Purpose Symptomatic hydronephrosis of pregnancy (SHOP) presents with flank pain but may include fever, bacteremia, or sepsis that is harmful to the mother and fetus. Current literature focuses on double-J stents (DJS) in SHOP patients with sparse reporting on percutaneous nephrostomy (PCN) outcomes. We assess the safety of PCN for SHOP. Methods We used CPT codes to identify women with SHOP who underwent PCN at our institution. Gravid women with maternal kidney infection were identified by ICD10 code and selected as a comparative high-risk (HR) group. Retrospective analysis was used to gather data on initial clinical presentation and demographics. Outcomes included fetal data, APGAR scores, and neonatal intensive care unit (NICU) admission. The number of procedures a mother underwent involving all PCN placements and subsequent changes, along with total procedural radiation dose measured in milligray (mGy), was collected. Multivariable regression analysis was performed to assess significance. Results HR ( n = 43) and SHOP ( n = 44) groups included a similar number of patients. No statistical differences were noted between groups regarding BMI, body temperature, creatinine, and CBC. No differences were noted in maternal or fetal outcomes between groups. The average patient had 4.6 procedures with mean and median radiation exposure of 108 mGy and 58.2 mGy, respectively. Conclusion Maternal and fetal outcomes are acceptable with PCN placement and demonstrate non-inferiority to comparative HR pregnancy groups. PCN is a reasonable option for patients requiring intervention for SHOP. Further studies should consider randomization between treatment modalities to better identify the optimal treatment for women with SHOP.

Intraductal biliary stones can result in significant acute and long-term complications. When patients' anatomy precludes more traditional management, the interventional radiologist may be called upon to provide well-established techniques for percutaneous biliary drainage and stone removal. This can be particularly challenging when the patient has excessively mobile, impacted, large or multiple stones. Percutaneous biliary endoscopy with adjunct interventional techniques can successfully treat these patients avoiding the patient dreaded "tube for life" scenario. Direct percutaneous visualization of the biliary tree can also diagnose and provide symptomatic relief for stone-mimicking pathologic conditions such as biliary tumors. This article will review the role, technique, and considerations for percutaneous biliary endoscopy and adjunct interventions in patients with isolated and complex, biliary stone disease and stone-mimicking pathologies.

Multiple sclerosis (MS) is a disorder characterized by damage to the myelin sheath insulation of nerve cells of the brain and spinal cord affecting nerve impulses which can lead to numerous physical and cognitive disabilities. The disease, which affects over 500,000 people in the United States alone, is widely believed to be an autoimmune condition potentially triggered by an antecedant event such as a viral infection, environmental factors, a genetic defect or a combination of each. Chronic cerebrospinal venous insufficiency (CCSVI) is a condition characterized by abnormal venous drainage from the central nervous system that has been theorized to have a possible role in the pathogenesis and symptomatology of MS (1). A significant amount of attention has been given to this theory as a possible explanation for the etiology of symptoms related to MS patients suffering from this disease. The work of Dr. Zamboni, et al, who reported that treating the venous stenoses causing CCSVI with angioplasty resulting in significant improvement in the symptoms and quality of life of patients with MS (2) has led to further interest in this theory and potential treatment. The article presented describes endovascular techniques employed to diagnose and treat patients with MS and CCSVI.