Sucesso da punção intravenosa periférica após capacitação dos profissionais de enfermagem para o uso da transiluminação / Puncture Success after training nurses in the use of transillumination / Éxito de la punción venosa periférica después de la formación de profesionales de enfermería en el uso de la transiluminación

Objetivo: avaliar o índice de sucesso na primeira tentativa de cateterização intravenosa periférica em crianças após capacitação de profissionais de enfermagem para o uso de transiluminação. Método: estudo observacional, prospectivo, comparativo do tipo antes e depois, realizado com enfermeiros e técnicos de enfermagem que foram capacitados para a cateterização guiada pela transiluminação e observados executando 35 procedimentos antes e 35 após a capacitação, no período de novembro de 2018 a maio de 2019, após aprovação do mérito ético do protocolo de pesquisa. Os dados foram analisados de forma descritiva e analítica. Resultados: o índice de sucesso na primeira tentativa foi de 62,9% antes e 65,7% depois (p=0,803). Os técnicos de enfermagem executaram mais a punção antes da capacitação e os enfermeiros depois (p<0,01). Conclusão: a capacitação de profissionais para realizar a punção guiada pela transiluminação aumentou o índice de sucesso na primeira tentativa de punção intravenosa periférica, sem diferença estastiticamente significativa(AU)

Objective: to evaluate the puncture success in the first attempt in children after training nursing professionals in the use of transillumination. Method: observational, prospective, comparative before-and-after study, carried out with nurses and nursing technicians were trained for transillumination-guided catheterization and observed performing 35 procedures before and 35 after training, from November 2018 to May 2019, after approval of the ethical merit of the research. Data were analyzed descriptively and analytically. Results: success in the first attempt was 62.9% before and 65.7% after (p=0.803). Nursing technicians performed more punctures before training and nurses after (p<0.01). Conclusion: the training professionals to perform transillumination-guided puncture increased success in the first attempt at peripheral intravenous puncture, without significant statistical difference(AU)

Objetivo: evaluar la tasa de éxito en el primer intento de cateterización venosa periférica en niños después de capacitar a los profesionales de enfermería en el uso de la transiluminación. Método: estudio observacional, prospectivo, comparativo de antes y después, realizado junto a enfermeros y técnicos de enfermería capacitados para cateterización guiada por transiluminación y observados realizando 35 procedimientos antes y 35 después del entrenamiento, de noviembre de 2018 a mayo de 2019, previa aprobación del mérito ético del protocolo de la investigación. Los datos se analizaron de forma descriptiva y analítica. Resultados: la tasa de éxito en el primer intento fue del 62,9% antes y del 65,7% después (p=0,803). Los técnicos de enfermería realizaron más punciones antes del entrenamiento y los enfermeros después (p<0,01). Conclusión: la formación de profesionales para realizar la punción guiada por transiluminación aumentó la tasa de éxito en el primer intento de punción venosa periférica, sin diferencia estadística significativa(AU)

Design and application of a B-ultrasound-guided deep vein puncture precise positioning device / 中华危重病急救医学

Deep venipuncture catheterization is a routine and basic operation in the treatment of critically ill patients, and it is the most effective way to quickly correct the shock. Clinical B-ultrasound guided deep vein catheters can improve the success rate of puncture, but in the process of operation, the short axis needs to be replaced by the long axis. In the replacement process, the stability of the novice is insufficient, the positioning is difficult, and the operation time is too long. If only short axis puncture is used, it is impossible to know whether the current position of the puncture needle, and the puncture may be too deep and stray into the artery. The accuracy of the 45 degree angle of the injection point requires a very experienced operator. In view of the above shortcomings, doctors in the department of critical care medicine of Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a B-ultrasound puncture equipment, which has obtained the National Invention Patent of China (ZL 2016 1 0571557.X). The device is composed of B-ultrasound probe fixing frame, sliding scale plate, simulation slide rule, puncture needle, sliding device. By sliding device the angle of the pinhole channel, it is conducive to the accurate positioning of the puncture target, optimizing the operation procedure, improving the puncture speed and accuracy, effectively reducing the occurrence of puncture complications, ensuring patient safety, reducing unnecessary waste of human and material resources. It can reduce the workload of medical staff and is worthy of clinical practice.

