Chiba Needle Research Articles

Transvaginal Aspiration of Ovarian Cysts: Long-Term Follow-up

Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy. Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness. Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy. Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.

Percutaneous Ethanol ablation of small Hepatocellular Carcinomas: Twenty years on

Percutaneous Ethanol ablation of small Hepatocellular Carcinomas: Twenty years on

Accuracy and Outcome of Sonographically Guided Intra-articular Sodium Hyaluronate Injections in Patients With Osteoarthritis of the Hip

The aim of this study was to evaluate the accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. The prospective study involved 10 patients who had the diagnosis of unilateral hip osteoarthritis. The mean age of the patients was 63.2 years (range, 27-80 years). Depending on patient body weight, either a 3.5- to 5-MHz convex transducer or a 5- to 12-MHz linear transducer was used to examine each affected joint. Every subject received 3 injections of sodium hyaluronate, 1 per week for 3 consecutive weeks. With real-time sonographic monitoring, each joint was penetrated with a 20-gauge Chiba needle. Contrast medium was injected initially, and proper intra-articular placement was verified with computed tomography before the hyaluronate injection. Each patient's outcome was assessed on the basis of visual analog scale results and Western Ontario and McMaster Universities osteoarthritis index findings that were recorded before the set of injections and 2, 4, and 6 months after the third injection. Computed tomography confirmed accurate placement in all 30 injections in the study. The visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index scores showed that 80% of the patients had less pain in the joint at 6 months after the last injection. Sonographically guided intra-articular injection of sodium hyaluronate for patients with hip osteoarthritis is easy to perform and is a safe, economical, and well-tolerated form of treatment. In contrast to fluoroscopic or computed tomographic guidance, the sonographic technique exposes neither the patient nor the physician to radiation.

Transhepatic Portal Venous Power-Pulse Spray Rheolytic Thrombectomy for Acute Portal Vein Thrombosis After CT-Guided Pancreas Biopsy

Transhepatic Portal Venous Power-Pulse Spray Rheolytic Thrombectomy for Acute Portal Vein Thrombosis After CT-Guided Pancreas BiopsyGlenn W. Stambo1 and Leopoldo Grauer2Audio Available | Share

Combined therapy of radiofrequency ablation and ethanol injection of rabbit liver: an in vivo feasibility study.

Our purpose was to compare the effects of percutaneous radiofrequency ablation (RFA) combined with percutaneous ethanol injection (PEI) on the extent of ablation in in vivo rabbit liver tissue as compared with either therapy alone. Twenty-two New Zealand white rabbits were included in this study and allocated into three groups: group A: conventional RFA (n = 6); group B: PEI (n = 6): group C: combined RFA and PEI (n = 10). For combined RFA and PEI, under ultrasound guidance, 1 mL of absolute ethanol was injected into the target area of the liver parenchyma through a 21-gauge Chiba needle before performing RFA. RFA was performed using a 17-gauge internally cooled electrode with 1-cm active tip, and RF energy (30 W) was applied for 3 minutes, with or without ethanol injection. After RFA or PEI, contrast-enhanced computed tomography and CT-pathologic correlation were performed. The short-axis and long-axis diameters of thermal lesions of each group were compared. All procedures were technically successful and a total of 38 lesions were produced. The mean short-axis and long-axis diameter of the coagulation necrosis in rabbits of group C (combination of RFA and PEI), were significantly larger than those of other groups: group A: 10.3 +/- 2 mm and 11.4 +/- 2 mm: group B: 3.1 +/- 1 mm and 4.3 +/- 2 mm: group C: 12.8 +/- 3 mm and 17.8 +/- 6 mm (p < 0.05). On contrast-enhanced CT scan, the lesions of rabbits of the group C appeared to be more frequently irregular compared to those of group A (20% in group A vs. 67% in group C). There were three complications including two localized hematomas and one cardiopulmonary failure. Combined RFA and PEI could increase the dimension of coagulation necrosis without increasing complications and therefore, may be successfully used for treating larger lesions.

