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Background: Some patients suffering from thoracolumbar complete burst fracture causing neurological deficit may be eligible for single-stage posterior-only three column reconstruction with spine jack expansion kyphoplasty. Method: Short segment monoaxial pedicle screws are placed. Spine jack working channels are positioned in the comminuted vertebral body. Then, the surgeon can perform jack expansion kyphoplasty and short-segment fixation and distraction in the order best suited, considering whether the collapsed vertebral body has been expanded thanks to hyperlordosis positioning. This strategy allows to regain both native vertebral body height and proper regional sagittal balance. Wide decompression with laminectomy and arthrectomy is necessary at the level of posterior wall recession. Conclusion: Combination of short segment pedicle screw fixation with distraction and open spine jack kyphoplasty is technically feasible and avoids the need for corpectomy in complete burst fractures with neurological deficit. [ABSTRACT FROM AUTHOR]

Background: Percutaneous microwave ablation is a recent validated management line which is less invasive treatment option, with highly effective results and could be utilized efficiently in management of osteoid osteoma. This study aimed for assessment of the safety and efficacy of microwave ablation in managing osteoid osteoma. Methods: We enrolled 18 patients with osteoid osteoma who underwent microwave ablation at Zagazig University Hospitals followed by post-procedure computed tomography (CT) follow up in this clinical trial. The collected data included the severity of pain, use of pain medication after ablation and any post-procedure complications. Results: There was statistically significant improvement in VAS one week postoperatively as compared to preoperative value where all patients had preoperative pain score from 8 to 9 (p<0.001). One month and 6 months postoperatively, all patients had no pain (pain score 0). Larger percentage of patients passed uncomplicated (88.9%), one patient developed superficial infection and another one had skin numbness. Both patients with complications needed postoperative pain medications as they had postoperative pain score 2 which indicated use of pain medications. A statistically significant positive correlation was revealed between cycles of ablation and preoperative pain scores (p=0.036). Conclusions: Percutaneous CT guided microwave ablation may be used as an efficient safe treatment line among osteoid osteoma patients, contrary to surgery, with no major complications (infection or neurovascular injury) that have been reported after microwave ablation for osteoid osteoma. [ABSTRACT FROM AUTHOR]

Introduction: Fibrinolytic agents (FA) activate the fibrinolytic system, converting plasminogen into plasmin to break down fibrin. Their use for irrigation of abdominal abscesses is debated, and this meta‐analysis evaluates their efficacy. Methods: We searched PubMed, Embase, and Cochrane Central for randomized controlled trials (RCTs) comparing FA and saline in percutaneous drainage of abdominal abscesses. Outcomes included length of hospitalization, duration of drainage, and drainage volume. We pooled mean differences (MD) and 95% confidence intervals (CI) using a random‐effects model. We also performed a trial sequential analysis (TSA). Results: We included six RCTs encompassing 299 patients. In the overall analysis, FA increased drainage volume (MD 104.25 mL; 95% CI 35.72–172.77 mL; p = 0.003; I2 = 0%). In children, saline reduced hospitalization duration (MD −1.26 days; 95% CI −1.98 to −0.55 days; p = 0.0006; I2 = 0%), whereas FA increased drainage volume (MD 84.66 mL; 95% CI 5.77–153.54 mL; p = 0.04; I2 = 0%). In adults, FA significantly reduced hospitalization duration (MD −11.12 days; 95% CI −15.16 to −7.08 days; p < 0.00001; I2 = 0%) and duration of drainage (MD −6.53 days; 95% CI −9.25 to −3.81 days; p < 0.00001; I2 = 0%) while increasing drainage volume (MD 164.47 mL; 95% CI 26.16–302.78 mL; p = 0.02; I2 = 0%). On TSA, the required information size was achieved only for the adult subgroup's hospitalization and drainage duration. Conclusion: In adults, FA reduce hospitalization and drainage duration and increase drainage volume. In children, saline seems more effective in reducing hospitalization duration, while FA increase drainage volume. These findings underscore the need for age‐specific treatments and further research, especially in the pediatric population. [ABSTRACT FROM AUTHOR]

A growing number of treatments for genitourinary diseases can result in various iatrogenic complications. Multimodality imaging in the post-procedural setting is essential for early and accurate diagnosis to limit morbidity and mortality. We review common and uncommon treatment-induced pathologies affecting the genitourinary system via a case-based approach. We illustrate notable complications affecting the kidneys, ureters, bladder, and urethra induced by percutaneous procedures, external beam radiation, immunotherapy, laparoscopic/robotic pelvic surgery, and intravesicular BCG. Finally, we provide guidance on optimal imaging techniques for diagnosis and highlight the role of image-guided interventions for mitigation of complications. [ABSTRACT FROM AUTHOR]

In addition to the fact that the significance of the nephrolitometric scoring systems (NSSs) remains unclear, no study has been conducted to assess the effectiveness of these scoring systems in percutaneous nephrolithotomy (PNL) performed in the supine position. We aimed to compare the CROES, Guy's scoring system (GSS), S.T.O.N.E., and S-ReSC NSSs for success and complications in patients undergoing supine mini-PNL (m-PNL). The prospectively recorded data of the patients who underwent supine m-PNL was reviewed retrospectively, and a total of 112 patients were included in the study. Demographic, operation, post-procedure data, and CROES, GSS, S.T.O.N.E., and S-ReSC scores were assessed and compared between the stone-free (SF) and residuel groups. There were significant differences between the SF and residual groups in terms of mean CROES, S.T.O.N.E., and S-ReSC scores (p = 0.003, p = 0.009, and p = 0.015, respectively). Similarly, there were significant differences between the grades of these scoring systems and the success of the procedure (p = 0.035, p = 0.007, and p = 0.007, respectively). However, the GSS was insignificant. The area under curve values in ROC analysis of CROES, S.T.O.N.E., and S-ReSC NSSs were 0.695, 0.665, and 0.656, respectively (p = 0.003, p = 0.011, and p = 0.017, respectively). No statistically significant difference was found between the grades of all four NSSs and the complication rates. The study showed a strong correlation between CROES, STONE, and S-ReSC NSSs in predicting SF status after supine m-PNL. However, none of the NSSs could predict the complications. [ABSTRACT FROM AUTHOR]

