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1.
Medicine (Baltimore) ; 100(22): e26174, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087881

RESUMO

ABSTRACT: Percutaneous vertebroplasty (VP) and kyphoplasty (KP) are well-established minimally invasive surgical procedures for the treatment of osteoporotic vertebral compression fractures (OVCF). However, some drawbacks have been reported regarding these procedures, including height loss, cement leakage, and loss of the restored height after balloon deflation. We performed a novel VP technique to minimize these limitations of conventional procedures. This study aimed to compare radiological and clinical outcomes of our method using a larger-diameter needle versus conventional VP (using a smaller needle) for thoracolumbar OVCF.From April 2016 to May 2017, 107 consecutive patients diagnosed with thoracolumbar OVCF were enrolled. Patients were divided into two groups: group 1 underwent conventional VP, i.e., using a smaller diameter needle, and group 2 underwent VP through a modified method with a larger-diameter needle. For radiological evaluation, parameters related to anterior vertebral height (AVH) and segmental angle were assessed using plain standing radiographs, and patient-reported outcomes were evaluated using the visual analog scale. Cement injection amount and leakage pattern were also analyzed. Group 2 showed a larger anterior vertebral height change than group 1 immediately postoperatively and one year postoperatively. The 1-year postoperatively-AVH maintained better in group 2 than in group 1. Group 2 showed more significant improvement of segmental angle immediately postoperatively than group 1 (3.15° in group 1 vs 9.36° in group 2). IYPo-visual analog scale significantly improved in both groups, with greater improvement in group 2 (3.69 in group 1 vs 5.63 in group 2). A substantially larger amount of cement was injected, with a lower leakage rate in group 2 than in group 1.A novel VP technique using a larger-diameter needle showed superior radiological and clinical outcomes than conventional VP. Therefore, it can be considered a useful treatment option for OVCF.


Assuntos
Fraturas por Compressão/cirurgia , Agulhas/efeitos adversos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Estatura/fisiologia , Cimentos Ósseos/efeitos adversos , Cimentos Ósseos/uso terapêutico , Estudos de Casos e Controles , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Humanos , Cifoplastia/métodos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Agulhas/estatística & dados numéricos , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Radiografia/métodos , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas/cirurgia , Vertebroplastia/estatística & dados numéricos , Escala Visual Analógica
2.
BMJ Case Rep ; 14(3)2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33649032

RESUMO

A 31-year-old female physician was diagnosed with bilateral pneumothorax a day after her acupuncture treatment. Her body mass index was 16.9 and she did not have a prior history of respiratory disease or smoking. Acupuncture needles may easily reach the pleura around the end of the suprascapular angle of the levator scapulae muscle where the subcutaneous tissue is anatomically thin. In our patient, the thickness between the epidermis and the visceral pleura in this area was only 22 mm as confirmed by an ultrasound scan. Although she felt chest discomfort 30 min after the procedure, she assumed the symptom to be a reaction to the acupuncture. In light of our case, we advise practitioners to select appropriate acupuncture needles for patients based on the site of insertion and counsel them regarding the appearance of symptoms such as chest pain and dyspnoea immediately after the procedure.


Assuntos
Terapia por Acupuntura , Pneumotórax , Terapia por Acupuntura/efeitos adversos , Adulto , Dispneia , Feminino , Humanos , Agulhas/efeitos adversos , Pleura , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia
3.
Ugeskr Laeger ; 183(4)2021 01 25.
Artigo em Dinamarquês | MEDLINE | ID: mdl-33491629

RESUMO

Acupuncture is gaining popularity in Denmark. Needle insertion in the chest area is associated with the risk of serious adverse events. In Denmark, a law has been passed requiring formal education if a practitioner wishes to perform acupuncture in the chest area. In this case report a novice inflicted a right-sided pneumothorax upon himself by using acupuncture in the upper chest area with needles obtained over the internet.


