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1.
Anticancer Res ; 40(4): 2231-2238, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234919

RESUMEN

AIM: Acute post-operative pain following modified radical mastectomy (MRM) in patients with breast cancer is challenging for anesthesiologists. This study aimed to prospectively compare the quality outcome of interfascial plane blocks performed with ultrasound guidance, and evaluate the consequences of sharing tasks with the breast surgeon. PATIENTS AND METHODS: The study involved 255 patients scheduled for unilateral MRM, who were divided into two groups: Pecs group: General anesthesia plus ultrasound-guided modified pectoral nerves blocks type I and II, including serratus and parasternal infiltration according to surgical requirements; and Control group: general anesthesia only. Quality was evaluated based on perioperative opioid consumption, reported pain intensity, rescue analgesic requirement, side-effects and length of hospital stay. Moreover, a breast surgeon with expertise in ultrasound-guided breast biopsy was trained to perform the blocks. The patient benefits from regional anesthesia delivered by a non-anesthesiologist were assessed. RESULTS: Significant reductions were noted in all of the following: Intraoperative opioid consumption (p<0.001), Numerating Rating Scale pain scores taken 0 and 24 h after surgery (p<0.001), post-operative analgesic administration (p<0.001), nausea and vomiting at 0, 6, and 12-h intervals (p<0.05), and hospital stay (p<0.001) were observed in the Pecs group compared with the control group. Furthermore, data obtained from patients receiving the block from the surgeon showed comparable benefits with no complications. CONCLUSION: Interfascial plane blocks may be an important alternative protocol in MRM, enhancing patient safety and cost benefits. Improvements in cross-disciplinary expertise through flexibility in the training of professionals with other backgrounds may provide effective analgesia and favorable outcomes.


Asunto(s)
Anestesia General/métodos , Neoplasias de la Mama/cirugía , Mama/cirugía , Mastectomía Radical Modificada/métodos , Bloqueo Nervioso/métodos , Nervios Torácicos/fisiopatología , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Anestesiólogos , Mama/fisiopatología , Neoplasias de la Mama/fisiopatología , Femenino , Humanos , Mastectomía Radical Modificada/efectos adversos , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Estudios Prospectivos
2.
Medicine (Baltimore) ; 99(15): e19721, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282729

RESUMEN

INTRODUCTION: Moderate to severe postoperative pain and associated opioid use may interfere with patients' well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain. METHODS: This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat. DISCUSSION: This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block. TRIAL REGISTRATION NUMBER: NCT03691922; Recruited Date of registration: October 2, 2018.


Asunto(s)
Artroscopía/efectos adversos , Bloqueo Nervioso/métodos , Músculos Paraespinales/diagnóstico por imagen , Hombro/cirugía , Ultrasonografía Intervencional/métodos , Analgésicos Opioides/normas , Analgésicos Opioides/uso terapéutico , Anestesia Local/métodos , Canadá/epidemiología , Método Doble Ciego , Economía/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Músculos Paraespinales/efectos de los fármacos , Músculos Paraespinales/inervación , Satisfacción del Paciente , Hombro/patología , Resultado del Tratamiento
3.
West J Emerg Med ; 21(2): 353-358, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-32191193

RESUMEN

INTRODUCTION: We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training. METHODS: We identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training. RESULTS: The USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; p<0.001); 29 out of 30 (96%) successful radial arterial lines were placed using USGAC, whereas 14 out of 30 (47%) successful lines were placed using traditional AC (p<0.001). There was no significant difference in length of procedure or complication rate between the two groups. There was no difference in provider experience with respect to USGAC vs traditional AC. CONCLUSION: EM residents were more successful and had fewer cannulation attempts with USGAC when compared to traditional AC after standard, intern-level ultrasound training.


