Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 623
Filtrar
1.
Medicina (Kaunas) ; 55(8)2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366186

RESUMO

Background and objectives: Medical devices such as catheters are used on a large scale to treat heart and cardiovascular diseases. Unfortunately, they present some important drawbacks (structure failure, calcifications, infections, thrombosis, etc.), with the main side effects occurring due to adhesion and proliferation of bacteria and living cells on the surface of the implanted devices. The aim of this work is to modify the surface of polyvinyl chloride (PVC), an affordable biocompatible material, in order to reduce these aforementioned side effects. Materials and Methods: The surface of PVC was modified by depositing a thin layer also of PVC that incorporates an active substance, dicoumarol (a well-known anticoagulant), by spin coating process. The modified surfaces were analyzed by Fourier-transform infrared (FT-IR) microscopy, Fourier-transform infrared (FT-IR) spectroscopy, Ultraviolet-visible spectroscopy (UV-VIS), and Scanning electron microscopy (SEM) in order to determine the surface morphology and behavior. The samples were tested for Gram-positive (S. aureus ATCC 25923) and Gram-negative (P. aeruginosa ATCC 27853) standard strains from American Type Culture Collection (ATCC). Results: The material obtained had a smooth surface with a uniform distribution of dicoumarol, which is released depending on the deposition parameters. The concentration of dicoumarol at the surface of the material and also the release rate is important for the applications for which the surface modification was designed. PVC modified using the proposed method showed a good ability to prevent salt deposition and decreased the protein adhesion, and the resistance to bacterial adherence was improved compared with standard PVC.


Assuntos
Dicumarol/uso terapêutico , Cloreto de Polivinila/efeitos adversos , Materiais Biocompatíveis , Cateteres/efeitos adversos , Cateteres/microbiologia , Cateteres/normas , Dicumarol/normas , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Humanos , Cloreto de Polivinila/normas , Cloreto de Polivinila/uso terapêutico
2.
A A Pract ; 13(8): 313-315, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31343432

RESUMO

We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed.


Assuntos
Cateterismo/efeitos adversos , Cateteres/efeitos adversos , Bloqueio Nervoso , Amputação , Cotos de Amputação , Cateterismo/instrumentação , Falha de Equipamento , Nervo Femoral , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/terapia , Membro Fantasma/terapia , Nervo Isquiático
3.
World Neurosurg ; 130: 54-58, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31265926

RESUMO

BACKGROUND: Some mechanical thrombectomy techniques for acute ischemic stroke use a combination of an aspiration catheter and stent retriever. We experienced a rare case of aspiration catheter coil breakage and subsequent retrieval using a stent retriever. CASE DESCRIPTION: A 79-year-old man suddenly developed somnolence, global aphasia, and right hemiplegia. Magnetic resonance imaging revealed acute infarction of the left frontal lobe and occlusion of the left common carotid artery. Thus, using an aspiration catheter and a stent retriever, mechanical thrombectomy was performed. The stent retriever was deployed from the middle cerebral artery to the internal carotid artery and retracted into the aspiration catheter placed in the internal carotid artery proximal to the thrombus. The catheter was bent during retraction of the stent retriever. After thrombus aspiration, the internal carotid and anterior and middle cerebral arteries were successfully reperfused; however, the stent retriever captured a broken section of the winding coil of the aspiration catheter. We suspected that an X-ray marker on the stent retriever broke the winding coil at the bent segment of the aspiration catheter and the stent captured the broken coil. CONCLUSIONS: The combined use of an aspiration catheter and a stent retriever may cause unexpected device breakage, especially when the catheter is bent.


Assuntos
Cateteres/efeitos adversos , Remoção de Dispositivo/métodos , Falha de Prótese/efeitos adversos , Stents Metálicos Autoexpansíveis/efeitos adversos , Trombectomia/efeitos adversos , Idoso , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Humanos , Masculino , Trombectomia/instrumentação
5.
J Craniofac Surg ; 30(3): e243-e244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31048620

RESUMO

The authors report an unusual case of distal ventriculoperitoneal shunt catheter into the pulmonary vasculature. The migrated catheter was extracted through a thoracotomy and venotomy, with the cooperation of Neuroneurosurgery and Cardiovascular team. This rare complication after ventriculoperitoneal shunt surgery should be paid enough attention. There were 2 possible mechanisms. To solve the problem, multidisciplinary cooperation should be applied.


