Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.523
Filtrar
1.
J Cardiothorac Surg ; 15(1): 291, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008467

RESUMO

BACKGROUND: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). METHODS: This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. RESULTS: A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan-Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray's test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray's test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. CONCLUSIONS: The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.


Assuntos
Ablação por Cateter , Doenças das Valvas Cardíacas/cirurgia , Idoso , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter/métodos , Cateteres , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
2.
Anim Sci J ; 91(1): e13457, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32959472

RESUMO

This study aimed to compare the efficiency of non-surgical embryo transfer (ET) using a newly developed catheter, which enables transferring embryos into a proximal site of the uterus (mostly uterine body), and surgical ET of vitrified porcine embryos. In Experiment 1, the catheter was inserted into 12 gilts, with each half of the group allocated to skilled or novice operators. The time required for insertion into the uterus did not differ between skilled and novice operators (4 min 9 s and 4 min 6 s, respectively). In Experiment 2, 12 gilts were used as recipients for non-surgical and surgical ET with vitrified embryos (n = 6, each). There was no significant difference in the rate of piglet production based on the number of transferred embryos between surgical and non-surgical ET (25.8% vs. 15.4%, p = .098). The results suggest that non-surgical ET catheter allowed for easy insertion and transfer of embryos without special training. Although the catheter is effective for deposition of embryos into the proximal site of uterus, the efficiency of piglet production is not enhanced compared with surgical ET. The ET method using this catheter, being labor-saving and less-invasive, may contribute to the improvement of ET in pigs.


Assuntos
Técnicas de Cultura Embrionária/métodos , Técnicas de Cultura Embrionária/veterinária , Transferência Embrionária/métodos , Transferência Embrionária/veterinária , Suínos/fisiologia , Útero , Vitrificação , Animais , Cateteres , Transferência Embrionária/instrumentação , Feminino , Reprodução , Fatores de Tempo
3.
Medicine (Baltimore) ; 99(38): e22311, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957394

RESUMO

Diabetes mellitus results in an attenuated inflammatory response, reduces pulmonary microvascular permeability, and may decrease the risk of developing acute respiratory distress syndrome (ARDS). Studies have shown that patients with ARDS are better managed by a conservative as compared to liberal fluid management strategy. However, it is not known if the same fluid management principles hold true for patients with comorbid diabetes mellitus and ARDS.As diabetes mellitus results in reduced pulmonary microvascular permeability and an attenuated inflammatory response, we hypothesize that in the setting of ARDS, diabetic patients will be able to tolerate a positive fluid balance better than patients without diabetes.The Fluid and Catheter Treatment Trial (FACTT) randomized patients with ARDS to conservative versus liberal fluid management strategies. In a secondary analysis of this trial, we calculated the interaction of diabetic status and differing fluid strategies on outcomes. Propensity score subclassification matching was used to control for the differing baseline characteristics between patients with and without diabetes.Nine hundred fifty-six patients were analyzed. In a propensity score matched analysis, the difference in the effect of a conservative as compared to liberal fluid management strategy on ventilator free days was 2.23 days (95% CI: -0.97 to 5.43 days) in diabetic patients, and 2.37 days (95% CI: -0.21 to 4.95 days) in non-diabetic patients. The difference in the effect of a conservative as compared to liberal fluid management on 60 day mortality was 2% (95% CI: -11.8% to 15.8%) in diabetic patients, and -7.9% (95% CI: -21.7% to 5.9%) in non-diabetic patients.When comparing a conservative fluid management strategy to a liberal fluid management strategy, diabetic patients with ARDS did not have a statistically significant difference in outcomes than non-diabetic patients.


