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1.
Rev Invest Clin ; 72(3): 144-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584329

RESUMO

The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.


Assuntos
Betacoronavirus , Controle de Doenças Transmissíveis/instrumentação , Infecções por Coronavirus/prevenção & controle , Máscaras , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Microbiologia do Ar , Betacoronavirus/isolamento & purificação , Controle de Doenças Transmissíveis/legislação & jurisprudência , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Surtos de Doenças , Transmissão de Doença Infecciosa/prevenção & controle , Desenho de Equipamento , Falha de Equipamento , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Influenza Humana/virologia , Tamanho da Partícula , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Utilização de Procedimentos e Técnicas , Avaliação de Programas e Projetos de Saúde , Dispositivos de Proteção Respiratória , Síndrome Respiratória Aguda Grave/epidemiologia , Taxa de Sobrevida
2.
Medicine (Baltimore) ; 99(25): e20565, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569180

RESUMO

RATIONALE: Ventriculoperitoneal shunt (VPS) is the most common treatment for idiopathic normal pressure hydrocephalus, a subtype of hydrocephalus characterized by gait disturbance, dementia, and urinary incontinence. However, while the malfunction of VPS is reported at a high rate, the involvement of chronic cholecystitis in shunt malfunction is rare. PATIENT CONCERNS: A 73-year-old woman with idiopathic normal pressure hydrocephalus who received a VPS but subsequently developed chronic cholecystitis. The patient suffered from drowsiness and was unable to walk. Her family found that she presented with poor appetite and was bloated. DIAGNOSES: Chronic cholecystitis was confirmed through abdominal computed tomography, which showed a swollen, and enlarged gallbladder, and flatulence. A head computed tomography scan indicated hydrocephalus with enlarged ventricular system and paraventricular edema. INTERVENTIONS: Laparoscopic cholecystectomy was performed successfully, requiring no further shunt manipulation. OUTCOMES: The patient's memory and cognitive ability were slightly impaired without a positive sign in the abdomen. No catheter or abdominal infection signs were observed during the following 3 months of follow-up. CONCLUSION: To the best of our knowledge, this report is the first to reveal that shunt malfunction may result from chronic cholecystitis, which induced the presently observed intra-abdominal hypertension.


Assuntos
Colecistite/complicações , Falha de Equipamento , Derivação Ventriculoperitoneal/efeitos adversos , Idoso , Colecistectomia Laparoscópica , Colecistite/dietoterapia , Colecistite/cirurgia , Feminino , Cabeça/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 99(21): e20015, 2020 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481269

RESUMO

The purpose of this study is to define the rate of implant failure and risk factors for failure in patients treated operatively for displaced medial epicondyle fractures.Patients <18 years of age with medial epicondyle humerus fractures that were treated with screw or k-wire fixation between 2005 and 2015 were eligible. Inclusion criteria included follow-up until radiographic union and no known medical conditions that could impair healing.Thirty four patients with 35 fractures were identified with an average age of 12 years old. 11.4% (n = 4/35) of fractures were treated using K-wires, 25.7% (n = 9/35) were treated using a screw and washer construction, and 62.9% (n = 22/35) were treated using screw alone. There were 16 reported complications (46%) including implant prominence requiring reoperation (6), implant failure (1), and fracture displacement (1). Other complications included non-union/delayed union (4), new ulnar nerve palsy (2), and decreased range of motion (2). Rates of complications were not different between the types of fixation (P = 1.0). Those who developed complications were younger than those who did not (P = 0.05). 91.4% of patients returned to full activity including weight bearing and throwing sports.Although 25% of patients experienced implant complications and the overall complication rate approached 50%, nearly all reported return to full activity.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/etiologia , Adolescente , Parafusos Ósseos/efeitos adversos , Fios Ortopédicos/efeitos adversos , Criança , Falha de Equipamento , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
4.
J Contemp Dent Pract ; 21(4): 351-352, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32584267