The purpose of the current work was to develop and characterize ethosomes of vitamin D3 gel that could more effectively work against psoriasis. Psoriasis is a chronic immune-mediated inflammatory skin disease. Due to vitamin D3 role in proliferation and maturation of keratinocytes, it has become an important local therapeutic option in the treatment of psoriasis. In this research we have initiated worked on ethosomes gels containing vitamin D3 to treat psoriasis. Soya lecithin 1–8% (w/v), propylene glycol and ethanol were used to create the formulations, which were then tested for vesicle size, shape, surface morphology, entrapment effectiveness, and in vitro drug permeation. The drug encapsulation efficiency of ethosomes was 96.25% ± 0.3. The particle sizes of the optimized ethosomes was 148 and 657 nm, and the PDI value was 0.770 ± 0.12 along with negative charge − 14 ± 3. Fourier transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC) along with thermogravimetric analysis (TGA) studies confirmed the absence of interactions between vitamin D3 and other ingredients. It was determined that the total amount of medication that penetrated the membrane was 95.34% ± 3. Percentage lysis was very negligible for all strengths which were found less than 15%. Based on our research, ethosomes appear to be safe for use. The vitamin D3 ethosomal gel order, description, pH, and viscosity were all within the specified ranges, according to the findings of a 6-month investigation into the stability profile of the completed system. In this research, we successfully prepared ethosomes loaded with vitamin D3 and then converted it into gel for patients' easy applications. [ABSTRACT FROM AUTHOR]

Objective: Knowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included. Results: Among white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a comparative analysis of procedural efficacy, safety, and patient outcomes between 2 distinct approaches for percutaneous antegrade double-J ureteral stent (DJS) insertion: the first-hand approach and via a nephrostomy route. Methods: Electronic records of patients undergoing percutaneous antegrade ureteral DJS placement from January 2016 to 2023 were reviewed. Patients were categorized into 2 groups based on stent placement technique: the first-hand group, involving a single-stage approach without prior percutaneous nephrostomy catheter insertion, and the nephrostomy group, where stent placement occurred through a percutaneous nephrostomy tube. Clinical data, including patient demographics, primary diagnoses, procedural details, complication rates, stent placement success, and post-procedural outcomes, were collected and analysed. Results: Both approaches demonstrated high technical success rates (93.1%). However, the nephrostomy route group exhibited a comparatively higher fluoroscopy exposure rate (8.2 min) than the first-hand group (6.8 min). Moreover, the complication risk increased by 3.08 times in patients treated with the nephrostomy method (P = .047). Notably, in cases of urinary malignancies, the preference was for placing DJS via nephrostomy. Conclusion: The first-hand approach should be prioritized as the initial choice in suitable cases owing to its reduced fluoroscopy time, lower complication rate, and the single-stage nature of the procedure. Advances in knowledge: With the exception of cases necessitating urgent drainage, such as post-renal acute renal failure and urosepsis, the first-hand method is the primary approach for inserting DJS. This is primarily due to the significantly shorter radiation time and the single-stage nature of the procedure. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) has emerged as a potential alternative for aortic valve surgery to treat aortic valve stenosis. There is limited evidence on the comparative outcomes of TAVI access approaches, specifically the percutaneous (PC) vs surgical cutdown (SC) approach. This study aimed to assess the short-term outcomes in patients undergoing PC vs SC access for transfemoral transcatheter aortic valve replacement. PubMed, SCOPUS, and EMBASE were searched to identify relevant studies. The primary outcomes were short-term all-cause mortality, bleeding, vascular complications, and length of in-hospital stay for patients who underwent transfemoral TAVI. Both matched and unmatched observational studies were included and subgroup analyses were performed. This systematic review and meta-analysis was performed in line with the PRISMA guidelines. Fifteen observational studies involving 7,545 patients (3,033 underwent the PC approach and 2,466 underwent the SC approach) were included. There were no clinically significant between-group differences in short-term mortality, bleeding, length of in-hospital stay, or major vascular complications. However, minor vascular complications were significantly higher in patients who underwent PC-TAVI (p=0.007). In the matched subgroup, all outcomes were comparable between both groups, with the largest difference being observed in minor vascular complications more frequently occurring in the PC group (p=0.08). The evidence shows that outcomes were comparable between the two methods of access, rendering both the PC and SC approaches equally effective for transfemoral TAVI. However, it is worth noting that minor vascular complications were more pronounced in the PC group. [ABSTRACT FROM AUTHOR]

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Background: An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population. Objective: To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs. Methods: This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements. Results: We identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements. Conclusion: Transcatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance. [ABSTRACT FROM AUTHOR]

Background: Percutaneous dilatational tracheostomy (PDT) is the preferred method for managing critically ill patients requiring prolonged mechanical ventilation. We aimed to compare the safety of PDT performed by intensivists versus surgeons. Methods: This retrospective, single center, cohort study included all the patients who underwent PDT from 2014 to 2023. Propensity score matching was performed to adjust the imbalances of covariates between the groups. The primary outcome was the occurrence of early complications after PDT. Secondary outcomes were the development of late complications of PDT and mortality directly related to tracheostomy. Results: 1685 consecutive patients with critical illness were included in the analysis. Of these, 1396 (82.8%) PDTs were performed by surgeons and 289 (17.2%) by intensivists with background residency training in internal medicine. Early complications were reported in 80 (5.7%) of the patients in the surgeon group and in 13 (4.5%) patients in the intensivist group (p = 0.40). Minor hemorrhage was the most common early complication. Secondary outcomes were comparable in both groups. In a propensity score‐matched cohort, the findings remained consistent. Conclusions: This study suggests that PDT can be performed by intensivists, as well as surgeons, with the same safety profile. Our findings underscore the importance of incorporating PDT into the intensive care unit (ICU) training syllabus, ensuring the procedure is readily accessible with reliance on the expertise of ICU staff. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the factors influencing the efficacy and safety of the ultrasound-guided radiofrequency ablation of renal tumors. Between January 2010 and December 2018, 159 patients with renal tumors treated with ultrasound-guided percutaneous radiofrequency ablation at our institution were included in this study. Biopsies were performed for histopathological analysis prior to each ablation. Patients underwent computed tomography follow-ups at 3, 6, and 12 months and were subsequently observed on an annual basis. The primary efficacy rate (i.e., residual tumor), local tumor progression, morbidity and mortality, and possible outcome predictors (age, body mass index, gender, tumor size, tumor location, tumor characteristics, ablation temperature, and reported technical problems) were analyzed using binary logistic regression. At the first follow-up, 3 months after ablation, the primary efficacy rate was 79%. Two percent of the tumors showed local tumor progression during the whole follow-up. Tumor proximity to the collecting system and the final temperature in the ablation region were associated with the occurrence of residual tumor (OR = 2.85, p = 0.019 and OR = 4.23, p = 0.006, respectively). A similar trend was shown for tumors larger than 3 cm (p = 0.066). A short distance to the collecting system and the ablation temperature were significantly related to the occurrence of residual tumors after the radiofrequency ablation of small renal masses. The ultrasound guidance used in our study has a lower primary efficacy rate than the computed tomography guidance used in comparable studies. [ABSTRACT FROM AUTHOR]