Assuntos
Diabetes Mellitus/terapia , Hidratação/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Adulto , Idoso , Cateteres , Tratamento Conservador , Diabetes Mellitus/congênito , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Síndrome do Desconforto Respiratório do Adulto/complicações
4.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981623

RESUMO

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Assuntos
Hemorragia Gastrointestinal/terapia , Manuseio das Vias Aéreas , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Oclusão com Balão , Fatores de Coagulação Sanguínea/administração & dosagem , Transfusão de Sangue/métodos , Cateteres , Serviço Hospitalar de Emergência , Fator Xa/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Infusões Intraósseas , Infusões Intravenosas , Anamnese , Exame Físico , Inibidores da Bomba de Prótons/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Ressuscitação , Tromboelastografia , Vasoconstritores/uso terapêutico
5.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784245

RESUMO

We describe a case of a patient who presented to the emergency department with severe shortness of breath and was diagnosed with mild COVID-19 pneumonia and concomitant intermediate-high risk saddle pulmonary thromboembolism. Additionally, the patient had sustained a significant head injury 2 days prior due to a syncopal episode. The patient was treated successfully with catheter-directed thrombolysis (CDT). The case highlights the importance of considering thromboembolic complications in COVID-19 infection, independent of the severity of the associated pneumonia. The case also demonstrates the potential benefit of CDT in treating COVID-19-related thromboembolism.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Cateteres , Diagnóstico Diferencial , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Pandemias , Embolia Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
PLoS One ; 15(8): e0236946, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764790

RESUMO

Hemodialysis catheters are used to support blood filtration, yet there are multiple fundamentally different approaches to catheter tip design with no clear optimal solution. Side-holes have been shown to increase flow rates and decrease recirculation but have been associated with clotting/increased infection rates. This study investigates the impact of changing the shape, size and number of side-holes on a simple symmetric tip catheter by evaluating the velocity, shear stress and shear rate of inflowing blood. A platelet model is used to examine the residence time and shear history of inflowing platelets. The results show that side-holes improve the theoretical performance of the catheters, reducing the maximum velocity and shear stress occurring at the tip compared to non-side-hole catheters. Increasing the side-hole area improved performance up to a point, past which not all inflow through the hole was captured, and instead a small fraction slowly 'washed-out' through the remainder of the tip resulting in greater residence times and increasing the likelihood of platelet adhesion. An oval shaped hole presents a lower chance of external fibrin formation compared to a circular hole, although this would also be influenced by the catheter material surface topology which is dependent on the manufacturing process. Overall, whilst side-holes may be associated with increased clotting and infection, this can be reduced when side-hole geometry is correctly implemented though; a sufficient area for body diameter (minimising residence time) and utilising angle-cut, oval shaped holes (reducing shear stress and chances of fibrin formation partially occluding holes).


Assuntos
Cateteres , Diálise Renal/instrumentação , Velocidade do Fluxo Sanguíneo , Plaquetas/citologia , Cateteres/estatística & dados numéricos , Biologia Computacional , Simulação por Computador , Desenho de Equipamento , Hemodinâmica , Humanos , Hidrodinâmica , Modelos Cardiovasculares , Adesividade Plaquetária
8.
Arch. argent. pediatr ; 118(3): e317-e323, jun. 2020. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1117350

RESUMO

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.


Stenotrophomonas maltophilia is a multidrug-resistant, Gram-negative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0­18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophiliaisolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0­7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Bacteriemia , Stenotrophomonas maltophilia , Turquia , Estudos Retrospectivos , Cateteres , Infecções , Antibacterianos/uso terapêutico
9.
PLoS One ; 15(6): e0234471, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520972

RESUMO

Abdominal spacers are useful for maintaining the distance between the target tumors and surrounding tissues, such as the gastrointestinal tract, in patients treated with carbon ion radiotherapy. Surgical intervention to remove the spacers is sometimes necessary because of abdominal infections triggered by long-term spacer placement or intestinal perforation. Therefore, spacers that do not require surgical removal and provide effective drainage against abdominal infections are urgently needed. This study aimed to develop a spacer that could be removed non-surgically and one that provides the therapeutic effect of drainage in patients who receive carbon ion radiotherapy for abdominal tumors. A novel fan-shaped spacer was constructed from a film drain that was folded along the trigger line. Simple withdrawal of the trigger line caused the film drain to fold and the holding lines to become free. We performed laparoscopy-assisted insertion with pneumoperitoneum and blind removal of the spacer fourteen times using a porcine model. Saline in the abdominal cavity was effectively aspirated using the spacer. Our novel fan-shaped spacer could be removed safely without surgery and was able to drain fluid effectively from the abdominal cavity.


