Catheter Research Articles

Percutaneous Jejunostomy

AbstractDirect percutaneous jejunostomy placement is an often underutilized procedure that can allow for supplemental enteral nutrition in a certain subset of patients, in which percutaneous gastrostomy is not technically feasible, or in patients who require post-pyloric feeding. Percutaneous jejunostomy catheter placement was first described in the 1980s; since that time there have been minimal case series on the procedural technique and outcomes. At our institution, we perform percutaneous jejunostomy placement as a planned two-stage procedure. During the initial stage, direct jejunostomy is performed under a combination of fluoroscopic and ultrasound guidance, after distending the jejunum through a nasojejunal tube. After confirming intraluminal access, at least one Cope suture anchor is deployed, and guidewire access is maintained. Subsequently, the track is serially dilated, and a 14-Fr pigtail catheter is placed into the jejunum. Approximately 4 to 6 weeks later, the patient returns for conversion of the pigtail drain into a formal jejunostomy catheter with retention balloon, under fluoroscopic guidance. Several of the prior larger studies on the technique have noted major complications to occur in 12% of patients and minor complications to occur in 9.8% of patients. While percutaneous jejunostomy placement is not a frequently performed procedure, technical success and complication rates are comparable to that of surgical jejunostomy.

Functional disorders of the lower urinary tract in diabetes mellitus

Type2 diabetes mellitus is awell-known metabolic disease with increasing prevalence. Diabetic-related complications lead to different types of organ damage, some of which some of which are less well-known. In the lower urinary tract, acomplex interplay of neuronal, myogenic, and urothelial dysfunction leads to functional disorders of the lower urinary tract, with disorders of bladder storage and bladder emptying being in the forefront. In Germany, the number of patients with diabetes mellitus is estimated at over 8million, with up to 2million undiagnosed cases. Exact figures on diabetes-related dysfunction of the lower urinary tract are not available, partly because the early phase is often asymptomatic. Symptomatic patients often initially report symptoms of urgency, but later reduced sensitivity and ultimately afeeling of residual urine and urinary retention. Treatment options are limited, not always evidence-based, and often only evaluated in patients without diabetes. Behavioral therapy measures, drug therapy, peripheral neuromodulation, and catheter use such as single-use catheterization or permanent catheter diversion are used. In order to ensure optimal diagnosis and therapy, an understanding of the underlying pathologies and functional diagnostics is necessary.

Related factors of postoperative half-year care utilization for health status and recovery in older adults with hip fracture: A retrospective study of Osaka National Health Insurance Data.

The aim of this study was to investigate the relationship between preoperative patient factors and postoperative half-year health care utilization reflecting recovery, common complications, comorbidities, and significant health concerns, identifying strong risk and protective factors. This retrospective cohort study utilized linear, quantile, and ordinal regressions to analyze Osaka National Health Insurance data from 26 606 elderly patients who underwent hip fracture surgery between 2012 and 2018. The key factors associated with multiple postoperative care utilizations (P < 0.001) included: 1 Compared with men, women were strongly negatively correlated with postoperative length of stay (LOS) at q90, diabetes prescriptions or drip injections, while showing strong positive associations with postoperative antihypertensive, antiosteoporosis, and antidementia prescriptions. 2 Age has a strong negative correlation with antiosteoporosis or diabetes prescriptions but strongly positive associations with indwelling urinary catheters or drip injections. 3 The preoperative 1-year LOS correlated positively with the postoperative LOS or indwelling urinary catheters, and the strongest associations were observed at q25 with the postoperative LOS. It was significantly and negatively associated with antihypertensive or antidementia prescriptions. 4 Many preoperative care utilizations were positive factors, and some were strong factors at q25 of the LOS. Nuanced relationships between the female sex; preoperative LOS; antidementia, antiosteoporosis, antihypertensive and constipation prescriptions; indwelling catheters, and postoperative LOS were elucidated. These are key risks during shorter postoperative LOS, while male subgroups are at a higher risk during longer LOS duration. Patients with extended preoperative diabetes prescriptions or drip injections are at high risk of multiple postoperative care. Geriatr Gerontol Int 2025; ••: ••-••.

Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study.