Gestión del capital venoso de los recién nacidos hospitalizados: catéter de línea media (CM) con técnica adaptada. Servicio de Neonatología, Hospital Público de Chile / Venous capital management of hospitalized newborns: midline catheter (MC) with adapted technique. Neonatology Service, Chilean public hospital

INTRODUCCIÓN: El catéter midline o de línea media (CM) es un dispositivo de acceso vascular que mide de 6 a 20cm, con la punta del dispositivo ubicado en venas basílica, braquial o cefálica debajo del pliegue axilar. El catéter de línea media se caracteriza por ser un acceso confiable y proporcionar menores complicaciones que un catéter intravenoso periférico corto. Este tipo de dispositivo vascular se ha utilizado ampliamente en adultos, pero faltan estudios desarrollados en el área neonatal. OBJETIVO: fue describir las características de la utilización de catéter midline con técnica adaptada en recién nacidos hospitalizados con necesidad de terapia intravascular en un hospital público de Chile, durante 2 años de seguimiento. METODOLOGÍA: Investigación descriptiva y retrospectiva, estuvo orientada a la identificación de las variables relacionadas a: tiempo de permanencia, características de la terapia intravascular, sitio de inserción, complicaciones y causa de retiro. RESULTADOS: La muestra estuvo conformada por 163 usuarios entre 24 y 41 semanas de edad gestacional, peso de nacimiento en un rango de 500 y 4880 gramos. El 87,7% se retiró por término de tratamiento intravascular, mientras que el 12,3% del total de los CM presentó complicaciones. El promedio de rendimiento del CM fue de 7,99 días, el sitio de inserción más frecuente correspondió a extremidad superior derecha, mientras que su utilización estuvo dada principalmente para fleboterapia, antibióticos y nutrición parenteral periférica. CONCLUSIÓN: Se concluye que el CM con técnica adaptada en usuarios neonatales presenta una alta tasa de éxito para completar la terapia intravascular periférica y bajo porcentaje de complicaciones.

INTRODUCTION: The midline catheter (MC) is a vascular access device measuring 6 to 20cm, with the tip of the device located in the basilic, brachial or cephalic veins below the axillary crease. The midline catheter is characterized as a reliable access and provides fewer complications than a short peripheral intravenous catheter. This type of vascular device has been widely used in adults, but studies developed in the neonatal area are lacking. OBJECTIVE: to describe the characteristics of the use of midline catheter with adapted technique in hospitalized newborns in need of intravascular therapy in a public hospital in Chile, during 2 years of follow-up. METHODOLOGY: Descriptive and retrospective research was oriented to the identification of variables related to: length of stay, characteristics of intravascular therapy, site of insertion, complications and cause of withdrawal. RESULTS: The sample consisted of 163 users between 24 and 41 weeks of gestational age, birth weight in the range of 500 and 4880 grams. Eighty-seven point seven percent were withdrawn due to the end of intravascular treatment, while 12.3% of the total MC presented complications. The average MC performance was 7.99 days, the most frequent insertion site corresponded to the right upper extremity, while its use was mainly for phlebotherapy, antibiotics and peripheral parenteral parenteral nutrition. CONCLUSION: The MC with adapted technique in neonatal users presents a high success rate to complete peripheral intravascular therapy and a low percentage of complications.

Tradução, validação e adaptação transcultural de instrumento para ensino de cricotireodostomia por punção / Translation, validation and cross-cultural adaptation of instrument for teaching needle cricothyroidotomy

Considerando o enfrentamento da pandemia ocasionada pela Covid-19, várias habilidades se tornaram essenciais aos profissionais atuantes nos departamentos de emergência. Dentre elas, as técnicas para o manejo das vias aéreas e a realização de cricotireoidostomia por punção. O objetivo do estudo foi: traduzir, validar e adaptar de forma transcultural um roteiro de simulação para o ensino da habilidade técnica de cricotireoidostomia por punção. Estudo metodológico, sendo respeitadas as etapas de tradução, adaptação transcultural e validação pertinentes ao método. A pesquisa originou um roteiro de prática simulada para o ensino da habilidade de cricotireoidostomia por punção. Concluiu-se que a eficácia da metodologia de simulação realística está alinhada à construção e validação de roteiros que conduzam a prática de forma padronizada, respeitando todas as etapas do método.