Purpose: The results of past studies comparing percutaneous techniques with traditional open techniques for hallux valgus are controversial. Therefore, this study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. Methods: Seventy-one patients with mild to severe hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35) between October 2019 and September 2020. Radiological and clinical outcomes were assessed preoperatively and postoperatively. Outcome measures included the foot and ankle outcome score, foot functional index, visual analogue scale (VAS) scores for pain, range of motion (ROM) of the first metatarsophalangeal (MTP) joint, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening. Additionally, the first metatarsal declination angle was measured to evaluate sagittal malunion. Results: The mean first metatarsal declination angle decreased significantly at 12 months postoperatively in both groups (p = 0.021 and p < 0.001 in the percutaneous and open groups, respectively), and the decrement was significantly greater in the open group (p = 0.033). The mean VAS score for pain on postoperative day one was 4.2 ± 1.9 and 5.3 ± 1.7 in the percutaneous and open groups, respectively (p = 0.019). The mean ROM of the first MTP joint did not change significantly after surgery, from 72.5 ± 7.5 preoperatively to 71.0 ± 9.5 at 12 months postoperatively in the percutaneous group (p = 0.215); however, it decreased significantly from 70.6 ± 7.3 preoperatively to 63.4 ± 10.4 at 12 months postoperatively in the open group (p < 0.001). There were no significant differences between the groups regarding other clinical outcomes. Conclusion: The percutaneous group showed a lower immediate pain level at postoperative day 1 and better ROM of the first MTP joint at 12 months postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous thermal ablation is an effective treatment for primary and metastatic liver tumors and is a recommended local therapy for early-stage hepatocellular carcinoma (HCC). Reported evidence shows an increase in the ablation zone volume over the first 24-h post-liver ablation. This report compares ablation zone volumes immediately at the completion (T = 0) of 26 microwave ablations of liver tumors to 24-h post-procedure (T = 24) volumes. Materials and methods: 20 patients, 13 (65%) males, underwent a total of 26 hepatic microwave ablations (MWA) under ultrasound guidance. Contrast-enhanced CT (CECT) or MRI was performed immediately and another CECT 24 h post operatively. Evaluation of the ablation zone and comparison of the two post-operative scans were done using BioTrace software. The expansion of ablation zones on post-op CECTs was matched point by point per direction. The distance between each 2 points was measured and grouped by distance. The incidence of each specific distance was then converted into a percentage, first for each case separately, then for all cases altogether. Data were tested by a matched paired one-sided t test. Results: The median lesion diameter was 1.5 cm (range 0.5–3.3) with 16 (62%) HCC cases and 9 hepatic metastases (4 neuroendocrine carcinoma, 4 colorectal carcinomas, 1 breast carcinoma, 1 pancreatic cancer). The data show a consistent volume expansion greater than 30% (p = 7.7e−5) 24-h post-ablation, where the median expansion is 57%. Distances between T = 0 and T = 24 equal to 3–7 mm occur in over 35% of the cases. Conclusion: The ablation zone expansion at 24-h post-op was not uniform. The final ablation zone is difficult to predict at the time of the procedure. The awareness of the ablation zone expansion is important when treating near-critical structures, managing the heat sink effect, and preserving liver parenchyma. [ABSTRACT FROM AUTHOR]

Abstract Objective Knowing factors that impact catheter stay duration is important since removing drainage catheters too early or late can have significant consequences. We present a single center retrospective study that analyzes multiple variables, including abscess size, white blood cell count, and patient age, to see if a correlation between them and duration of catheter stay exists. The inclusion criteria were patients that had abdominal abscesses treated with percutaneous abscess drainage using a pigtail catheter, ≥ 18 years of age, and had available medical images and records. 44 patients were included. Results Among white blood cell count, patient age, and abscess volume, the only significant relationship with duration of catheter stay was abscess size (R = 0.42, p-value = 0.0049).

Abstract The purpose of the current work was to develop and characterize ethosomes of vitamin D3 gel that could more effectively work against psoriasis. Psoriasis is a chronic immune-mediated inflammatory skin disease. Due to vitamin D3 role in proliferation and maturation of keratinocytes, it has become an important local therapeutic option in the treatment of psoriasis. In this research we have initiated worked on ethosomes gels containing vitamin D3 to treat psoriasis. Soya lecithin 1–8% (w/v), propylene glycol and ethanol were used to create the formulations, which were then tested for vesicle size, shape, surface morphology, entrapment effectiveness, and in vitro drug permeation. The drug encapsulation efficiency of ethosomes was 96.25% ± 0.3. The particle sizes of the optimized ethosomes was 148 and 657 nm, and the PDI value was 0.770 ± 0.12 along with negative charge − 14 ± 3. Fourier transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC) along with thermogravimetric analysis (TGA) studies confirmed the absence of interactions between vitamin D3 and other ingredients. It was determined that the total amount of medication that penetrated the membrane was 95.34% ± 3. Percentage lysis was very negligible for all strengths which were found less than 15%. Based on our research, ethosomes appear to be safe for use. The vitamin D3 ethosomal gel order, description, pH, and viscosity were all within the specified ranges, according to the findings of a 6-month investigation into the stability profile of the completed system. In this research, we successfully prepared ethosomes loaded with vitamin D3 and then converted it into gel for patients’ easy applications.

Abstract Background An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population. Objective To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs. Methods This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio

Objectives: Rheumatic mitral stenosis (RMS) remains a significant health challenge, particularly in low- and middle-income countries, due to limited access to preventive measures and timely treatment. Percutaneous mitral balloon valvuloplasty (PMBV) has become the preferred treatment for RMS, offering a less invasive alternative to surgical mitral valve replacement. This study aimed to evaluate the demographic, clinical, and echocardiographic characteristics of patients with RMS undergoing PMBV and to assess the procedural outcomes. Materials and Methods: This study included 52 patients who underwent PMBV RMS. Patients with non-RMS, incomplete patient files, or previous valve surgeries were excluded. Results: The procedural success rate was 87%, with better outcomes observed in patients with a Wilkins score ≤8 than in those with a score >8. PMBV resulted in a significant increase in mitral valve area (MVA) (from 1.18±0.19 cm² to 2.27±0.48 cm², p=0.001) and a decrease in both mean mitral valve gradient (from 12.82±3.5 mmHg to 5.97±2.04 mmHg, p=0.001) and maximum mitral valve gradient (from 27.12±14.0 mmHg to 12.70±3.1 mmHg, p=0.001). Although the procedure was generally safe, manageable complications, such as chordal rupture (1 case, 1.9%) and mitral regurgitation (MR) progression, were observed, particularly in patients with higher Wilkins scores. Conclusion: The significant improvements in MVA and reduced gradient observed in our study underscore the effectiveness of PMBV, even in patients with higher Wilkins scores. Although we observed manageable complications, such as chordal rupture and MR progression, the overall safety and efficacy of PMBV in our patient population highlight its value as a practical and effective treatment option for RMS in our clinical setting. These findings support the continued use of PMBV as a standard treatment approach in our region, potentially enhancing the quality of care for patients with this condition.