This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

Isolated Continuous Lumbar Plexus Block Infusion for Hip Fractures: Their Role as Sole Analgesic and Anaesthetic Modality—A Retrospective Observational Study

Background and Aims: India is one of the advancing ageing societies of the world; with this, the country’s demographic structure also changes. The incidence of lower limb fractures is high in this population, and it threatens their health both physically and mentally. Therefore, an effective anaesthesia and analgesia regimen is crucial for smooth and stable surgery and perioperative care. Methods: In this retrospective study, we aimed to describe the use of lumbar plexus block with an indwelling catheter as a sole anaesthetic technique intra-operatively and for providing peri-operative pain relief for 54 patients with intertrochanteric fracture posted for proximal femoral nailing or dynamic hip screw fixation from October 2020 to October 2023. Results: It was found that pain scores remained less than 1 for the majority of the study duration. Most patients underwent surgery within the first day of admission in our hospital and surgery lasted for one to two hours. All patients were discharged within five days of hospitalisation. There were no failures of the blocks before and during the surgical procedures. There were no records of any complications related to the technique. No supplement opioid was used during the procedure. Conclusion: With adequate monitoring, expertise, knowledge and familiarity with the procedure, lumbar plexus block with continuous infusion via a perineural catheter supplemented with periprocedural sedation can be used as a safe and effective anaesthetic technique for hip and proximal femur fracture reduction surgeries.

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature—Description of Different Approaches and Tools

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Methods: Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Results: Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter (“spaghetti twisting technique”). Conclusions: (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications.

Peripheral Vascular Emboli in Patients with Infective Endocarditis are Common.

Infective endocarditis (IE) is associated with significant morbidity and mortality and places patients at risk for subsequent peripheral vascular emboli. Our goals were to analyze the incidence of peripheral emboli and their associated complications and outcomes. A retrospective single-center review of all patients with IE from 2013-2021 was performed. Patients with IE who suffered peripheral vascular emboli were identified and their clinical characteristics and outcomes were analyzed. Overall, 525 IE patients were identified and of these, 14.3% had peripheral emboli. In patients with peripheral emboli, the average age was 47 years and 58.7% were of male gender; race composition included 56% White and 24% Black patients. Comorbidities included hypertension (49.3%), congestive heart failure (30.7%), prior valve replacement/repair (26.7%), and diabetes (24%). Intravenous drug use (62.7%) was the most common cause of IE followed by non-dental infectious sources (16%), an indwelling catheter (6.7%), or dental infection (4%). Valve distribution was mitral (45.3%), aortic (28%), and tricuspid (24%). Gram-positive organisms, including MRSA (30.7%) and MSSA (25.3%), were the most commonly identified bacteria and Candida was identified in 6.7% of patients. Splenic (57.3%, n = 43) and renal (32%, n = 24) arteries were the most common locations for peripheral vascular emboli followed by lower (28%, n =21) and upper extremity (2.7%, n = 2) arteries. Cerebrovascular emboli occurred concurrently in 20 (26.7%) patients with other peripheral emboli. The most common locations for embolism that underwent an intervention were the common femoral (54.4%), superficial femoral (54.4%), popliteal (36.4%), tibial (27.3%), deep femoral (27.3%), peroneal (9.1%), superior mesenteric (SMA) (9.1%), and brachial (9.1%) arteries. While open surgical embolectomy (81.8%) was the most common intervention, one patient underwent an endovascular intervention. Other interventions included two lower extremity amputations (one primary and one after embolectomy), one infrapopliteal bypass for a popliteal artery occlusion, and an attempted SMA embolectomy stopped due to cardiac arrest. One patient with splenic and cerebrovascular emboli had a mycotic thoracic aneurysm which was deemed non-operative. At 30-days, 1-year and 5-years, 92%, 83%, and 65% of patients with IE survived, respectively; among those with IE and peripheral emboli, 86%, 71%, and 43% of patients survived, respectively (P = .01). Those who underwent peripheral vascular interventions, had a 1- and 5-year survival of 45.5% and 36.6%, respectively. Peripheral vascular emboli are common in patients with infective endocarditis and frequently occur in association with cerebral embolic events. Overall morbidity and mortality is high in this young population, in particular for those undergoing interventions.

Robot-assisted ureteral reconstruction for managing kidney transplant patients with ureteric complications.