Peritoneal fluid collection in healthy cattle and evaluation of changes in cell morphology during storage in refrigerated and non-refrigerated samples / Colheita do fluido peritoneal de bovinos sadios e verificação das alterações na morfologia celular quando mantido refrigerado ou à temperatura ambiente

This study aimed to evaluate the appropriate sites of abdominocentesis for peritoneal fluid collection in cattle and to investigate the time of cell viability in vitro, comparing three methods of sample conservation. Twenty-one healthy cattle (19 females and 2 males) were subjected to a laparocentesis procedure to obtain peritoneal fluid, with punctures in three defined sites: left cranial, right cranial, and right caudal. The total peritoneal fluid collected was divided into three aliquots and maintained under three preservation conditions: room temperature (26°C), refrigeration (4°C), and room temperature (26°C) with the addition of 1µL of 10% formaldehyde per 1mL of peritoneal fluid. The peritoneal fluid analysis performed immediately after collection consisted of: physical examination (color, appearance, volume, and specific gravity), biochemical measures (pH, total protein, fibrinogen, creatinine, and glucose), and cellularity (total and differential counts). The determination of proteins and the examination of cells were repeated in each separate aliquot at two, four, six, and eight hours after harvest. Data were analyzed through repeated measures ANOVA or Friedman test. The harvest was productive in 67% of cattle. The left cranial and the right cranial puncture sites were the most appropriate. Peritoneal fluid analyzed after collection, the total protein concentration ranged from 1.4 to 3.6g/dL, and number of leukocytes ranged from 54 to 1,322 cells/µL; 60 to 95% of leukocytes were lymphocytes. The protein concentration decreased, but the absolute values of leukocytes, lymphocytes, and segmented neutrophils did not change up to eight hours after collection, independent of the maintenance method. Cell lysis was delayed by cooling, and the addition of formaldehyde did not help preserve the integrity of cellular morphology. Laparocentesis is a safe and secure procedure in cattle and maybe more productive when performed in specific sites on the left or right sides of the cranial abdominal wall. Peritoneal fluid samples may be analyzed with reliable results for up to eight hours after collection when kept refrigerated and for up to six hours when kept at room temperature.(AU)

O estudo teve como objetivo avaliar os locais adequados de laparocentese para a colheita de fluido peritoneal de bovinos e estabelecer o tempo de viabilidade celular in vitro, comparando três métodos de conservação. Vinte e um bovinos hígidos (19 fêmeas e 2 machos) foram submetidos ao procedimento de laparocentese para obtenção de fluido peritoneal, com punção em três pontos definidos: cranial esquerdo, cranial direito e caudal direito. O volume total do líquido peritoneal foi dividido em três alíquotas mantidas sob três métodos de conservação: temperatura ambiente (26°C); refrigeração (4°C); e temperatura ambiente (26°C) com adição de 1µL de formol 10% para cada 1mL de líquido peritonial. A análise do líquido peritoneal realizada imediatamente após sua obtenção consistiu em: exames físico (cor, aspecto, volume e densidade); bioquímicos (pH, proteína total, fibrinogênio, creatinina e glicose); e da celularidade (contagens total e diferencial). A determinação de proteínas e o exame da celularidade foram repetidos, em cada alíquota separada, as duas, quatro, seis e oito horas após a colheita. Análise de variâncias de medidas repetidas ou teste de Friedman foram empregados para avaliação ao longo do tempo. A colheita foi produtiva em 67% dos bovinos e os locais de punção craniais esquerdo e direito foram os mais adequados. A concentração de proteína total variou de 1,4 a 3,6g/dL e o número de leucócitos de 54 a 1.322 células/µL, com predomínio de linfócitos (60 a 95% das células) no fluido peritoneal analisado logo após a colheita. A concentração de proteínas diminuiu, mas os valores absolutos de leucócitos, de linfócitos e de neutrófilos segmentados não se modificaram até oito horas após a colheita, independente do método de manutenção das amostras. A lise celular foi retardada pela refrigeração e a adição de formol não contribuiu para preservar a integridade da morfologia celular. A laparocentese é um procedimento seguro e de execução fácil em bovinos sendo mais produtiva quando realizada em locais específicos à esquerda ou à direita craniais da parede abdominal. Amostras de fluido peritoneal podem ser analisadas com resultados confiáveis quando mantidas refrigeradas por até oito horas após a colheita e quando mantidas à temperatura ambiente por até seis horas.(AU)