Assuntos
Neoplasias Abdominais/radioterapia , Cateteres , Drenagem/métodos , Radioterapia com Íons Pesados/métodos , Abdome/fisiopatologia , Neoplasias Abdominais/cirurgia , Animais , Drenagem/instrumentação , Suínos
10.
PLoS One ; 15(6): e0234567, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525955

RESUMO

BACKGROUND: We evaluated whether a simulation-based training with a vessel phantom improves the basic skills of a novice required for ultrasound-guided radial artery cannulation in real patients. In addition, we analysed whether repeated simulation training sets with an inter-training interval would accelerate the learning curve. METHODS: From March 2019 to July 2019, twenty-one anesthesiology residents were randomized into either a simulation group (n = 11) or control group (n = 10). Residents performed a total of 84 ultrasound-guided radial artery cannulations in real patients. The simulation group participated in two sets of simulation training on a vessel phantom (10 sessions per set) with a one-month inter-training interval. Trainee's performance proficiency was scored using a developed checklist, and a learning curve for each training set was constructed. To evaluate the effectiveness of our training curriculum in skill transfer, each resident performed four ultrasound-guided radial artery cannulations in real patients. The primary outcome was first attempt success rate and the secondary outcome was dynamic needle-tip positioning ability in real patients. RESULTS: The first attempt success rate and dynamic needle-tip positioning ability by ultrasound transducer were significantly higher in the simulation group than the control group (81.8% vs. 50%, P = 0.002 and 68.2% vs. 7.5%, P < 0.001, respectively). A reduced number of sessions was required to reach a plateau score on the learning curve in the repeated training set compared in the first-set (7 (5-8) vs. 3 (2-4), P = 0.003, respectively). CONCLUSIONS: Simulation-based training using a vessel phantom effectively improved the first attempt success rate for ultrasound-guided radial artery cannulation in real patients and the dynamic needle-tip positioning ability by ultrasound transducer in novice anesthesiology residents. In addition, repeated training curriculum accelerated the learning curve for recall skill proficiency and reduced inter-individual variability for skill acquisition. CLINICAL TRIAL REGISTRATION: Clinical Research Information Service (KCT0003471, Principle investigator: Jeong Jin Min, Date of registration: 06/March/2019).


Assuntos
Cateterismo Periférico/métodos , Artéria Radial/cirurgia , Treinamento por Simulação/métodos , Cirurgia Assistida por Computador/educação , Adulto , Cateterismo Periférico/instrumentação , Cateteres , Feminino , Humanos , Masculino , Estudantes de Medicina/estatística & dados numéricos , Cirurgia Assistida por Computador/métodos , Ultrassonografia/métodos
11.
Expert Rev Med Devices ; 17(7): 697-706, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32552093

RESUMO

INTRODUCTION: Acute ischemic stroke (AIS) secondary to the occlusion of a large intracranial vessel (LVO) is a recognized public health problem. Mechanical thrombectomy (MT) has gained full acceptance: Class A, Level 1 in 2015 after the publication of numerous trials. Further meta-analyses have scrutinized extensively those results and international recommendations and guidelines have been given. Nevertheless, multiple-specific points remain to be clarified and are or will be under investigations. AREAS COVERED: This review of the most recent literature (mostly publications after 2015) will cover the actual common practice for MT, especially focusing on the devices available (and their validation), how they are commonly used, relate the most relevant results, and detail some emerging technologies. EXPERT OPINION: The authors will express their own view on the current practice and emphasize on the areas where questions remain and hypothesize what specific improvements are necessary and prone to occur.


