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Queiroz VNF, Falsarella PM, Chaves RCDF, Takaoka F, Socolowski LR, Garcia RG. Risk of pulmonary aspiration during semaglutide use and anesthesia in a fasting patient: a case report with tomographic evidence. Einstein (Sao Paulo) 2023; 21:eRC0628. [PMID: 38126547 DOI: 10.31744/einstein_journal/2023rc0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety.
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Affiliation(s)
| | | | | | - Flávio Takaoka
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Valle LGM, Cunha MJS, Schmid BP, Falsarella PM, de Rezende MB, Felga GEG, Ogawa RE, Garcia RG, Affonso BB, Nasser F, Galastri FL. Radiological characteristics of hepatocellular carcinoma that achieved complete response after chemoembolization with drug-eluting beads for liver transplantation planning. Einstein (Sao Paulo) 2023; 21:eAO0307. [PMID: 37909650 PMCID: PMC10586851 DOI: 10.31744/einstein_journal/2023ao0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/22/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. METHODS This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. RESULTS Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. CONCLUSION HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation.
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Affiliation(s)
| | - Marcela Juliano Silva Cunha
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Bruno Pagnin Schmid
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Priscila Mina Falsarella
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Bruno de Rezende
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Renata Emy Ogawa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rodrigo Gobbo Garcia
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Breno Boueri Affonso
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Felipe Nasser
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Francisco Leonardo Galastri
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Junior AR, Volpi EM, Schmid BP, Falsarella PM, Garcia RG. The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules. Diagn Interv Radiol 2023; 29:628-631. [PMID: 36994971 PMCID: PMC10679636 DOI: 10.4274/dir.2022.221467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 01/15/2023]
Abstract
Diving thyroid nodules are a limitation of radiofrequency ablation because the mediastinal component cannot be adequately identified by ultrasound (US). We aim to describe a new technique, the iceberg technique, to overcome this issue and explain our three-year experience of using this novel method. The iceberg technique consists of a two-stage treatment. First, the ablation of the cervical portion of the nodules (easily visualized during the initial US exam) using trans-isthmic access is performed using the moving-shot technique. After three to six months, there is a volumetric reduction of the treated portion, leading to retraction of the thyroid parenchyma. This brings the mediastinal component to the cervical region, thereby enabling a perfect visualization by US. Then, the second stage of treatment is carried out with complete nodule ablation, and the region that was treated first is looked at a second time. From April 2018 to April 2021, nine patients with nine benign nodules were submitted for the iceberg technique. No complications occurred during the entire follow-up period. The patients displayed normal hormonal levels after the procedures, and there was a significant volume reduction of the nodules until three months post-ablation. The iceberg technique is an effective and safe option for the radiofrequency treatment of diving goiters.
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Affiliation(s)
- Antônio Rahal Junior
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Gilberto GM, Falsarella PM, Socolowski LR, Costa AM, Perin ACDS, Garcia RG. Alternative materials for antegrade implantation of a double-J catheter in a public health system. Einstein (Sao Paulo) 2023; 21:eCE0437. [PMID: 37132666 PMCID: PMC10124583 DOI: 10.31744/einstein_journal/2023ce0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Guilherme Moratti Gilberto
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Priscila Mina Falsarella
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Luis Ricardo Socolowski
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Arthur Munhoz Costa
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Arthur Cesar de Souza Perin
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Schmid BP, Silva Cunha MJ, Moreira Valle LG, Galastri FL, Affonso BB, Falsarella PM, Kaliks Guendelmann RA, Garcia RG, Nasser F. Transarterial Selective Internal Radiation Therapy with Yttrium-90 for Liver Metastatic Urothelial Carcinoma of the Ureter as a Bridging Therapy to Immunotherapy: A Case Report with a 10-Year Follow-Up. Case Rep Oncol 2023; 16:711-717. [PMID: 37933309 PMCID: PMC10625822 DOI: 10.1159/000531787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/16/2023] [Indexed: 11/08/2023] Open
Abstract
Primary transitional cell carcinoma of the ureter is a rare type of cancer with metastasis presented in approximately 25% at diagnosis. Due to its rarity and poor prognosis, the management of this neoplasm is still controversial, and the development of new therapies is of uttermost importance. Herein, we describe a case of a 54-year-old patient diagnosed with transitional cell carcinoma of the left ureter submitted to left nephroureterectomy (pT3N2M0) and methotrexate, vinblastine, doxorubicin, and cisplatin adjuvant chemotherapy. A single liver metastasis was detected and combination chemotherapy with gemcitabine and carboplatin was initiated along with stereotactic body radiation therapy. Despite these 2 previous chemotherapy regimens, the patient presented disease progression and transarterial selective internal radiation therapy (SIRT) with yttrium-90 was indicated. This locoregional treatment was performed with the administration of 1.2 GBq yttrium-90 resin microspheres (SIR-Spheres®, Sirtex Medical Limited, Sydney, NSW, Australia) into the right hepatic artery. Another systemic treatment was immunotherapy using nivolumab with excellent tolerability. After 10 years of follow-up, at the last clinical evaluation, the patient had no clinical symptoms and the last imaging follow-up using positron emission tomography-computed tomography scan showed complete response. This report introduces upper urinary tract urothelial carcinoma as a distinct type of malignancy in which SIRT can be safely implemented. As a transition method to nivolumab, it was successful. There might be a potential therapeutic synergism between these 2 treatment modalities.