To evaluate the feasibility of robot-assisted ureteral reconstruction as a minimally invasive alternative to open surgery for managing ureteric complications in transplanted kidneys. From January 2020 to December 2023, robot-assisted ureteral reconstruction was performed on fifteen kidney transplant patients with vesicoureteral reflux (VUR) or ureteral stricture who had previously failed endoscopic treatments. Twelve females and three males, with a mean age of 48.6±6.6 years, were included in the study. Nine patients (60.0%) underwent surgery due to VUR (grade III or higher) of the transplanted kidney, and six patients (40.0%) had transplanted ureteral strictures. Postoperative voiding cystourethrogram (VCUG) was performed at 3.2±1.6 months. Seven patients (77.8%) became VUR-free, while two patients (22.2%) had VUR regression from grade IV to I. All six patients who underwent reconstruction due to anastomosis site stricture became stenosis-free without the need for an indwelling ureteral catheter. In cases where the ureter was too short for reimplantation, a Boari flap or end-to-end anastomosis with the native ureter was performed. The mean hospital stay was 5.9±4.5 days. The urethral catheter was removed after 15.1±5.4 days, and the ureteral catheter was removed after 4.9±1.5 weeks. The mean follow-up period was 23.9±6.8 months, with no additional interventions required after surgery. No complications above Clavien-Dindo grade I were recorded. Robotic ureteral reconstruction is technically feasible and offers an effective, minimally invasive treatment for ureteric complications in kidney transplant patients, serving as an alternative to open surgery.

Impact of atrial fibrillation catheter ablation on the risk of progression of the disease towards a persistent form

Impact of atrial fibrillation catheter ablation on the risk of progression of the disease towards a persistent form

Managing Leaks and Fistulas After Laparoscopic Sleeve Gastrectomy: Challenges and Solutions.

Postoperative leaks after sleeve gastrectomy are a troublesome complication that occur in 0.7-5.3% of cases depending on the referenced source. These complications cause significant morbidity for patients requiring prolonged hospitalizations, nutritional support, intravenous antibiotics, and at times additional operations and procedures that risk further downstream complications. The patient presentation varies from relatively benign with minimal or no symptomatology, to the acutely ill with life-threatening sepsis. The management of gastric leak is dependent on a multitude of factors, including the initial presentation as well the surgeon's experience and preference. Here, we will summarize the current literature and discuss the different options that exist for the management of gastric leaks after sleeve gastrectomy including laparoscopic lavage, endoscopic stenting, endoscopic pigtail catheters, endoscopic vacuum therapy, and salvage surgical operations such as fistula jejunostomy and total gastrectomy. The aim is to provide a source for surgeons to reference when they encounter this disease pathology and to shed light on a daunting challenge for the modern bariatric surgeon.

Characterizing Risk Factors Associated With Recurrent Pleural Effusions in the Lung Transplant Recipients.

Pleural effusions remain a common postoperative complication following lung transplantation, occurring in 10% to 26% of cases. We aimed to explore potential clinical or radiographic features associated with clinically significant post-lung transplant pleural effusions requiring repeat interventions for their management. Lung transplantation recipients who underwent thoracentesis at our institution between June 2012 and October 2022 were reviewed. In total, 77 patients were included. Data were collected via the electronic health record and adjudicated through direct chart review. Patients were stratified by the need for a single thoracentesis (control group) or additional interventions, including serial thoracentesis, pigtail placement, and surgery (composite group). The computed tomography (CT) of the chest before the first thoracentesis was reviewed by a thoracic radiologist who was blinded to patient outcome. Single thoracentesis was used to manage 25 (32.5%) patients, 4 (5.2%) required multiple thoracenteses, 42 (54.5%) required a pigtail catheter, and 6 (7.8%) required decortication for definitive management. In the composite group compared with the control group, who were managed by a single thoracentesis, there was an increased incidence of loculations (36.8% vs. 8%, P=0.01), rounded atelectasis (22.8% vs. 4%, P=0.05), and larger effusion size (P=0.01). The composite group had higher pleural fluid eosinophils (0.33% vs. 0% in control, P = <0.01) and monocytes (14.8% vs. 7.3%, P=0.04) levels. Baseline imaging, such as larger effusion size, loculations and rounded atelectasis, and pleural fluid cell profile with increased eosinophils and monocytes, can potentially identify clinically significant and refractory pleural effusions.

A case of ureteral orifice obstruction by bladder indwelling catheter

A case of ureteral orifice obstruction by bladder indwelling catheter

Permanent tunneled catheter : Audit Analysis of Patients Presenting to A Tertiary Care Hospital.

Vascular access for chronic kidney disease (CKD) patient is vital for a smooth transition from CKD 5 into hemodialysis (HD). Patient resist the idea of early creation of AVF till they manifest complications such as fluid overload, electrolyte or metabolic. This audit report is a review of our patients who had a permanent catheter placed for hemodialysis. Methods: Retrospective analysis of our patient registry data. Results: Majority of the patients had PC placed as permanent access for HD and only 40% of these were due to failure of an already pplaced vascular. Access. Conclusion: Majority of our patients had PC as the only solution left for HD and this may be due to delay in AVF creation. Fistula first policy should be implemented with the help of special CKD clinics and patient education.