Assuntos
Cateteres/efeitos adversos , Migração de Corpo Estranho/diagnóstico por imagem , Coração/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Derivação Ventriculoperitoneal/efeitos adversos , Migração de Corpo Estranho/etiologia , Humanos , Hidrocefalia/terapia , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Chest ; 155(4): e97-e100, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30955587

RESUMO

CASE PRESENTATION: A 73-year-old man presented to the ED of an outside hospital with asymptomatic chest wall swelling 10 h after discharge from our hospital. Four days earlier, he had presented to our hospital with increased dyspnea, cough, and sputum production. His history was notable for severe COPD with bullous emphysema. Chest imaging demonstrated bilateral opacities and a collection of gas and liquid in the major fissure of the left lung. A catheter was placed into the collection of gas and liquid under imaging guidance. After 4 days, the catheter was removed without event and the patient was discharged from the hospital with an extended course of antibiotics. Imaging performed in the ED revealed gas in the tissues of the chest wall and no evidence of a pneumothorax. He was transported back to our hospital by helicopter.


Assuntos
Fístula Brônquica/complicações , Cateteres/efeitos adversos , Fístula Cutânea/complicações , Descompressão Cirúrgica/instrumentação , Remoção de Dispositivo/efeitos adversos , Enfisema Subcutâneo/etiologia , Idoso , Fístula Brônquica/diagnóstico , Fístula Brônquica/cirurgia , Fístula Cutânea/diagnóstico , Fístula Cutânea/cirurgia , Humanos , Masculino , Enfisema Subcutâneo/diagnóstico , Enfisema Subcutâneo/cirurgia , Tomografia Computadorizada por Raios X
7.
Int Urol Nephrol ; 51(6): 1019-1033, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31012037

RESUMO

OBJECTIVE: To provide updated evidence, we conducted a systematic review and meta-analysis to compare citrate lock with heparin in the prevention of hemodialysis catheter-related complications. METHODS: A systematic review and meta-analysis of randomized controlled trials were obtained by searching PubMed, EMBASE, Ovid, Cochrane library, and the Web of Science databases. Primary outcomes were catheter-related bloodstream infections (CRBI), exit-site infections, bleeding events, catheter removal for poor flow, and thrombolytic treatment. Secondary outcomes were thrombocytopenia, access-related admission, and all-cause mortality. RESULTS: The meta-analysis showed that the citrate lock containing antimicrobials can reduce the risk of CRBI when compared with heparin lock (RR: 0.34, 95% CI 0.24-0.49; I2 = 0%; P < 0.00001), and a tunneled cuffed catheter (TCC) was more beneficial for the prevention of CRBI (RR: 0.42, 95% CI 0.25-0.69; I2 = 40%; P = 0.0007) when compared with non-tunneled cuffed catheters (NTCC). The microbiological correlation analysis suggests that the occurrence of CRBI is closely related to S. aureus in catheters locked by citrate (P = 0.015) rather than by heparin (P = 0.868). In the analysis of exit-site infection, citrate lock with NTCC was more effective in preventing exit-site infection than heparin (RR: 0.48, 95% CI 0.31-0.75; I2 = 0%; P = 0.001). In addition, the risk of bleeding episodes was reduced in hemodialysis patients using citrate lock with TCC (RR: 0.53, 95% CI 0.32-0.86; I2 = 0%; P = 0.01) and patients with citrate alone (RR: 0.51, 95% CI 0.30-0.85; I2 = 12%; P = 0.010). The risk of catheter removal for poor flow (P = 0.91), thrombolytic treatment (P = 0.76), thrombocytopenia (P = 0.37), access-related admission (P = 0.10), and all-cause mortality (P = 0.62) was not significantly different. CONCLUSIONS: Antimicrobial-containing citrate lock solutions could reduce the risk of CRBI in hemodialysis patients. The occurrence of CRBI is closely related to S. aureus in catheters locked by citrate rather than by heparin. Citrate lock was effective in reducing exit-site infection in NTCC and bleeding events in TCC.