Manejo intraoperatório em cirurgia laparoscópica ou robótica para minimizar a dispersão de aerossóis: Adaptações ao contexto da pandemia por COVID-19 / Laparoscopic or robotic intraoperative management to minimize aerosol dispersion: Adaptations to the context of the COVID-19 pandemic

RESUMO A infecção pelo coronavírus determinante da doença COVID-19, também conhecida como SARS-COV2 foi classificada nos últimos meses como pandemia. Essa é potencialmente fatal, representando enorme problema de saúde mundial. A disseminação, após provável origem zoonótica na cidade de Wuhan, China, resultou em colapso do sistema de saúde de diversos países, alguns com enorme impacto social e número grande de mortes descritas na Itália e Espanha. Medidas extremas intra e extra-hospitalares têm sido implementadas a fim de conter a transmissão e disseminação da COVID-19. No âmbito cirúrgico, enorme quantidade de procedimentos considerados não essenciais ou eletivos foram prorrogados ou suspensos até resolução da pandemia. No entanto, cirurgias de urgência e oncológicas não permitem que o paciente espere. Nesta publicação, sugerimos e ensinamos adaptação a ser feita com materiais de uso corriqueiro em laparoscopias para evitar a contaminação ou a disseminação entre as equipes assistenciais e os pacientes.

ABSTRACT The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.

Punción percutánea transtorácica con aguja gruesa: complicaciones y factores de riesgo inherentes al paciente / Imaging-guided Chest Biopsies with Thick Needle: Complications and Risk Factors Inherent to the Patient

Objetivo Determinar la incidencia de complicaciones con el uso de una aguja gruesa (semiautomática Trucut 18), para punción pulmonar y realizar un análisis exploratorio de las variables inherentes al paciente que probablemente puedan tener relación con el desarrollo de complicaciones. Materiales y Métodos Estudio retrospectivo de una serie de casos de pacientes sometidos a punción percutánea transtorácica (PPT) con aguja gruesa y guiada por tomografía computada (TC) para el estudio de lesiones pulmonares; se realizó un análisis univariado. Resultados Se realizaron 26 punciones, la tasa de incidencia de complicaciones fue del 38,46% en 1 año; los pacientes presentaron: neumotórax leve (n » 7), neumotórax moderado (n » 3) y hemorragia alveolar difusa (n » 1). El análisis estadístico univariado mostró una diferencia estadísticamente significativa en la edad de los pacientes que presentaron complicaciones v/s los pacientes que no presentaron complicaciones (61,18 þ/- 3,6 versus 75,1 þ/- 2,46 años, p » 0,0107). Conclusión La PPT-TC es un procedimiento con una tasa considerable de complicaciones no severas; en nuestra serie de casos, la edad fue la variable que se asoció con mayor fuerza al probable desarrollo de complicaciones.