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Affiliation(s)
- Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Gilberto GM, Falsarella PM, Rocha E, Terra RM, Jacomelli M, Garcia RG. New endobronchial ultrasound (EBUS) techniques. einstein (São Paulo) 2022; 20:eCE0159. [PMID: 36102409 PMCID: PMC9469870 DOI: 10.31744/einstein_journal/2022ce0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/22/2022] [Indexed: 12/04/2022] Open
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Souza KPD, Gilberto GM, Mariotti GC, Falsarella PM, Galastri FL, Korkes F, Garcia RG. Transafferent nodal embolization for lymphocele treatment: case report. einstein (São Paulo) 2022; 20:eRC6889. [PMID: 35976354 PMCID: PMC9377309 DOI: 10.31744/einstein_journal/2022rc6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/02/2021] [Indexed: 11/05/2022] Open
Abstract
Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.
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Gilberto GM, Falsarella PM, Andrade JRD, Schmid BP, Mariotti GC, Terra RM, Campos JRMD, Succi JE, Garcia RG. Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review. Einstein (São Paulo) 2022; 20:eAO6665. [PMID: 35476085 PMCID: PMC9000983 DOI: 10.31744/einstein_journal/2022ao6665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.
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Souza KPD, Falsarella PM, Nasser F, Garcia RG, Hidal JT. Spontaneous renal artery dissection: angioplasty with stent implantation in one-year follow-up. Einstein (São Paulo) 2022; 20:eRC6570. [DOI: 10.31744/einstein_journal/2022rc6570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 11/05/2022] Open
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Falsarella PM, Rahal A, Dórea AA, Muniz FJ, Francisco MJ, Garcia RG, Queiroz MRGD. Omental lipoma in pediatric age group: clinical presentation, image findings and management. Einstein (São Paulo) 2022; 20:eRC5584. [PMID: 35170708 PMCID: PMC8827355 DOI: 10.31744/einstein_journal/2022rc5584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/19/2020] [Indexed: 11/09/2022] Open
Abstract
A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.
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Moratti Gilberto G, Mina Falsarella P, Batalha Megale A, Socolowski LR, Gobbo Garcia R. Pressurized hydrodissection for CT-guided percutaneous peritoneal navigation: The hydro jet technique. Eur J Radiol 2021; 145:110042. [PMID: 34801877 DOI: 10.1016/j.ejrad.2021.110042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this paper is to evaluate the effectiveness of a new technique of hydrodissection for peritoneal structures displacement during preoperative localization markers placement. We retrospectively reviewed two cases of percutaneous fiducial marker placement prior rescue retroperitoneal lymphadenectomy. In both cases pressurized 5% dextrose in water (D5W) was used to hydrodissect the peritoneal space and securely reach the lymph nodes. Two patients were submitted to water jet technique for transperitoneal trespassing to reach the retroperitoneum. The volume of fluid used to navigate was 125-200 mL and the mean time to cross the peritoneum was 6 min 47 s (ranging from 3″26' to 10″24'). In conclusion, Bowel and small vessels displacement using pressurized D5W is a safe method to reach retroperitoneal space during percutaneous procedures.
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Affiliation(s)
- Guilherme Moratti Gilberto
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-000, Brazil
| | - Priscila Mina Falsarella
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-000, Brazil.
| | - Adalberto Batalha Megale
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-000, Brazil
| | - Luis Ricardo Socolowski
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-000, Brazil
| | - Rodrigo Gobbo Garcia
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo 05652-000, Brazil.
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Mendes GF, Falsarella PM, Garcia RG, Sanches LG, Baroni RH. Evaluation of the blood-oxygen-level-dependent (BOLD) sequence with 3 Tesla device in renal transplant patients in the assessment of early allograft disfunction, correlated with biopsy. Einstein (Sao Paulo) 2021; 19:eAO6069. [PMID: 34431851 PMCID: PMC8362909 DOI: 10.31744/einstein_journal/2021ao6069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/26/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the ability of blood-oxygen-level-dependent (BOLD) magnetic resonance imaging at 3 Tesla to measure tissue oxygen bioavailability based on R2* values, and to differentiate between acute tubular necrosis and acute rejection compared to renal biopsy (gold standard). METHODS A prospective, single-center study, with patients submitted to renal transplantation between 2013 and 2014, who developed graft dysfunction less than 4 weeks after transplantation. All patients were submitted to abdominal magnetic resonance imaging at 3 Tesla using the same protocol, followed by two BOLD sequences and kidney biopsy. RESULTS Twelve male (68.75%) and three female (31.25%) patients were included. A total of 19 percutaneous renal biopsies were performed (four patients required a second biopsy due to changes in clinical findings). Pathological findings revealed ten cases of acute tubular necrosis, four cases of acute rejection, and five cases with other (miscellaneous) diagnoses. Comparison between the four groups of interest failed to reveal significant differences (p=0.177) in cortical R2* values, whereas medullary R2* values differed significantly (p=0.033), with lower values in the miscellaneous diagnoses and the acute tubular necrosis group. CONCLUSION BOLD magnetic resonance imaging at 3 Tesla is a feasible technique that uses indirect tissue oxygen level measurements to differentiate between acute rejection and acute tubular necrosis in renal grafts.
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Garcia RG, Katz M, Falsarella PM, Malheiros DT, Fukumoto H, Lemos GC, Teich V, Salvalaggio PR. Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis. Cardiovasc Intervent Radiol 2021; 44:892-900. [PMID: 33388867 DOI: 10.1007/s00270-020-02732-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications. MATERIALS AND METHODS Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien-Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data. RESULTS Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%, p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists-ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA. CONCLUSION PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.
