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1.
Int J Cancer ; 146(3): 781-790, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977121

RESUMO

Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.


Assuntos
Análise Custo-Benefício , Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico , Idoso , Biomarcadores Tumorais/genética , Biópsia/efeitos adversos , Biópsia/economia , Biópsia/normas , Brônquios/diagnóstico por imagem , Brônquios/patologia , Broncoscopia/efeitos adversos , Broncoscopia/economia , Broncoscopia/normas , Simulação por Computador , Redução de Custos , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Seguimentos , Perfilação da Expressão Gênica/economia , Perfilação da Expressão Gênica/normas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Sensibilidade e Especificidade , Padrão de Cuidado/economia , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/normas
2.
Medicina (Kaunas) ; 55(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31546869

RESUMO

Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.


Assuntos
Broncoscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Pneumotórax Artificial/instrumentação , Idoso , Biópsia/efeitos adversos , Broncoscopia/efeitos adversos , Temperatura Baixa , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Pneumotórax Artificial/efeitos adversos , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Anticancer Res ; 39(8): 4191-4197, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366505

RESUMO

BACKGROUND/AIM: Biopsy hole for bone tumour biopsy may cause pathological fractures. This study aimed to identify the optimal shape of bone tumour biopsy hole using the rabbit femoral head compression test to avoid pathological fracture. MATERIALS AND METHODS: A compression test with no defect was performed to identify bone fracture location. Three shapes of biopsy holes (same size) were made artificially. Sixty rabbit femurs were randomly divided (n=15 each) into control (no defect), Shape 1 (round), Shape 2 (square), and Shape 3 (rectangular) groups. RESULTS: Twelve out of fifteen femurs were fractured on the femoral shaft; the femoral shaft was targeted for the compression test. Compressive maximum load and fracture energy were significantly higher for Shape 3 than for the other Shapes. CONCLUSION: A rectangular biopsy hole helps minimise reduction in bone strength. The defect width may be related to fragility of the affected bone.


Assuntos
Biópsia/efeitos adversos , Neoplasias Ósseas/fisiopatologia , Fraturas do Fêmur/fisiopatologia , Fêmur/fisiopatologia , Animais , Fenômenos Biomecânicos , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico , Modelos Animais de Doenças , Fraturas do Fêmur/diagnóstico , Humanos , Coelhos
4.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31366683

RESUMO

BACKGROUND: Pediatric patients with cancer undergo repeated painful procedures, including bone marrow aspirations and biopsies (BMABs). Optimal management of procedure-related pain can reduce discomfort, anxiety, and distress. METHODS: Children with neuroblastoma were randomly assigned to 1 of 2 arms on a prospective, single-blind, crossover trial conducted at Memorial Sloan Kettering Cancer Center from October 2016 to January 2018 (www.clinicaltrials.gov, identifier NCT02924324). Participants underwent 2 sequential BMABs: one with general anesthesia (GA) alone, the other with GA plus local anesthesia (LA) (GA + LA). The objective was to assess procedure-related pain and its interference with quality of life (QoL) with GA versus GA + LA. Primary outcome was percentage of participants requiring postprocedural opioids. Secondary outcomes were total opioid and nonopioid analgesics, pain scores, time to first analgesic, QoL, and toxicity. Management of postprocedural pain was standardized. RESULTS: Of 56 participants randomly assigned (3-16.5 years old), 46 completed both procedures. There was no significant difference in percentage of participants requiring opioids with GA versus GA + LA (24% vs 20%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .002). There were no statistically significant differences in total opioid or nonopioid analgesic, 6- and 24-hour pain scores, median time to first analgesic, or pain interference. No adverse events occurred. CONCLUSIONS: LA was associated with significant improvement in pain scores in the immediate recovery period. LA did not reduce postprocedural opioid use, nor did it improve QoL for patients undergoing BMAB with GA.