Objective Establish the incidence of complications with the use of thick needle (Trucut 18) for pulmonary puncture and perform an exploratory analysis of the inherent variables to the patient that may be related to complication development. Materials and Methods Retrospective study of a case series of patients undergoing transthoracic percutaneous puncture (PPT) with thick needle,guided by computed tomography (CT) for the study of pulmonary lesions; a univariate and multivariate analysis was performed. Results 26 punctures were performed, the incidence rate of complications was 38.46% in 1 year: patients presented: mild pneumothorax (n » 7), moderate pneumothorax (n » 3) and diffuse alveolar hemorrhage (n » 1). The univariate statistical analysis showed a statistically significant difference in the age of the patients who presented complications v/s patients who did not present complications (61.18 þ/- 3.6 versus 75.1 þ/- 2.46 years, p » 0.0107). Conclusion PPT-CT is a procedure with a considerable rate of non-severe complications; in our case series, age was the variable that was most strongly associated with the probable development of complications.

Vascular access: the impact of ultrasonography / Acesso vascular: o impacto da ultrassonografia

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.

RESUMO Punções vasculares são muitas vezes necessárias em pacientes gravemente enfermos. São seguras, mas não isentas de complicações. A ultrassonografia associada à técnica de punção gera diminuição do número de tentativas, de complicações e de custos. O presente artigo revisou importantes publicações sobre o tema, bem como técnicas de punções, trazendo parte da experiência do centro de terapia intensiva de adultos do Hospital Israelita Albert Einstein, em São Paulo (SP) e discutindo tópicos que devem ser melhor explorados em estudos futuros.

Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis.

Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture / Estudo clínico duplo-cego randomizado comparando duas técnicas anestésicas para punção folicular guiada por ultrassom transvaginal

ABSTRACT Objective: To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration. Methods: A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol. Results: The results revealed a higher number of embryos formed in the FP Group (p50=2 versus 1; p=0.025), gestation rate two times higher in the FP Group (44.4% versus 22.2%; p=0.127), less time to reach AK=10 in the MRPB Group (p50=10 versus 2; p<0.001), and lower mean of hemodynamic parameters in the MRPB Group (p<0.05). Conclusion: Anesthesia with fentanyl and propofol as well as with midazolam, remifentanil, and paracervical block offered satisfactory anesthetic conditions when performing assisted reproduction procedures, providing comfort for the patient and physician.

RESUMO Objetivo: Comparar as técnicas anestésicas utilizando propofol e fentanil contra midazolam e remifentanil associados a um bloqueio paracervical com lidocaína na aspiração de oócitos transvaginal guiada por ultrassom. Métodos: Ensaio clínico randomizado duplocego (#RBR-8kqqxh) realizado em 61 mulheres submetidas ao tratamento de reprodução assistida. As pacientes foram divididas em dois grupos: um grupo foi submetido à indução da anestesia com 1mcg/kg de fentanil associada com 1,5mg/kg de propofol (Grupo FP, n=32), em comparação com ao grupo submetido à indução da anestesia utilizando 0,075mg/kg de midazolam associada com 0,25mcg/kg/min de remifentanil, e bloqueio paracervical com 3mL de lidocaína a 2% (Grupo MRBP, n=29). Foram avaliados os resultados reprodutivos, índice modificado de Aldrete e Kroulik, parâmetros hemodinâmicos e cortisol salivar. Resultados: Foi encontrado um número mais elevado de embriões formados no Grupo FP (p50=2 versus 1; p=0,025), taxa de gestação duas vezes mais elevada no Grupo FP (44,4% versus 22,2%; p=0,127), menos tempo para alcançar AK=10 no Grupo MRBP (p50=10 versus 2; p<0,001) e média mais baixa de parâmetros hemodinâmicos do Grupo MRBP (p<0,05). Conclusão: Ambas as anestesias (com fentanil e propofol, e com midazolam, remifentanil e bloqueio paracervical) ofereceram condições anestésicas satisfatórias na realização de procedimentos realizados em reprodução assistida, proporcionando conforto para o paciente e médico.