Assuntos
Terapia por Acupuntura , Pneumotórax , Terapia por Acupuntura/efeitos adversos , Humanos , Internet , Agulhas/efeitos adversos , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia
4.
Arq Bras Cir Dig ; 33(4): e1554, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503114

RESUMO

BACKGROUND: Fine needle biopsy (FNB) histological samples by endoscopic ultrasound. It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. AIM: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. METHODS: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. RESULTS: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. CONCLUSIONS: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/normas , Agulhas/classificação , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
5.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431448

RESUMO

Embolised needles causing injury to the right heart and cardiac tamponade has been reported before in intravenous drug users, but to our knowledge, this is the first reported case of a needle migrating via the pulmonary arterial system to cause perforation of the left ventricle. Appropriate utilisation of imaging modalities such as plain X-ray and point-of-care focused cardiac ultrasound can be vital and life-saving in the emergency setting, and the value of gated multidetector CT as a powerful tool for imaging moving structures is highlighted.


Assuntos
Migração de Corpo Estranho/diagnóstico , Traumatismos Cardíacos/diagnóstico , Ventrículos do Coração/lesões , Agulhas/efeitos adversos , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Ponte Cardiopulmonar , Ecocardiografia , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Masculino , Pericardiocentese , Artéria Pulmonar/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(51): e23665, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371104

RESUMO

ABSTRACT: Caudal epidural injection (CEI) is effective for lumbar spinal pain. However, accidental intravascular injection reduces therapeutic efficacy of CEI and leads to fatal complications such as hematoma, and neurologic deficit. Whitacre needle has been reported to be effective for reducing intravascular injection during transforaminal epidural injection, compared with Quincke needle. The bevel of Chiba needle is shorter than that of Quincke needle. In this study we compared Whitacre needle and Chiba needle on incidence of intravascular injection during CEI.This was a single-blind, randomized clinical consort study. After institutional Review Board approval, a total of 164 patients underwent CEI were randomly allocated to one of 2 group (Whitacre needle or Chiba needle group). Intravascular injection was assessed with real-time fluoroscopy. In addition, total procedure time was measured. Data were compared between groups, and P < .05 was consideredstatistically significant.There were no differences between groups in terms of patient demographic and clinical characteristics. There was no significant difference on incidence of intravascular injection between Whitacre and Chiba needle group (11% vs 19.5%, P = .192). However, the procedure time is significantly longer in the Whitacre than Chiba needle group (172.8 ±â€Š53.8 sec vs 147.1 ±â€Š61.1 sec, P = .005).Based on current study, our results indicated that Whitacre needle was not effective to decrease the incidence of intravascular injection during CEI, compared to Chiba needle.


Assuntos
Injeções Epidurais/efeitos adversos , Injeções Epidurais/instrumentação , Agulhas/efeitos adversos , Idoso , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas/estatística & dados numéricos
7.
Medicine (Baltimore) ; 99(43): e22895, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120838

RESUMO

BACKGROUND: Traditionally, S1 transforaminal epidural steroid injection (TFESI) has been performed using an anteroposterior (AP) fluoroscopic view. In 2007, the oblique "Scotty dog" (OS) approach was introduced as an alternative technique. We compared passage time of the needle into S1 foramen (Tf) between the anteroposterior (AP) and oblique "Scotty dog" (OS) approach during S1 TFESI. METHODS: In this prospective randomized controlled trial, seventy patients scheduled S1 TFESI were randomly allocated into AP or OS groups. In the AP group, a slight cephalad-caudad tilt was used. In the OS group, the C-arm was rotated ipsilateral oblique degrees to view the S1 Scotty dog. Both groups received injection of steroid mixed with local anesthetics. We measured the passage time of the needle into S1 foramen (Tf), primary outcome, and total procedure time (Tt) between the groups. We also recorded presence of intravascular injection, patients-assessed pain relief for one month and complications. RESULTS: The Tf and Tt were shorter in the OS than in the AP group (24.4 ±â€Š24.0 s vs 47. 8 ±â€Š53.2seconds; 93.3 ±â€Š35.0 seconds vs 160.0 ±â€Š98.7 seconds, P < .001, both). Incidence of intravascular injection (AP, 8 [22.8%]; OS, 4 [11.4%], P = .205), pain score, and complication rates were not statistically different between the two groups. In logistic regression analysis, the body mass index (BMI) was a risk factor for longer Tt (odds ratio [OR] = 1.27, 95% CI: 1.02-1.58, P = .030). CONCLUSION: The passage time of the needle into S1 foramen was shorter in OS approach and the OS approach reduced the procedure time compared with the AP approach during S1 TFESI. The practitioners should note that procedure time can be prolonged in obese patients.