Assuntos
Anestesia Geral/métodos , Anestesia Local/métodos , Medula Óssea/patologia , Neuroblastoma/diagnóstico , Neuroblastoma/cirurgia , Dor Pós-Operatória/prevenção & controle , Biópsia/efeitos adversos , Biópsia/tendências , Criança , Pré-Escolar , Estudos Cross-Over , Feminino , Humanos , Masculino , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Método Simples-Cego
5.
J Drugs Dermatol ; 18(7): 667-673, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334925

RESUMO

Background: Collagen-based products have been implemented in wound healing due to collagen's hemostatic properties, low antigenicity, and poor culture ability. Objective: To compare the rate and quality of full-thickness wound healing for topical collagen powder and primary closure. Methods: Eight volunteers received one 4 mm punch biopsy on each thigh. One wound was managed with primary closure while the other received daily collagen powder. Wounds were biopsied at four weeks for histopathological analysis. Subjects rated itch, pain, and treatment preferences at weeks 1, 2, 4, 6, and 12. Results: Six out of eight collagen-treated wounds were completely healed 4 weeks after initial wounding. Histologic analysis of the wounds revealed epidermal re-epithelization in both groups. More organized granulation tissue was noted in collagen-treated wounds and confirmed using Masson trichrome and CD31 staining for collagen and neoangiogenesis, respectively. Subjects reported similar itch and pain metrics between wounds. Both subjects and blinded dermatologists preferred the early cosmetic appearance of collagen-treated wounds over primarily closed wounds. Limitations: Small sample size, absence of negative control. Conclusion: These data suggest that collagen powder is non-inferior to primary closure at the macro- and microscopic levels, while possibly leading to superior early cosmetic outcomes and accelerated histologic wound maturation. Ethics/Clinical Trials Registration: Study was approved by the George Washington University Institutional Review Board (IRB protocol #121745). ClinicalTrials.gov: NCT03481907. J Drugs Dermatol. 2019;18(7):667-673.


Assuntos
Colágeno/administração & dosagem , Ferida Cirúrgica/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Doença Aguda/terapia , Adulto , Biópsia/efeitos adversos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pós , Pele/efeitos dos fármacos , Ferida Cirúrgica/etiologia , Resultado do Tratamento , Adulto Jovem
7.
Fertil Steril ; 112(1): 44-45, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277769

RESUMO

Testicular biopsy appears to enhance sexual function and to influence hormonal output. Stimulation of sexual function seems to be the earliest and most characteristic response to the operation and is probably attributable mainly to nervous stimulation. -Georgescu et al. 1969.


Assuntos
Biópsia , Recuperação Espermática , Testículo/patologia , Animais , Biópsia/efeitos adversos , Humanos , Libido , Masculino , Tamanho do Órgão , Medição de Risco , Análise do Sêmen , Recuperação Espermática/efeitos adversos , Testículo/fisiopatologia
9.
Respir Res ; 20(1): 140, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277659

RESUMO

BACKGROUND: Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. METHODS: In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as "no bleeding", "mild" (suction alone), "moderate" (additional intervention) or "severe" (prolonged monitoring necessary or fatal outcome), for each intervention. RESULTS: In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. CONCLUSIONS: Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. TRIAL REGISTRATION: The study was registered with clinicaltrials.gov ( NCT01894113 ).


Assuntos
Brônquios/patologia , Criocirurgia/efeitos adversos , Hemorragia/diagnóstico , Hemorragia/etiologia , Doenças Pulmonares Intersticiais/diagnóstico , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Biópsia/efeitos adversos , Biópsia/métodos , Estudos Cross-Over , Criocirurgia/métodos , Feminino , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
11.
Ital J Pediatr ; 45(1): 69, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171002

RESUMO

BACKGROUND: Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. CASE PRESENTATION: A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. CONCLUSIONS: A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.