RESUMO

In the last decades, the use of nickel-titanium (Ni-Ti) rotary instruments has become the most effective and popular method among endodontists for shaping root canals, even if there are still concerns regarding the increased risks of intracanal breakage or weakening of the instruments.1,2 So manufacturers started to modify the cross-sectional geometrical aspects of the files in order to improve their resistance to torsional and cyclic fatigue. Design is a major feature in determining instruments' properties including cutting efficiency, removal of debris, stresses generated during instrumentation, and the relative resistance to these stresses; however, a perfect design is not existing and any change in design is likely to provide some advantages but also some disadvantages.3,4.


Assuntos
Níquel , Titânio , Estudos Transversais , Ligas Dentárias , Instrumentos Odontológicos , Desenho de Equipamento , Falha de Equipamento , Preparo de Canal Radicular
6.
J Contemp Dent Pract ; 21(3): 277-279, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32434974

RESUMO

AIM: To evaluate the cyclic fatigue resistance of Reciproc blue (RB) 40/0.06 instruments tested at room temperature (20° ± 0.5°C) and at body temperature (37° ± 0.5°C) in a simulated stainless steel canal. MATERIALS AND METHODS: Twenty-four new RB 40/0.06 instruments were randomly divided into two groups (n = 12) according to the temperature used. Dynamic fatigue testing was performed using an artificial stainless steel canal with a 60° curvature angle and a 5-mm radius of curvature. The temperature was controlled throughout the experiment with an underwater thermometer and a thermostat. The data were analyzed descriptively using the IBM SPSS 23.0 program, considering p < 0.05. RESULTS: The time to fracture of the RB instruments differed significantly between the two temperatures (1083.82 seconds at 20°C and 403.80 seconds at 37°C). No significant differences were found in fragment size. CONCLUSION: An increase in temperature reduces the cyclic fatigue resistance of RB 40/0.06 instruments. The results of the study suggest that an intracanal cooling system can be favorable to the fracture resistance of the tested instruments. CLINICAL SIGNIFICANCE: A cooling system of the root canal system is important in endodontic as it favors the cyclic fatigue resistance of Ni-Ti instruments.


Assuntos
Instrumentos Odontológicos , Preparo de Canal Radicular , Desenho de Equipamento , Falha de Equipamento , Temperatura
7.
J Endod ; 46(8): 1136-1143, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32413441

RESUMO

INTRODUCTION: The aim of this study was to evaluate the cyclic fatigue resistance of 3 replicalike rotary instruments compared with their original brand systems using continuous rotation and optimum torque reverse (OTR) kinematics. METHODS: New F1 rotary instruments (n = 20 per group) from ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland) and ProTaper Gold (Dentsply Maillefer) original brand systems were compared with 3 replicalike instruments (U-File [Dentmark, Ludhiana, India], Super Files [Shenzhen Flydent Medical, Shenzhen, China], and Super Files Blue [Shenzhen Flydent Medical]) regarding cyclic fatigue resistance. In each group, the selected instruments were randomly distributed into 2 subgroups (n = 10) according to the kinematics. In the rotary group (ROT), the instruments were activated with a continuous clockwise rotation (300 rpm, 1.5 Ncm), whereas in the OTR group, asymmetric oscillatory motion was performed setting the OTR function at 300 rpm and adjusting the torque limit at the minimum level using the TriAuto ZX2 motor (J Morita, Kyoto, Japan). The time to fracture was recorded and statistically compared according to the kinematics (ROT × OTR) and the instrument type (replicalike × original brand) using the independent sample t test (α = 0.05). Additionally, the metal alloy characterization of each system was performed by differential scanning calorimetry and energy-dispersive X-ray spectroscopy. RESULTS: Statistical analysis revealed significantly higher time to fracture for all rotary systems tested in OTR motion compared with continuous rotation (P < .05) with a mean percentage increase ranging from 52.1% (ProTaper Gold) to 156.7% (U-File). The replicalike instruments showed a significantly higher time to fracture compared with the respective original brand instruments in either ROT or OTR motion (P < .05). Replicas presented austenitic temperatures above the ones displayed by the original brands and an almost equiatomic ratio between nickel and titanium elements. CONCLUSIONS: OTR motion significantly improved the fatigue resistance of both original and replicalike systems. The replicas showed higher cyclic fatigue resistance than original brand instruments and higher transition temperatures to the austenitic phase.