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Affiliation(s)
- Rodrigo Gobbo Garcia
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4o andar - Bloco A1, São Paulo, SP, 05652-900, Brazil
| | - Priscila Mina Falsarella
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil.
| | - Daniel Tavares Malheiros
- Value Management Office, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8º andar- bloco D, São Paulo, SP, 05652-900, Brazil
| | - Helena Fukumoto
- Financial Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 3º andar - Bloco E, São Paulo, SP, 05652-900, Brazil
| | - Gustavo Caserta Lemos
- Urology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4 andar - Bloco E, São Paulo, SP, 05652-900, Brazil
| | - Vanessa Teich
- Healthy Economics Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8 andar - Bloco D, São Paulo, SP, 05652-900, Brazil
| | - Paolo Rogério Salvalaggio
- Abdominal Surgery Division & Albert, Einstein Medical School, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 1oSS - Bloco A, São Paulo, SP, 05652-900, Brazil
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Sanches LP, Rahal Júnior A, Falsarella PM, Carvalho VDO, Valle LGM, Francisco Neto MJ, Garcia RG, Funari MBDG. Caecal appendix lipomatosis in a pregnant patient mimicking acute appendicitis. Einstein (Sao Paulo) 2020; 18:eRC5415. [PMID: 33295432 PMCID: PMC7690936 DOI: 10.31744/einstein_journal/2020rc5415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/05/2020] [Indexed: 11/11/2022] Open
Abstract
A 34-years-old pregnant woman admitted in the emergency unit complaining about worsening right iliac fossa pain for 2 days. Acute appendicitis was the suspected diagnosis. Laboratory exams were ordered and results were within normal limits for infectious and inflammatory aspects. Ultrasound scan revealed a pregnancy in course without alterations and a thickness of the appendix wall without inflammatory signs in the surrounding tissue. Because the suspicion of acute appendicitis remained, a magnetic resonance was done and confirmed the diagnosis of a cecal appendix lipomatosis.
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Souza KPD, Rahal A, Volpi EM, Falsarella PM, Hidal JT, Andreoni DM, Francisco-Neto MJ, Queiroz MRGD, Garcia RG. Hydrodissection and programmed stop sedation in 100 % of benign thyroid nodules treated with radiofrequency ablation. Eur J Radiol 2020; 133:109354. [PMID: 33099221 DOI: 10.1016/j.ejrad.2020.109354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To describe our group experience in treatment of benign symptomatic thyroid nodules using radiofrequency ablation technique always associated to routine pre-procedure hydrodissection and under sedation with programmed stop. METHODS Dual-center, retrospective study conducted between April 2018 and January 2020. A total of 52 symptomatic benign thyroid nodules were treated in 34 patients with ultrasound-guided percutaneous radiofrequency ablation. The technique of choice was moving-shot technique and 100 % patients underwent pre-procedural hydrodissection with 5% glucose solution, plus conscious sedation with programmed stop during procedure. RESULTS Most nodules were solid or almost completely solid (n = 45, 88.3 % of nodules), followed by cystic composition (n = 4, 7.8 %) and mixed (n = 2, 3.9 %). As for location, most were on the right lobe (n = 29, 56.9 %), followed by the left lobe (n = 17, 33.3 %) and isthmus (n = 5, 9.8 %). The average volume of nodules before ablation was 18.2 ± 20.5 mL. Volumetric reduction rates at one, three, six and twelve months after ablation were 46.6 %, 64.5 %, 76.1 % and 88.8 %, respectively. No complications strictly related to procedure were reported. No more than 5 min were added to total time of ablative treatment considering routine hydrodissection and stop programmed sedation. CONCLUSIONS Minimally invasive therapies applied to thyroid allow the preservation of healthy thyroid parenchyma and provide a very effective volumetric reduction of symptomatic benign thyroid nodules. Hydrodissection with 5 % glucose solution, conscious sedation and patient stimulation with programmed stop during procedure may provide greater safety to procedure, and, in our experience, could be done routinely in all patients.
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Affiliation(s)
- Katia Pinheiro de Souza
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil.
| | - Antonio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil; Department of Radiology, Hospital Israelita Albert Einstein. São Paulo, 05652-000 Brazil.
| | - Erivelto Martinho Volpi
- Head and Neck Surgery, Amato - Instituto de Medicina Avançada. São Paulo, 01431-001 Brazil; Hospital Alemão Oswaldo Cruz, São Paulo, 01323-020 Brazil.
| | - Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil.
| | - Jairo Tabacow Hidal
- Department of Endocrinology, Hospital Israelita Albert Einstein. São Paulo, 05652-000 Brazil.
| | | | - Miguel Jose Francisco-Neto
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil.
| | - Marcos Roberto Gomes de Queiroz
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, 05652-000 Brazil; Department of Radiology, Hospital Israelita Albert Einstein. São Paulo, 05652-000 Brazil.
| | - Rodrigo Gobbo Garcia
- Department of Radiology, Hospital Israelita Albert Einstein. São Paulo, 05652-000 Brazil.
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Galastri FL, Gilberto GM, Affonso BB, Valle LGM, Falsarella PM, Caixeta AM, Lima CA, Silva MJ, Pinheiro LL, Baptistella CDPA, Almeida MDD, Garcia RG, Wolosker N, Nasser F. Diagnosis and management of hepatic artery in-stent restenosis after liver transplantation by optical coherence tomography: A case report. World J Hepatol 2020; 12:399-405. [PMID: 32821338 PMCID: PMC7407914 DOI: 10.4254/wjh.v12.i7.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/02/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Percutaneous transluminal angioplasty and stenting represent an effective treatment for hepatic artery stenosis after liver transplantation. In the first year after stenting, approximately 22% of patients experience in-stent restenosis, increasing the risk of artery thrombosis and related complications, and 50% experience liver failure. Although angiography is an important tool for diagnosis and the planning of therapeutic interventions, it may raise doubts, especially in small-diameter arteries, and it provides low resolution rates compared with newer intravascular imaging methods, such as optical coherence tomography (OCT).