Novel retrograde puncture method to establish preperitoneal space for laparoscopic direct inguinal hernia repair with internal ring suturing

The aim of this study was to explore the clinical efficacy of a novel retrograde puncture approach to establish a preperitoneal space for laparoscopic direct inguinal hernia repair with inguinal ring suturing. Forty-two patients who underwent laparoscopic inguinal hernia repair with retrograde puncture for preperitoneal space establishment as well as inguinal ring suturing between August 2013 and March 2014 at our hospital were enrolled. Preperitoneal space was successfully established in all patients, with a mean establishment time of 6 min. Laparoscopic repairs were successful in all patients, with a mean surgical time of 26±15.1 min. Mean postoperative hospitalization duration was 3.0±0.7 days. Two patients suffered from postoperative local hematomas, which were relieved after puncturing and drainage. Four patients had short-term local pain. There were no cases of chronic pain. Patients were followed up for 6 months to 1 year, and no recurrence was observed. Our results demonstrate that preperitoneal space established by the retrograde puncture technique can be successfully used in adult laparoscopic hernioplasty to avoid intraoperative mesh fixation, and thus reduce medical costs.

A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy

ABSTRACT Objective: To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL. Materials and Methods: Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation. Results: This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases. Conclusions: Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.

Percutaneous puncture of renal calyxes guided by a novel device coupled with ultrasound

ABSTRACT Purpose: To evaluate the efficiency of a novel device coupled with ultrassound for renal percutaneous puncture. Materials and Methods: After establishing hydronephrosis, ten pigs had three calyxes of each kidney punctured by the same urology resident, with and without the new device ("Punctiometer"). Time for procedure completion, number of attempts to reach the calyx, puncture precision and puncture complications were recorded in both groups and compared. Results: Puncture success on the first attempt was achieved in 25 punctures (83%) with the Punctiometer and in 13 punctures (43%) without the Punctiometer (p=0.011). The mean time required to perform three punctures in each kidney was 14.5 minutes with the Punctiometer and 22.4 minutes without the Punctiometer (p=0.025). The only complications noted were renal hematomas. In the Punctiometer group, all kidneys had small hematomas. In the no Punctiometer group 80% had small hematomas, 10% had a medium hematoma and 10% had a big hematoma. There was no difference in complications between both groups. Conclusions: The Punctiometer is an effective device to increase the likelihood of an accurate renal calyx puncture during PCNL, with a shorter time required to perform the procedure.

Resección guiada por ecografía de gangliones dorsales de muñeca / Ultrasound-guided resection of dorsal wrist ganglion

Introducción: El objetivo de este trabajo fue evaluar prospectivamente los resultados del drenaje de gangliones dorsales de muñeca y la ruptura de su pedículo guiada por ecografía, y determinar su tasa de recidiva, las complicaciones y los resultados subjetivos. Materiales y Métodos: Se evaluaron prospectivamente 32 pacientes con gangliones dorsales sintomáticos de muñeca tratados mediante punción guiada por ecografía, aspiración del contenido y ruptura del pedículo con un trocar, entre enero de 2010 y junio de 2011. La edad de los pacientes promedió 31 años. Todos realizaban tareas administrativas, y retornaron a sus tareas habituales al día siguiente del procedimiento. El puntaje DASH previo al procedimiento fue, en promedio, de 2,90. El dolor previo al procedimiento promedió 7,75 puntos. Se separó a los pacientes en dos grupos, gangliones primarios (grupo 1: 19 pacientes) y gangliones recurrentes con cirugía previa (grupo 2: 13 pacientes). Resultados: Once pacientes tuvieron recidivas (34,3%) al año de seguimiento: 5 del grupo 1 (26,31%) y 6 del grupo 2 (46,1%). El puntaje DASH a los 6 meses promedió 1,91 (rango 1,02-3,98). El dolor a los 6 meses promedió 1,53 puntos (rango 0-4). Ningún paciente presentó complicaciones neurológicas o tendinosas, infección o hematomas (seguimiento promedio 6 meses). Conclusión: La técnica bajo control ecográfico es mínimamente invasiva con una tasa de recurrencia aceptable (26% en pacientes sin antecedente quirúrgico), considerando que plantea menores riesgos que los procedimientos quirúrgicos al igual que un menor costo y bajo costo laboral.

