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1.
Indian J Otolaryngol Head Neck Surg ; 76(2): 2108-2112, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38566716

RESUMO

Thyroid storm is an acute life-threatening condition of hyperthyroidism that can present with cardiac failure, requiring extracorporeal membrane oxygenation (ECMO). We present the first case reported of total thyroidectomy successfully performed while on ECMO for thyroid storm in a 32-year-old male. This case highlights the challenges of managing refractory thyroid storm with multi-organ failure. We demonstrate that total thyroidectomy may still be safely performed while on ECMO for thyroid storm, if steps are taken to optimise the patient perioperatively, with careful surgical and anaesthesia planning. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04430-9.

2.
JAMA Otolaryngol Head Neck Surg ; 148(9): 862-869, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35951318

RESUMO

Importance: Obstructive sleep apnea (OSA) is associated with a rise in serum inflammatory markers, which may be attenuated by sleep surgery. Objective: To evaluate whether sleep surgery was associated with improved levels of proinflammatory markers in adults with OSA. Data Sources: Two authors independently searched Cochrane, Embase, and PubMed databases from inception through June 14, 2022. Study Selection: Two authors searched the Cochrane, Embase, and PubMed databases for studies comparing preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery. Data Extraction and Synthesis: Data were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. To ensure relevance to clinicians and patients, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery. Main Outcomes and Measures: The primary outcome was the preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery, including C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6). Data analysis was performed from April to May 2022. Results: Of the 3218 studies screened, 26 studies with 1187 patients (mean [SD] age, 42.8 [11.1] years; 932 [78.5%] men and 255 [21.5%] women) were included. Soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, -0.377; 95% CI, -0.617 to -0.137), total cholesterol (SMD, -0.267; 95% CI, -0.417 to -0.116), LDL (SMD, -0.201; 95% CI, -0.344 to -0.058), IL-6 (SMD, -1.086; 95% CI, -1.952 to -0.221), tumor necrosis factor-α (SMD, -0.822; 95% CI, -1.617 to -0.027), triglyceride (SMD, -0.186; 95% CI, -0.301 to -0.071), and leptin (SMD, -0.519; 95% CI, -0.954 to -0.083) in patients with OSA. Meta-regression highlighted that increased age, higher preoperative score for cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90), and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels after soft-tissue sleep surgery. A greater reduction in apnea hypopnea index (AHI) was strongly associated with a greater reduction in total cholesterol and LDL. A greater reduction in body mass index and AHI were also associated with a greater increase in HDL. Conclusions and Relevance: The findings of this systematic review and meta-analysis of 26 studies suggest that sleep surgery is associated with decreased levels of CRP, total cholesterol, LDL, triglyceride, IL-6, leptin, and TNF-α, which may improve the inflammatory and cardiometabolic profile of patients who undergo sleep surgery.


Assuntos
Doenças Cardiovasculares , Apneia Obstrutiva do Sono , Adulto , Biomarcadores , Colesterol , Feminino , Humanos , Interleucina-6 , Leptina , Masculino , Pessoa de Meia-Idade , Sono , Apneia Obstrutiva do Sono/cirurgia , Triglicerídeos
3.
Laryngoscope Investig Otolaryngol ; 5(6): 1240-1246, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33364417