CASE SUMMARY A 64-year-old male developed hepatic artery stenosis one year after orthotropic liver transplantation and was successfully treated with percutaneous transluminal angioplasty with stenting. Five months later, the Doppler ultrasound results indicated restenosis. Visceral arteriography confirmed hepatic artery tortuosity but was doubtful for significant in-stent restenosis (ISR) and intrahepatic flow reduction. To confirm ISR, identify the etiology and guide treatment, OCT was performed. OCT showed severe stenosis due to four mechanisms: Focal and partial stent fracture, late stent malapposition, in-stent neointimal hyperplasia, and neoatherosclerosis.
CONCLUSION Intravascular diagnostic methods can be useful in evaluating cases in which initial angiography results are not sufficient to provide a proper diagnosis of significant stenosis, especially with regard to ISR. A wide range of diagnoses are provided by OCT, resulting in different treatment options. Interventional radiologists should consider intravascular diagnostic methods as additional tools for evaluating patients when visceral angiography results are unclear.
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Affiliation(s)
| | | | - Breno Boueri Affonso
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | | | - Priscila Mina Falsarella
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Adriano Mendes Caixeta
- Hospital Israelita Albert Einstein, Department of Interventional Cardiology, São Paulo 0562900, Brazil
| | - Camila Antunes Lima
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Marcela Juliano Silva
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Lucas Lembrança Pinheiro
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | | | - Márcio Dias de Almeida
- Hospital Israelita Albert Einstein, Department of Liver Transplant, São Paulo 05652900, Brazil
| | - Rodrigo Gobbo Garcia
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, Department of Vascular Surgery, São Paulo 05652-000, Brazil
| | - Felipe Nasser
- Hospital Israelita Albert Einstein, Department of Interventional Radiology, São Paulo 05652900, Brazil
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Carvalho VDO, Galastri FL, Affonso BB, Falsarella PM, Valle LGM, Ferraz-Neto BH, Rezende MBD, Motta-Leal-Filho JMD, Garcia RG, Nasser F. Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports. Einstein (São Paulo) 2020; 18:eRC4990. [PMID: 32130329 PMCID: PMC7032884 DOI: 10.31744/einstein_journal/2020rc4990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/03/2019] [Indexed: 01/06/2023] Open
Abstract
Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.
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Martins RB, Falsarella PM, Motta-Leal-Filho JMD, Galastri FL, Affonso BB, Garcia RG, Nasser F. Transesplenic access in the treatment of varicose gastrointestinal bleeding. Case and technical report. Einstein (Sao Paulo) 2020; 18:eRC4934. [PMID: 31994612 PMCID: PMC6980296 DOI: 10.31744/einstein_journal/2020rc4934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.
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Affiliation(s)
| | | | | | | | | | | | - Felipe Nasser
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Affonso BB, Galastri FL, da Motta Leal Filho JM, Nasser F, Falsarella PM, Cavalcante RN, de Almeida MD, Felga GEG, Valle LGM, Wolosker N. Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging. World J Gastroenterol 2019; 25:5687-5701. [PMID: 31602168 PMCID: PMC6785514 DOI: 10.3748/wjg.v25.i37.5687] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma (HCC) that underwent liver transplant (LT) after drug-eluting beads transarterial chemoembolization (DEB-TACE) for downstaging versus bridging. Overall survival and tumor recurrence rates were calculated, eligibility for LT, time on the waiting list and radiological response were compared. After TACE, only patients within Milan Criteria (MC) were transplanted. More patients underwent LT in bridging group. Five-year post-transplant overall survival, recurrence-free survival has no difference between the groups. Complete response was observed more frequently in bridging group. Patients in DS group can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
AIM To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.
METHODS Prospective cohort study of 200 patients included from April 2011 through June 2014. Bridging group included patients within MC. Downstaging group (out of MC) was divided in 5 subgroups (G1 to G5). Total tumor diameter was ≤ 8 cm for G1, 2, 3, 4 (n = 42) and was > 8 cm for G5 (n = 22). Downstaging (n = 64) and bridging (n = 136) populations were not significantly different. Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method. Additionally, eligibility for LT, time on the waiting list until LT and radiological response were compared.
RESULTS After TACE, only patients within MC were transplanted. More patients underwent LT in bridging group 65.9% (P = 0.001). Downstaging population presented: higher number of nodules 2.81 (P = 0.001); larger total tumor diameter 8.09 (P = 0.001); multifocal HCC 78% (P = 0.001); more post-transplantation recurrence 25% (P = 0.02). Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT (P = 0.005). Median time on the waiting list was significantly longer in downstaging group 10.6 mo (P = 0.028). Five-year post-transplant overall survival was 73.5% in downstaging and 72.3% bridging groups (P = 0.31), and recurrence-free survival was 62.1% in downstaging and 74.8% bridging groups (P = 0.93). Radiological response: complete response was observed more frequently in bridging group (P = 0.004).
CONCLUSION Tumors initially exceeding the MC down-staged after DEB-TACE, can achieve post-transplant survival and HCC recurrence-free probability, at five years, just like patients within MC in patients undergoing DEB-TACE.