Background: The aim of this study was to prospectively evaluate the results of dorsal wrist ganglion cyst drainage and pedicle rupture under ultrasound guidance, and to determine recurrence rate, complications and subjective outcomes. Methods: Thirty-two patients with symptomatic dorsal wrist ganglion cysts treated by ultrasound-guided puncture, aspiration and pedicle rupture with a trochar, between January 2010 and June 2011, were prospectively evaluated. Age of the patients averaged 31 years. All patients returned to their previous daily activities the day after the procedure. DASH score before the procedure averaged 2.90 points. The pre-drainage visual analog scale for pain averaged 7.75 points. Patients were divided into two groups: without previous surgery (group 1: 19 patients) or with previous surgery (group 2: 13 patients). Results: Eleven patients had recurrences (34.3%) after a six-month follow-up: 5 patients in group 1 (26.31%) and 6 in group 2 (46.1%). DASH score at final follow-up averaged 1.91 points. Pain score at last follow-up averaged 1.53 points. There were no neurological or tendinous complications, infection or hematomas (follow-up 6 months). Conclusions: The technique under ultrasound guidance is minimally invasive with an acceptable recurrence rate (26% in patients without previous surgical interventions), considering that it presents less risk than surgical procedures, its lower cost and the immediate return to work.

Intervention Planning Using a Laser Navigation System for CT-Guided Interventions: A Phantom and Patient Study

OBJECTIVE: To investigate the accuracy, efficiency and radiation dose of a novel laser navigation system (LNS) compared to those of free-handed punctures on computed tomography (CT). MATERIALS AND METHODS: Sixty punctures were performed using a phantom body to compare accuracy, timely effort, and radiation dose of the conventional free-handed procedure to those of the LNS-guided method. An additional 20 LNS-guided interventions were performed on another phantom to confirm accuracy. Ten patients subsequently underwent LNS-guided punctures. RESULTS: The phantom 1-LNS group showed a target point accuracy of 4.0 +/- 2.7 mm (freehand, 6.3 +/- 3.6 mm; p = 0.008), entrance point accuracy of 0.8 +/- 0.6 mm (freehand, 6.1 +/- 4.7 mm), needle angulation accuracy of 1.3 +/- 0.9degrees (freehand, 3.4 +/- 3.1degrees; p < 0.001), intervention time of 7.03 +/- 5.18 minutes (freehand, 8.38 +/- 4.09 minutes; p = 0.006), and 4.2 +/- 3.6 CT images (freehand, 7.9 +/- 5.1; p < 0.001). These results show significant improvement in 60 punctures compared to freehand. The phantom 2-LNS group showed a target point accuracy of 3.6 +/- 2.5 mm, entrance point accuracy of 1.4 +/- 2.0 mm, needle angulation accuracy of 1.0 +/- 1.2degrees, intervention time of 1.44 +/- 0.22 minutes, and 3.4 +/- 1.7 CT images. The LNS group achieved target point accuracy of 5.0 +/- 1.2 mm, entrance point accuracy of 2.0 +/- 1.5 mm, needle angulation accuracy of 1.5 +/- 0.3degrees, intervention time of 12.08 +/- 3.07 minutes, and used 5.7 +/- 1.6 CT-images for the first experience with patients. CONCLUSION: Laser navigation system improved accuracy, duration of intervention, and radiation dose of CT-guided interventions.

Conocimientos sobre el uso de la vía intraósea en situaciones de emergencia del profesional de enfermería que realiza la Especialidad de Emergencias y Desastres en la Universidad Nacional Mayor de San Marcos / Knowledge about the use of intraosseous route in emergency situations of the professional nursing who performs the Specialty of Emergencies and Disasters in the Greatest National University of San Marcos

