Objective: To study the frequency of pneumothorax and intrapulmonary haemorrhage in computed tomography (CT) guided transthoracic needle lung biopsy (NLB) and the factors that affect the development of these complications in Pakistan through a representative limited data obtained from a tertiary care centre. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, from Jan 2018 to Feb 2019. Methodology: A total of 68 patients who underwent CT-guided transthoracic biopsy were evaluated for intra- and immediate (within 04 hours) post-procedural pneumothorax and pulmonary haemorrhage. The factors affecting the development of these complications were evaluated. Results: Complications developed in 30 patients with the frequency of pneumothorax at 26.5 % and frequency of pulmonary haemorrhage at 19.1%. Significant risk factors for the development of pneumothorax were small lesions less than 2.5 cm in diameter (p-value <0.05), increased needle track path within the lung tissue of more than 21 mm (p-value = 0.05), and presence of emphysema in the surrounding lung tissue (p-value <0.05). In addition, smaller lesion size (p-value <0.05) and increased traversed lung parenchyma (p-value <0.05) were also significant factors in the development of intrapulmonary haemorrhage. Conclusion: Significant risk factors for pneumothorax and intrapulmonary haemorrhage are smaller lesion size and length of puncture path. The presence of emphysema is related to the development of pneumothorax.
Objective: To compare treatment with drug eluting beads Transarterial Chemoembolization (DEB TACE) vsConventional Transarterial chemoembolization (cTACE) in hepatocellular carcinoma (HCC) patients at firstfollow up.Study Design: Comparative Interventional Study.Place and Duration of Study: The study was conducted in the department of Radiology CMH Rawalpindiand Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi from July 2015 to May 2019.Materials and Methods: 254 patients were included in the study. Conventional TACE was done on 176 patientsand DEB TACE was done on 78 patients. All patients were called for follow up after 06 weeks. First responseevaluation of treated lesions in these patients was seen on triphasic CT liver after 06 weeks of TACE therapy.Results: On first follow up, out of 176 patients with cTACE, 'Total response' was seen in 90(51.1%) patients,'Partial response' in 76 patients (43.1%),'No response' in 04(2.27%) patients.' Progressive disease' was seen in06(3.4%) patients.DEB TACE was done in 78 patients. Out of these, 27 (34.6%) patients showed 'Total response'. 50(64.1%)patients showed 'Partial response', 'Progressive disease' was seen in one patient (.02%).Conclusion: The findings of this study have shown that c TACE has a better outcome regarding first responseevaluation. 'No response' to treatment was not seen in any patient with DEB TACE.
Objective: To assess the efficacy of intra-arterial lidocaine in peri & post-procedural pain control and the dose of narcotic analgesic required in hepatocellular carcinoma patients undergoing transarterial chemoembolization. Study Design: Comparative prospective study. Place and Duration of Study: Armed Forces Institute of Radiology and Imaging Rawalpindi, from Jan to Jun 2019. Methodology: A total of 60 patients included in this study where 42 males and 18 were females, age range 45-85 years who underwent transarterial chemoembolization for hepatocellular carcinoma, were included in the study. patients were equally divided into two groups, group a (30 patients) who underwent transarterial chemoembolization, received 60 mg of intraarterial lidocaine each and group b (30 patients) who underwent transarterial chemoembolization, intra-arterial lidocaine was substituted with normal saline.degree of post-procedural pain was assessed using a subjective method (visual analogue scales score) and an objective method (amount of post-procedural analgesics). Results: Average peri-procedure visual analogue scale score was 5.06 in group A patient versus 7.2 for those in group B patients (p=0.037). Post-procedure visual analogue scale score in the group A was 2.7 ± 0.520 and that for group B was 4.2 ± 0.761 (p=0.025). Mean of total dose of nalbuphine in group A was 4.96 ± 0.764 mg versus 8.3 ± 1.34 mg for patients in group B (p=0.036). Average length of post procedure hospital stay was 0.9 ± 0.203 and 1.41 ± 0.373 days for group A and group B respectively (p=0.002).Conclusion: Intra-arterial administration of lidocaine before infusing the embolization particles for transarterial chemoembolization.....................
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