Safety and efficacy of low-powered holmium laser enucleation of the prostate in comparison with plasma kinetic resection of prostate.

To compare the efficacy and safety of low-power holmium laser enucleation of the prostate (LP-HoLEP) with plasma kinetic resection of prostate (PKRP). Sixty-three patients treated with transurethral LP-HoLEP (observation group) and 68 patients treated with transurethral PKRP (control group) at Beijing Hospital of Traditional Chinese Medicine from November 2019 to November 2022 were retrospectively compared with regard to operation duration, intra-operative blood loss, prostate resection ratio, postoperative bladder irrigation time, postoperative indwelling urinary catheter time, postoperative urinary incontinence incidence, International Prostate Symptom Scale (IPSS), maximum urine flow rate (Qmax), and residual urine volume (RUV). In both groups, postoperative IPSS, Qmax, and RUV were significantly improved compared to preoperative values (P < 0.05). Comparing the observation group to the control group, the intra-operative blood loss were (59.6 ± 18.1) and (173.1 ± 85.3) ml, respectively (t = -10.350, P < 0.01); the prostate resection ratios were (81.2 ± 4.6) % and (56.7 ± 9.7)%, respectively (t = 18.230, P < 0.01); the postoperative bladder irrigation time was (39.1 ± 9.6) h and (49.7 ± 6.0) h, respectively (t = -7.623, P < 0.01); and the postoperative indwelling urinary catheter time was (111.5 ± 19.4) h and (120.4 ± 12.8) h, respectively (t = -3.125, P < 0.01). Comparing the observation group to the control group, the operation duration was (76.2 ± 18.6) and (83.0 ± 32.4) min, respectively, with no statistical difference (t = -1.226, P = 0.208); the postoperative urinary incontinence incidence was 12.7% and 8.8%, respectively and there was no statistical difference (χ² = 0.514, P = 0.473). LP-HoLEP offers excellent surgical efficacy and safety. LP-HoLEP is superior to PKRP in intra-operative blood loss, postoperative bladder irrigation time, and postoperative indwelling urinary catheter time, and can enucleate more hyperplastic glands.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

An unanticipated failure of nasogastric tube placement due to peripancreatic collection: A case report

Abstract Nasogastric tube (NGT) placement is a very common clinical procedure in the emergency department (ED). The procedure is very simple, yet difficulties and catastrophes of misplacement are much more than reported. We hereby report a case of failure of the NGT placement in a patient with acute pancreatitis with a huge abdominal collection and its interesting solution. A 33-year-old male presented to ED with severe pain abdomen, abdominal distension, and shortness of breath. Abdominal examination showed a tense swelling in the upper abdomen with a grossly distended abdomen. Respiratory distress and fatigue were detected, warranting quick interventions. The reason for respiratory fatigue was figured out to be increased abdominal pressure resisting diaphragmatic pull down. As the abdomen was tense, NGT placement was to be done as part of routine care. Placement of the NGT was challenging, and multiple attempts failed to negotiate it beyond 35–40 cm, even with the best hands. An upper abdomen scan with ultrasonography (USG) point of care ultrasonography revealed hypoechoic images, likely a huge collection. A percutaneous drainage was planned immediately, a USG-guided pigtail catheter of 10 F was placed, and almost 2000 ml of fluid was aspirated. It was decided to push Ryle’s Tube (RT), and surprisingly, it was easily negotiable by now. After confirmation by the auscultation method, it was fixed at the 60 cm mark. In our case, there was compression of the stomach by the huge peripancreatic collection to the extent that there was no patent lumen to pass on anything.

Percutaneous Retrieval of a Dislodged and Migrated Port Catheter Using Ablation Catheter and Balloon Trapping Technique

Totally implantable venous access devices (TIVADs) are routinely used in oncology patients, especially those requiring long-term chemotherapy. However, they are associated with minimal complications including catheter fracture. The fundamental approach for dislodged TIVAD is via percutaneous method. Reported here is a case of a 62-year-old woman with underlying rectosigmoid carcinoma presenting with dislodged port catheter within the right atrial appendage and the distal end lodged deeply into the hepatic vein. After multiple unsuccessful attempts with pigtail catheter, conventional snaring device and home-made snare, a deflectable ablation catheter was used and successfully retracted the deeply seated port catheter into the inferior vena cava. However, difficulty was encountered retrieving the port catheter due to malalignment of the port catheter to the femoral sheath. This was overcome by balloon trapping technique which aligned the port catheter with the femoral sheath allowing it to be retrieved safely, and the patient made a full recovery without any complications from the procedure.