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Affiliation(s)
- Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Francisco Leonardo Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | | | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Rafael Noronha Cavalcante
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | - Marcio Dias de Almeida
- Department of Liver Transplant, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
| | | | | | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo 05651-901, São Paulo, Brazil
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Martins DLN, Falsarella PM, Rahal Junior A, Garcia RG. Peri-prosthetic infection in the postoperative period of endovascular abdominal aorta aneurysm repair: treatment by percutaneous drainage. Einstein (Sao Paulo) 2019; 17:eRC4668. [PMID: 31291387 PMCID: PMC6611083 DOI: 10.31744/einstein_journal/2019rc4668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/21/2019] [Indexed: 11/05/2022] Open
Abstract
Endovascular aneurysm repair is an established technique for treating many infrarenal aortic aneurysms. Infection is one of the most serious complications of this technique, and although percutaneous treatment has been well established for intra-abdominal collections, its use to treat peri-prosthetic fluid collections has not been well determined. In this article we describe a small series of three patients who were treated with percutaneous drainage, with good clinical and imaging responses. Percutaneous drainage is a safe, effective and minimally invasive approach for treating this potentially fatal complication.
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Andrade JRD, Rocha RD, Falsarella PM, Rahal Junior A, Santos RSD, Franceschini JP, Fernando HC, Garcia RG. CT-guided percutaneous core needle biopsy of pulmonary nodules smaller than 2 cm: technical aspects and factors influencing accuracy. ACTA ACUST UNITED AC 2019; 44:307-314. [PMID: 30328929 PMCID: PMC6326710 DOI: 10.1590/s1806-37562017000000259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of CT-guided percutaneous core needle biopsy (CT-CNB) of pulmonary nodules ≤ 2 cm, as well as to identify factors influencing the accuracy of the procedure and its morbidity. METHODS This was a retrospective, single-center study of 170 consecutive patients undergoing CT-CNB of small pulmonary nodules (of ≤ 2 cm) between January of 2010 and August of 2015. RESULTS A total of 156 CT-CNBs yielded a definitive diagnosis, the overall diagnostic accuracy being 92.3%. Larger lesions were associated with a higher overall accuracy (OR = 1.30; p = 0.007). Parenchymal hemorrhage occurring during the procedure led to lower accuracy rates (OR = 0.13; p = 0.022). Pneumothorax was the most common complication. A pleura-to-lesion distance > 3 cm was identified as a risk factor for pneumothorax (OR = 16.94), whereas performing a blood patch after biopsy was a protective factor for pneumothorax (OR = 0.18). CONCLUSIONS Small nodules (of < 2 cm) represent a technical challenge for diagnosis. CT-CNB is an excellent diagnostic tool, its accuracy being high.
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Affiliation(s)
- Juliano Ribeiro de Andrade
- . Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Rafael Dahmer Rocha
- . Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Priscila Mina Falsarella
- . Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Antonio Rahal Junior
- . Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | | | | | | | - Rodrigo Gobbo Garcia
- . Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
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Rocha RD, Falsarella PM, Pereira De Azevedo AA, Garcia RG. Giant simple biliary cyst infection treated with minimally invasive percutaneous drainage. World J Nucl Med 2018; 17:293-295. [PMID: 30505229 PMCID: PMC6216735 DOI: 10.4103/wjnm.wjnm_63_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a minimally invasive alternative approach in a patient with infected hepatic cyst to stabilize the patient before definitive surgery. A 58-year-old man presented with fever and hypotension after 2 weeks of asthenia, chills, weight loss, slight abdominal pain, and a previous asymptomatic simple hepatic cyst. On ultrasound, a giant heterogeneous hepatic cyst with thick wall was noted. A positron emission tomography-computed tomography scan was indicated and demonstrated high uptake (standardized uptake value = 7.6) in the wall of the cyst, suggestive of infection. He underwent percutaneous drainage guided by the tomography. A 12 Fr drain was positioned inside the collection and 5 L of purulent material was aspirated from the cyst, and at day 12th, surgical resection was performed. Histopatological analysis confirmed a simple biliary cyst. The patient remains asymptomatic on 1-year follow-up. Percutaneous drainage before surgical treatment allowed the definitive approach to be performed with the patient in better clinical conditions.
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Affiliation(s)
- Rafael Dahmer Rocha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Rahal Junior A, Falsarella PM, Mendes GF, Hidal JT, Andreoni DM, Lúcio JFF, Queiroz MRGD, Garcia RG. Percutaneous laser ablation of benign thyroid nodules: a one year follow-up study. Einstein (Sao Paulo) 2018; 16:eAO4279. [PMID: 30517361 PMCID: PMC6276810 DOI: 10.31744/einstein_journal/2018ao4279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/30/2018] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules. Methods Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance. Results Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed. Conclusion Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.
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Martins DLN, Cavalcante Junior FDA, Falsarella PM, Rahal Junior A, Garcia RG. Percutaneous drainage of iliopsoas abscess: an effective option in cases not suitable for surgery. Einstein (Sao Paulo) 2018; 16:eRC4254. [PMID: 30281765 PMCID: PMC6178864 DOI: 10.1590/s1679-45082018rc4254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/24/2018] [Indexed: 12/20/2022] Open
Abstract
The aim of this study were to describe the technique of percutaneous drainage of iliopsoas abscess, and to discuss the benefits of using this minimally-invasive tool. A single center study with retrospective analysis of patients with psoas abscess confirmed by imaging scans, sent to the interventional medicine center and submitted to computed tomography and ultrasound-guided percutaneous drainage, from November 2013 to August 2016. Seven patients underwent percutaneous drainage of psoas abscess in this period. The mean initial drained volume was 61.4±50.7mL (ranging from 10 to 130mL), and the mean drainage duration was 8.3±2.8 days (ranging from 4 to 12 days). The success rate of the percutaneous procedures was 71.5%, and two patients required re-intervention. Image-guided percutaneous drainage of iliopsoas abscess is a minimally invasive, efficient and safe procedure, and an extremely valuable technique, especially for patients who are not suitable for surgical repair.