Assuntos
Ligas Dentárias , Falha de Equipamento , Fenômenos Biomecânicos , China , Instrumentos Odontológicos , Desenho de Equipamento , Índia , Preparo de Canal Radicular , Rotação , Estresse Mecânico , Titânio
8.
Med Hypotheses ; 141: 109781, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32361528

RESUMO

The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.


Assuntos
Microbiologia do Ar , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Ambiente Controlado , Pandemias , Pneumonia Viral/transmissão , Ventilação , Aerossóis , Ar Condicionado/efeitos adversos , Ar Condicionado/instrumentação , Ar Condicionado/métodos , Poluição do Ar em Ambientes Fechados , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/transmissão , Contaminação de Equipamentos , Desenho de Equipamento , Falha de Equipamento , Fômites/virologia , Calefação/efeitos adversos , Calefação/instrumentação , Calefação/métodos , Humanos , Doença dos Legionários/epidemiologia , Doença dos Legionários/transmissão , Modelos Biológicos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Engenharia Sanitária/instrumentação , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/transmissão , Esgotos/virologia , Ventilação/instrumentação , Ventilação/métodos
9.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(2): 160-165, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32314889

RESUMO

OBJECTIVE: This study aims to compare the efficiency of three kinds of microtube extraction devices, namely, instrument removal system (IRS), micro-retrieve and repair (MR&R) system, and MR&R system using modified microtube in removing separated instruments with different exposure lengths. METHODS: After a cross-section platform model was established, the IRS, MR&R, and MR&R modified microtube system with sidewall window reduced to 0.20 mm were used to retrieve various separated instrument models, and the differences in extraction effects were statistically analyzed by Chi-square test. The separated instrument models were divided into two groups: stainless steel and nickel-titanium instrument groups. In total, 23 instruments were tested for three times each. RESULTS: When the exposed length of separated instrument was 0.50 mm, the removal efficiency of the modified MR&R system group was significantly higher than those of the IRS and MR&R system groups (P<0.001). When the broken end of the fracture instrument was up to 1.00 mm, the success rates of the MR&R system and modified MR&R groups were significantly higher than that of the IRS group (P<0.01). No difference was observed among these three devices when the exposure length of separated instruments was 1.50 mm or higher. CONCLUSIONS: The MR&R and modified MR&R systems have good removal effect when the exposed length of separated instrument is small.


Assuntos
Instrumentos Odontológicos , Preparo de Canal Radicular , Ligas Dentárias , Cavidade Pulpar , Desenho de Equipamento , Falha de Equipamento , Aço Inoxidável , Titânio
10.
Br J Nurs ; 29(8): S44-S49, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32324455