Percutaneous Transhepatic Biliary Drainage Through the Normal Duct in Patients with Post-Operative Bile Leakage

Purpose: To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) through the normal duct in patients with post-operative bile leakage. Materials and Methods: From January 1998 to December 2003, fourteen patients (male: 12, female: 2, mean age: 56) with biliary leak after laparoscopic cholecystectomy (n=5), T-tube removal (n=5), choledochojejunostomy due to small bowel perforation (n=1), right lobectomy (n=1), laparoscopic adrenalectomy (n=1), and subtotal gastrectomy (n=1) were treated by means of PTBD; this was performed with the two-step approach. The central bile duct was cannulated using a 21-G Chiba needle to map the intrahepatic biliary tree. An 8.5-F drainage catheter tip was positioned at the CBD after puncturing peripheral bile duct with an additional Chiba needle. We evaluated the technical feasibility, the procedure-related complications, clinical efficacy and the duration of catheter placement. Results: PTBD of the normal duct with the two-step approach was successful in all but two cases. In these two cases, the two-step approach was failed due to the rapid disappearance of the targeted peripheral duct, and this was the result caused by biloportal fistula. PTBD was performed through the central bile duct in one patient, and through the remnant cystic duct in one patient. There were no procedure-related complications except for mild abdominal pain in seven patients. Bile leakage was demonstrated on cholangiogram in 10 of 14 patients; this occurred at the T-tube exit site (n=4), cystic duct stump (n=2), choledochojejunostomy site (n=1), resection margin of liver (n=1), caudate lobe (n=1), and GB bed (n=1). In 13 patients, the biliary leak stopped after drainage (mean duration: 32.1 days). In one patient, surgical management was performed one day after PTBD due to the excessive amount of bile leakage. Conclusion: PTBD is a technically feasible and clinically efficacious treatment for post-operative bile leakage, and it can replace the more invasive surgical or endoscopic management procedures.

Computed tomography-guided percutaneous drainage of splenic abscesses

Objective: The aim of the study is to evaluate the role of computed tomography (CT)-guided percutaneous drainage in the management of solitary splenic abscesses. Materials and methods: Sonography and CT were used in the initial diagnosis of splenic abscess in patients with vague left upper quadrant pain and/or fever. Solitary splenic abscesses of nine male patients whose ages varied between 21 and 27 years (mean age: 24.7 years) were percutaneously drained under CT guidance. Puncture with 18-gauge Chiba needles and coaxial guidewire technique was used for insertion of six or eight French pigtail catheters. Antibiotics in accordance with the microbiological results were also given adjuvant to drainage. Follow-up examinations were performed by sonography, daily for the first week and weekly for the next 7 weeks, and by CT at the end of first, fourth and eighth weeks. Results: All patients tolerated the intervention well, except for one complicating with splenic rupture and hemorrhage, who underwent emergency splenectomy. The remaining eight patients recovered within 4 weeks without any splenic sequela. A mean of 3.9 days was needed before removing the drainage catheter based on regression criteria. Discussions and conclusion: CT-guided percutaneous drainage of splenic abscesses may be proven effective and is superior to splenectomy in selected cases, as it preserves host immunity.

Combined treatment of radiofrequency ablation and acetic acid injection: an in vivo feasibility study in rabbit liver.

The aim of this study was to compare the effects of percutaneous radiofrequency ablation (RFA) combined with percutaneous acetic acid injection (PAI) and either therapy alone for their effects on in vivo rabbit liver tissue. Thirty New Zealand white rabbits were included in this study and were allocated to three groups: group A, conventional RFA (n = 10); group B, PAI (n = 10); and group C, combined RFA and PAI (n = 10). Under US guidance, 1 ml of 50% acetic acid was injected into the target area of the liver parenchyma through a 21-G Chiba needle before performing RFA. The RFA was then performed using a 17-G internally cooled electrode with 1-cm active tip, and RF energy (30 W) was applied for 3 min with or without acetic acid injection. After RFA or PAI, contrast-enhanced CT and CT pathologic correlation were performed. The maximum diameters of the thermal lesions in each group were compared. All procedures were technically successful, and a total of 30 lesions (10 lesions for each group) were produced. The mean maximum diameter of the coagulation necrosis in the rabbits of group C (25+/-9 mm) was significantly larger than the diameters of the other groups: 12.2 +/- 1 mm (group A) and 14.3 +/- 3 mm (group B; p = 0.001). On contrast-enhanced CT scanning, the lesions of group B (7 of 10, 70%) appeared frequently irregular compared with those of groups A (2 of 10, 20%) and C (4 of 10, 40%; p = 0.08). There were seven complications (23.3%): a localized hematoma in a group-A rabbit; two hematomas and one chemical peritonitis in group-B rabbits; and a hematoma, a chemical peritonitis, and a burn injury to the stomach in group-C rabbits. Compared with the group-A rabbits (1 of 10, 10%), the group-B (3 of 10, 30%) and group-C rabbits (3 of 10, 30%) showed a tendency toward complications, but the difference was not significant (p = 0.48). Under the present experimental condition, combined RFA and PAI was able to increase the diameter of coagulation necrosis up to 2.5 cm without significantly increasing complications.

