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Pérez-Montalbán M, García-Domínguez E, Oliva-Pascual-Vaca Á. Subdiaphragmatic phrenic nerve supply: A systematic review. Ann Anat 2024; 254:152269. [PMID: 38692333 DOI: 10.1016/j.aanat.2024.152269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve. MATERIALS AND METHODS A computerised systematic search of the Web of Science database was conducted. The key terms used were phrenic nerve, subdiaphragmat*, esophag*, liver, stomach, pancre*, duoden*, intestin*, bowel, gangli*, biliar*, Oddi, gallbladder, peritone*, spleen, splenic, hepat*, Glisson, falciform, coronary ligament, kidney, suprarenal, and adrenal. The 'cited-by' articles were also reviewed to ensure that all appropriate studies were included. RESULTS A total of one thousand three hundred and thirty articles were found, of which eighteen met the inclusion and exclusion criteria. The Quality Appraisal for Cadaveric Studies scale revealed substantial to excellent methodological quality of human studies, while a modified version of the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool denoted poor methodological quality of animal studies. According to human studies, phrenic supply has been demonstrated for the gastro-esophageal junction, stomach, celiac ganglia, liver and its coronary ligament, inferior vena cava, gallbladder and adrenal glands, with half of the human samples studied presenting phrenic nerve connections with any subdiaphragmatic structure. CONCLUSIONS This review provides the first systematic evidence of subdiaphragmatic phrenic nerve supply and connections. This is of interest to professionals who care for people suffering from neck and shoulder pain, as well as patients with peridiaphragmatic disorders or hiccups. However, there are controversies about the autonomic or sensory nature of this supply.
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Affiliation(s)
- María Pérez-Montalbán
- Universidad de Sevilla. Facultad de Enfermería, Fisioterapia y Podología, Departamento de Fisioterapia, Spain
| | | | - Ángel Oliva-Pascual-Vaca
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Spain; Escuela de Osteopatía de Madrid, Madrid, Spain.
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Transjugular versus Transfemoral Transcaval Liver Biopsy: A Single-Center Experience in 500 Cases. J Vasc Interv Radiol 2020; 31:1394-1400. [PMID: 32798119 DOI: 10.1016/j.jvir.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of transfemoral transcaval liver biopsies (TFTC) with that of transjugular liver biopsies (TJLB) at a single tertiary-care institution. MATERIALS AND METHODS A retrospective review was performed of 500 consecutive transvenous liver biopsies between December 2010 and December 2018. The cases included 286 TFTC patients at a median age of 54 years old (interquartile range [IQR], 42-63 years of age), 37.4% were female; and 214 TJLB patients at a median age of 55 years old (IQR, 46-61 years of age), 45.4% female. Patient demographic and laboratory data and technical and histopathological success, fluoroscopy times, and complications were recorded. Comparative statistical analyses were performed using a 2-sample test or a Wilcoxon ranked sum test for continuous variables and a chi-square test or Fisher exact test for categorical variables when appropriate. RESULTS TFTC and TJLB data are presented as: technical success rates of 99.3% (283 of 286) and 100% (214 of 214), respectively; histopathologic success rates of 96.5% (275 of 285) and 95.8% (205 of 214), respectively; and major complication rates of 1.4% (4 of 284) and 5.6% (12 of 214), respectively (P = .009). There were no hepatic injuries in the TFTC group, whereas the TJLB group included 6 significant hepatic injuries requiring intervention. Median fluoroscopic times were 5.5 minutes (IQR, 3.9-8.6 minutes) for TFTC and 8.1 minutes (IQR, 5.2-13.1) for TJLB (P < .001). CONCLUSIONS In this single-institution study, TFTC was associated with a lower major complication rate and lower fluoroscopy times than conventional TJLB with similar technical and histopathologic successes.
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Neuberger J, Patel J, Caldwell H, Davies S, Hebditch V, Hollywood C, Hubscher S, Karkhanis S, Lester W, Roslund N, West R, Wyatt JI, Heydtmann M. Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology. Gut 2020; 69:1382-1403. [PMID: 32467090 PMCID: PMC7398479 DOI: 10.1136/gutjnl-2020-321299] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
Liver biopsy is required when clinically important information about the diagnosis, prognosis or management of a patient cannot be obtained by safer means, or for research purposes. There are several approaches to liver biopsy but predominantly percutaneous or transvenous approaches are used. A wide choice of needles is available and the approach and type of needle used will depend on the clinical state of the patient and local expertise but, for non-lesional biopsies, a 16-gauge needle is recommended. Many patients with liver disease will have abnormal laboratory coagulation tests or receive anticoagulation or antiplatelet medication. A greater understanding of the changes in haemostasis in liver disease allows for a more rational, evidence-based approach to peri-biopsy management. Overall, liver biopsy is safe but there is a small morbidity and a very small mortality so patients must be fully counselled. The specimen must be of sufficient size for histopathological interpretation. Communication with the histopathologist, with access to relevant clinical information and the results of other investigations, is essential for the generation of a clinically useful report.