Assuntos
Anemia/etiologia , Biópsia/efeitos adversos , Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente
13.
Am J Forensic Med Pathol ; 40(3): 289-292, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31205056

RESUMO

The bone marrow biopsy is usually a safe procedure; however, it can occasionally present important complications. These complications are not always immediately evident or quickly diagnosed and may include pain at the biopsy site, trauma to neighboring structures, vascular injuries, infection, transient pressure neuropathies, pneumoretroperitoneum, and hemorrhage. Several risk factors are recognized, including thrombocytopenia, concurrent use of anticoagulants, and the presence of an underlying myeloproliferative disorder. While several reports of adverse events have been published, only 2 deaths attributable to this procedure have been reported. We present 2 cases of fatal hemorrhage after bone marrow biopsy.


Assuntos
Biópsia/efeitos adversos , Medula Óssea/patologia , Hemorragia/patologia , Espaço Retroperitoneal/patologia , Choque Hemorrágico/etiologia , Idoso , Evolução Fatal , Feminino , Humanos , Artéria Ilíaca/lesões , Artéria Ilíaca/patologia , Masculino , Pessoa de Meia-Idade
14.
Fertil Steril ; 112(1): 82-88, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056308

RESUMO

OBJECTIVE: To investigate whether blastocyst biopsy in preimplantation genetic testing (PGT) increases the risk of adverse neonatal outcomes. DESIGN: Retrospective cohort study. SETTING: University-affiliated center. PATIENTS: Live births after blastocyst biopsy combined with frozen ET (PGT group) and frozen blastocyst transfer after in vitro fertilization or intracytoplasmic sperm injection (control group). INTERVENTION(S): Blastocyst biopsy. MAIN OUTCOME MEASURE(S): Gestational age (GA), birth weight (BW), and rates of preterm birth (PB), very preterm birth (VPB), extreme preterm birth (EPB), low birth weight (LBW), very low birth weight (VLBW), and macrosomia. RESULT(S): No significant differences were observed in the sex ratio, GA, PB, VPB, EPB, BW, or rates of LBW, VLBW, and macrosomia between the PGT and control groups for either singletons or twins. However, the cesarean section rate of the PGT group was significantly higher than that of the control group for twins (adjusted odds ratio, 2.383 [1.079, 5.259]). Regarding fluorescence in situ hybridization-PGT neonates, neonatal outcomes, including GA, BW, and rates of PB, VPB, LBW, and VLBW, did not differ between the different groups of biopsied cells (≥10 group and <10 group) for either the grade B or grade C trophectoderm score subgroups; however, in the grade B trophectoderm score subgroup, the rate of boy babies in the ≥10 group was significantly higher than that in the <10 group (83.3% vs. 40.9%). The association between the number of biopsied cells and GA/BW was not statistically significant. CONCLUSION(S): Blastocyst biopsy may not add additional risk to neonatal outcomes when compared with a control group.


Assuntos
Blastocisto/patologia , Transferência Embrionária , Fertilização In Vitro , Testes Genéticos , Diagnóstico Pré-Implantação/métodos , Adulto , Biópsia/efeitos adversos , Peso ao Nascer , Transferência Embrionária/efeitos adversos , Feminino , Fertilização In Vitro/efeitos adversos , Idade Gestacional , Humanos , Hibridização in Situ Fluorescente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Nascimento Vivo , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento
15.
Fertil Steril ; 112(1): 140-148.e12, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056314

RESUMO

OBJECTIVE: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). DESIGN: Systematic review and network meta-analysis of randomized controlled trials. SETTING: Not applicable. PATIENT(S): Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. INTERVENTION(S): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). MAIN OUTCOME MEASURE(S): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. RESULT(S): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). CONCLUSION(S): Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.