Assuntos
Fluoroscopia/instrumentação , Injeções Epidurais/métodos , Erros Médicos/efeitos adversos , Radiculopatia/terapia , Esteroides/administração & dosagem , Administração Intravenosa/estatística & dados numéricos , Idoso , Anestésicos Locais/administração & dosagem , Índice de Massa Corporal , Feminino , Humanos , Incidência , Injeções Epidurais/efeitos adversos , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Medição da Dor/métodos , Estudos Prospectivos , República da Coreia/epidemiologia , Distúrbios Somatossensoriais/psicologia , Fatores de Tempo
9.
Tokai J Exp Clin Med ; 45(3): 108-112, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901896

RESUMO

A 33G, 12-mm needle broke and entered the soft tissue in a 60-year old man. Panoramic X-ray imaging and cone-beam computed tomography (CT), which we performed a few hours after the breakage, revealed the needle in the soft tissue of the lower right mandibular molar. We immediately made an incision in the buccal gingiva of the lower right mandibular molar under local anesthesia and attempted to remove the needle but could not locate it. Thereafter, we adopted a watch-and-wait approach, as the patient had no subjective symptoms. Nine months later, we confirmed via CT that the needle had migrated subcutaneously to the right side of the neck. Two months later, we identified its location using C-arm fluoroscopy and removed it under general anesthesia. This report is a rare case and we are the first to document the subcutaneous migration of a fractured needle.


Assuntos
Corpos Estranhos , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/cirurgia , Gengiva , Mandíbula , Pescoço , Agulhas/efeitos adversos , Anestesia Dentária , Anestesia Local , Tomografia Computadorizada de Feixe Cônico , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Br J Radiol ; 93(1114): 20200316, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32516553

RESUMO

The identification of retained needles is essential because of their sharp structure with possible life-threatening complications. However, radiological evaluation could be challenging, especially in case of needles' relatively poor conspicuity and small dimension. This pictorial essay focuses on clinical issues (needle features, retention mechanisms and associated complications) and technical aspects (choice of the best diagnostic modality and technique) that can lead the radiologist to an earlier and proper diagnosis of needle retention in order to provide the best treatment for the patient.


Assuntos
Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Agulhas/efeitos adversos , Humanos
12.
Eur J Cancer ; 131: 53-67, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32302949

RESUMO

BACKGROUND: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. METHODS: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. RESULTS: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/ GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. CONCLUSION: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families.


Assuntos
Antineoplásicos/administração & dosagem , Agulhas/efeitos adversos , Neoplasias/tratamento farmacológico , Dor Processual/prevenção & controle , Estresse Psicológico/prevenção & controle , Fatores Etários , Criança , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Injeções/efeitos adversos , Injeções/psicologia , Oncologia/métodos , Oncologia/normas , Neoplasias/psicologia , Dor Processual/etiologia , Dor Processual/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Psicológico/etiologia
13.
Acta Diabetol ; 57(10): 1151-1157, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32300875