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Affiliation(s)
- James Neuberger
- Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jai Patel
- Department of Vascular Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen Caldwell
- Liver Unit, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Susan Davies
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Coral Hollywood
- Department of Gastroenterology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Stefan Hubscher
- Department of Pathology, University of Birmingham, Birmingham, UK
| | - Salil Karkhanis
- Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Judith I Wyatt
- Department of Pathology, St James University Hospital, Leeds, UK
| | - Mathis Heydtmann
- Department of Gastroenterology, Royal Alexandra Hospital, Glasgow, UK
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Oliva-Pascual-Vaca Á, González-González C, Oliva-Pascual-Vaca J, Piña-Pozo F, Ferragut-Garcías A, Fernández-Domínguez JC, Heredia-Rizo AM. Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review. Diagnostics (Basel) 2019; 9:diagnostics9040186. [PMID: 31726685 PMCID: PMC6963844 DOI: 10.3390/diagnostics9040186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/01/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.
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Affiliation(s)
- Ángel Oliva-Pascual-Vaca
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (Á.O.-P.-V.); (C.G.-G.); (A.M.H.-R.)
| | - Carlos González-González
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (Á.O.-P.-V.); (C.G.-G.); (A.M.H.-R.)
| | - Jesús Oliva-Pascual-Vaca
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (Á.O.-P.-V.); (C.G.-G.); (A.M.H.-R.)
- Escuela de Osteopatía de Madrid, 28002 Madrid, Spain
- Department of Physiotherapy, Universitary School of Osuna, University of Sevilla, 41640 Sevilla, Spain;
- Correspondence:
| | - Fernando Piña-Pozo
- Department of Physiotherapy, Universitary School of Osuna, University of Sevilla, 41640 Sevilla, Spain;
| | - Alejandro Ferragut-Garcías
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07112 Palma de Mallorca, Spain; (A.F.-G.); (J.C.F.-D.)
| | - Juan Carlos Fernández-Domínguez
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07112 Palma de Mallorca, Spain; (A.F.-G.); (J.C.F.-D.)
| | - Alberto Marcos Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; (Á.O.-P.-V.); (C.G.-G.); (A.M.H.-R.)
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Transfemoral Transcaval Core-Needle Liver Biopsy: An Alternative to Transjugular Liver Biopsy. J Vasc Interv Radiol 2015; 27:370-5. [PMID: 26723528 DOI: 10.1016/j.jvir.2015.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/03/2015] [Accepted: 11/07/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To describe the technique and outcome of transfemoral transcaval (TFTC) core-needle liver biopsies. MATERIALS AND METHODS Retrospective chart review was performed on 121 patients who underwent transvenous liver biopsies at a single institution between February 2014 and July 2015, yielding 66 total TFTC liver biopsies for review (65.2% male; mean age, 53.2 y ± 15.0). From August 2014 through July 2015, TFTC biopsies accounted for 64 of 77 (83%) transvenous biopsies. Hepatic tissue was obtained directly through the intrahepatic inferior vena cava from a femoral venous approach. Procedural complications were classified according to Society of Interventional Radiology guidelines. RESULTS Of the 66 biopsies, technical success was achieved in 64 cases (97.0%). Histopathologic diagnoses were made in 63 cases (95.5%). Fragmented or limited specimens in which a pathologic diagnosis was still made occurred in four cases (6.1%). Complications occurred in two cases (3.0%). Venous pressure measurements were requested in 60 cases, and all were successfully obtained. CONCLUSIONS TFTC core-needle liver biopsies are feasible and safe as demonstrated in this series of patients.
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Levien A, Weisse C, Donovan T, Berent A. Assessment of the efficacy and potential complications of transjugular liver biopsy in canine cadavers. J Vet Intern Med 2014; 28:338-45. [PMID: 24765677 PMCID: PMC4858024 DOI: 10.1111/jvim.12305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Transjugular liver biopsy (TJLB) is used in humans at risk of bleeding. There are no reports of its use in veterinary medicine. Objective To assess the efficacy and potential complications of TJLB in canine cadavers, and compare with samples obtained via needle liver biopsy (NLB) and surgical liver biopsy (SLB). Animals Twenty‐five medium and large breed canine cadavers. Methods Prospective study. TJLBs were procured through the right jugular vein. After biopsy, intravenous contrast and gross inspection were used to assess the biopsy site. Minor and major complications were recorded. NLBs and SLBs were then obtained. Histopathology was performed, and TJLB and NLB were compared for number of complete portal tracts (CPTs), length, and fragmentation. Pathologic process and autolysis were assessed in all samples. Results All TJLBs yielded liver tissue. The proportion of minor complications was 12/25 (48%), and major complications 16/25 (64%); 13/16 (81%) of the major complications were liver capsule perforation. In 21/25 (84%), the histopathology in the SLB was reflected in the TJLBs. For cases with minimal autolysis, median number of CPTs in TJLBs was 7.5, compared with 4 in NLBs (P = .018). Median length of TJLB specimen was 28 mm compared to 22 mm in NLBs (P = .007). Fragmentation rate was median of 1.25 for TJLB compared to 1.50 in NLBs (P = .11). Conclusions and Clinical Importance TJLB is technically feasible and achieves comparable results to NLB and SLB. The number of complications, in particular liver capsule perforation, was greater than expected. Further studies are indicated before clinical use is recommended.