The purpose of this study was to examine the factors influencing the efficacy and safety of the ultrasound-guided radiofrequency ablation of renal tumors. Between January 2010 and December 2018, 159 patients with renal tumors treated with ultrasound-guided percutaneous radiofrequency ablation at our institution were included in this study. Biopsies were performed for histopathological analysis prior to each ablation. Patients underwent computed tomography follow-ups at 3, 6, and 12 months and were subsequently observed on an annual basis. The primary efficacy rate (i.e., residual tumor), local tumor progression, morbidity and mortality, and possible outcome predictors (age, body mass index, gender, tumor size, tumor location, tumor characteristics, ablation temperature, and reported technical problems) were analyzed using binary logistic regression. At the first follow-up, 3 months after ablation, the primary efficacy rate was 79%. Two percent of the tumors showed local tumor progression during the whole follow-up. Tumor proximity to the collecting system and the final temperature in the ablation region were associated with the occurrence of residual tumor (OR = 2.85, p = 0.019 and OR = 4.23, p = 0.006, respectively). A similar trend was shown for tumors larger than 3 cm (p = 0.066). A short distance to the collecting system and the ablation temperature were significantly related to the occurrence of residual tumors after the radiofrequency ablation of small renal masses. The ultrasound guidance used in our study has a lower primary efficacy rate than the computed tomography guidance used in comparable studies.

ABSTRACT Purpose: to identify risk factors for urinary septic shock in patients who underwent percutaneous nephrolithotomy (PCNL). Materials and Methods: Data from PCNL procedures performed between January 2009 and February 2020 were retrospectively analyzed. The study included all patients over 18 years old with kidney stones larger than 15 mm who underwent PCNL. Patients who underwent mini-PCNL or combined surgeries, such as ureteroscopy or bilateral procedures, were not included in the study. Logistic regression was conducted to determine the risk factors for urinary septic shock within 30 days post-operation in patients who underwent PCNL. Results: Urinary septic shock was observed in 8 out of the 1,424 patients analyzed (0.56%). The presence of comorbidities, evaluated using the Charlson Comorbidity Index (CCI) (OR 1.46 [CI 95% 1.15-1.86], p=0.01), larger stones (41.0 mm [IQR 30.0-47.5 mm] vs. 24.0 mm [IQR 17.0-35.0 mm], OR 1.03 [CI 95% 1.01-1.06], p=0.04), and a positive preoperative urine culture (OR 8.53 [CI 95% 1.71-42.45], p 2, larger stones (≥ 35 mm), and a positive preoperative urine culture were at even higher risk of urinary septic shock (OR 15.40 [CI 95% 1.77-134.21], p=0.01). Conclusion: Patients with larger stones, positive preoperative urine culture, and a higher CCI are at risk for urinary septic shock after PCNL. These findings are of utmost importance for optimizing the perioperative care of these patients to prevent life-threatening complications.

Purpose: To provide an updated systematic review on the use of geniculate artery embolization (GAE) in the management of recurrent hemarthrosis post-total knee arthroplasty (TKA). Materials and Methods: A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications, and follow-up data were extracted and analyzed using STATA 14.1. Results: A total of 20 studies (9 case reports, 11 case series; n= 214) were included for review. In all cases, patients underwent coil embolization of one or more geniculate arteries. Procedure success was reported in 94.8% (n=203/214) of cases without perioperative adverse events. Improvement of symptoms was seen in 72.6% (n=119/164) of cases, with 30.7% (n=58/189) of cases requiring repeat embolization. Recurrent hemarthrosis occurred in 22.2% (n=22/99) of cases over a mean follow-up of 48 months. Conclusion: GAE appears to be a safe and effective treatment for recurrent hemarthrosis following TKA. Future studies in the form of randomized controlled trials should be conducted to further evaluate such embolization techniques and compare outcomes between GAE and standard techniques. Clinical Impact: Conservative management of post total knee arthroplasty (TKA) hemarthrosis is successful in only one third of cases. Geniculate artery embolization (GAE) has recently gained attention due to its minimally invasive nature compared to open or arthroscopic synovectomy promising faster rehabilitation, decreased infection rates and less additional surgeries. The purpose of this article was to summarize current literature, provide an updated review on the use of GAE in the management of recurrent hemarthrosis post-TKA and describe immediate and long-term outcomes in an effort to help optimize current treatment algorithms. [ABSTRACT FROM AUTHOR]

Background and objective: Staghorn stones are large branching stones that completely or partially occupy the renal pelvis and renal calyces. The developments in the urological field have decreased the role of open surgery (OS) and currently percutaneous nephrolithotomy (PCNL) is considered as the gold standard procedure for the management of staghorn stone. This study aimed to determine the outcomes of open surgery and percutaneous nephrolithotomy for the treatment of unilateral staghorn stone. Methods: This retrospective analysis included 76 patients with unilateral staghorn stone who had been treated with either percutaneous nephrolithotomy (57) or open surgery (19). A comparison was made between the mentioned groups (PCNL vs. OS). Results: The differences between the two groups were not significant in term of preoperative characteristics. In addition, there was no significant difference between the two groups for intraoperative, postoperative complications and the rate of stone clearance (P = 0.447, P = 0.180, P = 0.259 respectively). The means of postoperative hospital stay (days) and recovery time (weeks) were significantly lower in the PCNL than OS (P

Abstract Background Whether endobiliary radiofrequency ablation (EB-RFA) changes the standard role of stent placement in treating unresectable malignant biliary obstruction (MBO) remains unclear. The aim of this study is to compare percutaneous EB-RFA and metal stent placement (RFA-Stent) with metal stent placement alone (Stent) in treating unresectable MBO using a propensity score matching (PSM) analysis. Methods From June 2013 to June 2018, clinical data from 163 patients with malignant biliary obstruction who underwent percutaneous RFA-Stent or stenting alone were retrospectively analyzed using a nearest-neighbor algorithm to one-to-one PSM analysis to compare primary and secondary stent patency (PSP, SSP), overall survival (OS) and complications between the two groups. Results Before matching, for whole patients, RFA-Stent resulted in longer median PSP (8.0 vs. 5.1 months, P = 0.003), SSP (9.8 vs. 5.1 months, P