RESUMO

HIGHLIGHTS: Ultrasound shows several venous changes in pediatric PIV-containing veins. Changes were visualized by ultrasound in the absence of physical exam findings. Venous luminal narrowing, wall thickening, and thrombosis may explain PIV failure. BACKGROUND: Peripheral intravenous catheters (PIVs) are routinely used for venous access in hospitalized pediatric patients to administer fluids and medications and to aspirate blood. Unfortunately, PIVs do not remain functional for the entire duration of intravascular need. We hypothesized that PIV malfunction may be related to venous changes that can be visualized with ultrasound (US) imaging. The purpose of this study was to describe and document such changes in pediatric patients. METHODS: This Institutional Review Board-approved study was performed at a tertiary pediatric medical center. Patients underwent US scans of their PIV-containing veins, documenting venous characteristics such as depth, diameter, wall thickness, blood flow, valves, branch points, and presence of thrombus. Patient demographics and PIV characteristics were also recorded. RESULTS: Data from 30 patients including 12 males and 18 females with a mean age of 11 years were analyzed. Mean venous depth and diameter were 2.07 ± 0.13 and 2.02 ± 0.18 mm, respectively. Mean PIV dwell time at time of evaluation was 3.3 days. PIV-associated venous changes were seen in 73% of accessed veins and included lumen narrowing (47%), wall thickening (33%), presence of thrombus (20%), and absence of blood flow around the PIV tip (40%). CONCLUSION: PIV-associated venous changes are seen with US in the majority of pediatric patients with indwelling PIVs but are not necessarily appreciated on physical exam. These changes may help explain the high rate of pediatric PIV device failure. Given the small sample size, further investigation is needed to better characterize PIV-associated venous changes in children.


Assuntos
Cateterismo Periférico/métodos , Veias/diagnóstico por imagem , Criança , Falha de Equipamento , Feminino , Humanos , Infusões Intravenosas , Masculino , Ultrassonografia
11.
J Allergy Clin Immunol Pract ; 8(6): 1791-1794, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32304834

RESUMO

During the unprecedented times caused by the novel coronavirus disease 2019, there is rapidly evolving information and guidance. However, a focus must also be on proper and effective risk communication. This is especially the case during pandemics that have high rates of infection, significant morbidity, lack of therapeutic measures, and rapid increases in cases, all of which apply to the current coronavirus disease 2019 pandemic. A consequence of poor risk communication and heightened risk perception is hoarding behavior, which can lead to lack of medications and personal protective equipment. One potential way to ensure appropriate risk communication is using social media channels, and ensuring an ongoing consistent media presence. Another important step is to include all stakeholders including members of the allergy community in broader public health messaging. As we continue to face unprecedented times in the allergy community, an understanding and appreciation of risk communication will be essential as we communicate with, and inform, our patients, and our colleagues, moving forward.


Assuntos
Comunicação , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Saúde Pública , Risco , Acesso à Informação , Falha de Equipamento , Colecionismo , Humanos , Meios de Comunicação de Massa , Equipamento de Proteção Individual/provisão & distribução , Mídias Sociais
12.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(1): 92-94, 2020 Jan 08.
Artigo em Chinês | MEDLINE | ID: mdl-32343077

RESUMO

OBJECTIVE: To compare the performance of the GE cyclotron MINItrace system before and after the upgrade. METHODS: The upgrade of the MINItrace system included replacing the silver target with the Nb syetem and adopting the latest RF control and management system and lastest ion source system.The failrue rate and production efficiency were retrospectively analyzed before and after the upgrade. RESULTS: After the upgrade, the cyclotron failure rate decreased by 86.2%, the average capacity increased by 45%. CONCLUSIONS: After the upgrade of MINItrace cyclotron, the failure rate is sharply reduced, and the production efficiency is grately improved.


Assuntos
Ciclotrons/normas , Falha de Equipamento , Estudos Retrospectivos
13.
Br J Nurs ; 29(6): 353-357, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32207647

RESUMO

Twiddler's syndrome is a rare cause of pacemaker failure, where patient manipulation of the pulse generator results in lead dislodgement or retraction. Variations in manifestation have been identified including reel syndrome, where rotation occurs around the transverse axis resulting in coiling of the leads, and ratchet syndrome where arm movement results in lead displacement. Device manipulation leading to device failure has been documented in up to 1.7% of implants, particularly in patients with large pockets or mental disorders. Such complications have serious consequences, particularly in pacing-dependent patients where loss of capture may result in asystole. This article reviews the case of an 84-year-old patient presenting at 8-month pacemaker follow-up in complete heart block with no evidence of pacemaker function.


