Journal of Interventional Medicine最新文献

Patients with acute nonvariceal gastrointestinal bleeding (GIB) not treatable via endoscopic therapy require angiography and endovascular management. If the source of the bleeding can be identified on angiography, the bleeding can be controlled with minimal complications by endovascular treatments such as intra-arterial infusion of vasopressin, embolization, covered stent placement, or a combination thereof. This pictorial essay reviews the angiographic findings for and the endovascular management of acute nonvariceal GIB.

We report two cases of hepatic encephalopathy caused by molecular targeted drugs after the Transjugular intrahepatic portosystemic shunt (TIPS) procedure in our center. The liver toxicities and anti-angiogenic effects induced by targeted drugs may generate an imbalance in ammonia metabolism, elevating blood ammonia levels. TIPS diverts partial blood supply from the liver, aggravates liver impairment, and shunts ammonia-rich blood from the intestine into the systemic circulation. These may be the mechanisms leading to hepatic encephalopathy caused by molecular targeted drugs following TIPS. When clinicians choose molecular targeted therapy as the second or third targeted therapy for patients who have undergone TIPS, the consequence of drug-induced hepatic encephalopathy should also be considered.

Objective

This study aimed to investigate the application value of contrast-enhanced ultrasound (CEUS) before and after minimally invasive ablation procedures for benign thyroid nodule(s) (BTN).

Methods

This prospective study included patients with BTNs scheduled to undergo ultrasound-guided minimally invasive ablation treatment. CEUS was performed before and after ablation (at 1 day, and 1, 6, and 12 months after ablation). Changes in microvascular perfusion and the volume of BTNs were noted and assessed.

Results

Sixty-two patients (62 BTNs), who underwent ablation procedures between June 2016 and August 2020, were included. All lesions were confirmed by biopsy, and histopathological results were obtained before ablation treatment. On preoperative CEUS, the lesions exhibited hyperenhancement (53.23%) or iso-enhancement (46.77%) during the arterial phase, and all lesions exhibited iso-enhancement in the venous and late phases. One day after ablation, none of the BTNs exhibited obvious enhancement on CEUS. One (1.61%) lesion was re-treated due to a nodule-like enhancement area detected by CEUS at the 6-month follow-up. The mean nodular volume reduction rate (VRR) at 1, 6, and 12 months follow-up demonstrated no significant difference between the two ablation groups (microwave ablation versus radiofrequency ablation). Twelve months after ablation, the mean (±SD) VRR of all BTNs was 60.3 ​± ​10.3%.

Conclusion

CEUS helped guide treatment decisions for BTNs before ablation treatment. Moreover, it could also be used to accurately and noninvasively evaluate treatment efficacy.

Background

Port-A-Cath systems (PCS) are safe and convenient devices for long-term infusion in patients with malignant tumors. This study retrospectively analyzed the complications from PCS and their management.

Methods

Data of 1695 adults (641 males and 1054 females) with malignant tumors who underwent PCS implantation in our center from January 1, 2009 to December 31, 2019 who had complete follow-up records were collected in this study. The early and late complications and corresponding treatments were studied.

Results

A total of 1716 PCSs were implanted; 21 patients underwent 2 implantations each. The success rate was 100% and no severe complications occurred during implantation. The overall occurrence rate of post-implantation complications was 18.5% (318/1716); 5.5% (94/1716) were early complications and 13.0% (224/1716) were late complications. A total of 451 PCSs were removed, of which 398 were removed due to the end of chemotherapy, while 53 were removed because of complications. A total of 4 deaths occurred from these complications.

Conclusions

The incidence of intra- and post-operative complications is low. In most cases, complications can be effectively controlled without the removal of the PCS and regular follow-up and maintenance are critical.

Hepatic hemangiomas (HHs) are the most common benign tumors of the liver. These tumors are mainly asymptomatic and do not require treatment. Nevertheless, there are some special cases that require therapeutic intervention, and surgery and intervention are currently the primary treatment modalities. Despite significant advances in the development of minimally invasive techniques and their popularization, interventional treatment of HH is still the preferred choice. In the present review, we discuss the pathological properties, type of blood supply, and treatment indications for HH and assess the status and progress of the existing interventional treatments.