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Falsarella PM, Rocha RD, Rahal Junior A, Mendes GF, Garcia RG. Minimally invasive treatment of complex collections: safety and efficacy of recombinant tissue plasminogen activator as an adjuvant to percutaneous drainage. Radiol Bras 2018; 51:231-235. [PMID: 30202126 PMCID: PMC6124593 DOI: 10.1590/0100-3984.2017.0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To analyze the efficacy of recombinant tissue plasminogen activator (r-TPA)
injection in the evolution of percutaneous drainage of thick
collections. Materials and Methods This was a single-center study involving the retrospective analysis of
hospitalized patients undergoing percutaneous drainage of thick (superficial
or intracavitary) fluid collections, followed by injection of a fibrinolytic
agent (r-TPA) into the affected space. Results A total of 53 percutaneous drainage procedures, with r-TPA injection, were
performed in 51 patients. Abdominal and pelvic collections were the most
common, being seen in 38 (73%) of the procedures; in 35 (66%), the etiology
of the collection was attributed to postoperative complications. A total of
61 catheters were used in order to drain the 53 collections. Of those 61
catheters, 52 (85%) were large (12-16 Fr) and 9 (15%) were small (4-10 Fr).
The mean r-TPA dose was 5.7 mg/collection per day, and the mean time from
r-TPA injection to drain removal was 7.7 days. Percutaneous drainage in
combination with r-TPA injection was successful in 96% of the cases. None of
the patients showed coagulation changes during the study period. Conclusion The use of once-daily, low-dose r-TPA for up to three consecutive days, as an
adjunct to percutaneous drainage of thick collections, with or without
loculation, appears to be an effective technique.
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Affiliation(s)
- Priscila Mina Falsarella
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rafael Dahmer Rocha
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Antonio Rahal Junior
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Guilherme Falleiros Mendes
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rodrigo Gobbo Garcia
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Azevedo AAP, Rahal A, Falsarella PM, Lemos GC, Claros OR, Carneiro A, de Queiroz MRG, Garcia RG. Image-guided percutaneous renal cryoablation: Five years experience, results and follow-up. Eur J Radiol 2018; 100:14-22. [DOI: 10.1016/j.ejrad.2018.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/16/2017] [Accepted: 01/02/2018] [Indexed: 02/06/2023]
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Rahal Junior A, Falsarella PM, Ferreira VTR, Mariotti GC, de Queiroz MRG, Garcia RG. Injecting hemostatic matrix in the path of biopsies: efficacy, potential complications, and the management of such complications. Radiol Bras 2018; 51:102-105. [PMID: 29743737 PMCID: PMC5935404 DOI: 10.1590/0100-3984.2017.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To describe the technique of injecting hemostatic matrix, as well as the
experience of our interventional radiology department in its
application. Materials and Methods We conducted a single-center study with retrospective analysis of the
experience of our group in the use of hemostatic gelatin matrix in
percutaneous biopsies. Results In a total of 73 biopsies in different organs, such as the liver, kidney, and
spleen, hemostatic gelatin matrix was introduced into the coaxial needle.
The only complication observed was migration of the hemostatic matrix to the
left kidney collecting system, and that was resolved with clinical
treatment. There were no cases of bleeding after the injection of hemostatic
matrix. Conclusion The use of hemostatic matrices in the path of percutaneous biopsies is
another tool available for consideration in minimally invasive
procedures.
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Affiliation(s)
- Antonio Rahal Junior
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Priscila Mina Falsarella
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Guilherme Cayres Mariotti
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marcos Roberto Gomes de Queiroz
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rodrigo Gobbo Garcia
- MD, Physician in the Department of Interventional Radiology of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Affonso BB, Motta-Leal-Filho JMD, Cavalcante FDA, Galastri FL, Cavalcante RN, Falsarella PM, Nasser F, Garcia RG. Aspects of images in magnetic resonance of liver tumors treated with transarterial selective internal radiotherapy with yttrium-90. Einstein (Sao Paulo) 2017; 16:eRC4015. [PMID: 29267431 PMCID: PMC6066153 DOI: 10.1590/s1679-45082017rc4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 07/30/2017] [Indexed: 08/30/2023] Open
Abstract
Transarterial selective internal radiation therapy with yttrium-90, also known as radioembolization, is a therapy based on the administration of resin or glass microspheres loaded with the radioisotope yttrium-90, via selective arterial catheterization of tumor-feeding vessels. It is classified as a type of locoregional therapy and its main goal is to treat patients with primary or secondary hepatic lesions that are unresectable and not responsive to other therapies. Since it is a new technology still restricted to very few hospitals in Brazil, but used in patients throughout the country, it is necessary to demonstrate the main aspects of hepatic lesions treated with selective internal radiation therapy found in magnetic resonance imaging, and to make specific considerations on interpretation of these images. The objective of this report is to demonstrate the main aspects of magnetic resonance imaging of unresectable primary or secondary hepatic lesions, in patients submitted to transarterial selective internal radiation therapy.