RESUMO

OBJECTIVES: Obstructive sleep apnoea is characterized by repetitive obstruction of the upper airway during sleep. These repeated oxygen desaturations increase cardiovascular and cerebrovascular morbidity and mortality significantly. Upper airway surgery is an option for patients who fail continuous positive airway pressure therapy. Airway collapse is usually multilevel and hypopharyngeal collapse is a challenging area to address. It is hypothesized that hyoid expansion with hyomandibular suspension can potentially increase upper airway dimensions at the hypopharynx. This study aims to document the effect of hyoid expansion using titanium plate and screws with hyomandibular suspension on hypopharyngeal airway dimensions. It is an anatomical feasibility study performed using 10 human cadaver heads. METHODS: The hyoid bone is trifractured. The expanded hyoid is then suspended to the mandible. Computed tomography (CT) scans were performed on the cadavers to measure the airway dimensions before and after the procedure. RESULTS: This procedure resulted in statistically significant increase in airway dimensions at the level of the hypopharynx in all 10 human cadaver heads. Increase in cross-sectional area correlated significantly with increase in 3-dimentional (3D) volume.The mean area of the airway at the level of the hyoid increased from 999.3 ± 193.0 mm2 to 1241.4 ± 103.2 mm2. Statistically significant increase in upper airway volume based on 3D reconstruction was also noted. Upper airway volume increased from 6.94 ± 6.46 mL to 13.58 ± 8.29 mL. CONCLUSION: Airway dimensions increased with hyoid expansion and hyomandibular suspension in our cadaveric study measured using CT scans. Further studies are needed to see if this technique can be translated to clinical use in live patients. LEVEL OF EVIDENCE: NA.

4.
Sleep Med Clin ; 14(1): 83-89, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30709537

RESUMO

Obstructive sleep apnea is a medical syndrome with multifactorial pathophysiology. Surgery can be the primary treatment option when anatomic factors are identified with narrowing at specific or general levels of pharyngeal airway. The surgeries are directed to the etiologic anatomic structure to achieve greatest effectiveness. Body weight, Mallampati scale, and tonsil grade are key evaluations to select effective surgical procedures. Surgical weight reduction, maxillomandibular advancement, and pharyngeal soft tissue surgeries are considered for the patient with obesity, maxillomandibular retrognathism, and tonsillar hypertrophy, respectively. Tailored surgical planning can meet the patients needs for airway, esthetics, and normal Angle's occlusion.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono/cirurgia , Estética , Humanos , Faringe/cirurgia
5.
Robot Surg ; 3: 13-28, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-30697552

RESUMO

OBJECTIVE: To review the existing literature on the role of transoral robotic surgery (TORS) for tongue base reduction in the management of adult obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: We searched PubMed, MEDLINE, and Scopus databases from the first literature report of this surgical technique to July 30, 2015 for studies investigating the use of TORS for tongue base reduction in treating adult OSAHS. Our primary outcome measures were Apnea- Hypopnea Index (AHI), lowest oxygen saturation (LSAT), Epworth Sleepiness Score (ESS), and the rates of surgical cure (AHI<5) and success (50% reduction in AHI accompanied by a postoperative AHI<20). Our secondary outcome measures were the volume of tissue resected and correlation to AHI, polysomnographic parameters, subjective outcomes, and body mass index. Complications of surgery were also analyzed. RESULTS: Thirteen articles were critically evaluated for this research. However, only four case series qualified for statistical analysis of postoperative polysomnographic outcomes and six case series for analysis of postoperative complications. They were case series with a total of 451 adult patients. Pooled analysis revealed statistically significant improvements in AHI, LSAT, and ESS after surgery by 26.83/hour, 5.28% and -8.03, respectively. The average rates of surgical cure and success were 23.8% and 66.7%, respectively. No study reported any deaths or complications related to the use of robotic equipment. The major complication rate was 6.9%, and the minor complication rate was 30.0%. Major complications included major bleeding (2.9%), severe odynophagia with dehydration (3.3%), and oropharyngeal stenosis (0.7%). Minor complications included transient bleeding (0.5%), transient dysphagia (3.8%), and dysgeusia (6.6%). CONCLUSION: TORS for tongue base reduction, as a component of multilevel surgery, is an effective treatment option for OSAHS with an acceptable morbidity. This conclusion is based on the analysis of the results of multiple case series. Future studies should entail prospective randomized controlled trials with larger sample size for longer follow-up period.