CT-guided needle biopsy of deep pelvic lesions by extraperitoneal approach through iliopsoas muscle.

We report our experience with computed tomography (CT)-guided coaxial needle biopsy of deep pelvic lesions by an extraperitoneal approach through the iliopsoas muscle, using a curved needle for difficult-to-reach lesions. We reviewed the records of all patients with pelvic masses who underwent CT-guided percutaneous biopsy via iliopsoas muscle between January 1999 and December 2001. Direct anterior or posterior approach to the lesion was obstructed by bowel, bladder, vessels, or bones in all patients. An 18-gauge guide needle was advanced through the iliopsoas muscle and a 22-gauge Chiba needle was used to perform the biopsy. A custom-tailored curved 22-g needle was used in 17 procedures when the location of the iliac vessels and the slope of the iliac wing obstructed a straight path to the lesion. Fifty-three patients underwent 57 CT-guided needle biopsies during the study period. The lesions comprised obturator (n = 25), internal iliac (n = 11), anterior external iliac (n = 4), and common iliac nodes (n = 4); soft tissue masses along pelvic side-wall (n = 6); adnexal lesions (n = 5); a loculated fluid collection, and a perirectal node. All lesions were safely accessed, and major vessels and viscera were avoided in all cases. Of the 57 biopsies, 53 (93%) yielded diagnostic specimens. No major complications were encountered. CT-guided coaxial needle biopsy by an anterolateral approach through the iliopsoas muscle, with the use of a curved needle in selected cases is safe and effective for obtaining samples from deep pelvic lesions.

The value of transrectal ultrasound guided needle aspiration in treatment of prostatic abscess

Introduction: Prostatic abscess (PA) is a very uncommon disorder. The value of transrectal ultrasound (TRUS) guided aspiration in the treatment of PA has not been clearly defined. We present our experience with six such patients. Materials and methods: Between July 1997 and December 2002, six patients with PA were diagnosed by TRUS and treated by TRUS guided needle aspiration in our department. PA was defined as hypoechoic, inhomogenous, thick walled fluid collection. TRUS guided needle aspiration of the abscess was performed transrectally in all patients with a 20-cm long 18 gauge Chiba needle. Succesfull treatment criteria were defined as clinical improvement in symptoms and decrease of more than half of the estimated abscess volume on follow up TRUS control. Patients with continuing clinical symptoms were defined as treatment failures. Results: The most common TRUS finding was detection of a hypoechoic area with inhomogeneous structures, which was determined in all patients (100%). In some patients irregular contour and heterogeneous areas were additionally described. TRUS guided needle aspiration treatment of PA was successful in five of six patients (83.3%). In one patient treatment failed and the abscess recurred 3 weeks after the procedure. As this patient had additionally a bladder outflow obstruction, transurethral resection of the prostate was performed instead of a repeat procedure. There were no complications associated with the procedure. Conclusions: In conclusion, TRUS has an important value in diagnosis and treatment of PA. TRUS guided aspiration is an effective and minimally invasive treatment modality for PA which causes no serious complications.

Radicular Pain After Vertebroplasty

Study Design. During vertebroplasty (VP), polymethylmethacrylate (PMMA) may leak into the posterior epidural venus plexus, provoking symptoms ranging from radicular pain to medullar compression. Objectives. To propose and test the feasibility of a procedure (cooling system) to prevent radicular irritation caused by foraminal PMMA leakage. Summary of Background Data. Foraminal leak of PMMA, as observed during VP, may lead to radiculalgia. Several mechanisms of nerve root irritation have been proposed. Considering heat or local chemical irritation has led us to treat immediately by local periradicular irrigation with a cooling liquid. Methods. Four consecutive patients with observed foraminal leakage were treated by local fluid injection. Immediately after observation of a foraminal leak, a 20-gauge Chiba needle was positioned to reach the foramen. Ten cubic centimeters of lidocaine (0.2%) was followed by 100–200 cc of pressurized saline perfusion within 10–20 minutes (cooling system). Results. In all patients with foraminal leakage, no radicular pain existed after application of the cooling system. No complications were observed with its use. Conclusion. In presence of a foraminal leakage, the immediate application of a cooling irrigation may protect the root from injury, which is explained by the hypothesis that the main mechanism of injury may be more related to heat or chemical irritation of the nerve than compression.