Assuntos
Assistência Ambulatorial/métodos , Analgésicos/administração & dosagem , Biópsia/efeitos adversos , Endométrio/patologia , Histeroscopia/efeitos adversos , Manejo da Dor/métodos , Dor/prevenção & controle , Hemorragia Uterina/patologia , Analgésicos/efeitos adversos , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Naproxeno/administração & dosagem , Meta-Análise em Rede , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Sucção/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Hemorragia Uterina/etiologia
16.
BMC Musculoskelet Disord ; 20(1): 211, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31084601

RESUMO

BACKGROUND: Chronic nonbacterial osteomyelitis (CNO) is a rare chronic autoinflammatory syndrome affecting mainly children and young adults. The natural history of the disease is marked by recurrent pain as the mainstay of inflammatory outbreaks. Typical radiographic findings are osteosclerosis and hyperostosis of the medial clavicle, sternum and first rib. Compression of the brachial plexus is exceedingly rare and one of the few surgical indications. Literature on total clavicle reconstruction is scarce. While claviclectomy alone has been associated with fair functional and cosmetic outcomes, several reconstruction techniques with autograft, allograft or even cement ("Oklahoma prosthesis") have been reported with the aim of achieving better pain control, cosmetic outcome and protecting the brachial plexus and subclavian vessels. We herewith report a unique case of complicated CNO of the clavicle treated with total clavicle reconstruction using a free peroneal graft. CASE PRESENTATION: A 21-year-old female patient presented with CNO of her left clavicle, associated with recurrent, progressive and debilitating pain as well as limited range of motion. In recent years, she started complaining of paresthesia, weakness and pain radiating to her left arm during arm abduction. The clavicle diameter reached 6 cm on computed tomography, with direct compression of the brachial plexus and subclavian vessels. Following surgical biopsy for diagnosis confirmation, she further developed a chronic cutaneous fistula. Therefore, a two-stage total clavicle reconstruction using a vascularized peroneal graft stabilized by ligamentous reconstruction was performed. At two-year follow-up, complete pain relief and improvement of her left shoulder Constant-Murley score were observed, along with satisfactory cosmetic outcome. CONCLUSIONS: This case illustrates a rarely described complication of CNO with direct compression of the brachial plexus and subclavian vessels, and chronic cutaneous fistula. To our knowledge, there is no consensus regarding the optimal management of this rare condition in this context. Advantages and complications of clavicle reconstruction should be carefully discussed with patients due to limited evidence of superior clinical outcome and potential local and donor-site complications. While in our case the outcomes met the patient's satisfaction, it remains an isolated case and further reports are awaited to help surgeons and patients in their decision process.


Assuntos
Aloenxertos Compostos/transplante , Fístula Cutânea/cirurgia , Procedimentos Ortopédicos/métodos , Osteomielite/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Biópsia/efeitos adversos , Clavícula/diagnóstico por imagem , Clavícula/patologia , Clavícula/cirurgia , Fístula Cutânea/etiologia , Feminino , Humanos , Ligamentos/cirurgia , Osteomielite/diagnóstico , Osteomielite/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
17.
Eur J Obstet Gynecol Reprod Biol ; 237: 189-197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31071652

RESUMO

BACKGROUND: Colposcopy is an office gynecological procedure used for cervical evaluation in patients with abnormal cervical cytology. It is considered an important tool for early detection of cases of cervical cancer. OBJECTIVE: To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy of local anesthetics in pain relief during colposcopic-guided biopsy. DATA SOURCES: Several electronic databases included MEDLINE, EMBASE, Cochrane Library, ISI and Scopus were searched using the relevant MeSH terms. METHODS OF STUDY SELECTION: All RCTs assessing the effect of local anesthetics in relieving pain during colposcopy were considered for this meta-analysis. There were 1339 studies identified of which 11 studies deemed eligible for this review. We performed quality and risk of bias assessment for all included studies. DATA EXTRACTION: Three researchers independently extracted the data from the individual articles and entered it into RevMan software. The extracted outcomes included pain scores and the duration of the procedure. RESULTS: Eleven RCTs were included. Local anesthesia (LA) was associated with higher pain at speculum insertion than control (SMD = 0.23, 95% CI [0.03, 0.43]). While, LA significantly reduced biopsy pain than control (SMD= -0.57, 95% CI [-0.94, -0.20]). The overall pooled estimate showed no significant difference between LA and control regarding postprocedural pain, pain on endocervical curettage, pain expectancy, and overall pain scores. CONCLUSIONS: This meta-analysis suggests that local anesthetics are effective in pain relief during a colposcopic-guided biopsy; however there is no strong evidence to recommend its use in current practice.