6.
Otolaryngol Head Neck Surg ; 148(6): 991-6, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23558287

RESUMO

OBJECTIVE: Malignant otitis externa (MOE) is a severe disease with varying outcomes. Despite advances in antibiotic treatment, a significant proportion still succumbs to this disease. We aimed to analyze the effect of clinical factors on prognosis and to review treatment outcomes in our institution. STUDY DESIGN: Case series with retrospective chart review of MOE cases from 2006 to 2011. SETTING: Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, a tertiary referral center. SUBJECTS AND METHODS: Patients with MOE admitted for treatment were studied and divided into 2 outcome groups depending on response to a 6-week course of intravenous antibiotics. Demographic and disease factors were analyzed with regard to outcome. RESULTS: Nineteen cases were analyzed. Disease resolved in 63.2% after 6 weeks of antibiotics. Mortality was 21.1%. Age, diabetic control, duration of diagnostic delay, cranial nerve involvement, and inflammatory markers were not found to predict prognosis. Erythrocyte sedimentation rate and C-reactive protein levels correlated with disease activity and can be used to monitor progress. Clival involvement was associated with persistent disease (P = .002). Only 63.2% of cases had positive cultures. Pseudomonas aeruginosa was the main organism, and 33.3% of isolates were multidrug resistant. Outcome was not different in cases where culture-directed therapy was employed vs those where empirical ceftazidime and fluoroquinolone were used (P = .650). CONCLUSION: Malignant otitis externa remains an insidious disease with significant mortality. Involvement of the clivus portends a poorer prognosis. Combination therapy with intravenous ceftazidime and oral fluoroquinolone remains relevant despite concerns of culture-negative cases and multidrug-resistant Pseudomonas.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Otite Externa/tratamento farmacológico , Otite Externa/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Otite Externa/microbiologia , Otite Externa/patologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Singapura/epidemiologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Cardiovasc Intervent Radiol ; 36(5): 1355-63, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23404519

RESUMO

PURPOSE: Malignancies may cause urinary tract obstruction, which is often relieved with placement of a percutaneous nephrostomy tube, an internal double J nephro-ureteric stent (double J), or an internal external nephroureteral stent (NUS). We evaluated the affect of these palliative interventions on quality of life (QoL) using previously validated surveys. METHODS: Forty-six patients with malignancy related ureteral obstruction received nephrostomy tubes (n = 16), double J stents (n = 15), or NUS (n = 15) as determined by a multidisciplinary team. QoL surveys were administered at 7, 30, and 90 days after the palliative procedure to evaluate symptoms and physical, social, functional, and emotional well-being. Number of related procedures, fluoroscopy time, and complications were documented. Kruskal-Wallis and Friedman's test were used to compare patients at 7, 30, and 90 days. Spearman's rank correlation coefficient was used to assess correlations between clinical outcomes/symptoms and QoL. RESULTS: Responses to QoL surveys were not significantly different for patients receiving nephrostomies, double J stents, or NUS at 7, 30, or 90 days. At 30 and 90 days there were significantly higher reported urinary symptoms and pain in those receiving double J stents compared with nephrostomies (P = 0.0035 and P = 0.0189, respectively). Significantly greater fluoroscopy time was needed for double J stent-related procedures (P = 0.0054). Nephrostomy tubes were associated with more frequent minor complications requiring additional changes. CONCLUSION: QoL was not significantly different. However, a greater incidence of pain in those receiving double J stents and more frequent tube changes in those with nephrostomy tubes should be considered when choosing palliative approaches.