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Affiliation(s)
- A.S. Levien
- Department of SurgeryThe Animal Medical CenterNew YorkNY
| | - C. Weisse
- Department of Interventional Radiology and Interventional EndoscopyThe Animal Medical CenterNew YorkNY
| | - T.A. Donovan
- Department of PathologyThe Animal Medical CenterNew YorkNY
| | - A.C. Berent
- Department of Interventional Radiology and Interventional EndoscopyThe Animal Medical CenterNew YorkNY
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Abstract
Liver biopsy is considered the gold standard for the evaluation of acute and chronic liver disorders. Transjugular liver biopsy (TJLB) was described by Dotter in 1964 and clinically performed for the first time by Hanafee in 1967. TJLB consists of obtaining liver tissue through a rigid cannula introduced into one of the hepatic veins, typically using jugular venous access. The quality of the TJLB specimens has improved so much that the samples obtained by this method are comparable with those obtained with the percutaneous technique. TJLB is indicated for patients with coagulopathy, ascites, peliosis hepatis, morbid obesity, liver transplant, or in patients undergoing a transjugular intrahepatic portosystemic shunt procedure. The technical success rate for a TJLB procedure ranges from 87 to 97%. Sample fragmentation has been reported in 14 to 25% of the TJLB samples. The complication rates are low and range between 1.3% and 6.5%. The purpose of this article is to provide a review of the fundamental aspects of the TJLB procedure, including technique, indications, contraindications, results, and complications.
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Affiliation(s)
- George Behrens
- Section of Interventional Radiology, Department of Radiology and Nuclear Medicine, RUSH University Medical Center, Chicago, Illinois
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Dönmez H, Kahriman G, Ozcan N, Mavili E, Deniz K. Transjugular liver biopsy: results of 97 patients. Balkan Med J 2012; 29:129-32. [PMID: 25206981 DOI: 10.5152/balkanmedj.2011.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 06/02/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and efficacy of transjugular liver biopsy in patients with contraindicated percutaneous biopsy. MATERIALS AND METHODS Between June 2005 and April 2010, 97 patients who were admitted for transjugular liver biopsy were enrolled in this retrospective study. All liver biopsies were obtained using an 18 gauge Quick-Core liver biopsy set through the right hepatic vein via the internal jugular vein. Clinical indication, histopathological diagnosis, and complications were noted. RESULTS Primary technical success was achieved in 93 (95.8%) patients. Hepatic veins could not be catheterized and opacified in two patients and in the remaining two patients the veins could be opacified and catheterized but we were not able to pass the biopsy needle into the hepatic vein because of the acute angle between the inferior vena cava and hepatic veins. At least two specimens were obtained from each patient. The most frequent histopathological diagnosis was cirrhosis. A subcutaneous hematoma around the puncture side was encountered in one patient. CONCLUSION Transjugular liver biopsy is a feasible and effective alternative in patients with contraindication for percutaneous biopsy.
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Affiliation(s)
- Halil Dönmez
- Department of Radiology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Güven Kahriman
- Department of Radiology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Nevzat Ozcan
- Department of Radiology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Ertuğrul Mavili
- Department of Radiology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
| | - Kemal Deniz
- Department of Pathology, Faculty of Medicine, Erciyes University, Gevher Nesibe Hospital, Kayseri, Turkey
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Keshava SN, Mammen T, Surendrababu N, Moses V. Transjugular liver biopsy: What to do and what not to do. Indian J Radiol Imaging 2011; 18:245-8. [PMID: 19774169 PMCID: PMC2747432 DOI: 10.4103/0971-3026.41839] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Shyamkumar N Keshava
- Department of Radiology, Christian Medical College, Vellore - 632 004, Tamil Nadu, India
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Bryk SG, Censullo ML, Wagner LK, Rossman LL, Cohen AM. Endovascular and interventional procedures in obese patients: a review of procedural technique modifications and radiation management. J Vasc Interv Radiol 2006; 17:27-33. [PMID: 16415130 DOI: 10.1097/01.rvi.0000186953.44651.19] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
As the prevalence of obesity in the United States continues to increase, the volume of endovascular and fluoroscopically guided procedures is also increasing. With obese patients, it often seems the only consideration is whether the table weight tolerance can accommodate the patient. This is a naive approach to performing procedures in obese patients, as there are multiple considerations involved in providing state-of-the-art endovascular and interventional care to obese patients. A growing collection of literature is beginning to surface regarding the appropriate modifications in the interventional care of these patients. This article reviews the relevant literature on this important subject.
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Affiliation(s)
- Scott G Bryk
- Department of Radiology, The University of Texas Health Science Center at Houston, 6431 Fannin, MSB2.100, Houston, Texas 77030, USA
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