Assuntos
Anestésicos Locais/uso terapêutico , Biópsia/efeitos adversos , Colposcopia/efeitos adversos , Dor Processual/tratamento farmacológico , Humanos , Manejo da Dor/métodos , Dor Processual/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Zhonghua Wai Ke Za Zhi ; 57(6): 428-433, 2019 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-31142067

RESUMO

Objective: To evaluate the effect of multimodal analgesia using periprostatic nerve block anesthesia (PNB) combined with flurbiprofen in patients undergoing transperineal template-guided prostate biopsy (TTPB). Methods: Totally 166 patients (aged (68.2±9.1) years, range: 47 to 81 years) who received TTPB from October 2017 to June 2018 at Department of Urology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University were enrolled prospectively. All the patients were randomly divided into 2 groups. The observation group (n=79) was given flurbiprofen axetil 1 mg/kg intravenously for half an hour before operation and lidocaine was used for PNB before the biopsy. The control group (n=87) was given normal saline combined with PNB. A visual analog scale (VAS) and visual numeric scale (VNS) were used to assess the patients' pain and quantify their satisfaction at two time points: VAS-1 and VNS-1: during biopsy procedure, VAS-2 and VNS-2: 30 min after the procedure. The date were compared by t test, χ(2) test, Fisher exact test and two-way repeated measures anova analysis between the 2 groups. Results: The age, total prostate volume, serum prostate-specific antigen and the number of cores were comparable among the 2 groups (P>0.05). The VAS-1 scores of the control group and the observation group were 2.8±1.7, 1.9±1.2, respectively, and the VNS-1 were 3.1±0.7, 3.4±0.3, respectively. The VAS-1 were significantly lower in observation group than in control group (F=3.904, P=0.000). Conversely, the VNS-1 were higher in observation group (F=3.526, P=0.000). At 30-minute postoperative, the VAS-2 and VNS-2 were 0.7±0.4 and 3.7±0.2 in the control group, respectively. The VAS-2 and VNS-2 were 0.6±0.5 and 3.8±0.1 in the observation group, respectively. There were no significant differences in the pain scores or the satisfaction scores between the 2 groups (F=1.429, 2.825; P=0.136, 0.083). The incidence of overall complications was 26.4% (23/87) in the control group and 25.3% (20/79) in the observation group, with no statistical difference between the 2 groups (χ(2)=0.027, P=0.869). And the complications had no statistically significant difference among the 2 groups including hematuria, urinary retention, infection, hematospermia, vascular and neurological reactions, nausea, vomiting, dizziness, headache, and respiratory depression (P>0.05). Conclusion: The multimodal analgesia induced by PNB and flurbiprofen could effectively relieve the pain for patients who received TTPB.


Assuntos
Analgésicos/uso terapêutico , Flurbiprofeno/uso terapêutico , Bloqueio Nervoso/métodos , Dor Processual/tratamento farmacológico , Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Analgesia , Anestésicos Locais/administração & dosagem , Biópsia/efeitos adversos , Quimioterapia Combinada , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Processual/etiologia , Períneo , Próstata/inervação
19.
Fertil Steril ; 112(2): 283-290.e2, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31103283

