The primary treatment for Parkinson's disease is dopaminergic stimulation. Although levodopa has historically been administered orally, maintaining a predictable plasma concentration of the drug is challenging. As a result, enteral administration of carbidopa/levodopa (Duopa) has emerged as a promising tool in the treatment of the disease. This requires placement of an enteric catheter, two of which have been approved by the Food and Drug Administration for delivery of Duopa. The approved tubes are placed using the "peroral" or "pull" technique, a method traditionally requiring endoscopy. This technical note describes placement of the AbbVie PEG-J tube by means of the peroral route while utilizing only sonographic and fluoroscopic guidance. After placing an orogastric tube and achieving percutaneous access to the stomach under fluoroscopic visualization, a snare catheter is advanced through the percutaneous access into the stomach. The orogastric tube is engaged with the snare and retracted, bringing the attached snare with it to the mouth. The AbbVie PEG tube is attached to the snare, pulled back down the esophagus and into the stomach before being retracted through the percutaneous access to the skin. Finally, the AbbVie J tube is advanced through the gastrostomy tube into the proximal jejunum and attached with the provided connectors. As demonstrated, the AbbVie PEG-J tube can be placed safely and effectively using a percutaneous image-guided technique without the use of an endoscope.

Improvement in breast cancer screening technology has increased the detection of architectural distortion, which can often indicate underlying malignancy; however, there are also many benign causes of architectural distortion. We present a case of architectural distortion caused by cyst aspiration, representing a novel, benign cause.

RANO RulesBaseline MRI should be performed 24-48hrs post-op, with DWI Measurement = product of max. cross-sectional enhancing component -margins must be clearly defined and >10mm-do not include cystic/surgical cavity -multiple lesions: measure 2 largest (min.) and up to 5 (max.), then sum up (ie. 12.6mm x13.3mm = 167.6mm)Non-measurable disease: unidimensional, < 10mm, ill-defined margins, nonenhancing component (T2/FLAIR)Completed chemoRT

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