Enhanced Irrigant Delivery to the Ethmoid Sinuses Directly Following Ethmoid Punch Sinusotomy.
Ann Otol Rhinol Laryngol. 2017 Dec;126(12):804-812
Authors: Abuzeid WM, Peterson AZ, Rathor A, Xu JC, Velasquez N, Rashan AR, Thamboo A, Nayak JV
OBJECTIVES: Ethmoid punch sinusotomy (EPS) is a feasible treatment for ethmoid sinusitis in a subset of chronic rhinosinusitis (CRS) patients per a recent report. This adjunctive work investigates the technical characteristics of EPS and determines if EPS measurably alters the topical delivery of irrigant into the ethmoid sinuses in a cadaveric model.
METHODS: The sinonasal cavities of 10 human cadaver heads were irrigated with a solution containing methylene blue and radio-opaque contrast prior to and following EPS. Procedural characteristics and irrigant distribution were assessed by endoscopy and computed tomography.
RESULTS: Forty EPS procedures were performed through the ethmoid bulla and basal lamella. Compared to controls, EPS enhanced dye distribution into the anterior (90% vs 35%, P < .004) and posterior (90% vs 35%, P < .002) ethmoid sinuses, representing a 157% increase for each of these sites. Contrast was detected in a higher proportion of anterior (65% vs 5%, P < .001) and posterior (60% vs 0%, P < .001) ethmoid sinuses. Endoscopically guided catheter instillation of contrast through the EPS sites achieved radiotracer distribution throughout the ethmoid complex.
CONCLUSIONS: Ethmoid punch sinusotomy sites can be reliably created via micro-minimally invasive procedures. Ethmoid punch sinusotomy improves irrigant delivery to the ethmoid sinuses, providing mechanistic understanding for the clinical outcomes observed in CRS patients.
PMID: 29047295 [PubMed - indexed for MEDLINE]
Percutaneous Cholecystostomy and Hydrodissection in Radiofrequency Ablation of Liver Subcapsular Leiomyosarcoma Metastasis Adjacent to the Gallbladder: Protective Effect.
J Radiol Case Rep. 2016 Oct;10(10):24-32
Authors: Azevedo A, Falsarella P, Rocha R, Rahal A, Garcia R
Uterine leiomyosarcoma is an uncommon pathology, predominantly found in aged population. Patients with metastatic disease have poor survival and therapy mainly consists of palliative systemic chemotherapy. However, more aggressive strategies such as radiofrequency ablation (RFA) may benefit patients with limited secondary disease. RFA is considered a simple and safe modality for treatment of hepatic lesions. The benefits related to RFA include low morbidity, short hospital stay and the possibility to repeat the procedure when necessary due to recurrences. However, minor and major complications related to mechanical and thermal damage may occur, especially in cases of tumors adjacent to extrahepatic organs and those at subcapsular position. This case report shows a successful RFA of two hepatic subcapsular leiomyosarcoma metastases neighbouring the gallbladder, without a safe cleavage plane from it. Combined hydrodissection, percutaneous cholecystostomy and continuous irrigation were performed as effective techniques to prevent thermal injury. Clinical and radiological follow up demonstrates no local complication.
PMID: 28580054 [PubMed - indexed for MEDLINE]