Assuntos
Trombectomia/instrumentação , Trombectomia/tendências , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Cateteres , Humanos , Stents , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
12.
PLoS One ; 15(6): e0234919, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559223

RESUMO

BACKGROUND: The ribcage and diaphragm are mechanical barriers for laparoscopic access during hepatectomy. Here, we introduce the varied application of intercostal trans-diaphragmatic ports during laparoscopic hepatectomy, and describe the management of intercostal ports with key technical points. METHODS: From January 2013 to December 2017, 180 patients underwent laparoscopic hepatectomy. In 32 of these patients (17.8%), intercostal ports (31 right and one left) were applied, and we analyzed the feasibility and safety of intercostal ports during laparoscopic hepatectomy. RESULTS: The main tumor location was segment VII and VIII (78%). The major type of laparoscopic hepatectomy was partial hepatectomy (91%). In the majority of cases (66%) the number and size of intercostal trocars was a single 5-mm port. The median operative time and blood loss were 232 min and 50 mL, respectively. A chest drain was placed via the hole of the intercostal port on the chest wall in two cases (6.3%). The median duration of the post-operative hospital stay was 6 days. There was no conversion, and a pure laparoscopic hepatectomy was achieved in all cases. There was no mortality. As for complications due to the application of intercostal ports, an asymptomatic pneumothorax was detected in only one case, and it was cured by conservative treatment. CONCLUSIONS: The ribcage and diaphragm could be overcome as barriers to laparoscopic access by the placement of intercostal ports with minimal access during laparoscopic hepatectomy. The use of an intercostal port and proper management allows for a feasible approach and safe resection during laparoscopic hepatectomy.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Diafragma/cirurgia , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Costelas/cirurgia
14.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(2): 172-178, 2020 Feb 08.
Artigo em Chinês | MEDLINE | ID: mdl-32400994

RESUMO

Irreversible electroporation (IRE) is an emerging tissue ablation technique. Compared with thermal ablation technique such as radiofrequency, IRE can achieve focal ablation in a shorter time without heat sink effect while sparing the tissue scaffold. IRE has been demonstrated to be a feasible therapeutic modality for the liver, pancreatic, and prostatic cancer. In recent years, several studies regarding of catheter-directed IRE for digestive tract, bronchus, urinary tract, and myocardium have been performed, which preliminarily demonstrated the safety and efficacy of IRE for tissue ablation under endoscopic or interventional technique. This study summarized the research progress of catheter-directed IRE for tissue ablation. The critical technique and future direction of catheter-based IRE are prosp.


Assuntos
Ablação por Cateter , Eletroporação , Cateteres , Endoscopia , Humanos
16.
Am J Vet Res ; 81(5): 448-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32343173

RESUMO

OBJECTIVE: To evaluate a novel 2-catheter technique for urethral catheterization in female cats and small dogs and compare the time required for and success rates achieved by use of the novel technique versus traditional methods (blind technique in cats and digital palpation in dogs) as performed by personnel (catheter placers [CPs]) with different levels of experience in urinary catheter placement. ANIMALS: 39 healthy sexually intact female animals (24 cats and 15 dogs weighing < 10 kg). PROCEDURES: 2 CPs were board certified in veterinary surgery, 1 of whom had experience with the novel technique, and the other did not. The third CP was a veterinary surgical intern who was unfamiliar with the novel technique. For each animal enrolled in the study, 1 CP performed catheterization with the novel technique and traditional methods. Data recorded included the time required for successful catheterization and whether a successful catheterization was achieved within a 3-minute time limit. RESULTS: The overall success rates were 79.5% (31/39 animals) with the novel technique and 43.6% (17/39 animals) with traditional methods. Median times for successful catheter placement were 48 seconds for the novel technique and 41 seconds for traditional methods. Among CPs, success rates or times to successful catheter placement did not differ significantly. CONCLUSIONS AND CLINICAL RELEVANCE: Study results suggested that the novel 2-catheter technique for urethral catheterization may be a more efficient option than traditional methods for gaining access to the urinary bladder in cats and small dogs, particularly when patient size limits use of instrumentation or digital palpation.


