了证实。所有确定责任节段的51例均顺利完成了经皮内镜下责任节段减压治疗术,手术平均时间为76.8(58~150)min,未出现神经根损伤、感染及局部血肿、硬膜囊破裂、术后椎体失稳。所有患者都定期随访,随访平均时间为18.3(12~47)个月。与手术前相比,术后7 d、3、6和12个月时的VAS评分和ODI评分均明显降低,差异有统计学意义(P<0.01)。改良Macnab标准疗效评价:优21例,良23例,可5例,差2例,优良率为86.3%。结论 选择性神经根封闭对腰椎多节段退变患者的责任节段判定简单可靠。内镜下责任节段减压治疗多节段腰椎退变疾患安全可行,创伤小,效果佳。     

The radiologic evaluation of gross cecal distension: emphasis on cecal ileus

A retrospective review of plain abdominal radiographs in 46 patients with gross cecal distension (greater than 10 cm) was performed. In 25 (54%) of 46 patients, the cecum was dilated out of proportion to the rest of the colon and was rotated anteromedially. The term cecal ileus is used to describe this situation. Five (20%) of 25 patients with cecal ileus developed perforation. Four of these patients died as a result of the perforation. The risk of perforation was related more to duration of cecal distension than to absolute cecal size. Aggressive decompressive measures, including consideration of cecostomy, appear warranted in patients with gross cecal distension, especially when it is dilated out of proportion to the rest of the colon and has persisted for several days.     

MDCT of acute cecal conditions

The cecum comprises a relatively short segment of the gastrointestinal tract, but it can be affected by numerous acute conditions. Acute conditions may arise from processes primary to the cecum, such as volvulus, bascule, neoplasm, and trauma. Alternatively, acute conditions can be due to secondary to systemic or nearby pathology, such as infection, inflammatory processes, ischemia, and infarction. While it is common to suspect appendicitis as the etiology of acute right lower quadrant abdominal pain, the cecum should also be considered as a potential cause of pain, especially in the setting of an abnormal or absent appendix. Multi-detector computed tomography (MDCT) has evolved to become the best imaging modality to evaluate patients presenting with right lower quadrant abdominal pain or suspected acute cecal pathology. Strengths of MDCT include rapid acquisition of images, high spatial resolution, and ability to create multi-planar reconstructed images. In this pictorial review, we illustrate and describe key MDCT findings for various acute cecal conditions with which the emergency radiologist should be familiar.     

Percutaneous decompression of the bowel with a small-caliber needle: a method to facilitate percutaneous abdominal access

OBJECTIVE: In our pediatric interventional practice, we have found that occasionally a loop of bowel is interposed between the stomach and the anterior wall of the abdomen, preventing safe needle access for procedures such as placement of a gastrostomy tube. The use of a small-caliber needle to aspirate air from the colon or small bowel, for bowel decompression, may be a safe way to aid in establishing a safe access route for the subsequent percutaneous introduction of larger needles or tubes. CONCLUSION: Our retrospective review of patients who have undergone bowel-gas aspiration during an interventional procedure shows that the aspiration of air from the colon with a small-caliber needle is technically easy and may permit completion of an abdominal procedure.