Assuntos
Anticoagulantes/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Citratos/uso terapêutico , Heparina/uso terapêutico , Diálise Renal/instrumentação , Infecções Relacionadas a Cateter/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/efeitos adversos
8.
Eur J Vasc Endovasc Surg ; 57(5): 667-675, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31005512

RESUMO

OBJECTIVE: Catheter directed thrombolysis (CDT) for peripheral arterial occlusions is a well established alternative to thrombo-embolectomy in patients with (sub)acute limb ischaemia. However, protocols are heterogeneous and need optimisation to improve results and lower bleeding risks. The objective was to review the results and outcomes of different CDT protocols for patients with peripheral arterial occlusions. DATA SOURCES: Electronic information sources (MEDLINE, Embase, Cochrane) and reference lists were searched to identify studies reporting results of CDT of peripheral arterial occlusions. METHODS: Two independent observers performed study selection, quality assessment and data extraction. Primary outcomes were treatment duration, success rates, and bleeding complications. Secondary outcomes were mortality and amputation rates. RESULTS: One hundred and six studies were included: 19 randomised controlled trials (RCTs), 38 prospective studies, 48 retrospective studies, and one mixed cohort study. The studies comprised a total number of 10,643 cases of which 9877 received CDT for lower extremity arterial occlusion, with a mean treatment duration of 21.4 h (95% confidence interval [CI] 21.0-21.8), an angiographic patency of 75% (95% CI 74.6-75.1), and freedom from amputation rate of 91% (95% CI 90.3-90.7). Pooled results showed a thrombolysis duration with high dose protocols of 21.9 h (95% CI 21.4-22.5) and 32.7 h with low dose protocols, with bleeding rates of 16.7% (95% CI 16.3-17.1) and 13.4% (95% CI 12.8-14.0), respectively. Weighted mean results for all RCTs and prospective cohorts of >100 cases analysed separately, showed comparable results to all observational cohorts pooled. Bleeding complications occurred in 18% (95% CI 17.8-18.3) of patients and remain an important risk of CDT. CONCLUSION: CDT is an effective treatment for peripheral arterial occlusions, the main concern is bleeding complications. Although no formal meta-analysis could be performed, the pooled results suggest that lower doses of fibrinolytics lead to similar success rates at a cost of longer treatment duration but with less bleeding. There is large variation in treatment protocols and the available literature suffers from absence of reporting standards and high heterogeneity.


Assuntos
Cateterismo Periférico/efeitos adversos , Fibrinolíticos/uso terapêutico , Trombólise Mecânica/efeitos adversos , Doença Arterial Periférica/terapia , Hemorragia Pós-Operatória/epidemiologia , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Cateteres/efeitos adversos , Protocolos Clínicos , Humanos , Trombólise Mecânica/instrumentação , Trombólise Mecânica/métodos , Hemorragia Pós-Operatória/etiologia , Fatores de Tempo , Resultado do Tratamento
9.
PLoS One ; 14(4): e0202456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943189

RESUMO

Many lung diseases, such as the acute respiratory distress syndrome (ARDS), display significant regional heterogeneity with patches of severely injured tissue adjacent to apparently healthy tissue. Current mouse models that aim to mimic ARDS generally produce diffuse injuries that cannot reproducibly generate ARDS's regional heterogeneity. This deficiency prevents the evaluation of how well therapeutic agents reach the most injured regions and precludes many regenerative medicine studies since it is not possible to know which apparently healing regions suffered severe injury initially. Finally, these diffuse injury models must be relatively mild to allow for survival, as their diffuse nature does not allow for residual healthy lung to keep an animal alive long enough for many drug and regenerative medicine studies. To solve all of these deficiencies in current animal models, we have created a simple and reproducible technique to selectively induce lung injury in specific areas of the lung. Our technique, catheter-in-catheter selective lung injury (CICSLI), involves guiding an inner catheter to a particular area of the lung and delivering an injurious agent mixed with nanoparticles (fluorescently and/or radioactively labeled) that can be used days later to track the location and extent of where the initial injury occurred. Furthermore, we demonstrate that CICSLI can produce a more severe injury than diffuse models, yet has much higher survival since CICSLI intentionally leaves lung regions undamaged. Collectively, these attributes of CICSLI will allow investigators to better study how drugs act within heterogeneous lung pathologies and how regeneration occurs in severely damaged lung tissue, thereby aiding the development of new therapies for ARDS and other heterogenous lung diseases.


