Percutaneous needle procedures

Schwerck W, Braun B, Dombrowsky H (1979) Real time ultrasound examination in the diagnosis of gastrointestinal tumours. J Clin Ultrasound 7 425-431 Sheafor DH, Paulson EK, Simmons CM et al (1998) Abdominal percutaneous interventional procedures comparison of CT and US guidance. Radiology 207 705-710 Shidham VB, Weiss JP, Quinn TJ et al (1998) Fine needle aspiration cytology of gastric solitary fibrous tumor. A case report. Acta Cytol 42 1159-1166 Smith EH (1984) The hazards of fine-needle aspiration biopsy. 

Conradie, J.P. Fluoroscopy based needle positioning system for percutaneous nephrolithotomy procedures. PhD Dissertation, Stellenbosch Stellenbosch University (2008)... 

Fig. 28.5. Robot for percutaneous needle puncture procedures (PAKY-RCM system). The lower joints are positioned and locked manually, while the upper stages are motorized. The needle positioner at the tip is transparent to X-rays to enable radiographic guidance. [Reproduced from Stoianovici et al. (1998) with permission]...

WiCKBOM was the first to describe percutaneous diagnostic antegrade pyelography in 1954. Percutaneous needle nephrostomy to relieve obstruction was subsequently described by Goodwin et al. (1955). Stables et al. (1978) later demonstrated the very low complication rate of this procedure and established it as the treatment of choice for the emergency relief of renal obstruction. 

The electrophysiological procedure provided an evaluation of the reinnervation of plantar muscles after transection and grafting of the sciatic nerve. Electrical stimuli were applied to the nerve via percutaneous needle electrodes, both proximal and distal to the transection site, and the resulting compound muscle action potentials (CMAPs) elicited in the plantar muscles of the foot were recorded using a concentric needle. The time between the stimulation of the nerve and the onset of the elicited CMAPs, termed the distal motor latency, was measured. ... 

Percutaneous splenoportography has lost its importance. Should a direct procedure be indicated, laparoscopic splenoportography is a possible alternative. Recently, a new technique has been described. (134) The percutaneous splenic puncture is performed using a thin needle under screen control, with the needle directed at the splenic hilus. The pressure of the splenic pulp can be measured directly in order to estimate the portal vein pressure. Contrast medium is injected manually or by a special device. From this depot in the red pulp, the splenic vein, the portal vein and the intrahepatic branches of the portal vein are contrasted within a few seconds, (s. fig. 8.12) Complications resulting from percutaneous splenoportography include afterbleeding from the spleen, bilateral rupture of the spleen, arterial aneurysms and a.v. shunts — these complications are serious in nature, but rare. Contraindications for the procedure should be carefully observed, (s. tab. 8.6)... 

Percutaneous fine-needle biopsy This technique is associated with the risk of tumour cell spreading. The frequency of subcutaneous implantation metastases is reported to be 2% they generally appear within 3 months. When this procedure is indicated, the bleeding risk from the usually hypervascularized tumour must also be taken into account. The cytologic-diagnostic sensitivity is 80-85% of cases specificity is 97-100%. (31-33, 128)... 

Stoianovici, D., et al., An efficient needle injection technique and radiological guidance method for percutaneous procedures, in First Joint Conference CRVMed II MRCAS III, March 1997, Grmioble, France. 

Fig. 1.2a-c. A multimodality fusion imaging system (Virtual Navigator System, Esaote SpA, Genoa, ltaly)-real-time registration and fusion of pre-procedure CT volume images with intraprocedure US-used for a percutaneous radiofrequency ablation of an hepatocellular carcinoma targeting of the lesion (a), needle placement (b) and evaluation of the ablation zone... 

Accidental exposures to potentially infective blood and body fluids are common in health care despite risk reduction policies [5, 6]. The greatest risk of blood-borne infections is posed by percutaneous injuries either by sticking with a needle or cutting with a sharp object. This may happen during the medical procedure performed to the patient or by handling used instruments afterwards. 

PTC involves the insertion of a fine needle percutane-ously though the liver into a bile duct and subsequent opacification of the ducts by injection of contrast medium. The procedure is easy when the ducts are dilated and more difficult, sometimes exceedingly so, when the ducts are of normal caliber or minimally dilated. 

Fig. 10.3a-c. Painful metastasis of T2 vertebral body. Percutaneous vertebroplasty under dual guidance of computed tomography and fluoroscopy, a Lytic metastasis of T2. b Transpedicular needle placement. The needle was positioned in the anterior portion of the lesion, c A total of 1.5 ml of cement was injected under fluoroscopy control. Complete pain relief after the procedure... 

Additional clinical applications in the body that can benefit from C-arm CT are drainages and punctures. When performing percutaneous biliary drainage procedures, Froehlich et al. (2000), for example, found that C-arm CT resulted in decreased procedure and fluoroscopy times. C-arm CT can also be beneficial for complicated transjugular intrahepatic portosystemic shunt cases (SzE et al. 2006). Binkert et al. (2006) described another successful application for C-arm devices providing both 2D and 3D imaging. They used the 3D cross-sectional information for needle placement and 2D fluoroscopy to perform embolization of translum-bar type II endoleaks. 

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