Assuntos
Atitude Frente a Saúde , Cuidados Paliativos/métodos , Qualidade de Vida/psicologia , Obstrução Ureteral/psicologia , Atividades Cotidianas/psicologia , Adaptação Psicológica/fisiologia , Feminino , Seguimentos , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/estatística & dados numéricos , Dor/etiologia , Dor/psicologia , Cuidados Paliativos/psicologia , Estudos Prospectivos , Stents/efeitos adversos , Stents/estatística & dados numéricos , Inquéritos e Questionários , Resultado do Tratamento , Ureter/cirurgia , Obstrução Ureteral/cirurgia
8.
Ann Otol Rhinol Laryngol ; 121(10): 678-81, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23130544

RESUMO

OBJECTIVES: This study aimed to determine whether computed tomographic (CT) scans on which foreign body impaction cannot be detected can be relied upon to decide whether a patient requires further investigation by esophagoscopy. This information might minimize unnecessary esophagoscopy without incurring the risk of a missed impacted foreign body. METHODS: In a retrospective chart review of all patients admitted to National University Hospital, Singapore, over the period 2004 to 2011 for an ingested foreign body, case files of patients who underwent preoperative CT scanning followed by esophagoscopy were identified and reviewed. The results of the CT scan and the findings of esophagoscopy in these patients were analyzed. RESULTS: A total of 376 patients underwent rigid esophagoscopy for an ingested foreign body during this period. Of these, 119 patients had CT scans performed before the endoscopy. Based on our analysis, the sensitivity of CT scanning was 100%, and the specificity was 70.6%. The positive predictive value was 89.5%, and the negative predictive value was 100%. None of the patients who had CT scans with no detectable foreign body had complications on follow-up. CONCLUSIONS: CT scanning appeared to be sensitive and specific in investigation of patients with an ingested foreign body. It also has a high negative predictive value, which may allow it to be the only preliminary investigation in these patients. Based on these data, a prospective study with close monitoring of patients who have CT scans with no detectable foreign body can be designed to accrue more patients to answer this query.


Assuntos
Esôfago/diagnóstico por imagem , Corpos Estranhos/diagnóstico , Tomografia Computadorizada por Raios X , Esofagoscopia , Esôfago/cirurgia , Feminino , Corpos Estranhos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sensibilidade e Especificidade
9.
AJR Am J Roentgenol ; 197(5): 1244-50, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22021521

RESUMO

OBJECTIVE: Although CT is most commonly used for guidance of radiofrequency ablation (RFA) of renal masses, other publications have shown that ultrasound alone may be used. Therefore, we compared the complications and technical effectiveness of renal RFA guided by ultrasound alone versus combined CT and ultrasound guidance. MATERIALS AND METHODS: We retrospectively analyzed outcomes and complications of percutaneous renal RFA in two groups of patients for whom RFA was guided by either ultrasound alone (group 1) or combined CT and ultrasound (group 2). The sole factor in determining the method of guidance was preablation imaging. All other technical factors were consistent between the two groups. RESULTS: There were 28 masses in 27 patients in group 1 and 32 masses in 29 patients in group 2. There was an overall major complication rate of 3.3% (2/60). Major complications occurred equally in group 2 (3.1% [1/32]) compared with group 1 (3.6% [1/28]). Overall ablative effectiveness was 93% (26/28) in group 1 and 84% (27/32) in group 2. There was no statistical difference between the two groups. CONCLUSION: In proper hands, sonography guidance alone is a safe and effective method for performance of renal RFA in preselected cases and can decrease CT utilization. The use of CT is reserved for situations in which pretreatment RFA imaging suggests difficulty in ultrasound mass visualization or when the mass is in close proximity to structures that may be injured by thermal ablation.


Assuntos
Ablação por Cateter , Neoplasias Renais/cirurgia , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Gadolínio DTPA/administração & dosagem , Humanos , Iohexol/administração & dosagem , Neoplasias Renais/diagnóstico por imagem , Modelos Logísticos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
10.
Cardiovasc Intervent Radiol ; 34(2): 306-18, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20683722