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Affiliation(s)
| | | | | | | | | | | | - Felipe Nasser
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Affonso BB, Leal Filho JMDM, Cavalcante RN, Falsarella PM, Galastri FL, Cardoso RS, Nasser F. Intra-arterial fibrinolysis for the management of acute ischemia on a below-knee amputation stump. Case report. ACTA ACUST UNITED AC 2017; 16:eRC4014. [PMID: 29069141 PMCID: PMC6066151 DOI: 10.1590/s1679-45082017rc4014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022]
Abstract
Preservation of the knee joint has enormous advantages in terms of mobility and rehabilitation of an amputee. Any cause of breakdown requiring revision to an above-knee amputation is a major setback because it reduces the patient’s rehabilitative potential. We report a case of intra-arterial thrombolysis use to save a below-knee amputation stump with acute ischemia. A 56-year-old man who sought the emergency department with 1-day history of acute pain on his right below-knee stump. The angiography confirmed popliteal artery occlusion. Pharmacomechanical thrombectomy, with Aspirex (rotational catheter to restore blood flow in occluded vessel, by removing occlusion material from the vessel) and recombinant tissue plasminogen activator, was performed. After 9 years of follow-up the patient remained asymptomatic, capable of independent ambulation with prosthetic limb. Intra-arterial fibrinolysis seems to be a safe and effective treatment for cases of acutely ischemic amputation stump.
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Affiliation(s)
| | | | | | | | | | | | - Felipe Nasser
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Valle LGM, Rahal A, Falsarella PM, de Andrade JR, Smaletz O, Osawa A, Garcia RG. Prostate cancer recurrence in vas deferens - fusion image guide as an important tool in dignosis. Int Braz J Urol 2017; 44:192-195. [PMID: 29064653 PMCID: PMC5815551 DOI: 10.1590/s1677-5538.ibju.2017.0071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/17/2017] [Indexed: 11/22/2022] Open
Abstract
The biochemical recurrence after local treatment for prostate cancer is an often challenging condition of clinical management. The aim of this report is to demonstrate the importance of the association of various imaging methods in the identification and subsequent accurate percutaneous biopsy in patients with recurrence of prostate cancer, especially in unusual sites. An 86 years old male with biochemical recurrence, during radiological investigation a PET-MRI was noted the presence of an asymmetry of the vas deferens with PSMA- 68Ga uptaken, suggesting the recurrence. A percutaneous fusion biopsy with PET-MRI and ultrasound was performed using transrectal access using ultrasound confirming infiltrating adenocarcinoma of the wall of the vas deferens, compatible with neoplastic prostate recurrence. The fusion image technique combines the real-time view of the US to the possibility of higher definition and higher specificity, methods more anatomical detail as tomography and magnetic resonance imaging, simultaneously. High resolution acquired in PET / MR associated with image fusion allows orientation procedures, even in areas of difficult access, with greater accuracy than conventional techniques.
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Affiliation(s)
| | - Antônio Rahal
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Priscila Mina Falsarella
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | | | - Oren Smaletz
- Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Akemi Osawa
- Departamento de Medicina Nuclear e Radiologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
| | - Rodrigo Gobbo Garcia
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, São Paulo, Brasil
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Garcia RG, Falsarella PM, Rahal A, Dos Santos RS. Percutaneous treatment of persistent chylothorax: technical challenges in a complex case. J Thorac Dis 2017; 9:E333-E334. [PMID: 28459233 DOI: 10.21037/jtd.2017.01.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Antonio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Rahal A, Falsarella PM, Rocha RD, Lima JPBC, Iani MJ, Vieira FAC, Queiroz MRGD, Hidal JT, Francisco MJ, Garcia RG, Funari MBDG. Correlation of Thyroid Imaging Reporting and Data System [TI-RADS] and fine needle aspiration: experience in 1,000 nodules. Einstein (Sao Paulo) 2017; 14:119-23. [PMID: 27462883 PMCID: PMC4943343 DOI: 10.1590/s1679-45082016ao3640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/08/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To correlate the Thyroid Imaging Reporting and Data System (TI-RADS) and the Bethesda system in reporting cytopathology in 1,000 thyroid nodules. METHODS A retrospective study conducted from November 2011 to February 2014 that evaluated 1,000 thyroid nodules of 906 patients who underwent ultrasound exam and fine needle aspiration. RESULTS A significant association was found between the TI-RADS outcome and Bethesda classification (p<0.001). Most individuals with TI-RADS 2 or 3 had Bethesda 2 result (95.5% and 92.5%, respectively). Among those classified as TI-RADS 4C and 5, most presented Bethesda 6 (68.2% and 91.3%, respectively; p<0.001). The proportion of malignancies among TI-RADS 2 was 0.8%, and TI-RADS 3 was 1.7%. Among those classified as TI-RADS 4A, proportion of malignancies was 16.0%, 43.2% in 4B, 72.7% in 4C and 91.3% among TI-RADS 5 (p<0.001), showing clear association between TI-RADS and biopsy results. CONCLUSION The TI-RADS is appropriate to assess thyroid nodules and avoid unnecessary fine needle aspiration, as well as to assist in making decision about when this procedure should be performed. OBJETIVO Apresentar a correlação entre o Thyroid Imaging Reporting and Data System (TI-RADS) e o sistema Bethesda, para relatar citopatologia em 1.000 nódulos tireoidianos. MÉTODOS Estudo retrospectivo realizado no período de novembro de 2011 a fevereiro de 2014, que avaliou 1.000 nódulos tireoidianos de 906 pacientes submetidos a exame de ultrassonografia e à punção aspirativa por agulha fina. RESULTADOS Observou-se associação significativa entre o TI-RADS e o resultado da classificação de Bethesda (p<0,001). A maioria dos indivíduos com TI-RADS 2 ou 3 teve resultado citológico Bethesda 2 (95,5% e 92,5%, respectivamente). Entre aqueles classificados TI-RADS 4C e 5, a maioria teve resultado Bethesda 6 (68,2% e 91,3%, respectivamente; p<0,001). A proporção de malignidades em TI-RADS 2 foi 0,8% e em TI-RADS 3 foi 1,7%. Entre TI-RADS 4A, foi de 16,0%, 43,2% em 4B, 72,7% em 4C e em 5 foi de 91,3% (p<0,001), mostrando clara associação entre o TI-RADS e os resultados da biópsia. CONCLUSÃO O TI-RADS é apropriado para avaliar nódulos da tireoide e evitar punção aspirativa por agulha fina desnecessária, além de auxiliar na decisão sobre quando este procedimento deve ser realizado.