Asunto(s)
Cateterismo Periférico , Servicios Médicos de Urgencia/métodos , Arteria Radial , Ultrasonografía Intervencional , Adulto , Cateterismo Periférico/métodos , Servicio de Urgencia en Hospital , Femenino , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Arteria Radial/diagnóstico por imagen , Ultrasonografía , Ultrasonografía Intervencional/métodos , Dispositivos de Acceso Vascular
4.
Expert Rev Cardiovasc Ther ; 18(2): 103-115, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32077345

RESUMEN

Introduction: Angiography is routinely used to perform percutaneous coronary intervention (PCI). However, angiography has many limitations that prevent accurate assessment of coronary lesions. The development and evolution of intravascular imaging have offset the limitations of angiography. Overwhelming evidence supports intravascular imaging guidance to optimize PCI results and studies have shown that it is associated with better outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used modalities and both have far greater spatial resolution compared with angiography. There are advantages and disadvantages to both IVUS and OCT, and the optimal modality will depend on patient factors and indications.Areas covered: This review will summarize clinical evidence and current practices in the use of intravascular imaging in PCI. Literature review from year 2000-2019 was completed via PubMed search using keywords.Expert commentary: Intravascular imaging is an essential tool in PCI that has outcome implications, but it is still underutilized. Proper image acquisition, accurate interpretation, and correct decision-making are needed for patients to benefit from imaging-guided PCI. Training and education are essential in successful utilization of imaging technology. High-definition IVUS is likely to gain favor as there is improved image resolution without the use of contrast.


Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Intervención Coronaria Percutánea , Tomografía de Coherencia Óptica/métodos , Ultrasonografía Intervencional/métodos , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Resultado del Tratamiento
5.
Radiol Clin North Am ; 58(2): 445-462, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32044017

RESUMEN

Radiological guided intervention techniques are discussed in obstetric and gynecologic patients. Fallopian tube recanalization, postpartum hemorrhage control, techniques of treating uterine leiomyomas, pelvic congestion treatment, and the use of percutaneous and transvaginal ultrasonography-guided aspirations and biopsy are covered. These techniques use basic radiological interventional skills and show how they are adapted for use in the female pelvis.


Asunto(s)
Embolización Terapéutica/métodos , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/terapia , Complicaciones del Embarazo/diagnóstico por imagen , Complicaciones del Embarazo/terapia , Ultrasonografía Intervencional/métodos , Femenino , Enfermedades Urogenitales Femeninas/patología , Ginecología , Humanos , Biopsia Guiada por Imagen/métodos , Obstetricia , Embarazo , Complicaciones del Embarazo/patología
6.
Am Heart J ; 221: 74-83, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31951847

RESUMEN

BACKGROUND: Clinical data support the use of intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) as being associated with improved outcomes. Nonetheless, global utilization of IVUS remains low. We hypothesize that, in the revascularization of complex lesions, IVUS use is associated with improved outcomes. METHODS: All patients with complex lesions treated with PCI at a single center from 2003 to 2016 were stratified by use of IVUS. Complex lesions were defined as follows: American College of Cardiology/American Heart Association type C lesions, in-stent restenosis, long lesions, bifurcations, severe calcification, left main lesions, and chronic total occlusions. The primary end point was the rate of major adverse cardiac events (MACE) at 1-year follow-up, defined as the composite of all-cause mortality, Q-wave myocardial infarction, and target vessel revascularization. Inverse probability weighting was used in the adjusted analysis. RESULTS: A total of 6,855 patients were included in the final analysis, of whom 67.3% had IVUS and 32.7% had angiography alone. The primary end point occurred in 13.4% of patients treated with IVUS and 18.3% of patients treated with angiography alone (P < .001). Inverse probability weighting-adjusted 1-year MACE rates demonstrated significant reduction with IVUS for each complex lesion type. CONCLUSIONS: Among patients with complex lesions, the use of IVUS was associated with lower MACE 1 year after PCI than angiography alone was. Because of the increased procedural risk in complex lesions, routine utilization of IVUS-guided PCI should be considered in this subset of patients.


Asunto(s)
Enfermedad de la Arteria Coronaria/cirugía , Intervención Coronaria Percutánea/métodos , Ultrasonografía Intervencional/métodos , Anciano , Aterectomía Coronaria , Angiografía Coronaria , Stents Liberadores de Fármacos , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Infarto del Miocardio/epidemiología , Revascularización Miocárdica/estadística & datos numéricos , Stents , Cirugía Asistida por Computador/métodos
7.
Medicine (Baltimore) ; 99(2): e18747, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914094