RESUMO

AIMS: Intraoperative complications in cataract surgery are more common in diabetic patients. Solving aphakia in these circumstances remains a challenge, as the scleral structure has been shown to be different in diabetes. This study aims to analyze the role of a secondary sutureless scleral intraocular lens (IOL) flanged fixation in diabetic patients without capsular support and to compare the anatomical and functional outcomes using a 30 gauge (G) ultrathin wall needle vs. a 27G needle. METHODS: Retrospective, observational cohort study. 105 eyes (105 patients) who underwent PPV with secondary IOL fixation using a sutureless 27G (n = 51) or a 30G ultrathin wall (UTW) needle technique (n = 54) and had a 24 months postoperative follow up. Consecutive patients' records were reviewed for lens stability and centration parameters, intra- and postoperative complications at 7 days, 1, 3, 6, 12, and 24 months after surgery. Correlations between outcome measures and needle size (27G vs. 30G UTW) were analyzed. RESULTS: IOL displacement occurred in 30 patients (41.2%) in the 27G group and did not occur in the 30G UTW needle group (p < 0.001). Mean time until IOL displacement was 10.5 ± 7.0 months (range: 7 days-24 months). IOL centricity was significantly better in the 30G ultrathin wall needle group compared to 27 G (p = 0.001). Additional surgical interventions were necessary only in the 27G group (n = 14). CONCLUSIONS: Sutureless IOL flanged technique using a 30G UTW needle is more predictable and has less complications in aphakic diabetic patients, compared to a 27G needle technique.


Assuntos
Diabetes Mellitus/cirurgia , Retinopatia Diabética/cirurgia , Implante de Lente Intraocular/instrumentação , Agulhas , Procedimentos Cirúrgicos sem Sutura/instrumentação , Adulto , Idoso , Afacia/epidemiologia , Afacia/cirurgia , Argentina/epidemiologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Retinopatia Diabética/epidemiologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Implante de Lente Intraocular/efeitos adversos , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Esclera/cirurgia , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/métodos , Acuidade Visual
14.
Medicine (Baltimore) ; 99(9): e19331, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118765

RESUMO

BACKGROUND: Cricothyroidotomy is the final strategy in the "cannot intubate, cannot oxygenate" scenario, but half of needle cricothyroidotomy attempts result in failure. The most frequent complication in needle cricothyroidotomy is posterior tracheal wall injury. We hypothesized that needle length is related to posterior wall injury and compared needle cricothyroidotomy with a commercial kit to a modified shorter needle to evaluate success and posterior wall injury rates. METHODS: The commercial kit has a needle stopper to prevent posterior wall injury, with a penetrating length of 25 mm. We made long stopper to shorten the length by 5 mm (net 20 mm penetrating length). Residents were recruited, received a lecture about cricothyroidotomy and practiced needle cricothyroidotomy using the commercial kit on a simulator. They then performed cricothyroidotomy using the commercial kit or the shorter needle on an ex-vivo porcine larynx covered with artificial skin. An intra-tracheal endoscope recorded the procedure. The video was evaluated for success/failure or posterior wall injury by independent evaluators. Larynxes with a distance from the outer surface to the inner lumen exceeding 13 mm were excluded. The distance in each larynx was measured by dissection after the study. Success and posterior wall injury rates were analyzed using Fisher exact test (P < .05 was statistically significant). RESULTS: Forty-seven residents participated in the study. Data for two residents were excluded. There was no statistically significant difference in success rate between the commercial kit (100%, 45/45) and the shorter needle (91%, 41/45, P = .12). Failure was defined if the needle tip did not reach the lumen in four trials. Cannulated but complicated by posterior wall injury occurred in 33% (15/45) with the commercial kit and 5% (2/43) with the shorter needle (P < .01). CONCLUSION: During needle cricothyroidotomy, force is needed for the needle to penetrate the cricothyroid ligament. The advancing needle sometimes cannot be stopped after penetrating the cricothyroid ligament. These data suggest that needle length is associated with posterior wall injury.