E-cadherin Expression on Fine Needle Aspiration Biopsies of Breast Invasive Ductal Carcinomas and Its Relationship to Clinicopathologic Factors

To evaluate E-cadherin expression on fine needle aspiration biopsies (FNAB) of breast ductal invasive carcinomas and to correlate that expression with the grade of the tumors, axillary lymph node status, primary tumor size, menopausal status, estrogen-progesterone receptors and Bcl-2 expression. One hundred female patients ranging in age from 25 to 82 underwent FNAB under ultrasound guidance and were diagnosed as having breast carcinomas. Biopsy was done with 22-gauge Chiba needles under local anesthesia. All FNAB specimens were stained using Papanicolaou and Giemsa stain, diagnosed cytologically as ductal invasive breast carcinomas and confirmed histologically postoperatively. E-cadherin (L-CAM), monoclonal mouse IgG1, primary antibodies ER (clone 1D5), PGR (clone PGR) and Bcl-2 monoclonal antibody (clone 124) were used. Immunostaining was performed using the alkaline phosphatase method. The expression (transmembrane) of E-cadherin was found in 66 (66%) cases. Decreased expression of E-cadherin statistically correlated (P < .005) (chi 2 test) with high grade (grade 3) tumors (26.6%), axillary lymph node metastasis (42.2%) (according to the TNM classification), premenopausal status (43.1%), negative estrogen-progesterone receptors (49.1% and 41%, respectively) and negative Bcl-2 expression (32.2%). No relationship was found between E-cadherin expression and primary tumor size. E-cadherin evaluation on FNAB specimens can be helpful in preoperatively predicting tumor cell differentiation and invasiveness, defining a population of patients with breast ductal carcinomas and a possible poor outcome, and should be taken into consideration in management of the disease.

Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults.

We prospectively determined the accuracy of computerized tomography (CT) and needle biopsy of solid renal masses. A total of 100 patients with a solid renal mass who were scheduled for operation were prospectively evaluated. CT was performed before radical or partial nephrectomy. Biopsy of the surgical specimens was done twice through the tumor using an 18 gauge biopsy gun. Specimens were sent for permanent section and review by 2 pathologists blinded to each other and to the whole tissue specimens. Images were reviewed by 2 radiologists blinded to each other and to the results of pathological analysis. Results of CT and permanent biopsy were compared with the results of whole tissue specimen analysis. Specimens were obtained from 59 radical and 41 partial nephrectomies. Malignant neoplasms were present in 85 patients (85%). Overall accuracy was 77% and 72%, the nondiagnostic rate was 20% and 21%, sensitivity was 81% and 83%, and specificity was 60% and 33%. For the 2 radiologists overall accuracy was 60% and 66%, the nondiagnostic rate was 31% and 23%, sensitivity was 70% and 77%, and specificity was 20% and 20%, respectively. Overall permanent biopsy results were accurate in more than 72% of cases and CT was accurate in more than 60%. However, because the nondiagnostic rate for CT and needle biopsy was 20% and 31%, respectively, and specificity was low, we do not recommend routine preoperative CT and subsequent needle biopsy to guide treatment decision making. Rather, cases must be decided individually.

Computerised tomography guided transthoracic aspiration biopsy

We report our experience of 32 patients, which were subjected to Computerised tomography (CT) guided transthoracic fine needle aspiration biopsy (T-FNAB) with particular reference to technique, sensitivity and complication rate following the procedure. The biopsy aspirate was obtained either using a spinal or a Chiba needle. Pneumothorax occurred in 7 patients and transient postbiopsy haemoptysis in 2 patients. None of the patients with pneumothorax or haemoptysis required any treatment.

Saline-enhanced radiofrequency thermal ablation of the lung: a feasibility study in rabbits.