RESUMEN

BACKGROUND: A low first-pass success rate of radial artery cannulation was obtained when using the conventional palpation technique (C-PT) or conventional ultrasound-guided techniques, we; therefore, evaluate the effect of a modified long-axis in-plane ultrasound technique (M-LAINUT) in guiding radial artery cannulation in adults. METHODS: We conducted a prospective, randomized and controlled clinical trial of 288 patients undergoing radial artery cannulation. Patients were randomized 1:1 to M-LAINUT or C-PT group at Fujian Medical University Union Hospital between 2017 and 2018. Radial artery cannulation was performed by 3 anesthesiologists with different experience. The outcome was the first and total radial artery cannulation success rates, the number of attempts and the cannulation time, and incidence of complications. RESULTS: Two hundred eighty-five patients were statistically analyzed. The success rate of first attempt was 91.6% in the M-LAINUT group (n = 143) and 57.7% in the C-PT group (n = 142; P < .001) (odds ratio, 7.9; 95% confidence interval, 4.0-15.7). The total success rate (≤5 minutes and ≤3 attempts) in the M-LAINUT group was 97.9%, compared to 84.5% in the palpation group (P < .001) (odds ratio, 8.5; 95% confidence interval, 2.5-29.2). The total cannulation time was shorter and the number of attempts was fewer in the M-LAINUT group than that in the C-PT group (P < .05). The incidence of hematoma in the C-PT group was 19.7%, which was significantly higher than the 2.8% in the M-LAINUT group (P < .001). CONCLUSIONS: Modified long-axis in-plane ultrasound-guided radial artery cannulation can increase the first and total radial artery cannulation success rates, reduce the number of attempts, and shorten the total cannulation time in adults.


Asunto(s)
Cateterismo Periférico/métodos , Palpación/métodos , Arteria Radial , Ultrasonografía Intervencional/métodos , Anciano , Anestesiólogos , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
8.
Anaesthesia ; 75(4): 499-508, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31984478

RESUMEN

Interscalene brachial plexus block provides analgesia for shoulder surgery but is associated with hemidiaphragmatic paralysis. Before considering a combined suprascapular and axillary nerve block as an alternative to interscalene brachial plexus block, evaluation of the incidence of diaphragmatic dysfunction according to the approach to the suprascapular nerve is necessary. We randomly allocated 84 patients undergoing arthroscopic shoulder surgery to an anterior or a posterior approach to the suprascapular nerve block combined with an axillary nerve block using 10 ml ropivacaine 0.375% for each nerve. The primary outcome was the incidence of hemidiaphragmatic paralysis diagnosed by ultrasound. Secondary outcomes included: characterisation of the hemidiaphragmatic paralysis over time; numeric rating scale pain scores; oral morphine equivalent consumption; and patient satisfaction. The incidence of hemidiaphragmatic paralysis was 40% (n = 17) vs. 2% (n = 1) in the anterior and posterior groups, respectively (p < 0.001). In one third of patients with hemidiaphragmatic paralysis, it persisted beyond the eighth hour. The median (interquartile range [range]) oral morphine equivalent consumption was significantly higher in the posterior approach when compared with the anterior approach, whether in the recovery area (20 [5-31 (0-60)] mg vs. 7.5 [0-14 (0-52)] mg, respectively; p = 0.004) or during the first 24 h (82 [61-127 (12-360) mg] vs. 58 [30-86 (0-160)] mg, respectively; p = 0.01). Patient satisfaction was comparable between groups (p = 0.6). Compared with the anterior approach, diaphragmatic function is best preserved with the posterior needle approach to the suprascapular nerve block.


Asunto(s)
Bloqueo Nervioso/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Parálisis Respiratoria/inducido químicamente , Hombro/inervación , Hombro/cirugía , Ultrasonografía Intervencional/métodos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Resultado del Tratamiento
9.
Urology ; 135: 117-123, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31568795