Duodeno-duodenostomy (DD) has been proposed as a more physiological alternative to conventional duodeno-jejunostomy (DJ) for pancreas transplantation. Accessibility of percutaneous biopsies in these grafts has not yet been assessed. We conducted a retrospective study including all pancreatic percutaneous graft biopsies requested between November 2009 and July 2021. Whenever possible, biopsies were performed under ultrasound (US) guidance or computed tomography (CT) guidance when the US approach failed. Patients were classified into two groups according to surgical technique (DJ and DD). Accessibility, success for histological diagnosis and complications were compared. Biopsy was performed in 93/136 (68.4%) patients in the DJ group and 116/132 (87.9%) of the DD group (p = 0.0001). The graft was not accessible for biopsy mainly due to intestinal loop interposition (n = 29 DJ, n = 10 DD). Adequate sample for histological diagnosis was obtained in 86/93 (92.5%) of the DJ group and 102/116 (87.9%) of the DD group (p = 0.2777). One minor complication was noted in the DD group. The retrocolic position of the DD pancreatic graft does not limit access to percutaneous biopsy. This is a safe technique with a high histological diagnostic success rate. [ABSTRACT FROM AUTHOR]

Background: Whether endobiliary radiofrequency ablation (EB-RFA) changes the standard role of stent placement in treating unresectable malignant biliary obstruction (MBO) remains unclear. The aim of this study is to compare percutaneous EB-RFA and metal stent placement (RFA-Stent) with metal stent placement alone (Stent) in treating unresectable MBO using a propensity score matching (PSM) analysis. Methods: From June 2013 to June 2018, clinical data from 163 patients with malignant biliary obstruction who underwent percutaneous RFA-Stent or stenting alone were retrospectively analyzed using a nearest-neighbor algorithm to one-to-one PSM analysis to compare primary and secondary stent patency (PSP, SSP), overall survival (OS) and complications between the two groups. Results: Before matching, for whole patients, RFA-Stent resulted in longer median PSP (8.0 vs. 5.1 months, P = 0.003), SSP (9.8 vs. 5.1 months, P < 0.001) and OS (7.0 vs. 4.5 months, P = 0.034) than the Stent group. After matching (54 pairs), RFA-Stent also resulted in better median PSP (8.5 vs. 5.1 months, P < 0.001), SSP (11.0 vs. 6.0 months, P < 0.001), and OS (8.0 vs. 4.0 months, P = 0.007) than Stent. RFA-Stent was comparable with Stent for complication rates. In Cox analysis, RFA-Stent modality and serum total bilirubin level were independent prognostic factors for PSP. RFA-Stent modality, performance status score and combination therapy after stent were independent prognostic factors for OS. Conclusion: Percutaneous RFA-Stent was superior to Stent in terms of PSP, SSP, and OS in selected patients with unresectable MBO. [ABSTRACT FROM AUTHOR]

Purpose: To date, the surgical treatment of severe hallux valgus deformity remains challenging despite the various methods presented. This study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting severe hallux valgus deformities. Methods: This prospective follow-up study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up. Results: In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01). Conclusions: p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating severe hallux valgus deformities. [ABSTRACT FROM AUTHOR]

The rise of minimally invasive lumbar fusions and advanced imaging technologies has facilitated the introduction of novel surgical techniques with the trans-facet approach being one of the newest additions. We aimed to quantify any pathology-driven anatomic changes to the trans-facet corridor, which could thereby alter the ideal laterality of approach to the disc space. In this retrospective cohort study, we measured the areas and maximum permissible cannula diameters of the trans-facet corridor using commercially available software (BrainLab, Munich, Germany). Exiting and traversing nerve roots, thecal sacs, and lumbar vertebrae were manually segmented on T2-SPACE magnetic resonance imaging. Spondylolisthesis, disc protrusions, and disc space heights were recorded. A total of 118 trans-facet corridors were segmented bilaterally in 16 patients (65.6 ± 12.1 years, 43.8% female, body mass index 29.2 ± 5.1 kg/m2). The mean areas at L1–L2, L2–L3, L3–L4, and L4–L5 were 89.4 ± 24.9 mm2, 124 ± 39.4 mm2, 123 ± 26.6 mm2, and 159 ± 42.7 mm2, respectively. The mean permissible cannula diameter at the same levels were 7.85 ± 1.43 mm, 8.98 ± 1.72 mm, 8.93 ± 1.26 mm, and 10.2 ± 1.94 mm, respectively. Both parameters increased caudally. Higher degrees for spondylolisthesis were associated with larger areas and maximum cannula diameters on regression analysis (P < 0.001). Our results illustrate that pathology, like spondylolisthesis, can increase the area of the trans-facet corridor. By understanding this effect, surgeons can better decide on the optimal approach to the disc while taking into consideration a patient's unique anatomy. [ABSTRACT FROM AUTHOR]

Showing results of open and percutaneous surgical management of traumatic AO type A3, A4 and B2 thoracic and lumbar fractures. Retrospective comparative analysis of traditional open fusion versus percutaneous navigated fixation of thoracic and lumbar spinal fractures. Minimum 24 months follow-up to collect ODI and VAS outcome scores for comparative analysis was required. Fifty-seven patients with a mean age of 39 years met the inclusion criteria. Twenty-six patients were in the open group (Group O) and 31 in the percutaneous group (Group P). The majority of fractures were either type A3 or A4; there were three type B chance fractures in Group O and one in Group P. VAS and ODI scores followed comparable trends in the two groups until the final follow-up. The main statistically significant result between the two groups was blood loss, which was lower in Group P (110 versus 270 ml in Group O on average), although this did not reflect into different clinical outcomes. Similar peri-operative measures of operating time and length of stay were found between the two groups. A significantly higher degree of loss of reduction was noted at follow-up in Group P (8° versus 5° in Group O on average). Open and percutaneous posterior fixation techniques of thoracic and lumbar fractures in this cohort were associated with different perioperative blood losses as well as radiological measurements, but not with clinically meaningful differences in patient reported outcome measures at 24 months' follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The expression "learning curve" indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called "minimally invasive surgery") has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet necessary to become skilled in a specific minimally invasive surgery (MIS) procedure. Methods: From January 2015 to June 2018, 46 consecutive patients were evaluated and included in the study. Patients were divided into 2 groups according to the surgery period: first 30 feet (Group 1), and subsequent 30 feet (Group 2) from the whole population evaluated. Age, body mass index, and operative time were evaluated. Hallux valgus angle and the 1 to 2 intermetatarsal angle were also measured. Patients were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) forefoot scale, the Foot and Ankle Ability Measure activities of daily living (FAAM ADL) subscale and the visual analog scale (VAS). Results: The comparison of the 2 groups showed statistically significant differences in hallux valgus angle (HVA) but not in intermetatarsal angle (IMA). The mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS score in Group 1 were 12.83, 3.93, and 24.77 points, respectively. In Group 2, the mean improvement between pre- and postoperative FAAM ADL, VAS, and AOFAS scores were 15.19, 4.3, and 24.5 points, respectively. The differences between groups in FAAM ADL score was statistically significant (P = 0.0364). Group 1 showed a global complication rate of 16.67% (n = 5) while group 2 showed 3,3% (n = 1). Conclusion: After the first 30 cases, radiographic, clinical, and functional outcomes substantially improved, and the level of the perioperative complications decreased. The results suggest that the learning curve plateau for performing a percutaneous subcapital osteotomy can be reached after 30 surgeries. Levels of Evidence: Level III [ABSTRACT FROM AUTHOR]