RESUMO

PURPOSE: The primary purpose of this study was to demonstrate intraobserver/interobserver reproducibility for novel semiautomated measurements of hepatic volume used for Yttrium-90 dose calculations as well as whole-liver and necrotic-liver (hypodense/nonenhancing) tumor volume after radioembolization. The secondary aim was to provide initial comparisons of tumor volumetric measurements with linear measurements, as defined by Response Evaluation Criteria in Solid Tumors criteria, and survival outcomes. METHODS: Between 2006 and 2009, 23 consecutive radioembolization procedures were performed for 14 cases of hepatocellular carcinoma and 9 cases of hepatic metastases. Baseline and follow-up computed tomography obtained 1 month after treatment were retrospectively analyzed. Three observers measured liver, whole-tumor, and tumor-necrosis volumes twice using semiautomated software. RESULTS: Good intraobserver/interobserver reproducibility was demonstrated (intraclass correlation [ICC] > 0.9) for tumor and liver volumes. Semiautomated measurements of liver volumes were statistically similar to those obtained with manual tracing (ICC = 0.868), but they required significantly less time to perform (p < 0.0001, ICC = 0.088). There was a positive association between change in linear tumor measurements and whole-tumor volume (p < 0.0001). However, linear measurements did not correlate with volume of necrosis (p > 0.05). Dose, change in tumor diameters, tumor volume, and necrotic volume did not correlate with survival (p > 0.05 in all instances). However, Kaplan-Meier curves suggest that a >10% increase in necrotic volume correlated with survival (p = 0.0472). CONCLUSION: Semiautomated volumetric analysis of liver, whole-tumor, and tumor-necrosis volume can be performed with good intraobserver/interobserver reproducibility. In this small retrospective study, measurements of tumor necrosis were suggested to correlate with survival.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Compostos Radiofarmacêuticos/uso terapêutico , Radioisótopos de Ítrio/uso terapêutico , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Necrose , Variações Dependentes do Observador , Tamanho do Órgão , Doses de Radiação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
11.
AJR Am J Roentgenol ; 195(5): 1220-30, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20966331

RESUMO

OBJECTIVE: Linear measurements, such as those described by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria, may be limited for assessment of response after transarterial chemoembolization (TACE). The purpose of this pilot study was to show intra- and interobserver reproducibility of volumetric measurements of Ethiodol (ethiodized oil) seen within tumor 24 hours after TACE and of necrotic and viable tumor 1 month after treatment. Volumetric measurements are compared with linear measurements and survival outcomes. MATERIALS AND METHODS: Between 2006 and 2009, 37 consecutive TACE procedures were performed in 27 patients with hepatic malignancies. CT images obtained 24 hours and 1 month after TACE were retrospectively analyzed. Three observers measured volumes twice. Intraoperator reproducibility was determined using Wilcoxon's signed rank test to assess whether the difference in each volumetric measurement approaches zero. The intraclass correlation coefficient (ICC) and Bland-Altman plots were used to determine interoperator reproducibility. Survival data were retrospectively obtained from the electronic medical record. RESULTS: Good intraobserver reproducibility and interobserver reproducibility (p > 0.05, ICC > 0.9, respectively) were shown for Ethiodol, whole tumor, and necrotic tumor volumes. The volume of Ethiodol correlated with subsequent necrotic tumor volume (p = 0.009), reduction in whole tumor volume (p = 0.004), and patient survival (p = 0.029). Kaplan-Meier curves suggest that Ethiodol accumulation in more than 50% of the tumor and a 10% or greater increase in the volume of necrotic tumor correlated with survival (p = 0.028 and 0.047, respectively). CONCLUSION: Semiautomated volumetric analysis can be performed with good intra- and interobserver reproducibility. The volume of Ethiodol accumulated in the tumor after TACE correlates with subsequent necrosis. These early measurements may predict survival outcomes.