RESUMEN

OBJECTIVE: To elucidate the accuracy of MRI and MRI-ultrasound fusion guided targeted biopsy (TBx) on risk stratification in men who underwent subsequent radical prostatectomy (RP). MATERIALS AND METHODS: A single-center, retrospective study was performed in men at risk for prostate cancer who (n = 140) underwent TBx and RP between November 2012 and August 2018. Comparisons were made between patients clinically staged by preoperative MRI and TBx Gleason grade group (GGG) and stage after RP. Multivariable regression was performed to identify factors associated with MRI and TBx compared to RP grading, staging, and consistency with National Comprehensive Cancer Network (NCCN) risk stratification. RESULTS: There was an increase in NCCN risk stratification in 47 men (33.6%) and a decrease in 17 men (12.1%) compared to the resected prostate. GGG upgrading and downgrading occurred in 35 (25.0%) and 31 men (22.1%), respectively. Upstaging occurred in 41 men (29.3%). In adjusted analysis for age, BMI, PSA Density (PSAD), median maximal diameter of the regions of interest, and PIRADS, men with PIRADS 4 were less likely to be upgraded (OR 0.26, 95% CI 0.08-0.81, P = .020) than PIRADS 3. PSAD ≥ 0.15 ng/mL/cc was associated with upstaging (OR 3.92, 95% CI 1.60-9.62, P = .003). CONCLUSION: Accurate risk stratification is critical for disease management, mandated by the increasing use of active surveillance, partial gland ablation, and androgen deprivation therapy with radiation therapy for men with unfavorable intermediate and high-risk prostate cancer. This study confirms the need for advances in imaging and biomarker to increase the accuracy of pretreatment staging.


Asunto(s)
Imagen Multimodal/métodos , Próstata/patología , Prostatectomía , Neoplasias de la Próstata/diagnóstico , Anciano , Biopsia con Aguja Gruesa/estadística & datos numéricos , Humanos , Biopsia Guiada por Imagen/estadística & datos numéricos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Próstata/diagnóstico por imagen , Próstata/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Ultrasonografía Intervencional/métodos
10.
World Neurosurg ; 133: e443-e447, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31526885

RESUMEN

BACKGROUND: S1 transforaminal epidural steroid injection (S1-TFESI) results in positive clinical outcomes for the treatment of pain associated with the S1 nerve root. S1-TFESI via the transforaminal approach is commonly performed under fluoroscopic guidance. Ultrasound guidance is an alternative to mitigate radiation exposure. However, performing spinal procedures under ultrasound guidance has some limitations in confirming the position of the needle tip and vascular uptake. New techniques are therefore needed to make ultrasound and fluoroscopy complementary. Our objective was to describe a novel technique for S1-TFESI and confirm its reproducibility. METHODS: Records of patients with S1 radiculopathy were reviewed retrospectively; those treated using the new S1-TFESI technique were selected. Initially, ultrasound was used to distinguish anatomy of the sacral foramen and guide initial placement of the needle entry point. Fluoroscopy was subsequently used to confirm needle tip position and vascular injection. The number of times the needle required reinsertion was recorded, and ultrasound and C-arm images were stored. RESULTS: Sixty-seven S1-TFESIs were performed in 56 patients. All injections exhibited epidural spread of contrast media, not only to the S1 nerve. The cephalad angle was 16.25 ± 6.75° (range, 5-27°), the oblique angle was 2.48 ± 2.62° (range, 0-7°), and the mean number of attempts was 1.24 ± 1.25. CONCLUSIONS: The new technique, involving the use of ultrasound to guide initial placement of the needle entry point, followed by confirmatory imaging and any needed adjustment with the use of fluoroscopy, can be a technique to complement the shortcomings of using ultrasound or fluoroscopy alone.


Asunto(s)
Corticoesteroides/administración & dosificación , Fluoroscopía/métodos , Inyecciones Epidurales/métodos , Bloqueo Nervioso/métodos , Radiculopatía/tratamiento farmacológico , Radiografía Intervencional/métodos , Ultrasonografía Intervencional/métodos , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Medios de Contraste , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sacro , Adulto Joven
11.
Ann R Coll Surg Engl ; 102(1): 43-48, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31865760

RESUMEN

INTRODUCTION: The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS: We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS: A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS: Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.