Assuntos
Disfunção Cognitiva/complicações , Falha de Equipamento , Marca-Passo Artificial/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Bloqueio Cardíaco/terapia , Humanos , Síndrome
14.
Surg Clin North Am ; 100(2): 461-468, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169190

RESUMO

Robotic-assisted surgery has represented a revolution for surgical practice and minimally invasive surgery. The case volume is increasing exponentially and the numbers continue to grow particularly owing to urology and general surgery subspecialties. Nonetheless, robotic surgery is not exempt from complications, which can occur during the preoperative, intraoperative, and postoperative periods, and in particular with issues related to patient preparation, team dynamics, equipment failure, complications related to the surgical act, and surgical outcomes.


Assuntos
Complicações Intraoperatórias , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Robóticos , Competência Clínica , Falha de Equipamento , Humanos , Procedimentos Cirúrgicos Robóticos/instrumentação
15.
Drug Discov Ther ; 14(1): 27-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32147627

RESUMO

Up to 50% peripheral intravenous catheters (PIVs) are removed prematurely because of failures. Catheter failure (CF) leads to replacement and is a great concern for patients and medical staff. It is known that visualization of catheters and vessels with ultrasonography (US) during placement prevents CF. However, US is not a common technique for general nurses. In order to standardize US-assisted PIV placement techniques, an algorithm is needed. This study aimed to develop an algorithm using US-assisted PIV placement to reduce CF rate. Furthermore, to evaluate the effectiveness of the algorithm, CF rates were compared before and after intervention. A pretest-posttest study was performed. The intervention was PIV placement by 23 nurses undergoing training sessions for the algorithm. Intention to treat, per protocol analyses were applied. Logistic regression analysis was used for factor analysis. The CF rate in the pre-intervention group 35.2% (19/54) did not significantly differ from post-intervention group 33.6% (48/143) (p = 0.831), yet significantly differ from complete algorithm-use group 8.7% (2/23; p = 0.017). In factor analysis, compliance to the algorithm was significantly correlated with CF (p = 0.032). The compliance rate was low 16.1% (23/143). Algorithm compliance reduced CF by confirming appropriate catheter tip position from the insertion to the securement phase. This algorithm effectively reduced CF, however, the compliance rate was unacceptable. In order to increase the compliance rate, modified algorithm and new visualizing technology is required.


Assuntos
Algoritmos , Cateterismo Periférico , Ultrassonografia , Falha de Equipamento , Humanos
16.
World Neurosurg ; 137: 421-424, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32112937

RESUMO

BACKGROUND: An epidural nerve block injection is the most common modality of treatment for control of low backache associated with radiating pain. Epidural catheter injections are also widely used by pain physicians to control cancer pain. Epidural catheters could be associated with procedure-related complications, such as epidural hematoma, epidural abscess, and post-dural puncture headache, and rare complications, such as shearing or breakage of the catheter tip. In this report, we describe the full-endoscopic removal of a sheared epidural catheter fragment. CASE DESCRIPTION: A man aged 24 years presented with low backache radiating to his left leg with numbness and weakness. Left-sided L4-L5 disc herniation was diagnosed on magnetic resonance imaging, and the patient was posted for an epidural nerve block. The epidural catheter broke during removal, and a 4-cm fragment was retained in the epidural space. We performed an interlaminar full-endoscopic removal of the sheared epidural catheter. Postoperatively, the patient reported excellent clinical outcome. CONCLUSIONS: Interlaminar full-endoscopic procedure could be used for the removal of the retained epidural catheter as a practical option.


Assuntos
Cateteres , Falha de Equipamento , Corpos Estranhos/cirurgia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/terapia , Neuroendoscopia/métodos , Radiculopatia/terapia , Analgesia Epidural/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Bloqueio Nervoso/métodos , Radiculopatia/etiologia , Adulto Jovem
18.
Medicine (Baltimore) ; 99(8): e19195, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080105

RESUMO

RATIONALE: Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS: We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS: Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS: Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES: After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION: Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.