Long-term impact of atrial fibrillation catheter ablation on heart failure with preserved ejection fraction.

The efficacy of catheter ablation as a treatment approach for patients with concurrent atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) has been inadequately investigated. This study's objective was to assess the effectiveness of atrial fibrillation ablation (AFA) in patients with heart failure with preserved ejection fraction. Utilizing the TriNetX research network, we identified individuals aged 18 and older with atrial fibrillation (AF) and concurrent heart failure with preserved ejection fraction (HFpEF) from January 1, 2010, to June 1, 2021. Patients were further classified based on their catheter ablation procedure, using Current Procedural Terminology codes. Following propensity-score matching, each cohort consisted of 9440 patients. The primary endpoint was all-cause mortality at two years and secondary outcomes during the 2-year follow-up encompassing readmissions for heart failure, AF, and stroke. In propensity-matched cohort, patients with AF and HFpEF who underwent AFA plus medical therapy had significantly lower all-cause mortality at two years than those who did not undergo AFA (hazard ratio (HR): 0.37, 95% CI: 0.34-0.40; P < 0.001) even after matching antiarrhythmic medications. At two years, secondary outcomes including HF readmissions (HR: 0.86 95% CI: 0.84-0.89; P < 0.001) and stroke readmissions (HR: 0.66 95% CI: 0.59-0.73; P < 0.001) were lower in the AFA group. AFA amongst AF patients with concomitant HFpEF showed a significant reduction in all-cause mortality. It also leads to significant reductions in readmissions due to HF and ischemic stroke at two years.

Primary central nervous system lymphoma of the spinal cord: A LOC network cohort study.

Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% cases); there are very little data pertaining to PCNSL involving the spinal cord. We retrospectively selected from the French LOC network database adult immunocompetent patients diagnosed with PCNSL involving the spinal cord between 2011 and 2022. Of the 2043 patients records retrieved from the database, 16 patients (median age: 62.5 years, median Karnofsky performance status: 40) satisfied our study's selection criteria. The median diagnostic delay was 97 days. Upon diagnosis, 10 patients could not walk, and seven had an indwelling urinary catheter. All of the patients had undergone MRI that revealed expansive lesion(s) with homogeneous contrast enhancement. Brain lesions were found in nine patients and CSF IL-10 was increased in 9 of 10 patients. The diagnosis of PCNSL was made based on brain biopsy (n=6), spinal cord biopsy or surgery (n=6) or cytologic analysis of CSF (n=4). All the patients were treated with high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (n=1) or autograft (n=4). The median PFS and OS were 29 and 51 months, respectively. Among the responders, 33% remained in a wheelchair, and only 25% regained the ability to walk without assistance. Considering the high risks associated with a spinal cord biopsy, the rarity of the disease and the lack of specificity of its clinicoradiological presentation, the diagnosis of spinal cord lymphoma is often delayed. Searching for other lymphomatous locations or assaying CSF IL-10 may be helpful in this disease, which can cause irreversible handicap.

A Randomized Non-Inferiority Clinical Trial of 14Fr Thal versus 28Fr Tube Thoracostomy for Traumatic Hemothorax.

The traditional treatment of traumatic hemothorax (HTX) is large bore chest tubes (CT) ≥28Fr. Recent evidence shows 14Fr pigtail catheters are as effective in drainage of HTX as larger CT. However, this has not been shown in 14Fr Thal tubes, a straight chest tube placed utilizing Seldinger technique. A single center, prospective randomized controlled trial was performed at an ACS verified Level 1 trauma center comparing 14Fr Thal CT (14CT) to 28Fr CT (28CT) between May 2017 and September 2021. The primary outcome was failure of drainage of hemothorax requiring additional intervention. Secondary outcomes included duration of chest tube placement, length of stay, tube-specific complications, and 90-day hospital readmission. Farrington-Manning approach was used for non-inferiority tests. Wilcoxon 2-samples test or t test was used for continuous variables, and Pearson chi-square or Fisher exact test was used for categorical variables. 109 patients were included in the randomized trial. There were 54 patients in the 14CT cohort, and 55 patients in the 28CT cohort. The primary outcome of drainage failure was similar between groups (8.3% 14CT vs 3.9% 28CT). Using a 15% non-inferiority margin 14CT is non-inferior to 28CT. No differences were identified in secondary outcomes. 14Fr Thal tubes have similar efficacy in drainage of traumatic hemothorax when compared with 28Fr chest tubes with similar complication rates (NCT03167723).