Asunto(s)
Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Fina/normas , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/normas , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto Joven
12.
Anaesthesia ; 75(1): 72-79, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31506918

RESUMEN

Technology that facilitates performance of deep peripheral nerve blocks is of clinical interest. The Onvision™ is a new device for ultrasonographic needle tip tracking that incorporates an ultrasound sensor on the needle tip that is then represented by a green circle on the ultrasound screen. The primary aim of this study was to investigate the effect of needle tip tracking on procedural time in the first human volunteer study. Secondary outcome measures included: number of hand movements; hand movement path length; block success rate; block onset time; block duration; discomfort experienced by the volunteers; and the anaesthetists' confidence as to whether their block would be successful. Two anaesthetists performed ultrasound-guided lumbar plexus blocks with an out-of-plane technique, with and without the use of needle tip tracking. In total, data from 25 volunteers were studied. Mean (SD) procedural time was 163 (103) s with needle tip tracking and 216 (117) s without (p = 0.10). Hand motion analysis showed that needle tip tracking was associated with a significant decrease in the mean (SD) number of intended needling hand movements (39 (29) vs. 59 (36); p = 0.03) and path lengths (3.2 (3.1) m vs. 5.5 (4.5) m; p = 0.03). No differences were found for any other secondary outcomes. The use of Onvision needle tip tracking did not reduce procedural time for out-of-plane ultrasound-guided lumbar plexus block but did reduce the number of hand movements and path lengths. This may indicate improved needle control but further studies are needed to confirm this finding.


Asunto(s)
Anestésicos Locales/administración & dosificación , Agujas , Bloqueo Nervioso/instrumentación , Bloqueo Nervioso/métodos , Ultrasonografía Intervencional/métodos , Adulto , Anciano , Estudios Cruzados , Femenino , Humanos , Plexo Lumbosacro , Masculino , Persona de Mediana Edad , Adulto Joven
13.
Anaesthesia ; 75(1): 80-88, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31506921

RESUMEN

Visibility of the needle tip is difficult to maintain during ultrasound-guided nerve block. A new needle has been developed that incorporates a piezo element 2-2.3 mm from the tip, activated by ultrasound. The electrical signal manifests as a coloured circle surrounding the needle tip, and allows real-time tracking. We hypothesised that novice regional anaesthetists would perform nerve block better with the tracker turned on rather than off. Our primary objective was to evaluate the new needle by measuring the performance of novice anaesthetists conducting simulated sciatic block on the soft embalmed Thiel cadaver. Training consisted of a lecture, scanning in volunteers and practice on cadavers. Testing entailed scanning the sciatic nerve of a cadaver and conducting 20 in-plane sciatic blocks in the mid-to-upper thigh region. Subjects were randomised equally, in groups of five, according to the sequence: tracker on/off/on/off; or tracker off/on/off/on. Video recordings were assessed by six raters for steps performed correctly and errors committed. Eight subjects were recruited and 160 videos were analysed. Using the tracking needle, five correct steps improved and one error reduced. The benefits included: better identification of the needle tip before advancing the needle, OR (95%CI) 3.4 (1.6-7.7; p < 0.001); better alignment of the needle to the transducer, 3.1 (1.3-8.7; p = 0.009); and better visibility of the needle tip 3.0 (1.4-7.3; p = 0.005). In conclusion, use of the tracker needle improved the sciatic block performance of novices on the soft embalmed cadaver.


Asunto(s)
Anestesia de Conducción/instrumentación , Agujas , Bloqueo Nervioso/instrumentación , Nervio Ciático , Ultrasonografía Intervencional/métodos , Anestesia de Conducción/métodos , Cadáver , Humanos , Bloqueo Nervioso/métodos
14.
J Matern Fetal Neonatal Med ; 33(1): 174-176, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30244617

RESUMEN

Point of care lung ultrasound (POC-LUS) has played important roles in diagnosing neonatal lung diseases and assisting in their treatment. A newborn infant with severe respiratory distress diagnosed as pulmonary atelectasis caused by congenital massive pleural effusion, whose consolidated lung recruitment after pleural puncture drainage under POC-LUS guidance. Lung ultrasound can be performed easily and timely at bed-side with free of radiation exposure, thus it should be used extensively in the neonatal department.


Asunto(s)
Drenaje/métodos , Derrame Pleural/terapia , Sistemas de Atención de Punto , Atelectasia Pulmonar/terapia , Punciones/métodos , Ultrasonografía Intervencional/métodos , Humanos , Recién Nacido , Enfermedades del Recién Nacido/terapia , Masculino , Derrame Pleural/complicaciones , Derrame Pleural/congénito , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/congénito , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Resultado del Tratamiento
15.
Einstein (Sao Paulo) ; 17(4): eMD5157, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826074

RESUMEN

Elastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.


Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad/métodos , Endosonografía/métodos , Ganglios Linfáticos/diagnóstico por imagen , Linfoma no Hodgkin/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Adulto , Anciano de 80 o más Años , Biopsia con Aguja Fina , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas
17.
Medicine (Baltimore) ; 98(52): e18564, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31876758

RESUMEN

BACKGROUND: This study was designed to systematically evaluate the clinical efficacy and safety of ultrasound-guided intrathyroidal injection of glucocorticoids (GCs) versus routine oral administration of GCs for subacute thyroiditis (SAT) and to help seek evidence of evidence-based medicine (EBM) for ultrasound-guided intrathyroidal injection of GCs in the treatment of SAT. METHODS: Seven Chinese and English databases, including Chinese National Knowledge Infrastructure, Wanfang Data, VIP Information China Science and Technology Journal Database, SinoMed, PubMed, Cochrane Library, and Embase, were searched to collect randomized control trials on ultrasound-guided intrathyroidal injection of GCs in the treatment of SAT, which were published up to July 1, 2019. According to the method as described in Cochrane Reviewers' Handbook 5.1.0, the Cochrane Collaboration's tool for assessing risk of bias was employed to evaluate the quality of the literatures included. Statistical analysis was made by using Stata 12.0. The "metanif" command was used for sensitivity analysis to assess the stability of the results. Funnel diagram method, Egger linear regression method, and clipping complement method were used to evaluate publication bias. RESULTS: This study was carried out in strict accordance with the standard procedures for meta-analysis in the Cochrane Reviewers' Handbook 5.1.0. Critical data about the primary and secondary outcome measures were obtained by statistical analysis. CONCLUSION: This study would draw a definite conclusion about whether ultrasound-guided intrathyroidal injection of GCs is effective and safe in the treatment of SAT on the basis of EBM. This conclusion would provide scientific evidence for the clinical treatment of SAT.


Asunto(s)
Glucocorticoides/administración & dosificación , Tiroiditis Subaguda/tratamiento farmacológico , Ultrasonografía Intervencional , Administración Oral , Glucocorticoides/uso terapéutico , Humanos , Inyecciones/efectos adversos , Inyecciones/métodos , Glándula Tiroides/diagnóstico por imagen , Resultado del Tratamiento , Ultrasonografía Intervencional/efectos adversos , Ultrasonografía Intervencional/métodos
18.
Medicine (Baltimore) ; 98(48): e18168, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770265

RESUMEN

RATIONALE: Recent years have witnessed a marked improvement in the safety and accuracy of nerve blocks with the help of ultrasound and other visualization technologies. This study reports a challenging case of a severe complication during the ultrasound-guided stellate ganglion block. PATIENT CONCERNS: A 28-year-old male patient with refractory migraine complained episodic pulsatile pain with photophobia, haphalgesia of the scalp for 3 years. INTERVENTIONS: Ultrasound-guided stellate ganglion block with 4 ml of 1% lidocaine was administrated. OUTCOMES: A sudden loss of consciousness and tonic-clonic seizure was occurred after negative aspiration and test dose. Further sonographic examination revealed a variation in the left vertebral artery, which remained unrecognized during the needle insertion because of its sliding ability under the differential pressure applied by the probe. LESSONS: Inadvertent intra-arterial injection of a local anesthetic agent could be minimized under the ultrasound guidance with various protective strategies, including the determination of any prior variation, optimizing the block route, maintaining a constant probe pressure, and using saline for the test dosage. This case resulted in the implementation of new protocols of the ultrasound-guided stellate ganglion block in our department.