Assuntos
Placas Ósseas/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/cirurgia , Idoso , Artroplastia do Joelho/métodos , Falha de Equipamento , Feminino , Fraturas do Fêmur/epidemiologia , Humanos , Obesidade/epidemiologia , Osteoporose/epidemiologia , Fraturas Periprotéticas/epidemiologia , Suporte de Carga/fisiologia
19.
Br J Radiol ; 93(1109): 20190505, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101462

RESUMO

OBJECTIVE: Percutaneous transluminal balloon angioplasty (PTA) is recommended as the first choice to treat stenosis of Brescia-Cimino arteriovenous fistulas (B-C AVFs). The ability to predict which B-C AVFs are at risk for recurrent stenosis post-PTA would allow closer monitoring of patients, and possibly result in surgical intervention rather than repeat PTA. The purpose of this study was to identify predictive factors of primary patency after PTA in B-C AVFs. METHODS: Patients diagnosed with B-C AVF primary stenosis and treated by PTA between November 2013 and March 2018 were included in the study. Patient and stenotic lesion characteristics and PTA procedure factors were included in the analysis. The Kaplan-Meier method was used to analyze the primary patency rate. Cox proportional hazard regression analysis was used to identify factors predictive of decreased primary patency. RESULTS: 74 patients (35 males, 39 females) with a mean age of 61.68 ± 11.44 years (range, 36-84 years) were included in the study. The mean B-C AVF age was 16.34 ± 12.93 months (range, 2-84 months), and the median primary patency time was 7.79 ± 0.48 months. Cox proportional hazard regression analysis revealed stenosis location at the inflow artery [hazard ratio (HR)=3.83, 95% confidence interval (CI): 1.46-10.09] or anastomosis (HR = 1.90, 95% CI: 1.09-3.32), dilation >2 times during PTA (HR = 2.30, 95% CI: 1.22-4.34), and residual stenosis >30% (HR = 2.42, 95% CI: 1.26-4.63) were significantly associated with decreased patency. CONCLUSION: In conclusion, the primary patency rate of PTA for B-C AVF dysfunction is reduced by dilation >2 times, residual stenosis >30%, and stenosis located at the inflow artery or anastomosis. These results may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with AVF dysfunction. ADVANCES IN KNOWLEDGE: A number of studies have been conducted to examine the predictors of primary patency after PTA, however, no definitive conclusions have been reached. Our study revealed that stenosis location at the inflow artery or anastomosis, dilation >2 times during PTA, and residual stenosis >30% were the predictors of primary patency after PTA, which may help in tailoring surveillance programs, multiple PTA, or a proximal re-anastomosis surgery in patients with arteriovenous fistulas dysfunction.


Assuntos
Angioplastia com Balão/métodos , Derivação Arteriovenosa Cirúrgica , Oclusão de Enxerto Vascular/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/terapia , Procedimentos Endovasculares/métodos , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/instrumentação , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologia
20.
Vasc Endovascular Surg ; 54(3): 233-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31957599

RESUMO

Industry has long fought the battle to design a vascular catheter that is less thrombogenic. Indwelling catheters provide long-term central venous access, but they develop fibrin sheaths as the vascular system recognizes them as foreign bodies. Peripheral catheters and central catheters can be changed over a guidewire when they form a fibrin sheath or otherwise malfunction. However, totally implantable venous access devices such as a port cannot be easily exchanged over a wire. Therefore, when a port malfunctions, thrombolytics are usually the only option attempted before the port is explanted and a new site is prepared for access. We present a minimally invasive technique demonstrating port salvage that does not require explant.


Assuntos
Obstrução do Cateter/etiologia , Cateterismo Periférico/métodos , Cateteres de Demora , Falha de Equipamento , Fibrina , Dispositivos de Acesso Vascular , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Resultado do Tratamento
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