Assuntos
Antineoplásicos/administração & dosagem , Antineoplásicos/farmacocinética , Quimioembolização Terapêutica/métodos , Óleo Etiodado/administração & dosagem , Óleo Etiodado/farmacocinética , Neoplasias Hepáticas/terapia , Interpretação de Imagem Radiográfica Assistida por Computador , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Automação , Tumor Carcinoide/diagnóstico por imagem , Tumor Carcinoide/terapia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Humanos , Insulinoma/diagnóstico por imagem , Insulinoma/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Necrose , Projetos Piloto , Reprodutibilidade dos Testes , Estudos Retrospectivos , Software , Estatísticas não Paramétricas , Resultado do Tratamento
12.
Radiology ; 256(2): 397-405, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20530754

RESUMO

PURPOSE: To compare an algorithm of gradually ramped-up power to a full-power-level technique to determine which technical parameters maximized tissue coagulation by using a saline-perfused electrode. MATERIALS AND METHODS: Institutional review board approval was not necessary and animal committee approval was unnecessary because an ex vivo bovine liver model was used and the animals were not specifically killed for this study. This four-part experiment utilized multiple ablations of ex vivo bovine liver with a standard radiofrequency (RF) generator and an internally cooled needle. First, 10 RF ablations were performed at 20-60 W for 12 minutes. Second, ablation volumes obtained from an algorithm of eight ablations performed at 50 W were compared with those obtained from an algorithm of eight ablations that were gradually ramped-up to 50 W, until full impedance. Third, volumes obtained from 10 ablations performed at impedance control power levels were compared with those obtained from 10 ablations performed with a gradual ramp-up of power that started at 50 W, terminating at full impedance. Last, the third part was repeated, but with 11 ablations continuing past full impedance for 12 minutes each. RESULTS: In the first part, maximum measurements of tissue coagulation seemed to plateau from 40 to 60 W. The second part produced significantly larger measurements of tissue coagulation than did the use of a constant power level of 50 W. The third and final parts produced larger measurements of tissue coagulation than did utilizing full power for 12 minutes. Larger measurements and volumes were obtained from repeat ablations after the generator reached impedance level than were obtained from ablations stopped at maximum impedance. CONCLUSION: A gradual ramp-up of power and repeating ablations after power impedance level is reached are the two methods that increased tissue ablation in this ex vivo experiment.


Assuntos
Ablação por Cateter/instrumentação , Eletrodos , Hepatectomia/instrumentação , Hepatectomia/métodos , Fígado/fisiologia , Fígado/cirurgia , Cirurgia Assistida por Computador/métodos , Animais , Temperatura Corporal , Ablação por Cateter/métodos , Bovinos , Temperatura Baixa , Técnicas In Vitro
13.
Radiology ; 255(3): 764-71, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20406882

RESUMO

PURPOSE: To prospectively assess the incidence of delayed adverse reactions (DARs) in patients undergoing contrast material-enhanced computed tomography (CT) with the low osmolar nonionic contrast agent iohexol and compare with the incidence of DARs in patients undergoing unenhanced CT as control subjects. MATERIALS AND METHODS: Institutional review board approval and informed written consent for this prospective study were obtained. The study was HIPAA compliant. Patients undergoing CT for routine indications were enrolled from a random next-available scheduling template by an on-site clinical trials monitor. All subjects received a questionnaire asking them to indicate any DAR occurring later than 1 hour after their examination. Sixteen manifestations were listed and included rash, skin redness, skin swelling, nausea, vomiting, and dizziness, among others. To ensure maximal surveillance, a clinical trials coordinator initiated direct telephone contact for further assessment. Patients suspected of having moderately severe cutaneous reactions were invited to return for a complete dermatologic clinical assessment including skin biopsy, if indicated. Statistical analysis was performed by using a two-sided Wilcoxon-Mann-Whitney test, a logistic regression utilizing a chi(2) test to adjust for sex and age, and a two-sided Fisher exact test. RESULTS: A total of 539 patients (258 receiving iohexol and 281 not receiving contrast material) were enrolled. DARs were observed in 37 (14.3%) of 258 subjects receiving iohexol and in seven (2.5%) of 281 subjects in the control group (P < .0001, chi(2) test) after adjusting for sex and age. Specific manifestations of DARs that were significantly more frequent at contrast-enhanced CT were skin rash (P = .0311), skin redness (P = .0055), skin swelling (P = .0117), and headache (P = .0246). DARs involving the skin included generalized rashes of the face, neck, chest, back, and extremities and were often associated with swelling, erythema, and pruritus. CONCLUSION: This study substantiates a frequent occurrence of DARs at contrast-enhanced CT compared with that in control subjects. Continued growth in the use of contrast-enhanced CT suggests a need for greater awareness and attention to prevention and management.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade Tardia/induzido quimicamente , Iohexol/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Hipersensibilidade Tardia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários
14.
Nephrol Dial Transplant ; 22(6): 1762-5, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17403697