Determinar los conocimientos sobre el uso de la vía intraósea en situaciones de emergencias en el profesional de Enfermería de la especialidad de Emergencias y Desastres en la UNMSM e identificar los conocimientos sobre la técnica de punción intraósea y el uso de los dispositivos intraóseos. Material y Método: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo simple de corte transversal. La población estuvo conformada por 35 profesionales de Enfermería. La técnica fue la encuesta y el instrumento el cuestionario aplicado previo consentimiento informado. Resultados: Del 100 por ciento (35), 11 por ciento (4) tienen conocimiento alto, 31 por ciento (11) medio y 57 por ciento (20) bajo. En cuanto a la técnica de punción intraósea, 6 por ciento (2) poseen conocimientos alto, 14 por ciento (5) medio y 80 por ciento (28) bajo. Respecto al uso de los dispositivos de punción intraósea, 11 por ciento (4) tienen conocimiento alto, 17 por ciento (6) medio y 72 por ciento (25) bajo. Conclusiones: Los conocimientos sobre el uso de la vía intraósea en situaciones de emergencia en el profesional de Enfermería no es el adecuado por lo que la mayoría tiene de medio a bajo referido a que no reconocen el tipo de vía al que pertenece el intraóseo, las indicaciones en niños y adultos, las zonas recomendadas, las ventajas y desventajas, sustancias que se pueden infundir, complicaciones y contraindicaciones. De igual modo en lo referido a la técnica de punción intraósea no conocen acerca de los pasos a seguir para la colocación de un catéter intraóseo, las medidas de asepsia, la comprobación de la correcta colocación del catéter. Sobre el uso de dispositivos intraóseos la mayoría no conocen los existentes actualmente en el mercado y sus principales características...

Objectives: To determine knowledge about using the intraosseous route in emergencies in professional nursing specialty Emergency Disaster San Marcos and identify the knowledge of intraosseous puncture technique and use of intraosseous devices. Material and Methods: The study is level application, quantitative, simple descriptive cross-sectional method. The population consisted of 35 nursing professionals. The technique was the survey instrument and the questionnaire administered prior informed consent. Results: 100 per cent (35), 11 per cent (4) have high awareness, 31 per cent (11) medium and 57 per cent (20) low. As regards the intraosseous puncture technique, 6 per cent (2) have high knowledge, 14 per cent (5) medium and 80 per cent (28) low. Regarding the use of the intraosseous needle devices, 11 per cent (4) have high awareness, 17 per cent (6) medium and 72 per cent (25) low. Conclusions: Knowledge about the use of intraosseous emergency in professional nursing is not adequate for what most have medium to low relative to not recognize the type of road to which the intraosseous part, the on-children and adults, the recommended areas, advantages and disadvantages, substances that can be infused, complications and contraindications. Similarly with regard to the technique of intraosseous puncture do not know about the steps for placing an intraosseous catheter aseptic measures, checking the correct placement of the catheter. On the use of intraosseous devices most do not know the present state of the market and its key features...

Cross-sectional study comparing different therapeutic modalities for cystic lymphangiomas in children

OBJECTIVE: Here, we describe our experience with different therapeutic modalities used to treat cystic lymphangiomas in children in our hospital, including single therapy with OK-432, bleomycin and surgery, and a combination of the three modalities. METHODS: We performed a retrospective, cross-sectional study including patients treated from 1998 to 2011. The effects on macrocystic lymphangiomas and adverse reactions were evaluated. Twenty-nine children with cystic lymphangiomas without any previous treatment were included. Under general anesthesia, patients given sclerosing agents underwent puncture of the lesion (guided by ultrasound when necessary) and complete aspiration of the intralesional liquid. The patients were evaluated with ultrasound and clinical examinations for a maximum follow-up time of 4 years. RESULTS: The proportions of patients considered cured after the first therapeutic approach were 44% in the surgery group, 29% in the bleomycin group and 31% in the OK-432 group. These proportions were not significantly different. Sequential treatment increased the rates of curative results to 71%, 74% and 44%, respectively, after the final treatment, which in our case was approximately 1.5 applications per patient. CONCLUSION: The results of this study indicate that most patients with cystic lymphangiomas do not show complete resolution after the initial therapy, regardless of whether the therapy is surgical or involves the use of sclerosing agents. To achieve complete resolution of the lesions, either multiple operations or a combination of surgery and sclerotherapy must be used and should be tailored to the characteristics of each patient. .

Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.