Assuntos
Cartilagem Cricoide/cirurgia , Agulhas/efeitos adversos , Traqueia/lesões , Animais , Estudos Cross-Over , Modelos Animais de Doenças , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Agulhas/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Suínos/lesões , Ensino
15.
Vet Surg ; 49 Suppl 1: O38-O44, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31981365

RESUMO

OBJECTIVE: To investigate the use of a needle arthroscope for diagnostic tenoscopy of the carpal sheath in standing horses. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Six forelimbs for the cadaveric part of the study and six horses for the in vivo part of the study. METHODS: Six cadaveric limbs were used to perform carpal sheath tenoscopy with a 1.2-mm-diameter needle arthroscope (65 and 100 mm long), followed by tenoscopy with a 4-mm arthroscope through a standard proximolateral approach. Then, unilateral standing carpal sheath tenoscopy was performed in six healthy sedated horses with a 65-mm-long needle arthroscope. Limbs were maintained in flexion during the procedure by using a custom-made splint and base. Degree of tenoscopic evaluation, safety, horse tolerance, and complications were recorded. RESULTS: Visibility at the most distal aspect of the sheath was absent for the needle arthroscopes vs a standard arthroscope. The maneuverability with a 65-mm needle arthroscope was excellent and allowed exhaustive visualization of the proximal region of the carpal sheath in cadaveric limbs and standing horses (six of six). However, visualization of the intertendinous recess was partial in most horses (four of six) vs cadavers (complete in six of six) because of remaining flexor tendon tension in standing horses. No major complications were encountered. CONCLUSION: Standing carpal sheath tenoscopy allowed a safe and thorough evaluation of most structures in the proximal region of the sheath and offers an alternative diagnostic technique. CLINICAL SIGNIFICANCE: Horses with unrewarding results after traditional imaging or that require an accurate diagnosis before treatment may benefit from this alternative procedure.


Assuntos
Artroscopia/veterinária , Membro Anterior/cirurgia , Cavalos/cirurgia , Tendões/cirurgia , Animais , Artroscópios/veterinária , Artroscopia/instrumentação , Artroscopia/métodos , Cadáver , Agulhas/efeitos adversos
16.
Australas Emerg Care ; 23(1): 23-28, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926959

RESUMO

BACKGROUND: Despite the introduction of a range of safety policies and sharps equipment designed to protect healthcare workers, rates of percutaneous injuries from occupational exposure to sharps remains high. This study examined the availability and use of various types of sharps devices in a tertiary hospital emergency department, to understand clinician choice between non-safety and safety devices; and to document their safe and unsafe use of sharps. METHODS: This mixed methods study consisted of areview of stock levels, a survey of staff usage, and a content analysis of semi-structured interview data to explore factors which impact on staff preferences for different sharps devices. RESULTS: Staff identified a range of sharps risks, as well as barriers and enablers to the use of safety devices. Availability of, and preference for, familiar devices influenced choice of devices used in clinical practice, despite awareness of associated risks. CONCLUSIONS: This understanding of equipment use and the factors that motivate such use have informed the first stage of the knowledge-to-action cycle. Knowledge translation, should include the development of policies to help reduce the risk of sharps injury. Culture change and ongoing skills development might help to overcome entrenched procedures and increase voluntary engagement with safer sharps.


Assuntos
Ferimentos Penetrantes Produzidos por Agulha/etiologia , Adulto , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Vidro , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Agulhas/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/estatística & dados numéricos , Pesquisa Qualitativa , Queensland/epidemiologia , Inquéritos e Questionários
17.
Med Sci Monit ; 26: e918619, 2020 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-31982889