Assuntos
Modelos Animais de Doenças , Lesão Pulmonar , Pulmão , Síndrome do Desconforto Respiratório do Adulto , Animais , Cateteres/efeitos adversos , Pulmão/metabolismo , Pulmão/patologia , Pulmão/fisiopatologia , Lesão Pulmonar/metabolismo , Lesão Pulmonar/patologia , Lesão Pulmonar/fisiopatologia , Camundongos , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Síndrome do Desconforto Respiratório do Adulto/patologia , Síndrome do Desconforto Respiratório do Adulto/fisiopatologia
10.
Wound Manag Prev ; 65(3): 30-37, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30986201

RESUMO

Fecal management devices (FMDs) are used to drain and contain fecal matter in incontinent, often acutely or critically ill patients to protect their skin as well as the environment from contamination. However, there is potential for contamination and resultant infection at various stages of FMD use. PURPOSE: This in vitro study was conducted to compare device removal factors and subsequent splash of simulated fecal matter of 3 different designs of FMDs using a simulated rectum. METHODS: A Universal Test Machine was used to automatically measure removal forces (in newtons [N]) and tube extensions as the FMDs were pulled from the simulated rectum by the machine. Splash distance and quantity were measured using a splash-capture cylinder and image analysis software. Each device was tested 3 times. Two-sample t tests were conducted to examine statistical differences in removal forces, removal extensions, and splash areas. RESULTS: The forces required to remove the FMDs from the simulated rectum were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (12.0 ± 0.3 N vs. 32.6 ± 4.3 N and 34.8 ± 3.1 N, respectively; P <.05). The extensions of the catheter tubing were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (32.0 ± 7.5 mm vs. 81.3 ± 9.1 mm and 105.2 ± 10.6 mm, respectively; P <.05). Simulated fecal matter was splashed over mean areas of 25.5 ± 16.1 cm2 and 27.3 ± 13.5 cm2 for the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon, respectively; no splash was observed for the device with a collapsible, donut-shaped retention balloon. CONCLUSION: In vitro observations suggest contamination and potential infection risk during FMD removal from the patient are influenced by FMD design. Future in vitro and clinical studies assessing the infectious nature of effluent and methods for containment are warranted.


Assuntos
Remoção de Dispositivo/efeitos adversos , Incontinência Fecal/terapia , Cateteres/efeitos adversos , Cateteres/microbiologia , Remoção de Dispositivo/métodos , Desenho de Equipamento/normas , Fezes , Humanos , Simulação de Paciente
11.
Curr Opin Anaesthesiol ; 32(3): 263-267, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985339

RESUMO

PURPOSE OF REVIEW: As the application of a test dose after epidural catheter insertion in obstetrics has recurrently been associated with serious adverse events affecting both maternal and foetal outcomes, the question whether to test or not remains a controversial issue. RECENT FINDINGS: Present guidelines do not provide clear recommendations in this regard and several recent surveys indicate a heterogeneity in clinical routine. SUMMARY: Physiological alterations during pregnancy and labour restrict the use and also the validity of traditional test agents. Epinephrine is not appropriate to detect a vascular insertion in labour and the application of a local anaesthetic test dose may lead to dose-dependent fatal consequences should the catheter be intrathecal, due to an increased sensitivity in parturients. Given the current practice of opioid-amended-low-concentration epidurals, the waiving of a test dose results at worst in a failed epidural, a stark contrast to the potentially severe to fatal complications of a 'traditional' test dose. Hence, an originally preventive measure providing potentially more harm than the consequences of the situation aimed to prevent, should not be recommended. A simple fractionated administration of the initial analgesic dose seems reasonable though.


Assuntos
Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Anestésicos Locais/administração & dosagem , Cateterismo/métodos , Epinefrina/administração & dosagem , Analgesia Epidural/efeitos adversos , Analgesia Epidural/instrumentação , Analgesia Epidural/normas , Analgesia Obstétrica/efeitos adversos , Analgesia Obstétrica/instrumentação , Analgesia Obstétrica/normas , Anestésicos Locais/efeitos adversos , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/normas , Cateteres/efeitos adversos , Relação Dose-Resposta a Droga , Espaço Epidural , Epinefrina/efeitos adversos , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/instrumentação , Injeções Epidurais/métodos , Injeções Epidurais/normas , Guias de Prática Clínica como Assunto , Gravidez
12.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-30939275