Purpose: To assess multicenter two-year patency outcomes of endovascular arteriovenous fistulas (endoAVF) created with the WavelinQ device. Materials and Methods: Patients who had fistulas created at three centers from January 2018 to December 2020 were included in this retrospective study. In total, 112 patients underwent endoAVF creation [40 females, 72 males; mean age 60 years (range 18–88)]. Data collected included patient demographics, location of fistula creation, interventions performed, and brachial artery flows pre- and post-creation. Two-year cumulative patency, functional patency, and primary patency were assessed with Kaplan–Meier methodology. Factors affecting patency and maturation were examined using the Cox proportional hazards model. Results: Technical success defined as angiographically successful endoAVF creation was 97.3% (109/112). In 11 patients the fistula did not mature for dialysis use. For 98 patients (87%) with endoAVF maturation, 12- and 24-month cumulative patency was 94.3% and 91.7%. Functional patency (two-needle cannulation) at 12 and 24 months was 95.7% and 92.7%, respectively. Median maturation time is 95 days (IQR 51–231 days). Male gender and brachial vein coiling at the time of endoAVF creation were predictive of maturation. There were 34 censored events (four patients undergoing renal transplantation; 30 patients deceased). Number of reinterventions per patient year was 0.73 where 43 were maturation procedures and 101 were maintenance procedures. One Grade 3 complication occurred of arterial access puncture site pseudoaneurysm. Conclusion: A high two-year functional and cumulative patency following endoAVF creation with the WavelinQ device was observed in this multicenter real-world experience Level of Evidence: 3 Level of Evidence III [ABSTRACT FROM AUTHOR]

Introduction: Cardiogenic shock (CS) is a complex life-threatening condition that results from primary cardiac dysfunction, leading to persistent hypotension and systemic hypoperfusion. Among the therapeutic options for CS are various percutaneous mechanical circulatory support (MCS) devices that have emerged as an increasingly effective hemodynamic support option. Percutaneous therapies can act as short-term mechanical circulatory assistance and can be split into intra-aortic balloon pump (IABP) and non-IABP percutaneous mechanical devices. Areas covered: This review will evaluate the MCS value while considering the mortality rate improvements. We also aim to outline the function of pharmacotherapies and percutaneous hemodynamic MCS devices in managing CS patients to avoid the onset of end-organ dysfunction and improve both early and late outcomes. Expert opinion: Given the complexity, acuity and high mortality associated with CS, and despite the availability and efficacy of pharmacological management, MCS is required to achieve hemodynamic stability and improve survival. Various percutaneous MCS devices are available with varying indications and clinical outcomes. The rates of early mortality and complications were found to be comparable between the four devices, yet, IABP seemed to show the most optimal clinical profile whilst ECMO demonstrated its more long-term efficacy. [ABSTRACT FROM AUTHOR]

Purpose: To describe a completely percutaneous approach for endovascular arch repair (arch–percutaneous endovascular aortic repair [PEVAR]) with a triple inner-branch device: the "Innominate Approach." Technique: After right axillary and single common femoral arteries percutaneous access, the arch stent-graft is introduced and deployed transfemorally using fusion overlay. The brachiocephalic artery (BCA) and the corresponding inner branch are cannulated from the axillary access. Through this access, a steerable-sheath guides antegrade cannulation of the left common carotid artery (LCCA) through its inner branch. Optionally, a wire preloaded through the left subclavian artery (LSA) and the LCCA branch, is snared from the BCA access providing LCCA through and through access. A 10 Fr sheath is then positioned from the BCA branch in the LCCA branch and a second, trans-axillary wire through the same sheath is used to catheterize the LCCA. The LCCA is then stented antegradely (regardless of approach). Finally, the BCA and LSA are bridged to complete the procedure. An additional novelty described is the use of VBX (W. L. Gore) as a bridging stent for the BCA. Conclusion: Arch-PEVAR is feasible with the use of adjuncts that are well-known for physicians performing complex endovascular repair. The "Innominate Approach" avoids access and exposure of the carotid arteries. Clinical Impact: We aim to describe the feasibility of the axillary artery as the main route to perform the brachiocephalic artery (BCA) and the left common carotid artery bridging stenting in case of arch endovascular repair (arch-EVAR) with a triple Inner-Branch Device. According to the present "Innominate Approach", percutaneous arch-EVAR is feasible using either a steerable sheath or a preloaded through-&-through wire. The Innominate approach, including a VBX bridging stent for the BCA, avoids carotid access and exposure, reduces the number of vascular accesses, and allows the downsizing of the trans-axillary devices. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment for trigeminal neuralgia includes percutaneous techniques, including balloon compression, first described in 1983 by Mullan and Lichtor (J Neurosurg 59(6):1007–1012, 6). Method: Here we present a safe and simple navigation-assisted percutaneous technique for balloon compression, which can also be used for glycerol injection. Conclusion: The navigation-assisted percutaneous technique for balloon compression for trigeminal neuralgia is a quick and safe treatment for patients not candidates for microvascular decompression. [ABSTRACT FROM AUTHOR]

Background: Disorders of consciousness (DoC) represent a spectrum of neurological conditions that pose significant treatment challenges. Percutaneous short-term spinal cord stimulation (SCS) has emerged as a promising experimental diagnostic treatment to assess and potentially improve consciousness levels. However, the effectiveness of this intervention is frequently compromised by the shift of electrodes, particularly in the cervical region, which can negatively affect therapeutic outcomes. Methods: This retrospective study aimed to study if electrodes shift in percutaneous short-term SCS in patients with DoC would affect the outcome. We analyzed the relationship between electrode shift length and patient outcome, as well as the correlation with various anatomical parameters, including the actual length of the cervical spine, linear length, spinal canal transverse diameter, spinal canal diameter, and C2 cone height, in a cohort of patients undergoing the procedure. Results: Our findings revealed that in patients with better outcome, there are significant less patient with electrode shift (p = 0.019). Further, a linear correlation was found between the length of electrode shift and patients' outcome (Rho = 0.583, p = 0.002), with longer shift lengths associated with poorer outcomes. Contrary to our expectations, there was no significant association between the measured anatomical parameters and the extent of electrode shift. However, a trend was found between the actual length of the cervical spine and the shift of the electrode (p = 0.098). Notably, the shorter spinal canal transverse diameter was found to be significantly associated with better outcome in patients with DoC receiving percutaneous short-term SCS (p = 0.033). Conclusion: These results highlight the clinical importance of electrode stability in the cervical region during SCS treatment for patients with DoC. Ensuring secure placement of electrodes may play a crucial role in enhancing patients' outcome and minimize postoperative complications. Given the lack of association with expected anatomical parameters, future research should investigate other factors that could impact electrode stability to optimize this therapeutic intervention. [ABSTRACT FROM AUTHOR]