RESUMO

OBJECTIVE: To assess whether pregnancies achieved with trophectoderm biopsy for preimplantation genetic testing (PGT) have different risks of adverse obstetric and neonatal outcomes compared with pregnancies achieved with IVF without biopsy. DESIGN: Observational cohort. SETTING: University-affiliated fertility center. PATIENT(S): Pregnancies achieved via IVF with PGT (n = 177) and IVF without PGT (n = 180) that resulted in a live birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Maternal outcomes including preeclampsia and placenta previa and neonatal outcomes including birth weight and birth defects. RESULT(S): There was a statistically significant increase in the risk of preeclampsia among IVF+PGT pregnancies compared with IVF without PGT pregnancies, with an incidence of 10.5% versus 4.1% (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [95% CI], 1.10, 8.29). The incidence of placenta previa was 5.8% in IVF+PGT pregnancies versus 1.4% in IVF without PGT pregnancies (aOR = 4.56; 95% CI, 0.93, 22.44). Similar incidences of gestational diabetes, preterm premature rupture of membranes, and postpartum hemorrhage were observed. IVF+PGT and IVF without PGT neonates did not have a significantly different gestational age at delivery or rate of preterm birth, low birth weight, neonatal intensive care unit admission, neonatal morbidities, or birth defects. All trends, including the significantly increased risk of preeclampsia in IVF+PGT pregnancies, persisted upon stratification of analysis to only singleton live births. CONCLUSION(S): To date, this is the largest and most extensively controlled study examining maternal and neonatal outcomes after trophectoderm biopsy. There was a statistically significant three-fold increase in the odds of preeclampsia associated with trophectoderm biopsy. Given the rise in PGT use, further investigation is warranted.


Assuntos
Ectoderma/patologia , Resultado da Gravidez/epidemiologia , Diagnóstico Pré-Implantação , Trofoblastos/patologia , Adulto , Biópsia/efeitos adversos , Estudos de Coortes , Feminino , Fertilização In Vitro/métodos , Fertilização In Vitro/estatística & dados numéricos , Testes Genéticos/métodos , Testes Genéticos/estatística & dados numéricos , Humanos , Recém-Nascido , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Diagnóstico Pré-Implantação/efeitos adversos , Diagnóstico Pré-Implantação/métodos , Diagnóstico Pré-Implantação/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos
20.
Rev Mal Respir ; 36(4): 455-460, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31005425

RESUMO

INTRODUCTION: In the diagnostic approach to interstitial lung disease (ILD), the use of transbronchial cryobiopsy (TBC) may offer an alternative to surgical lung biopsy (SLB). We report the diagnostic effectiveness and the safety of TBC in ILD based on the preliminary experience in two French university centers. METHODS: Twenty four patients underwent TBC for the diagnosis of ILD in the operating room between 2014 and 2017. All the histological diagnoses obtained were then reviewed and validated during multidisciplinary discussions (MDD). RESULTS: Patients had an average of 3 TBC.TBC samples were analyzable in 22/24 (91.7%) patients. In these, samples allowed a histological diagnosis to be made in 14/22 (63.6%) patients and a diagnosis with certainty in 13/22 (59%) after MDD. The overall diagnostic yield from TBC was 13/24 (54.2%). Nine (37.5%) patients had a pneumothorax. Five (20.8%) patients had a bleeding. There were no deaths. Taking into account a possible initial learning curve and considering only the 15 patients who had their TBC after 2015, we note that a diagnosis could be made after MDD for 12 of them, that is, 80%. CONCLUSION: A prospective randomized study is needed to evaluate the technique in France in order to specify its diagnostic performance and its safety profile in comparison to SLB.


Assuntos
Broncoscopia/métodos , Doenças Pulmonares Intersticiais/diagnóstico , Pulmão/patologia , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/métodos , Biópsia/efeitos adversos , Biópsia/métodos , Biópsia/estatística & dados numéricos , Broncoscopia/efeitos adversos , Broncoscopia/estatística & dados numéricos , Criobiologia/métodos , Feminino , França/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Doenças Pulmonares Intersticiais/epidemiologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
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