RESUMO

INTRODUCTION: Preterm infants require intravenous (IV) access for administration of medications, IV fluids, and parenteral nutrition. The scalp is a common site for obtaining IV access, and in children with hydrocephalus or wide fontanelles and sutures, there is a high probability of penetrating the meninges and brain matter with the scalp IV needle. If this penetration occurs and remains unnoticed, the contents of the IV infusion can infiltrate into the brain and cause severe brain damage. CASE PRESENTATION: A 3-day-old female neonate, born with myelomeningocele, was receiving total parenteral nutrition through a scalp-vein IV. She experienced a sudden increase in head circumference, a bulging fontanelle, and respiratory distress. Magnetic resonance images demonstrated subdural fluid collection, and the patient underwent emergency surgery. The dura, when opened, exuded milky-white fluid consistent in color with parenteral nutrition. Postoperative imaging showed a parenchymal abnormality caused by the intracranial and intraparenchymal infusion of parenteral nutrition. Four years later, the child had a shunt and had mild cognitive impairment. DISCUSSION: In cases of accidental intracranial administration of parenteral nutrition, we recommend that aggressive therapy be pursued to minimize the risks of developing comorbidities such as meningitis and to allow for maximal functional recovery.


Assuntos
Lesões Encefálicas/etiologia , Cateteres/efeitos adversos , Meningomielocele/terapia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/instrumentação , Couro Cabeludo , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/cirurgia , Disfunção Cognitiva/etiologia , Diagnóstico por Imagem , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Recém-Nascido , Infusões Intravenosas , Meninges/lesões , Meningomielocele/complicações , Nutrição Parenteral/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Índice de Gravidade de Doença , Derivação Ventriculoperitoneal
13.
Ren Fail ; 41(1): 113-117, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30909767

RESUMO

BACKGROUND: Prophylactic laparoscopic omentopexy is a safe technique to prevent catheter obstruction during peritoneal dialysis (PD). Here we described a technique through which the omentopexy was accomplished by Hem-o-loks before PD catheter insertion. METHODS: The procedures of omentopexy were described. To evaluate the efficiency of this surgical method, a retrospective review of PD catheter insertion cases and their follow-ups were performed, covering 10 consecutive patients with end-stage renal disease. RESULTS: All patients showed no intraoperative events. No catheter flow obstruction, migration, exit-site infection appeared during the follow-up. CONCLUSION: Laparoscopic PD catheter insertion using omentopexy can decrease catheter obstruction and migration.


Assuntos
Cateterismo/métodos , Falência Renal Crônica/terapia , Laparoscopia/métodos , Omento/cirurgia , Diálise Peritoneal/efeitos adversos , Adulto , Idoso , Obstrução do Cateter , Cateteres/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/instrumentação , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
14.
Ont Health Technol Assess Ser ; 19(1): 1-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30847008

RESUMO

Background: People with chronic urinary retention typically require intermittent catheterization. This review evaluates the effectiveness, safety, patient preference, cost-effectiveness, and budget impact of different types of intermittent catheter (IC). Specifically, we compared prelubricated catheters (hydrophilic, gel reservoir) and noncoated catheters, as well as their single use versus reuse (multiple use). Methods: We performed a systematic literature search and included randomized controlled trials, cohort, and case-control studies that examined any type of single-use versus multiple-use IC, hydrophilic single-use versus noncoated single-use, or gel reservoir single-use versus noncoated single-use. The outcomes of interest were symptomatic urinary tract infection (UTI), hematuria, other serious adverse events, and patient satisfaction. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also completed an economic evaluation, using the perspective of the Ontario Ministry of Health and Long-Term Care, to determine the cost-effectiveness of various intermittent catheters used in Ontario. We determined the budget impact of fully and partially funding various intermittent catheters for outpatients with chronic urinary retention. To understand patient experiences with intermittent catheterization, we interviewed 34 adults and parents of children affected by chronic urinary retention. Results: We found 14 randomized controlled trials that met the inclusion criteria. When comparing any type of single-use or multiple-use IC, we found no difference in UTI (RR = 0.98, 95% CI 0.70-1.39), hematuria, or serious adverse events, and inconclusive evidence on patient satisfaction.Our meta-analysis of studies on people living in the community showed that hydrophilic ICs may result in fewer UTIs than single-use noncoated ICs, but given the nature of the studies, we were uncertain about this conclusion.The nature of the available evidence also did not allow us to make definitive conclusions regarding whether one type of catheter was likely to result in less hematuria, fewer serious adverse events, or greater patient satisfaction.Our economic evaluation found that owing to small differences in quality-adjusted life-years and moderate to large incremental cost differences, the lowest-cost ICs-noncoated multiple-use (using one catheter per week or one catheter per day)-have the highest probability of being cost-effective. In a subpopulation of those clinically advised not to reuse ICs, single-use noncoated ICs have the highest probability of being cost-effective. As current funding is limited in the outpatient setting, publicly funding noncoated multiple-use catheters (one per day) would result in a total additional cost of $93 million over the first 5 years. People who use ICs reported that the high ongoing cost of purchasing catheters was a financial burden. Almost all said they would prefer not to reuse catheters sold as "single use" but could not afford to do so. Conclusions: Given the overall low quality of evidence in available studies, we are uncertain whether any specific type of IC (coated or noncoated, single- or multiple-use) significantly reduces symptomatic UTI, hematuria, or other serious adverse clinical events, or whether a specific type improves patient satisfaction. Therefore, the lowest-cost IC is likely the most cost-effective.