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Affiliation(s)
- Antonio Rahal
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Garcia RG, Rocha RD, Franceschini J, Ghefter MC, Affonso BB, Rahal A, Falsarella PM, Nasser F, dos Santos RS. Computed Tomography-Guided Percutaneous Thoracic Duct Sclero-Embolization for Persistent Chylothorax. Innovations 2016. [DOI: 10.1177/155698451601100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rafael Dahmer Rocha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Juliana Franceschini
- Department of Thoracic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Mário Cláudio Ghefter
- Department of Thoracic Surgery, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Antonio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Nasser F, Rocha RD, Falsarella PM, da Motta-Leal-Filho JM, Azevedo AA, Valle LGM, Cavalcante RN, Garcia RG, Affonso BB, Galastri FL. Percutaneous Treatment of Intrahepatic Biliary Leak: A Modified Occlusion Balloon Technique. Cardiovasc Intervent Radiol 2015; 39:773-777. [PMID: 26542028 DOI: 10.1007/s00270-015-1234-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To report a novel modified occlusion balloon technique to treat biliary leaks. METHODS A 22-year-old female patient underwent liver transplantation with biliary-enteric anastomosis. She developed thrombosis of the common hepatic artery and extensive ischemia in the left hepatic lobe. Resection of segments II and III was performed and a biliary-cutaneous leak originating at the resection plane was identified in the early postoperative period. Initial treatment with percutaneous transhepatic drainage was unsuccessful. Therefore, an angioplasty balloon was coaxially inserted within the biliary drain and positioned close to the leak. RESULTS The fistula output abruptly decreased after the procedure and stopped on the 7th day. At the 3-week follow-up, cholangiography revealed complete resolution of the leakage. CONCLUSION This novel modified occlusion balloon technique was effective and safe. However, greater experience and more cases are necessary to validate the technique.
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Affiliation(s)
- Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rafael Dahmer Rocha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil.
| | - Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | | | - André Arantes Azevedo
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Leonardo Guedes Moreira Valle
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rafael Noronha Cavalcante
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Breno Boueri Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
| | - Francisco Leonardo Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Albert Einstein Av., 627/701, Morumbi, São Paulo, 05652-900, Brazil
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Rocha RD, Azevedo AA, Falsarella PM, Rahal A, Garcia RG. Cerebral air embolism during CT-guided lung biopsy. Thorax 2015; 70:1099-100. [DOI: 10.1136/thoraxjnl-2015-207205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/14/2015] [Indexed: 01/05/2023]
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Falsarella PM, Rocha RD, Rahal A, de Barros RM, Garcia RG, Queiroz MR. Hypertensive pneumoperitoneum treated with minimally invasive percutaneous drainage. J Vasc Interv Radiol 2015; 26:931-3. [PMID: 26003466 DOI: 10.1016/j.jvir.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/05/2015] [Accepted: 01/05/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Priscila Mina Falsarella
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
| | - Rafael Dahmer Rocha
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
| | - Antonio Rahal
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
| | - Rodolfo Martins de Barros
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
| | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
| | - Marcos Roberto Queiroz
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Av Albert Einstein, 627, São Paulo, Brazil
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Abstract
UNLABELLED Renal transplant recipients have an increased risk of malignancies, especially nonmelanoma skin cancers, compared with the normal population. The aim of the present study was to analyze the incidence of skin malignancies in a setting of renal transplant recipients over 20 years follow-up. PATIENTS AND METHODS This retrospective analysis of medical records included posttransplant patients with biopsy-proven skin cancer. Recipients of pancreas kidney transplants or with suspected but not biopsy-proven skin malignancy were excluded from this series. RESULTS Among 1300 renal transplant recipients from January 1984 to December 2006, 33 (2.5%) were diagnosed with skin malignancies during follow-up. The majority of patients were men (70.2%), of white race (97%), and with a mean posttransplant follow-up of 65 months. The most frequent skin cancer was squamous cell carcinoma (46.2%), in single or multiple lesions (50% each group). Basal cell carcinoma was diagnosed in seven patients; most presented as a single lesion (71.3%). Eight patients presented with more than one histologic type of skin cancer; most frequently squamous and basal cell carcinomas. Kaposi sarcoma was diagnosed in four patients, one of whom also had a basal cell carcinoma. CONCLUSION The incidence of skin malignancies in this series was 2.5%. The most frequent tumor was squamous cell carcinoma, isolated or in association with basal cell carcinoma. An higher frequency was observed in white male patients, at a mean follow-up of 5 years posttransplantation.
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Affiliation(s)
- P M Falsarella
- Division of Nephrology, Department of Medicine, School of Medical Sciences. State University of Campinas, Unicamp, Campinas, São Paulo, Brazil
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