ObjectiveTo assess the feasibility and safety of CT-guided percutaneous transthoracic radiofrequency ablation (RFA) with saline infusion of pulmonary tissue in rabbits.Materials and MethodsTwenty-eight New Zealand White rabbits were divided into two groups: an RFA group (n=10) and a saline-enhanced RFA (SRFA) group (n=18). In the RFA group, percutaneous RFA of the lung was performed under CT guidance and using a 17-gauge internally cooled electrode. In the SRFA group, 1.5 ml of 0.9% saline was infused slowly through a 21-gauge, polyteflon-coated Chiba needle prior to and during RFA. Lesion size and the healing process were studied in rabbits sacrificed at times from the day following treatment to three weeks after, and any complications were noted.ResultsIn the SRFA group, the mean diameter (12.5 ± 1.6 mm) of acute RF lesions was greater than that of RFA lesions (8.5 ± 1.4 mm) (p < .05). The complications arising in 12 cases were pneumothorax (n=8), thermal injury to the chest wall (n=2), hemothorax (n=1), and lung abscess (n=1). Although procedure-related complications tended to occur more frequently in the SRFA group (55.6%) than in the RFA group (20%), the difference was not statistically significant (p = .11).ConclusionSaline-enhanced RFA of pulmonary tissue in rabbits produces more extensive coagulation necrosis than conventional RFA procedures, without adding substantial risk of serious complications.

Coeliac plexus block: utility of the anterior approach and the real time colour ultrasound guidance in cancer patient

Aims: The aim of our study was to demonstrate the efficacy of ultrasound-guidance compared with computed tomography (CT) guidance for coeliac plexus block in cancer patients. Methods: Coeliac plexus block (30 ml ethanol) was performed in 34 cancer patients (sex ratio: 10F, 24M), mean age: 54.8 years (range 26–67) under CT (n=21) and ultrasound-guidance (n=13). All patients had excruciating epigastric and generalized abdominal pain caused by cancer of the pancreas (n=13) or upper abdominal viscera (n=9) or a malignancy of extra-digestive origin (n=12). Feasibility and complication rates were analysed. Results: Notable pain relief was obtained in 27 (79%) of the patients. The technical success rate was 100% for CT-guidance and 93% (13/14) for ultrasound guidance. There were six minor complications (17%): chemical peritonitis (n=2), orthostatic arterial hypotension (n=2) and transient left shoulder pain (n=2), no major complications occurred. The target route was transhepatic in 6/13 of the ultrasound cases and mean length was 6 cm (range 3–12 cm). Colour Doppler sonography improved visualization of the 21 Gauge Chiba needle when the needle shaft was vibrated. Echogenic foci were observed around the origin of the coeliac trunk and superior mesenteric artery in all cases. CT coeliac block was successfully performed after failure of ultrasound guidance in one patient. Conclusion: Ultrasound guidance is safe and effective and should be attempted for coeliac plexus block whenever possible.

Trans-rectal ultrasonography (TRUS) with lipiodol injection for localization of the prostatic apex before radiotherapy planning

Purpose: To evaluate reliability of Trans-rectal ultra-sonography (TRUS) guidance with lipiodol injection for prostate localization before radiotherapy planning. Material and methods: From October 1997 to March 2000, 31 patients with prostatic adenocarcinoma and six patients with anastomotic recurrence after radical prostatectomy had TRUS-guided injection of lipiodol. Two milliliters of lipiodol were injected into each side of the prostate and 1 ml into both seminal vesicles with a 22 Gauge CHIBA needle and US probe guide before radiotherapy planning.We had established a contrast quality index (0 for no prostate enhancement to 5 for efficient pacification without any diffusion).On simulation films, we had performed anatomic measurements for comparison with other anatomic studies. Results: For all 37 patients, TRUS-guided injection was well tolerated. Among 31 patients with the prostate in situ, three had no apex opacification and 15 had no vesicle enhancement or peri-vesicle space diffusion. However, in 19 patients there was good contrast quality with an index score of ≥3. The majority of patients had prostatic apex between 1.5 and 3.5 cm from ischial tuberosities ligne (27 from 28 evaluable for apex). Among 19 evaluable patients, 15 had seminal vesicles 2–4 cm above the top of pubis.For six patients with anastomotic recurrence after radical prostatectomy, lipiodol was precious aid to locate it. We had only one failure because of a precocious bladder absorption relating to a delay which is too long between rectal probe locating and portal films. Conclusion: TRUS injection of lipiodol is a simple, inexpensive, relatively safe technique for localization of prostatic apex, but not appropriate for seminal vesicles enhancement. This is also an interesting method to locate anastomotic recurrence.