RESUMO

BACKGROUND Annular fiber closure techniques have been proven effective in reducing short-term recurrence after discectomy. However, annular fiber closure devices are expensive and still fail at a low rate. We present a novel suture method, needle-guided annular closure suture (NGACS) that does not require a special device and can be performed for annular fiber closure following microendoscopic discectomy. MATERIAL AND METHODS Twenty-five patients who underwent treatment with NGACS were reviewed by analysis of the medical records. The clinical outcomes were assessed and compared preoperatively and immediately, 1, 6, and 12 months postoperatively. The parameters included the Visual Analog Scale (VAS)-back and VAS-leg scores and the Oswestry Disability Index (ODI). Midsagittal T2WI images were obtained to evaluate lumbar disc degeneration using the Pfirrmann grade. Additional adverse events were also recorded and tracked. RESULTS The VAS-back and VAS-leg scores and the ODI were significantly different at each follow-up time point (P<0.001), and improvements in pain and disability were maintained well during the follow-up period. Lumbar disc reherniation or other serious adverse events were not observed in this series. There was no significant difference between the initial and final Pfirrmann grades (Z=-1.414, P=0.157). The preoperative average disc height was 9.94±1.97 mm, and the disc height at 12 months after surgery was 9.14±1.88 mm. The average decrease in disc height was 8.11±3.36%. CONCLUSIONS This study demonstrates the feasibility and superior clinical outcomes of the NGACS technique. This method can be a good substitution when annular fiber closure devices are not available. Moreover, this technique can be easily popularized due to its low cost and few restrictions.


Assuntos
Discotomia , Endoscopia , Vértebras Lombares/cirurgia , Agulhas , Técnicas de Sutura , Adulto , Avaliação da Deficiência , Discotomia/efeitos adversos , Endoscopia/efeitos adversos , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Técnicas de Sutura/efeitos adversos , Resultado do Tratamento , Escala Visual Analógica
18.
Eur J Vasc Endovasc Surg ; 59(2): 288-294, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31883684

RESUMO

OBJECTIVE: Arteriovenous grafts (AVGs) typically lose patency within two years of creation due to venous neointimal hyperplasia, which is initiated by disturbed haemodynamics after AVG surgery. Haemodialysis needle flow can further disturb haemodynamics and thus impact AVG longevity. In this computational study it was assessed how dialysis flow and venous needle positioning impacts flow at the graft-vein anastomosis. Furthermore, it was studied how negative effects of dialysis needle flow could be mitigated. METHODS: Non-physiological wall shear stress and disturbed blood flow were assessed in an AVG model with and without dialysis needle flow. Needle distance to the venous anastomosis was set to 6.5, 10.0, or 13.5 cm, whereas dialysis needle flow was set to 200, 300 or 400 mL/min. Intraluminal needle tip depth was varied between superficial, central, or deep. The detrimental effects of dialysis needle flow were summarised by a haemodynamic score (HS), ranging from 0 (minimal) to 5 (severe). RESULTS: Dialysis needle flow resulted in increased disturbed flow and/or non-physiological wall shear stress in the venous peri-anastomotic region. Increasing cannulation distance from 6.5 to 13.5 cm reduced the HS by a factor 4.0, whereas a central rather than a deep or superficial needle tip depth reduced the HS by a maximum factor of 1.9. Lowering dialysis flow from 400 to 200 mL/min reduced the HS by a factor 7.4. CONCLUSION: Haemodialysis needle flow, cannulation location, and needle tip depth considerably increase the amount of disturbed flow and non-physiological wall shear stress in the venous anastomotic region of AVGs. Negative effects of haemodialysis needle flow could be minimised by more upstream cannulation, by lower dialysis flow and by ensuring a central needle tip depth. Since disturbed haemodynamics are associated with neointimal hyperplasia development, optimising dialysis flow and needle positioning during haemodialysis could play an important role in maintaining AVG patency.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/prevenção & controle , Modelos Cardiovasculares , Neointima/patologia , Diálise Renal/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Implante de Prótese Vascular , Cânula/efeitos adversos , Simulação por Computador , Desenho Assistido por Computador , Oclusão de Enxerto Vascular/etiologia , Humanos , Hidrodinâmica , Hiperplasia/etiologia , Agulhas/efeitos adversos , Fluxo Sanguíneo Regional/fisiologia , Diálise Renal/instrumentação , Diálise Renal/métodos , Estresse Mecânico , Grau de Desobstrução Vascular/fisiologia
19.
Br J Radiol ; 93(1108): 20190866, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860329