RESUMO

BACKGROUND: Dysfunction of haemodialysis catheters is most commonly due to a narrowing of the catheter lumen and/or formation of a fibrin sheath around the catheter tip. Reported methods for restoring patency of the catheter lumen include passage of a J-tipped guide wire, passage of a biopsy brush through the catheter, or infusion of a thrombolytic agent into the catheter. While these methods are often effective, they suffer from several limitations. We present a minimally invasive technique to remove thrombi and debris from within the lumen of a partially thrombosed haemodialysis catheter while simultaneously stripping the fibrous sheath. METHODS: A 0.089 cm nitinol wire is bent to create a loop, which is then inserted via the catheters. Upon exiting the lumen of the catheters, the nitinol wire forces a snare open, which disrupts the fibrin sheath and catches intraluminal thrombi and debris. The technique requires no anaesthesia or recovery time. RESULTS: Initial clinical success in our series was achieved in all patients (7/7) as evidenced by restoration of target flow rates on subsequent haemodialysis. None of the patients experienced any complications as a result of the procedure. The catheter 2-, 4-, and 6-week primary success rates were 100% (8/8), 100% (8/8), and 100% (8/8) respectively with a mean duration of 17.1 weeks (range 8-40 weeks). CONCLUSIONS: The internal snare technique is an effective, inexpensive and minimally invasive approach to restoring patency to failed central venous access catheters.


Assuntos
Coagulação Sanguínea/fisiologia , Cateterismo Venoso Central/instrumentação , Fibrina/fisiologia , Diálise Renal/instrumentação , Grau de Desobstrução Vascular/fisiologia , Ligas/farmacologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Elasticidade , Fibrina/efeitos adversos , Humanos , Diálise Renal/efeitos adversos , Trombose/sangue , Trombose/fisiopatologia , Trombose/prevenção & controle
15.
Pain Physician ; 8(4): 385-90, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16850062

RESUMO

BACKGROUND: Over 500,000 percutaneous disc decompression procedures have been performed in the past 20 years. Various percutaneous techniques include chemonucleolysis, percutaneous lumbar discectomy, and laser discectomy which have reported success rates in the 70% to 75% range. This retrospective evaluation of 49 patients who underwent nucleoplasty procedures for treatment of herniated discs, evaluates the effectiveness of nucleoplasty in the reduction of pain, improvement of functional activity, and reduction of pain medication. OBJECTIVE: To illustrate the effectiveness of nucleoplasty in reducing low back pain in symptomatic patients with contained herniated discs. STUDY DESIGN: A retrospective, non-randomized study. METHODS: Forty-nine patients with either axial or radicular low back pain who had undergone the nucleoplasty procedure were included in this analysis. Patients were categorized in one of three different groups depending on time elapsed since the procedure was performed: less than 6 months, between 6 months and 1 year, and greater than 1 year. Pain reduction, work impairment, leisure impairment, medication use and patient satisfaction were all recorded during this study. Pain was quantified using a numeric pain scale from 0 to 10. Work and leisure impairment were measured on a scale of 1 to 5, with 1 signifying no impairment and 5 signifying extreme impairment. Medication use and patient satisfaction were also measured on a scale of 1 to 5. RESULTS: Significant pain relief, functional improvement, and a decrease in medication use were achieved following nucleoplasty. There were no complications associated with the procedure. CONCLUSION: Nucleoplasty should be used in those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.

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