A new interventional radiologic procedure was developed for treatment of epiphora. A small-bore, soft-tipped guide wire was introduced through the superior canaliculus and guided under fluoroscopic control through the nasolacrimal drainage system for retrieval through the nasal aperture. A small-bore angioplasty catheter was then introduced in a retrograde direction into the nasolacrimal drainage apparatus and dilated under fluoroscopic control. The procedure was attempted in 18 eyes of 17 patients with moderate to severe epiphora and was technically completed in 16; 13 of these cases demonstrated improvement, with 11 patients showing complete resolution of symptoms. In the three patients whose epiphora did not improve, no worsening of symptoms occurred. These results are preliminary; follow-up ranged from 7 weeks to 6 months. The authors believe that this technique may hold promise in the treatment of epiphora and may obviate the use of more invasive procedures.
The real-time ultrasonograms of 15 patients with pancreatic pseudocysts (10 infected and 5 noninfected) were analyzed to evaluate difference in ultrasound characteristics between the infected and noninfected pseudocysts. Only those who underwent ultrasound-guided aspiration or operation within one week after sonography were reviewed according to the size, multiplicity, air content, internal echoes, and wall characteristics (such as thickness, regularity, and calcification) of pseudocysts. Among these ultrasonographic features of pseudocysts, there was no statistically significant difference between the infected and noninfected pseudocysts in cyst size, wall characteristics (thickness, regularity, and calcification), multiplicity, and air content. The most important and unique feature was the internal echoes within the pseudocyst. The internal echoes were classified into three grades. All the infected pseudocysts and one noninfected pseudocysts had internal echoes of grade 1. The difference is statistically significant (p = 0.0037). These results indicate that grading internal echogenicity of the pseudocysts with real-time ultrasonographies can add additional information important in differentiating infected from noninfected pseudocysts.
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