Assuntos
Cateteres , Cateterismo Urinário/métodos , Retenção Urinária/terapia , Assistência Ambulatorial/economia , Cateteres/efeitos adversos , Cateteres/economia , Doença Crônica , Materiais Revestidos Biocompatíveis/uso terapêutico , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
15.
J Neurointerv Surg ; 11(7): 637-640, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30733300

RESUMO

INTRODUCTION: Various large-bore catheters can be employed for manual aspiration thrombectomy (MAT); clinical differences are rarely explored. METHODS: Prospectively collected demographic, angiographic, and clinical data for patients with acute internal carotid artery, middle cerebral artery M1, or basilar occlusions undergoing MAT over 23 months at a comprehensive stroke center were reviewed. We excluded patients in stentriever-based randomized trials/registries. The four most commonly utilized aspiration catheters were analyzed, and multivariate logistic regression analyses were performed to determine the effect of primary aspiration catheter choice on first-pass success, final reperfusion, and modified Rankin Scale (mRS) score at 90 days. RESULTS: Of 464 large vessel thrombectomies, 180 were performed via MAT on the first pass with one of four catheters. First-pass success was achieved in 42% of cases overall; this rate did not differ significantly between catheters: 50% for Sofia, 45% for CAT6, 40% for 0.072 inch Navien, and 36% for ACE68, p=0.67. Final Thrombolysis in Cerebral Infarction 2b or 3 reperfusion was achieved in 94% of cases overall: 97% of cases with CAT6, 95% with Sofia, 92% with Navien, and 92% with ACE68, p=0.70. Mean number of passes for index thrombus (2.0 overall), median procedure time (32 min overall), 90-day good outcome (mRS 0-2, mean 36%), and 90-day mortality (mean 27%) did not differ significantly between patients treated with different initial catheters. CONCLUSION: Among large-bore aspiration catheters, catheter selection is not an independent predictor of first-pass success, final reperfusion, or clinical outcome.


Assuntos
Cateteres , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Trombectomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Cateteres/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Reperfusão/métodos , Estudos Retrospectivos , Trombectomia/métodos , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(6): e14407, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732191

RESUMO

BACKGROUND: To integrate relevant clinical data of multicatheter accelerated partial breast irradiation (mAPBI) for reaching a comprehensive conclusion. METHODS: We did 3 meta-analyses for clinical outcomes including 1740 women from 4 articles, for acute radiotherapy (RT)-associated toxicity including 1255 patients from 5 articles, and for late RT-related toxicity involving 1565 patients from 9 papers. Clinical outcomes analyses were stratified by molecular subtypes, lymph nodes status, receptor status, and human epidermal growth factor receptor 2 (HER2) status. RESULTS: For the Luminal A/B phenotypes, the disease relapse and failure in survival significantly decreased when compared with triple negative (TN)/HER2-amplified subtypes (P < .00001). The 5-year regional nodal recurrence (RNR), 5-year distant metastasis-free survival (DMFS) and 5-year disease free-survival (DFS) of TN patients were significantly superior to HER2-overexpression patients (P < .00001). The 5-year cause-specific survival (CSS), 5-year DMFS and 5-year overall survival (OS) in women with lymph nodes-negative were significantly improved versus patients with lymph nodes-positive (P = .0001). Conversely, the positive status of HER2 compared with negative one significantly increased the rate of local recurrence (LR) (P = .02). For acute toxicity, the morbidity of dermatitis was significantly higher than hematoma and implant infection (P = .01, P < .0001, respectively). For late toxicity, the occurrences of fibrosis (32%) and telangiectasia (14%) were significantly higher than other complications (P < .0001). CONCLUSION: HER2-enriched subtype compared with other subtypes has significantly increased disease relapse and failure in survival. HER2-positive status is positively associated with an increased incidence of LR. Dermatitis is the most common acute RT-related toxicity and fibrosis is the first rife late RT-related toxicity.