Assuntos
Cateteres , Cateterismo Urinário/veterinária , Animais , Gatos , Cães , Feminino , Fatores de Tempo , Bexiga Urinária
17.
PLoS One ; 15(3): e0230821, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32231378

RESUMO

PURPOSE: Using 4D magnetic particle imaging (MPI), intravascular optical coherence tomography (IVOCT) catheters are tracked in real time in order to compensate for image artifacts related to relative motion. Our approach demonstrates the feasibility for bimodal IVOCT and MPI in-vitro experiments. MATERIAL AND METHODS: During IVOCT imaging of a stenosis phantom the catheter is tracked using MPI. A 4D trajectory of the catheter tip is determined from the MPI data using center of mass sub-voxel strategies. A custom built IVOCT imaging adapter is used to perform different catheter motion profiles: no motion artifacts, motion artifacts due to catheter bending, and heart beat motion artifacts. Two IVOCT volume reconstruction methods are compared qualitatively and quantitatively using the DICE metric and the known stenosis length. RESULTS: The MPI-tracked trajectory of the IVOCT catheter is validated in multiple repeated measurements calculating the absolute mean error and standard deviation. Both volume reconstruction methods are compared and analyzed whether they are capable of compensating the motion artifacts. The novel approach of MPI-guided catheter tracking corrects motion artifacts leading to a DICE coefficient with a minimum of 86% in comparison to 58% for a standard reconstruction approach. CONCLUSIONS: IVOCT catheter tracking with MPI in real time is an auspicious method for radiation free MPI-guided IVOCT interventions. The combination of MPI and IVOCT can help to reduce motion artifacts due to catheter bending and heart beat for optimized IVOCT volume reconstructions.


Assuntos
Artefatos , Cateteres , Imageamento Tridimensional/instrumentação , Movimento , Tomografia de Coerência Óptica/instrumentação , Imagens de Fantasmas
18.
World Neurosurg ; 139: 440-444, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32344131

RESUMO

BACKGROUND: Cerebrospinal fluid (CSF) drainage during the treatment of aortic disease is commonly performed to prevent spinal cord ischemia. Spinal subdural hematoma (SDH) has never been reported after CSF drainage during thoracic endovascular aortic repair (TEVAR). We present a case of concurrent intracranial subarachnoid hemorrhage (SAH) and spinal SDH after CSF drainage tube removal in a patient with TEVAR. CASE DESCRIPTION: A 73-year-old man was hospitalized to undergo TEVAR. The day before the procedure, a lumbar CSF drainage tube was inserted. Continuous CSF drainage was performed only during the procedure, and the tube was removed the following day. The patient complained of mild back pain on postoperative day 2; headache, bilateral lower limb paresis, and bladder and rectal disturbances developed on postoperative day 5. Brain and spinal magnetic resonance imaging revealed spinal subdural or subarachnoid hematoma and intracranial SAH. Lumbar laminectomies for spinal SDH removal were performed; lower limb strength improved immediately after surgery. At postoperative 2 years, the patient returned to his preoperative activity level; only mild right lower limb numbness persisted. CONCLUSIONS: We present a rare case of intracranial SAH and spinal SDH that developed after CSF drainage tube removal in a patient with TEVAR. CSF drainage should be carefully considered in patients undergoing aortic procedures, as SAH and spinal SDH may occur in addition to spinal cord ischemia.


Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Cateteres , Procedimentos Endovasculares/efeitos adversos , Hematoma Subdural Espinal/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Aneurisma Dissecante/cirurgia , Líquido Cefalorraquidiano , Drenagem/efeitos adversos , Drenagem/instrumentação , Humanos , Masculino , Hemorragia Subaracnóidea/etiologia
19.
J Clin Neurosci ; 76: 9-14, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32327379

RESUMO

PURPOSE: To overcome the limitations of traditional mechanical thrombectomy (MT), including catheter aspiration and stent retrievers, such as thrombus fragmentation or migration, we designed hybrid MT using an intermediate aspiration catheter and a Trevo stent simultaneously. We retrospectively compared hybrid MT with the traditional MT. METHODS: From January 2017 to January 2019, we performed MT on 91 occlusions, including internal carotid artery bifurcation (n = 17), M1 segment (n = 53) and M2 segment (n = 21), using hybrid MT (n = 42) and traditional MT (n = 49). RESULTS: Hybrid MT had a shorter procedure time (52.4 ± 22.0 vs. 73.0 ± 36.2 min, p = 0.002) and fewer attempts (1.50 ± 0.86 vs. 1.92 ± 1.10 times, p = 0.049) than traditional MT did. Hybrid MT achieved more good clinical outcome (3-month modified Rankin Scale score, 2 or less) and better successful recanalization (Thrombolysis In Cerebral Infarction grade, 2b or 3) than traditional MT did, but the difference was not significant (61.9% vs. 55.1%, p = 0.531, 92.9% vs. 87.8%, p = 0.498). Hybrid MT showed a higher first pass successful recanalization rate than traditional MT did (69.0% vs. 40.8%, p = 0.011). Multivariable logistic regression analysis demonstrated that first pass successful recanalization is related to the M1 segment rather than other segments (adjusted odds ratio (OR); 3.277, confidence interval (CI); 1.227-8.749, p = 0.018) and hybrid MT rather than traditional MT (adjusted OR; 4.995, CI; 1.725-14.460, p = 0.003). CONCLUSIONS: Hybrid MT can be used as a first-line MT modality, particularly in M1 occlusion, based on our high first pass successful recanalization results.


Assuntos
Isquemia Encefálica/terapia , Cateteres , Stents , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Idoso , Infarto Cerebral , Feminino , Fibrinólise , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Respir Med ; 166: 105931, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32250869

RESUMO

OBJECTIVE: Spontaneous pneumothorax occurs most frequently in young active patients. Published guidelines do not all agree about its initial management; most patients are hospitalised and treated with chest tube. This prospective multicentric cohort study was designed to assess the potential of ambulatory management. METHODS: We included all consecutive patients with large spontaneous primary (PSP) and secondary pneumothoraces (SSP) presenting at the Lorient, Vitré and Rennes hospitals between December 2013 and July 2016. They were treated with a small-bore pigtail catheter and one-way valve and managed as outpatients following a specific protocol. When this failed, patients were hospitalised on day 4 for suction and surgical pleurodesis was envisaged on day 6. Patients were followed-up for one-year to assess relapse. RESULTS: Of the 148 patients included (129 PSP, 19 SSP), 122 (82⋅4%) were managed exclusively as outpatient with success in 84⋅5% of PSP and 68⋅4% of SSP patients. There were few complications: 13 vaso-vagal episodes and 3 minor bleedings. The one-year recurrence rates were 33⋅1% for PSP and 52⋅6% for SSP (p = 0⋅114 Hazard Ratio = 0⋅538; IC95% [0⋅249-1⋅161]). CONCLUSION: These results are consistent with our previous study and confirm that this exclusive ambulatory management of spontaneous pneumothoraces can be successfully implemented in new centres with a high success rate and few complications.


Assuntos
Assistência Ambulatorial/métodos , Cateteres , Pneumotórax/terapia , Adolescente , Adulto , Cateterismo , Tubos Torácicos , Drenagem , Feminino , Humanos , Masculino , Pleurodese , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA