Research
Ultra Sonographic Profile of Nephroblastoma at the University Clinics of Kinshasa
Objective: To describe the ultrasonographic profile of nephroblastoma diagnosed at the university clinics of Kinshasa. Materials and methods: This is a descriptive study; it concerns 45 patients with Wilms' tumor diagnosed by ultrasonography at the university clinics of Kinshasa from 2016 to 2021, i.e. an overall period of six years. Two ultrasound scanners branded Phillips u-22 and Mindray DC-30 were used.
Percutaneous Radio-Guided Chemical Ablation with Absolute Ethanol of Cystic and Solid Lesions in Kinshasa Hospital Environments
Introduction: the main objective of the present study is to evaluate the therapeutic effectiveness and safety of percutaneous radio-guided chemical ablation with absolute ethanol (96%) in the therapeutic management of cystic and solid lesions. benign localization: thyroid classified EU-TIRADS 2, parathyroid, hepatic, renal, inguino-scrotal, ovarian as well as osteoarticular. Materials and Methods: Eighty patients were included in the present study. Ages ranged from six to seventy-five. After ultrasound reassessment, psychological preparation, premedication and local anesthesia; we perform a puncture-drainage of the lesion under strict ultrasound guidance with good visualization of the bevel, followed by rinsing for certain lesions and injection of 96% ethanol. The volume of ethanol injected was obtained by calculating 10 to 20% of the overall volume of the lesion. We performed one to three sessions of Sclerotherapy on our patients, particularly on D1-D4 and D7. We studied the effectiveness of sclerotherapy through the complete drying of the lesion, the reduction of the lesion volume to more than 50% of the initial volume as well as the disappearance of the pain. As for recidivism; it was evaluated by the persistence of pain, the persistence or reappearance of the cystic lesion with a residual volume estimated at more than 50%. Results: Out of eighty patients listed; We recorded 46.2% men and 53.8% women, with a sex ratio of 0.83%. The age of the patients was between 6 -75 years with an average age of 43.5±17.5 years. The youngest patient was 6 years old and the oldest 75 years old. The 37-47 age groups were the most represented with 26.3%. The majority of women were aged between 26-36 and 37-47 years, respectively 27.5% of the entire workforce. In addition, 17.5% of men were aged between 48-58 years. Nearly 55% of our patients consulted for cervical swelling; on an anatomopathological level; almost 64% of our patients had an inflammatory smear. 42.5% of the lesions treated were of thyroid location and the number of alcohol sessions depended on the organ treated, the content of the alcoholic lesion, gender without forgetting the volume of the alcoholic mass. Radiologically, the success rate was 95%, apart from one treatment failure in four patients who were asymptomatic. No complications; haemorrhagic or infectious has been encountered; except for one case of hypoglycemic shock, which was quickly corrected. Conclusion: Ethanol 96% is an effective liquid sclerosing agent treating benign cystic lesions: thyroid EU-TIRADS2, parathyroid, hepatic, renal Bosniak Ia, osteoarticular, inguino-scrotal as well as ovarian. Given the ease of obtaining ethanol in sub-Saharan hospital environments; Kinshasa in particular, the simplicity of the procedure, the low morbidity rate and its effectiveness; obliges us to recommend percutaneous ethanol sclerotherapy as a treatment of first choice instead of other complex percutaneous ablation techniques. The average volume of ethanol used was 12.85 ml; the largest volume of ethanol was 40 ml and the smallest volume was estimated at 2 ml. The average volume of treated lesions was 106.12 ml, the smallest lesion volume was 4 ml, and the large volume was 814 ml.
Assessment of Interventional Radiology Practice and Knowledge in the Democratic Republic of Congo
Introduction: Interventional radiology procedures are performed at three levels: primary, intermediate and tertiary. They are classified as simple, intermediate and complex procedures. These procedures have become commonplace in Western countries and in certain emerging countries in North and South Africa. However, some of these procedures are still largely unknown and impractical in the Democratic Republic of Congo (DRC), particularly in the hospital environment of Kinshasa. Intermediate and complex procedures are performed in specialized hospitals; they are time-consuming and involve a high risk of exposure to ionizing radiation. Objective: To assess practices and knowledge of interventional radiology in DRC hospitals. Methods: descriptive cross-sectional study conducted from 15/Aug/2023 to 15/Jan/2024, organized in the form of an anonymous electronic questionnaire evolving knowledge and practices of IR in hospital settings in DR Congo was sent electronically to healthcare providers (radiologists and non-radiologists) practicing in the Democratic Republic of Congo. The socio-demographic profile of respondents, radioprotection in IR, radiology equipment available, IR procedures performed and level of competence in radioprotection and IR were recorded. Results: The participation rate in the present series was 35.6% for radiologists and radiology assistants, and 64.4% for non-radiologists. There was a predominance of males (77.5%) and females (22.5%). The age range 32 - 41 was predominant in both groups; 19.5% for radiologists/radiology assistants and 25.4% for non-radiologists. The average age was 38.9 ± 7.3 years for radiologists/radiology assistants and 38.8 ± 9.1 years for non-radiologists. The provincial city of Kinshasa was the most represented province in the present series with 67.4%, followed by North Kivu with 5.5%.91.9% of participants had heard of IR, while 8.1% of respondents had never heard of the discipline. In terms of knowledge of IR procedures, 59.7% gave a positive response, of which only 26.2% had complex knowledge of IR procedures. Conclusion: The level of knowledge and practice of IR in hospitals in the DRC is generally inadequate. This calls on the health authorities to organize a strategic plan for equipping the various hospitals, not forgetting the ongoing training of radiologists and non-radiologists
Safety and Diagnostic Accuracy of Biopsy of Targeted Splenic Lesions Under Ultrasound Guidance Using the Multiple-Pass Technique Without Co-Axial in Kinshasa Hospitals
Introduction: The most frequent splenic pathologies can pose a diagnostic challenge to clinicians, radiologists and pathologists. These pathologies are innumerable, and may be of malignant or benign tumoral origin. Six techniques are currently available to obtain splenic tissue samples for pathological evaluation. Less invasive percutaneous techniques, performed by an interventional radiologist under ultrasound or CT guidance, include fine-needle aspiration biopsy and core tissue biopsy. They are associated with fewer complications and greater precision. Materials and Methods: This was a descriptive, multicenter, observational study of the various radioguided percutaneous splenic puncture-biopsy procedures performed using the multiple-pass technique without co-axial placement over a 5-year period. The objectives of the present study were to demonstrate the safety and diagnostic accuracy of targeted splenic puncture biopsy using the multiple-pass technique without co-axial placement, and to evaluate the rate of major complications of the said technique. Results: A total of eighteen patients underwent percutaneous splenic biopsy. In this study, patients aged ≤ 25 years (33.3%) and those aged 48-58 and 59-69 years were more likely to have undergone percutaneous splenic biopsy. (22.2% and 22.2%) were the most affected. Males predominated, with 66.7% versus 33.3%. Splenomegaly was the most frequently encountered clinical parameter with 44.44%. Lymphomatous lesions were present in 33.3% of patients, with CD20-negative diffuse large-cell lymphoma (11.1%), non-Hodgkin's lymphoma (11.2%) and hepatosplenic T lymphoma NOS (11.1%). Splenic tuberculosis ranked second in 22.2% of patients, and Gauchier's disease in 22.2%. Ultrasound was the most commonly used radiological guide in 88.9% of cases. The 14-gauge automatic gun was used in 44.4% of cases. The co-axial or indirect technique was used in all patients (100%); the multiple-pass technique without co-axial (T-MPSC) was used in all patients (100%); 4-5 cores were taken in the majority of patients (88.9%). No major complications were encountered in the present series. Conclusion: Radiation-guided percutaneous biopsy of splenic lesions with automatic or semi-automatic 14-16 G tru-cuts, using the coaxial-free multiple-pass technique (T-MPSC), yields large-calibre tissue material for accurate diagnosis during pathological analysis. This technique also avoids embolization of the co-axial pathway and per- or post-biosurgical haemorrhagic complications. In conclusion, percutaneous radio-guided splenic biopsy is an effective alternative to splenectomy in patients with single or multiple splenic lesions.