Introduction: Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. Methods: Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at p < 0.05. Results: The mean age was 40.21 ± 17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3 ± 6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5 ± 1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. Conclusion: Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. Level of evidence: II, prospective cohort study. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the factors influencing the diagnostic yield of microbiologic diagnosis obtained through percutaneous abdominal abscess drainage procedures. We analyzed the influence of diverse clinical, radiological, and pre-procedural factors on the success of microbiologic diagnosis in this context. Methodology: A retrospective analysis of patients who underwent percutaneous abdominal abscess drainage was performed to assess the factors affecting the diagnostic yield for microbiologic diagnosis. Results: A total of 174 patients undergoing percutaneous abdominal abscess drainage was included. The use of antibiotics during the procedure and the spread of the abscess to other organs significantly increased the likelihood of obtaining a positive culture. Specifically, antibiotic use during the procedure raised the risk by up to 3.30-fold (OR = 3.30, 95% CI 1.48-7.65, p = 0.004), while abscess spread to another organ increased the risk by approximately 1.87-fold (OR = 1.87, 95% CI 0.98-3.61, p = 0.057). Additionally, abscesses containing air and abscesses with an air-fluid level were more common in patients with positive culture results. Other factors, such as gender, age, malignancy prevalence, and surgical history, did not significantly impact culture results. Conclusions: This study provides valuable insights into the factors affecting the diagnostic yield of microbiologic diagnosis from percutaneous abdominal abscess drainage. The findings underscore the importance of considering patient-specific variables and procedural aspects when planning and executing abscess drainage procedures. Further research can build upon these insights to develop evidence-based guidelines for optimizing the diagnostic yield of percutaneous abdominal abscess drainage procedures. [ABSTRACT FROM AUTHOR]

Objectives Rheumatic mitral stenosis (RMS) remains a significant health challenge, particularly in low- and middle-income countries, due to limited access to preventive measures and timely treatment. Percutaneous mitral balloon valvuloplasty (PMBV) has become the preferred treatment for RMS, offering a less invasive alternative to surgical mitral valve replacement. This study aimed to evaluate the demographic, clinical, and echocardiographic characteristics of patients with RMS undergoing PMBV and to assess the procedural outcomes. Materials and Methods This study included 52 patients who underwent PMBV RMS. Patients with non-RMS, incomplete patient files, or previous valve surgeries were excluded. Results The procedural success rate was 87%, with better outcomes observed in patients with a Wilkins score ≤8 than in those with a score >8. PMBV resulted in a significant increase in mitral valve area (MVA) (from 1.18±0.19 cm² to 2.27±0.48 cm², p=0.001) and a decrease in both mean mitral valve gradient (from 12.82±3.5 mmHg to 5.97±2.04 mmHg, p=0.001) and maximum mitral valve gradient (from 27.12±14.0 mmHg to 12.70±3.1 mmHg, p=0.001). Although the procedure was generally safe, manageable complications, such as chordal rupture (1 case, 1.9%) and mitral regurgitation (MR) progression, were observed, particularly in patients with higher Wilkins scores. Conclusion The significant improvements in MVA and reduced gradient observed in our study underscore the effectiveness of PMBV, even in patients with higher Wilkins scores. Although we observed manageable complications, such as chordal rupture and MR progression, the overall safety and efficacy of PMBV in our patient population highlight its value as a practical and effective treatment option for RMS in our clinical setting. These findings support the continued use of PMBV as a standard treatment approach in our region, potentially enhancing the quality of care for patients with this condition. Keywords:Balloon valvuloplasty, gradient mitral, stenosis, percutaneous, rheumatic, Wilkins scores: [ABSTRACT FROM AUTHOR]

Introduction and aim. Orthopedic surgeries often require acquiring cancellous bone grafts, commonly sourced from the iliac crest. Traditional harvesting methods pose risks of donor site morbidity, prompting interest in minimally invasive techniques. This study introduces and evaluates the efficacy and safety of a percutaneous technique using a tap and drill sleeve for iliac crest bone graft harvesting. This study aims to assess outcomes and complications associated with a minimally invasive percutaneous technique for iliac crest bone graft harvesting through a retrospective analysis of twenty patients undergoing upper limb reconstructive surgery. Material and methods. A retrospective analysis was conducted on twenty patients who underwent upper limb reconstructive surgery between January and March 2023. The technique involved making a bone deep stab incision, precisely positioning a drill and tap sleeve, utilizing controlled tapping techniques, and extracting the graft. Post-operative assessments included evaluating pain levels, ambulation, and patient satisfaction. Results. The minimally invasive percutaneous technique demonstrated favorable outcomes, with reduced donor site morbidity observed. Within 24 hours post-operatively, 70% of patients reported low visual analogue scale scores, and 80% regained normal walking ability. No instances of post-operative paresthesia were reported. Conclusion. The examined minimally invasive percutaneous technique for iliac crest bone graft harvesting showed reliability and safety, particularly in low resource settings. Utilizing basic orthopedic tools such as tap and drill sleeves offers accessibility and affordability. This approach could effectively mitigate donor site morbidity in orthopedic reconstructive treatments. [ABSTRACT FROM AUTHOR]

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Background: Both an open cheilectomy with a Moberg osteotomy and percutaneous cheilectomy have been successfully used to treat hallux rigidus and preserve motion. However, there have been no studies that have compared these 2 procedures using validated patient-reported outcomes such as the Patient Reported Outcome Measurement Information System. Methods: A retrospective review of hallux rigidus patients between January 2016 and July 2021 collected 48 percutaneous cheilectomy (PC) patients and 71 open cheilectomy with Moberg (OCM) patients. Preoperative and minimum 1-year postoperative PROMIS scores were collected. Results: The OCM and PC cohorts did not have significant differences in their postoperative PROMIS scores. Both cohorts had modest but significant improvements postoperatively in the physical function, pain interference, and pain intensity domains. The OCM group had a larger degree of improvement in physical function, pain interference, and pain intensity (P =.015,.011,.001, respectively). No significant difference was identified in the reoperation rate. Conclusion: Patients undergoing an OCM had worse preoperative PROMIS scores and a modestly greater change in patient-reported outcomes than patients undergoing a PC. Level of Evidence: Level III, retrospective review. [ABSTRACT FROM AUTHOR]

