Background Transthoracic core needle biopsy (TTCNB) became a routinely offered procedure in Tanzania in October 2018. This study evaluates the safety and effectiveness of establishing a TTCNB program in a resource-limited setting.
Methodology A single center, prospective, observational cohort study was conducted at Muhimbili National Hospital on 90 patients who underwent computed tomography-guided TTCNB from October 2018 to May 2021. Patient and procedural data, including demographic information, complications, pathology results, and clinical outcomes, were stored in a Research Electronic Data Capture (REDCap) database. Follow-up was conducted at 4 weeks postprocedure by phone. Descriptive analysis was performed using Statistical Package for Social Sciences.
Results A total of 90 patients underwent TTCNB. Seven samples were lost or never processed. In total, 68/83 (81.9%) of processed samples were diagnostic, with 89.7% (n = 61) classified as malignant and 10.3% (n = 7) classified as benign. Overall, 82.4% (n = 56) were classified as primary malignancies, 7.4% (n = 5) as metastatic malignancies, 5.9% (n = 4) as benign tumors, and 4.4% (n = 3) as infectious. Reasons for nondiagnostic samples were crashed/insufficient samples in 53.3% (n = 8) and nonspecific chronic inflammation in 46.7% (n = 7). Minor (Society of Interventional Radiology [SIR] class A and B) complications occurred in 8 cases (8.9%), while there was 1 (1.1%) major complication (SIR class F). A total of 44/90 (48.9%) patients could be reached for follow-up at 4 weeks postprocedure. In addition, 31/44 (70.5%) of these patients had a diagnosis of malignancy. Of these, 20 received chemotherapy, 8 died prior to receiving any treatment, 2 declined any further medical or surgical intervention, and 1 was treated with surgical excision and adjuvant chemotherapy.
Conclusion Although recently introduced in Tanzania, TTCNB has been performed with 81.9% diagnostic accuracy and a complication rate comparable to existing literature.
localization of 42 pulmonary nodules (mean size, 7.3 mm; range, 4-18 mm). A 7 cm platinum micro coil was inserted into pulmonary nodules under CT guidance using a 21-gauge chiba needle. The technical details, surgical and pathologic findings associated with micro coil localizations were retrospectively evaluated. Result(s): All nodules were localized by CT guided micro coil with 100% technical success with mean time 13.4 minutes (range 8-26 minutes). 6 patients developed Mild parenchyma lung hemorrhage along with needle tract and 7 patient developed mild pneumothorax all are asymptomatic and no intervention needed. 3 patients developed moderate pneumothorax for which needle aspiration was performed but not chest tube was inserted. No other complication occurred. All micro coils were identified during the surgery except one which was dislodged and attached to chest wall (41 out of 42 micro coils) 97.6 % clinical success and all nodule were surgically resected. Pathology revealed 28 metastatic pulmonary nodules, 1 primary adenocarcinoma-in-situ and 13 benign pulmonary nodules. Micro coils did not affect the histopathology examination. Conclusion(s): CT-guided micro coil localization is an effective and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of pulmonary nodules.
were referred late 20 days plus postsurgery), six of which had re-surgery and one patient who had residual tubular cutaneousanastomosis fistula had track coiling with cessation of leakage. Conclusion: Fluoroscopic-guided esophageal stenting might be effective in bypassing anastomotic leakages following bariatric surgeries; however, it should be considered as soon as significant leakage is diagnosed and should be considered before resurgery. Placement of the stents was feasible without major procedurerelated complications.
Background Cervical cancer is the fourth most common cancer among women globally. Age-standardized cervical cancer mortality is higher in East Africa than anywhere else in the world. Prior to October 2018, patients presenting with obstructive uropathy secondary to late-stage cervical cancer in Tanzania who were no longer eligible for palliative chemoradiation therapy were discharged home without intervention. The purpose of this study was to evaluate whether the establishment of a percutaneous nephrostomy service in a quaternary hospital in Dar es Salaam, Tanzania, a resource-limited country, benefits patients who have late-stage cancer induced obstructive uropathy.
Materials and Methods A retrospective study was performed on patients who presented with obstructive uropathy secondary to late-stage cervical cancer and have undergone percutaneous nephrostomy at Muhimbili National Hospital and Ocean Road Cancer Institute from October 2018 to May 2021. Twenty-one interventional radiology (IR) teaching teams consisting of IR attendings, IR technologists, and nurses travelled to Tanzania from North America on monthly 2-week trips during that period. A review of preprocedural, procedural, and follow-up data was performed using Research Electronic Data Capture. Statistical analysis and comparison were performed on patients' creatinine levels preprocedure, 7 days and 30 days postprocedure.
Results Sixty-two patients qualified to be included in this study. In addition to the initial 62 nephrostomy placements, 14 follow-up procedures were performed either under visiting faculty supervision or independently by the Tanzanian IR fellows. Technical success rate was 98.7%. Complications (SIR Class A and B) occurred in eight cases. The average preprocedure creatinine (1051.48 ± 704.08µmol/L) decreased by 59% 7 days postprocedure and by 77% 30 days postintervention. Postprocedural clinical information was obtained for 28 (45.2%) patients and 18 were able to restart chemotherapy following nephrostomy.
Conclusion Prior to 2018, percutaneous nephrostomy placement was not available in Tanzania. This study presented the initial safety, technical feasibility, and clinical benefit of establishing a percutaneous nephrostomy service in such a resource-limited setting.
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