Asunto(s)
Bloqueo Nervioso Autónomo , Complicaciones Intraoperatorias , Lidocaína , Convulsiones , Ganglio Estrellado , Inconsciencia , Arteria Vertebral , Adulto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Bloqueo Nervioso Autónomo/efectos adversos , Bloqueo Nervioso Autónomo/métodos , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/terapia , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Masculino , Errores Médicos/prevención & control , Trastornos Migrañosos/cirugía , Atención al Paciente/métodos , Convulsiones/etiología , Convulsiones/terapia , Ganglio Estrellado/diagnóstico por imagen , Ganglio Estrellado/cirugía , Resultado del Tratamiento , Ultrasonografía Intervencional/métodos , Inconsciencia/etiología , Inconsciencia/terapia , Arteria Vertebral/anatomía & histología , Arteria Vertebral/lesiones
19.
Medicine (Baltimore) ; 98(48): e18251, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770288

RESUMEN

RATIONALE: Small cell carcinoma (SCC) occurs mostly in the lung, and small cell lung cancer accounts for 13% of newly diagnosed lung cancers. Only 2.5% of SCC occurs in extrapulmonary sites, and SCC of pleural origin is especially very uncommon. PATIENT CONCERNS: An 85-year-old man presenting with progressive dyspnea for more than 7 days. DIAGNOSES: Computed tomography scan of the chest showed massive pleural effusion and diffuse nodular thickening of the pleura on the right chest. Sonography-guided needle biopsy of the pleural mass was performed and histologic and immunohistochemical findings revealed SCC. Since no parenchymal lung lesion was observed, the patient was finally diagnosed with SCC of the pleura (SCCP). INTERVENTIONS: Due to the patient's old age and poor performance status, chemotherapy was not performed and only drainage of pleural effusion was conducted for symptom relief. OUTCOMES: Dyspnea improved after pleural effusion drainage. The patient was discharged and transferred to a local medical center for hospice care. LESSONS: Although primary SCCP is extremely rare, SCCP should also be considered as well as mesothelioma in case of presence of a pleural-based mass with massive pleural effusion.


Asunto(s)
Carcinoma de Células Pequeñas , Disnea , Derrame Pleural Maligno , Neoplasias Pleurales , Toracocentesis/métodos , Anciano de 80 o más Años , Carcinoma de Células Pequeñas/complicaciones , Carcinoma de Células Pequeñas/patología , Carcinoma de Células Pequeñas/fisiopatología , Disnea/diagnóstico , Disnea/etiología , Cuidados Paliativos al Final de la Vida , Humanos , Biopsia Guiada por Imagen/métodos , Masculino , Pleura/diagnóstico por imagen , Pleura/patología , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/etiología , Derrame Pleural Maligno/fisiopatología , Derrame Pleural Maligno/terapia , Neoplasias Pleurales/complicaciones , Neoplasias Pleurales/patología , Neoplasias Pleurales/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Intervencional/métodos
20.
J Interv Cardiol ; 2019: 6945372, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31772543

RESUMEN

Objectives: To assess the expansion pattern of coronary stents by using different balloon inflation times and pressures. Background: The selection of coronary stent size and its proper deployment is crucial in coronary artery interventions, having an impact on the success of the procedure and further therapy. Methods: Ten pairs of different stents were deployed under nominal pressure using sequential (5, 5, 10, and 10 seconds of repeated inflations, thus 30 seconds of summarized time) and continuous (30 seconds) deployment pattern. After each given time-point, intraluminal stent measurements were performed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Results: Both in-stent diameters and cross-section areas (CSA) of paired stents measured by OCT at all sequential time-points were significantly smaller compared to given manufacturers charts' values (90% to 94% for diameters and 81% to 88% for CSA, p<0.05). Significant increase of in-stent diameter and CSA was observed across the step-by-step deployment pattern. In-stent lumen measurements were significantly larger when sequential deployment pattern was applied compared to continuous deployment. Additional measurements were also done for overlapping segments of stents, showing smaller in-stent measurements of the latter compared to nonoverlapping segments. Validation of OCT and IVUS measurements using a phantom metallic tube showed perfect reproducibility with OCT and overestimation with IVUS (8% for diameters and 16% for CSA). Conclusions: Stent diameter after deployment is time-dependent and not only pressure-dependent. Different stent expansion behavior, depending on the applied deployment pattern (sequential and nonsequential), was observed.


Asunto(s)
Angioplastia Coronaria con Balón , Diseño de Equipo , Stents , Angioplastia Coronaria con Balón/instrumentación , Angioplastia Coronaria con Balón/métodos , Angiografía Coronaria/métodos , Humanos , Ensayo de Materiales/métodos , Stents/clasificación , Stents/normas , Factores de Tiempo , Tomografía de Coherencia Óptica/métodos , Ultrasonografía Intervencional/métodos
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