RESUMO

OBJECTIVE: This systematic review and meta-analysis investigated risk factors for pneumothorax following CT-guided percutaneous transthoracic lung biopsy. METHODS: A systematic search of nine literature databases between inception to September 2019 for eligible studies was performed. RESULTS: 36 articles were included with 23,104 patients. The overall pooled incidence for pneumothorax was 25.9% and chest drain insertion was 6.9%. Pneumothorax risk was significantly reduced in the lateral decubitus position where the biopsied lung was dependent compared to a prone or supine position [odds ratio (OR):3.15]. In contrast, pneumothorax rates were significantly increased in the lateral decubitus position where the biopsied lung was non-dependent compared to supine (OR:2.28) or prone position (OR:3.20). Other risk factors for pneumothorax included puncture site up compared to down through a purpose-built biopsy window in the CT table (OR:4.79), larger calibre guide/needles (≤18G vs >18G: OR 1.55), fissure crossed (OR:3.75), bulla crossed (OR:6.13), multiple pleural punctures (>1 vs 1: OR:2.43), multiple non-coaxial tissue sample (>1 vs 1: OR 1.99), emphysematous lungs (OR:3.33), smaller lesions (<4 cm vs 4 cm: OR:2.09), lesions without pleural contact (OR:1.73) and deeper lesions (≥3 cm vs <3cm: OR:2.38). CONCLUSION: This meta-analysis quantifies factors that alter pneumothorax rates, particularly with patient positioning, when planning and performing a CT-guided lung biopsy to reduce pneumothorax rates. ADVANCES IN KNOWLEDGE: Positioning patients in lateral decubitus with the biopsied lung dependent, puncture site down with a biopsy window in the CT table, using smaller calibre needles and using coaxial technique if multiple samples are needed are associated with a reduced incidence of pneumothorax.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Tomografia Computadorizada por Raios X , Humanos , Incidência , Agulhas/efeitos adversos , Posicionamento do Paciente/métodos , Punções/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco
20.
Dermatol Surg ; 46(4): 459-464, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31403543

RESUMO

BACKGROUND: Striae distensae have notoriously been difficult to treat due to their extensive involvement of nonfacial skin. Microneedling with its lack of thermal injury during microneedling treatment renders it a viable treatment option in darker skin tones and nonfacial regions due to the reduced risk of postinflammatory hyperpigmentation. OBJECTIVE: To describe the clinical results and side effects of microneedling in a series of 25 individuals with striae distensae. MATERIALS AND METHODS: Twenty-five consecutive adults (SPT I-V) with striae distensae involving the trunk and extremities were treated using a microneedling device. No additional treatments (topical or intralesional) were applied. Two assessors blinded to treatment protocol rated clinical improvement of striae on a 5-point scale. Side effects were monitored and tabulated. RESULTS: Patients received 1 to 3 consecutive monthly treatments. All striae improved at least 50% after an average of 1.8 treatments, and 28% of patients demonstrated more than 75% clinical improvement. Striae in thicker skin regions (e.g., buttocks/thighs) showed comparable clinical improvement than those in thinner skin areas (e.g., breasts) and did not require additional treatment sessions. Side effects were limited to transient erythema in all skin phototypes. No infections or dyspigmentation were observed. CONCLUSION: The clinical results obtained in this study support the safe and effective treatment of striae distensae with microneedling in light and dark skin tones in various body locations. Standardization of treatment protocols are anticipated with further (ongoing) studies.


Assuntos
Técnicas Cosméticas/instrumentação , Agulhas/efeitos adversos , Estrias de Distensão/terapia , Adulto , Técnicas Cosméticas/efeitos adversos , Eritema/epidemiologia , Eritema/etiologia , Extremidades , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Pigmentação/epidemiologia , Transtornos da Pigmentação/etiologia , Púrpura/epidemiologia , Púrpura/etiologia , Tronco , Resultado do Tratamento
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