Cell type accuracy of transthoracic fine needle aspiration material in primary lung cancer

The aim of this study was to evaluate the diagnostic accuracy of transthoracic fine needle aspiration (TFNA) materials in establishing the specific cell type in primary lung cancer, and to study the influence of several factors on this accuracy. The present study included 129 patients [(12 females, 117 males; mean age 54.6 years (range 25-75)] who underwent thoracotomy. The initial diagnosis was obtained by means of TFNA biopsy in all patients. Transthoracic fine needle aspiration was performed by 22-gauge Chiba needle with fluoroscopy guide in 93 patients and with computed tomography guide in 36 cases. The overall concordance was 73.6% (Kappa = 0.52). The worst agreement was obtained for the large cell carcinoma (40%; Kappa = 0.48). The likelihood of a correct diagnosis using the TFNA specimens was 6.2-fold higher for well-differentiated tumours than for poorly differentiated tumours (P < 0.005). The stage of tumour and diameter of the lesion had no effect on cell agreement. Cell agreement was higher in central lesions than peripheral lesions, but the difference was not statistically significant (P = 0.097). This difference was more significant between patients with central and peripheral epidermoid carcinoma (P = 0.057). In our opinion, cell typing by TFNA may lead to incorrect results in the presence of poor differentiation, mixed tumours and peripheral epidermoid carcinomas.

Ultrasound-guided percutaneous sclerotherapy of hydatid liver cysts in children.

To evaluate the efficacy of ultrasound (US) guided percutaneous sclerotherapy in the pediatric population, 14 hydatid liver cysts (HLC) in eight male patients whose ages ranged between 6 and 16 years (mean 9.9 years) were treated. The maximum diameter was 110 mm. Albendazole was administered orally to all patients for 1 week before percutaneous treatment and for 3-6 months after the procedure to prevent dissemination of the disease. Cyst puncture was performed with 20 G Chiba needles using US guidance. More than one-half of the estimated cyst volume was aspirated, then 20% hypertonic saline (7 cysts) or sterile 96% alcohol (7 cysts) equivalent to one-third of the estimated cyst volume was injected into the cavity and left for 5-15 min. Finally, all the fluid in the cavity was reaspirated. Catheterization was not performed. Follow-up US examinations were performed every month during the first 6 months and every 3 months thereafter. The follow-up period ranged between 6 and 51 months (mean 15 months). No major complications were seen during or after the procedures. Two cysts in two patients completely disappeared. Volumes of the 11 cysts in five patients who were followed for 6-21 months were markedly reduced (22%-64% of the initial volume) and thick septations and solid debris-like structures were seen within the cyst cavities. There was no significant change in 1 cyst. US-guided percutaneous sclerotherapy is thus a safe and effective treatment of HLC in children.

Tetracycline Hydrochloride Sclerotherapy: Renal, Hepatic, Ovarian, and Perivesical cysts

Purpose: To assess the efficacy and resulting complications of tetracycline sclerotherapy in renal, hepatic, ovarian, and perivesical cysts. Materials and Methods: We retrospectively reviewed 23 cases of benign cysts (16 renal, 4 hepatic, 2 ovarian, and 1 perivesical) in 22 patients in whom the condition was diagnosed or confirmed by either ultrasound, CT, or cytology, and who underwent percutaneous tetracycline sclerotherapy. Using a 21-gauge Chiba needle, the target cyst was punctured under ultrasound guidance. Prior to the injection of 1500 mg of tetracycline diluted in 5 ml of normal saline, almost all the cystic content was aspirated, and at the end of the procedure the tetra-cycline was left in the cyst. During a period of between 3 and 22 months, 18 of the 23 cases were followed up. Results: In six of the 18 cases followed up, the cysts either decreased in size by 10%, or collapsed completely. In seven cases a collapse of over 50% was noted, and in the remaining five the cyst recurred. In one of these, complete collapse occurred after retreatment at ten months, and the patient with a perivesical cyst underwent surgery six months after recurrence. Thus, treatment was effective (a collapse of at least 50%) in 13 of 18 cases (72.2%). This total of 13 comprised ten of 12 renal cysts (83.3%), two of two ovarian (100%), and one of three hepatic (33.3%). Percutaneous therapy was unsuccessful in five cases (two hepatic cysts, one renal, one para-pelvic and one perivesical). Complications occurring during the procedure or follow-up period included dis-comfort or mild pain, vomiting, and transient fever, though these subsided within 24 hours. In one patient with severe pain, this subsided after four days. Conclusion: As single-shot injection of tetracycline provides safe and effective treatment for renal and ovarian cysts, but for hepatic cysts is unsuccessful.