Background: The majority of patients of lung cancer have already lost the chance of surgery at the time of diagnosis. Percutaneous local thermal ablation is a precise minimally invasive technique and a viable alternative to surgical treatment. Compared with radiofrequency ablation and microwave ablation, percutaneous laser ablation for the treatment of lung tumors is less commonly used and reported, especially for primary lung cancer. Case presentation: A 63-year-old male patient with mixed pulmonary nodules selected computed tomography-guided electromagnetic navigation system for percutaneous biopsy and laser ablation therapy. The puncture point was determined through Computed tomography scanning, along with the placement of the electromagnetic navigation system locators. After rapid onsite evaluation and pathological examination of the puncture tissue specimen, the diagnosis of lung adenocarcinoma was confirmed. A 980-nanometer wavelength semiconductor laser fiber was inserted into the appropriate position guided by the electromagnetic navigation system. Subsequently, a power of 7 watt was applied to ablate the tumor for 30 seconds, then pause for 60 seconds before repeating the procedure. Positron emission tomographyComputed tomography examination was performed 1 month after operation, suggesting complete response of the tumor. Conclusion: Here, we present a case of percutaneous laser ablation treatment for primary lung cancer guided by computed tomography-electromagnetic navigation system. As a more precise, shorter duration, impedanceindependent, safe and effective minimally invasive thermal ablation method, it is expected to gain wider application and become a novel alternative for surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency thermorhizotomy (TRZ) is an established treatment for trigeminal neuralgia (TN). TRZ can result risky and painful in a consistent subset of patients, due to the need to perform multiple trajectories, before a successful foramen ovale cannulation. Moreover, intraoperative x-rays are required. Method: TRZ has been performed by using a neuronavigated stylet, before trajectory planning on a dedicated workstation. Conclusion: Navigated-TRZ (N-TRZ) meets the expectations of a safer and more tolerable procedure due to the use of a single trajectory, avoiding critical structures. Moreover, N-TRZ is x-ray free. Efficacy outcomes are similar to those reported in literature. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatic cancer ranks as the fourth deadliest form of cancer. However, it is essential to note that not all pancreatic masses signal primary malignancy. Therefore, it is imperative to establish the correct differential diagnosis, a process further supported by pre-operative biopsy procedures. This meta-analysis aims to compare the diagnostic performance of two minimally invasive biopsy approaches for pancreatic tissue sampling: percutaneous biopsies guided by computed tomography or ultrasound, and transduodenal biopsies guided by endoscopic ultrasound (EUS). Methods: A systematic literature search was conducted in the MEDLINE and Scopus databases. The included studies analyzed the diagnostic performance of the two biopsy methods, and they were assessed for risk of bias using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. Statistical analysis was carried out using the RevMan and MetaDisc software packages. Results: The statistical analysis of the results demonstrated the superiority of the percutaneous approach. Specifically, the pooled sensitivity, specificity, LR+, LR−and DOR for the percutaneous approach were 0.896 [95% CI: 0.878–0.913], 0.949 [95% CI: 0.892–0.981], 9.70 [95% CI: 5.20–18.09], 0.20 [95% CI: 0.12–0.32] and 68.55 [95% CI: 32.63–143.98], respectively. The corresponding values for EUS-guided biopsies were 0.806 [95% CI: 0.775–0.834], 0.955 [95% CI: 0.926–0.974], 12.04 [95% CI: 2.67–54.17], 0.24 [95% CI: 0.15–0.39] and 52.56 [95% CI: 13.81–200.09], respectively. Nevertheless, it appears that this statistical superiority is also linked to the selection bias favoring larger and hence more readily accessible tumors during percutaneous biopsy procedures. Conclusions: Concisely, our meta-analysis indicates the statistical superiority of the percutaneous approach. However, selecting the optimal biopsy method is complex, influenced by factors like patient and tumor characteristics, clinical resources, and other relevant considerations. [ABSTRACT FROM AUTHOR]

Spinal cord stimulators (SCSs) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6 ± 12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n = 12), too high (n = 2), or incompletely within the epidural space (n = 2). The mean duration from initial implantation to revision surgery was 44.8 ± 47.5 months. The mean operative duration was 126.1 ± 26.9 minutes and all patients required a "skip" laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4 ± 7.3 months. Mean preoperative pain intensity was 7.9 ± 1.5 and at last follow-up was 3.6 ± 1.7 (P < 0.001). All but 1 patient continued to use their device in follow-up. The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring. [ABSTRACT FROM AUTHOR]

Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary drainage (EUS-BD). ERCP has been adopted as a first-line treatment modality but EUS-BD is gradually emerging as a viable alternative. The aim of the current article is to assess the clinical outcomes of the three nonsurgical biliary drainage procedures. Materials and methods. A total of 102 consecutive patients with unresectable biliopancreatic malignancy inducing biliary obstruction and subjected to palliative treatment by means of ERCP, EUS-BD, or PTBD were retrospectively included in the study. Results. No difference in clinical and technical success of the procedures was found: ERCP—97.2% technical; 88.9% clinical; PTBD—94.4% technical, 72.2% clinical; EUS-BD—90% technical; 83.3% clinical. Adverse events (AEs) and reinterventions were significantly more common in PTBD (38.9% and 52.8%) and ERCP (27.9% and 25%) compared to EUS-BD (10% and 3.3%). Total duration of hospital stay and number of hospitalizations were lower in the EUS-BD compared to PTBD and ERCP groups. Conclusions. In the presence of adequate expertise, EUS-BD may be superior to PTBD and ERCP in achieving and sustaining biliary drainage in the setting of unresectable malignancy. [ABSTRACT FROM AUTHOR]

Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included. [ABSTRACT FROM AUTHOR]

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting. [ABSTRACT FROM AUTHOR]

Summary: The treatment strategy for refractory postoperative lymphatic leakage is controversial. While the utility of direct percutaneous embolization of lymphopseudoaneurysm has been investigated, only a few reports on this topic exist. The aim of this study was to evaluate the technical and clinical feasibility and safety of direct percutaneous embolization of lymphopseudoaneurysm for refractory postoperative lymphatic leakage. This case series included six consecutive patients who underwent direct percutaneous embolization of lymphopseudoaneurysm for refractory postoperative lymphatic leakage. Technical success (successful percutaneous approach and injection of NBCA glue to the lymphopseudoaneurysm), clinical success (unnecessity of percutaneous drainage tube of the lymphatic leakage), treatment duration (the duration from the treatment to the achievement of clinical success) and procedure‐related complications were mainly evaluated. Direct percutaneous embolization of the lymphopseudoaneurysm using NBCA glue was successfully performed in all cases. Clinical success was achieved in five of the six cases (83%). The mean treatment period was 9 days for the cases with clinical success. No major complications occurred postoperatively. In conclusion, direct percutaneous embolization of lymphopseudoaneurysm may become a feasible and safe treatment option for cases of refractory postoperative lymphatic leakage. [ABSTRACT FROM AUTHOR]