Assuntos
Braquiterapia/mortalidade , Neoplasias da Mama/radioterapia , Cateteres/efeitos adversos , Lesões por Radiação/etiologia , Lesões por Radiação/mortalidade , Adulto , Braquiterapia/instrumentação , Braquiterapia/métodos , Mama/patologia , Mama/efeitos da radiação , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Estadiamento de Neoplasias , Receptor ErbB-2 , Resultado do Tratamento
17.
Br J Neurosurg ; 33(3): 357-359, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30732482

RESUMO

Introduction: Ventriculo-peritoneal shunts (VPS) are still the mainstay treatment for hydrocephalus in children. It is generally accepted that VPS failure and infection rates are higher for neonates than for older children. We compared our 1-year failure and infection rates in under 3-month-old children compared with older children in our department. Results: We identified 58 children under 3 months of age who underwent VPS insertion between January 2007 and December 2016. They had a 29.3% (17) shunt failure rate over the first year. There were two confirmed shunt infections (3.4%). Discussion: The 1-year shunt failure rate at our institution for VPS insertion in children over 3 months is 26.1% and the infection rate is 4.3% (9). The literature suggests that the outcome for VPS in younger children is worse than for older children. Our work shows similar outcomes for all children compared to those under 3 months at time of VPS insertion alone. Conclusion: Children under 3-months-old undergoing VPS insertion should not automatically expect an increased 1-year failure or infection rate compared with older children. The reasons for this may be as a result of increased subspecialisation, the more widespread use of antibiotic-impregnated catheters and improved neonatal care.


Assuntos
Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Antibacterianos/uso terapêutico , Cateteres/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Falha de Tratamento
18.
Curr Opin Anaesthesiol ; 32(3): 315-324, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30789839

RESUMO

PURPOSE OF REVIEW: Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. RECENT FINDINGS: Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/µl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache. SUMMARY: Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.


Assuntos
Anestesia Epidural/efeitos adversos , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Infecções Relacionadas a Cateter/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Administração Intranasal , Anestesia Epidural/instrumentação , Anestesia Epidural/métodos , Anestesia Obstétrica/instrumentação , Anestesia Obstétrica/métodos , Raquianestesia/instrumentação , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/terapia , Cateterismo , Cateteres/efeitos adversos , Feminino , Humanos , Incidência , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia , Gravidez , Gravidez de Alto Risco
19.
J Interv Card Electrophysiol ; 55(2): 137-143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30712075

RESUMO

INTRODUCTION: Cardiac tamponade is a rare but life-threatening complication during atrial fibrillation (AF) catheter ablation. Contact force (CF)-sensing catheters improve ablation effectiveness. However, the impact of the application of CF-sensing catheters on the occurrence of cardiac tamponade remains unclear. The aim of this study is to evaluate the "real-world" impact of CF-sensing catheters on cardiac tamponade during AF ablation in an experienced medical center. METHODS AND RESULTS: This was a retrospective study of consecutive de novo AF ablation procedures at Beijing Anzhen Hospital between 2013 and 2016. The ablation procedure was divided into a CF group and a non-CF group. Logistic regression analysis was used to evaluate the association between the use of CF-sensing catheters and the risk of cardiac tamponade. A total of 5313 patients with AF were involved in this study. The incidence of cardiac tamponade in the CF group was significantly higher than that in the non-CF group (1.07% vs. 0.44%, P = 0.009). Of the cardiac tamponade cases in the non-CF group, 45.45% were delayed compared with 10% in the CF group (P = 0.011). Multivariate logistic regression analysis showed that CF-sensing catheters increased the risk of cardiac tamponade (OR = 2.34, 95% CI = 1.17-4.26, P = 0.015). Stratified analysis revealed patients with a smaller left atrium dimension, lower ejection fraction, longer procedure duration, or longer ablation duration had a greater risk of cardiac tamponade during ablation with CF-sensing catheters. CONCLUSIONS: CF-sensing catheters increase the risk of cardiac tamponade during AF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Tamponamento Cardíaco/etiologia , Cateteres/efeitos adversos , Complicações Intraoperatórias/etiologia , Ablação por Radiofrequência/instrumentação , Anticoagulantes/administração & dosagem , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA