Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 23.453
Filtrar
1.
Vasc Endovascular Surg ; 54(2): 118-125, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31690248

RESUMO

BACKGROUND: Expanded applications and increasing volumes of complex endovascular procedures have increased the risk of unintended intraoperative fragmentation and retention of catheters and sheaths. We describe a series of retained or fragmented endovascular devices, a quality improvement program to address this unmet need for improved detection of catheter fragmentation, and the results of this program. METHODS: Cases utilizing endovascular devices that resulted in a retained catheter fragment were identified and analyzed during divisional quality improvement review. One consistent area of concern was operating room (OR) staff unfamiliarity with verifying the integrity of an endovascular device. In response, a slide-based training protocol of focused, endovascular nursing education was implemented. Following perceived lack of improvement after this approach, we developed a handheld visual reference display of the tips of common catheters and sheaths. Staff was surveyed before and after intervention to assess the educational value of the display and the impact on staff device familiarity. RESULTS: All 4 described cases resulted in an unplanned return to the OR for retrieval of the fragmented catheter or sheath. No thromboembolic complications were observed, although associated intra-arterial thrombus was noted in 2 cases. Thirty-four OR nurses were polled to trial the visual reference display initiative, with 70% of those reporting primary surgical assignments outside of cardiovascular ORs. Introduction of the new visual reference display improved staff confidence in their ability to identify a broken device (2.4-3.7, P < .001). This improvement was most significant in OR staff with primary assignments in noncardiovascular services. CONCLUSION: Current OR standard operating procedures fail to address the potential for unintentionally retained catheters and wires during endovascular procedures. Our novel visual reference display of common endovascular items rather than conventional in-service training improved the ability of staff to identify device fragmentation at the time of the index procedure.


Assuntos
Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Falha de Equipamento , Corpos Estranhos/cirurgia , Dispositivos de Acesso Vascular , Adulto , Idoso , Atitude do Pessoal de Saúde , Competência Clínica , Desenho de Equipamento , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital , Enfermagem de Centro Cirúrgico , Reoperação , Resultado do Tratamento
2.
Int Endod J ; 53(2): 250-264, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31489641

RESUMO

AIM: To compare the mechanical properties and metallurgic features of new and used Reciproc Blue and Reciproc instruments. METHODOLOGY: A total of 120 R25 Reciproc Blue and R25 Reciproc instruments were used. The morphological, chemical, mechanical, thermal and phase composition characteristics of new and ex vivo used files were investigated by scanning electron microscopy (FEG-SEM) with energy dispersive X-ray spectroscopy (EDS), focused ion beam analysis (FIB), micro-Raman spectroscopy, FEG-SEM metallography, X-ray diffraction (XRD), differential scanning calorimetry (DSC) and indentation tests. Usage-induce degradation was evaluated. Ten new and ten used instruments per type were run until fracture occurred in a stainless steel artificial canal (60° angle of curvature, 4-mm radius). Time to fracture and the length of the fractured fragment were recorded. Torque and angle of rotation at failure of ten new and ten used instruments for each type were measured according to ISO 3630-1. The fracture surface of each fragment was examined. Two-way analyses of variance was used to analyse the data statistically (α-level 0.05). RESULTS: SEM analysis revealed microcracks near the tip on both files after ex vivo usage tests. FIB imaging and micro-Raman spectroscopy confirmed the presence of an oxide layer on the Reciproc Blue surface. There was no thinning of the coating after use. XRD revealed a reduction of martensite and R-phase in Reciproc Blue after use. DSC analysis revealed different transformation temperatures for the instruments analysed. Reciproc Blue was significantly more flexible than Reciproc for both new and used samples (P < 0.05), and they were significantly more resistant to cyclic fatigue than Reciproc (P < 0.05). Ex vivo usage reduced the fatigue resistance of both files. Torsional resistance of Reciproc and Reciproc Blue was not reduced by simulated use (P > 0.05). CONCLUSIONS: The thermal treatment of Reciproc Blue was associated with a finer structure with smaller grains than Reciproc, which increased its fracture resistance and was also responsible for its reduced hardness and lower elastic modulus. Both files were safe during ex vivo usage in severely curved canals.


Assuntos
Metalurgia , Preparo de Canal Radicular , Desenho de Equipamento , Falha de Equipamento , Dureza , Teste de Materiais , Estresse Mecânico , Propriedades de Superfície , Titânio , Torque
3.
Gen Dent ; 68(1): 36-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859660

RESUMO

The aim of this study was to compare, in pairs, the cyclic fatigue resistance, scanning electron microscopic (SEM) appearance, and energy-dispersive X-ray (EDX) profiles of 6 rotary files: ProTaper Gold vs EdgeTaper Platinum; ProTaper Universal vs EdgeTaper; and Vortex Blue vs EdgeSequel Sapphire. Six types of rotary file were tested in 2 sizes of each type. A 3-point cyclic fatigue apparatus imparting a 60-degree angle of curvature and a 3-mm radius of curvature was used to evaluate 30 files of each type and size. The cyclic fatigue testing results from similar file types and sizes were paired for statistical analysis. After fatigue testing was completed, 36 files (3 of each type and size) were randomly selected for SEM imaging and EDX analysis. When similar file types and sizes were paired in independent-samples t tests, statistically significant differences (P < 0.0001) in cyclic fatigue resistance were established. For both tested sizes, EdgeTaper Platinum exhibited significantly greater fatigue resistance than ProTaper Gold. ProTaper Universal and EdgeTaper each demonstrated significantly greater fatigue resistance than the other system in 1 size pairing. Vortex Blue exhibited significantly greater fatigue resistance than EdgeSequel Sapphire in both size pairings. In general, the heat-treated files demonstrated greater cyclic fatigue resistance than the non-heat-treated files. The SEM images verified that fracture patterns were consistent with cyclic fatigue failure. Differences in file design between the matched pairs were noted, particularly at the tips. The EDX comparisons showed that nickel and titanium were present in similar percentages (1:1 atomic ratio) for all file types. The disparities in cyclic fatigue results and tip design indicate that clinicians should not expect identical clinical performance from different files.


Assuntos
Instrumentos Odontológicos , Falha de Equipamento , Microscopia Eletrônica de Varredura/métodos , Preparo de Canal Radicular , Ligas Dentárias , Desenho de Equipamento , Humanos , Teste de Materiais , Níquel , Estresse Mecânico , Titânio
4.
Medicine (Baltimore) ; 98(44): e17757, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689833

RESUMO

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.


Assuntos
Cateteres de Demora/normas , Protocolos Clínicos , Neoplasias/enfermagem , Dispositivos de Acesso Vascular/normas , Adulto , Idoso , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Trombose/etiologia , Dispositivos de Acesso Vascular/efeitos adversos
5.
Gen Dent ; 67(6): 34-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658022

RESUMO

Although the incidence of broken needles in dental practice is minimal, needle breakage can occur as a result of manufacturing defects, inadequate patient management, or poor practitioner technique. Retrieval of a broken needle is justified not only because of the potential for needle migration but also because of psychological and medicolegal considerations. This case report describes the surgical removal of a dental needle that fractured during an attempt at local anesthesia. Identifying the precise location of the broken needle fragment and its relationship with the surrounding bones, vessels, and nerves is essential to designing an adequate treatment plan. If surgical retrieval is indicated, it should be performed immediately, especially in cases in which the needle fragment has not been bent or deformed. In the present case, the use of C-arm fluoroscopy aided the surgical removal while saving time and reducing the cost of treatment.


Assuntos
Anestesia Dentária , Falha de Equipamento , Corpos Estranhos , Agulhas , Anestesia Local , Instrumentos Odontológicos , Humanos
6.
Br J Nurs ; 28(18): 1170-1174, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597070

RESUMO

BACKGROUND: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. AIM: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). METHOD: an observational service evaluation. FINDINGS: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. CONCLUSION: securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.


Assuntos
Nutrição Enteral/instrumentação , Falha de Equipamento/estatística & dados numéricos , Unidades de Terapia Intensiva , Intubação Gastrointestinal/instrumentação , Nutrição Enteral/métodos , Humanos , Intubação Gastrointestinal/métodos
7.
Niger J Clin Pract ; 22(10): 1335-1340, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607721

RESUMO

Objective: The purpose of this study was to evaluate the cyclic fatigue resistances of the WaveOne Gold (WOG), ProTaper Next (PTN), 2Shape (TS) instruments. Materials and Methods: Totally 45 new WOG (25/.07), PTN (25/.06), TS (25/.06) files were tested inside the artificial canal of a custom-made stainless steel block with an inner diameter of 1.5 mm, a 60° angle, and a 5-mm radius of curvature. A 16-mm-long file segment (from the tip) was introduced and was immersed in 37°C water. The number of cycles to fracture (NCF), time to failure (TTF), fractured fragment length (FL) was recorded and the fractured surface was examined using microscope. Results: WOG > PTN > TS according to TTF results (P = 0.00). PTN > TS according to NCF results (P = 0.00). The FL values showed no significant difference (P = 0.335). Conclusions: Reciprocating motion can be used more safely than continuous rotation due to the higher cyclic fatigue resistance.


Assuntos
Ligas Dentárias , Instrumentos Odontológicos , Preparo de Canal Radicular/instrumentação , Temperatura Ambiente , Ligas , Análise do Estresse Dentário , Falha de Equipamento , Ouro , Humanos , Níquel , Rotação , Aço Inoxidável , Titânio
8.
Medicine (Baltimore) ; 98(39): e17105, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574809

RESUMO

We aimed to determine the accuracy and failure of OAK device, an automated screening, for the assessment of fall risk in a prospective cohort of healthy adults aged over 65 years. The algorithm for fall risk assessment of the centers for disease control and prevention (CDC) was used as reference standard. Of the 183 individuals recruited, the CDC algorithm classified 80 as being at moderate/high risk and 103 at low risk of falling. OAK device failure incidence was 4.9% (confidence interval [CI] upper limit 7.7%), below the preset threshold for futility-early termination of the study (i.e., not above 15%). The OAK device showed a sensitivity of 84% and a specificity of 67% (receiver operating characteristic [ROC] area 82%; 95% confidence interval [CI] 76-88%), not reaching the preplanned target sensitivity (not lower than 85%). Diagnostic accuracy was not far from the sensitivity levels similar to those obtained with other fall risk assessment. However, some limitations can be considered.ClinicalTrials.gov identifier: NCT02655796.


Assuntos
Acidentes por Quedas , Teste de Esforço/métodos , Programas de Rastreamento/métodos , Medição de Risco/métodos , Idoso , Desenho de Equipamento , Falha de Equipamento , Teste de Esforço/instrumentação , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
9.
J Endod ; 45(11): 1365-1370, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564462

RESUMO

INTRODUCTION: This study aimed to analyze the effects of ultrasonic removal of fractured files from the middle third of root canals on the vertical root fracture resistance. METHODS: This study was an extension of a previous study assessing the effects of fractured file removal on dentinal microcracks. It included 18 bilaterally matched pairs of human mandibular incisors prepared and analyzed in the previous study. Briefly, 1 member of each pair was assigned to an ultrasonic or a control group. In the ultrasonic group, K-files were fractured in the middle third of canals followed by ultrasonic file removal and canal preparation. In the control group, the root canals were simply prepared. Micro-computed tomographic imaging was performed before and after treatment, and the cross-sectional root images were screened for microcracks. For the present study, 3-dimensional reconstruction was performed for volumetric assessments. The fracture resistance was measured using a universal testing machine. All data were statistically analyzed. RESULTS: Fracture loads were significantly smaller in the ultrasonic group (P < .05). The percentage increase in the canal volume significantly influenced the root fracture resistance (P < .05), whereas microcracks had no significant effect (P > .05). CONCLUSIONS: Ultrasonic removal of fractured instruments from the middle third of root canals lowers the vertical root fracture resistance, with increased dentin removal being the primary cause.


Assuntos
Instrumentos Odontológicos , Cavidade Pulpar , Falha de Equipamento , Preparo de Canal Radicular , Ultrassom , Estudos Transversais , Dentina , Humanos
10.
Br J Nurs ; 28(19): S30-S36, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647743

RESUMO

This article reports the results of a single-site prospective audit evaluating the safety and effectiveness of urokinase (Syner-Kinase®) to restore patency in central venous access devices (CVADs) for cancer patients. CVADs are routinely inserted to allow the safe and timely administration of systemic anti-cancer therapies; therefore, catheter dysfunction can interrupt the treatment schedule and adversely affect patient outcome. The aim was to contribute to the development of evidence-based, standardised, best practice guidelines. Prospective data were collected from all patients (n=22) identified with an occluded CVAD, requiring use of Syner-Kinase to manage a persistent withdrawal occlusion or total occlusion, over a 6-month period. Findings revealed a single administration of Syner-Kinase for catheter occlusion clearance to be effective in 92% of cases. Results suggest that use of the thrombolytic agent is well-tolerated and an effective means of restoring patency for long-term CVADs in cancer patients.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Neoplasias/terapia , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Auditoria Clínica , Falha de Equipamento , Feminino , Humanos , Masculino , Estudos Prospectivos , Medicina Estatal , Resultado do Tratamento , Reino Unido
11.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(5): 388-390, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31625344

RESUMO

OBJECTIVE: Improve the integrity of the digestive electron microscope equipment and reduce the cost of equipment failure maintenance. METHODS: By studying the composition and function of the digestive electron microscope system and analyzing the causes of common faults, a targeted preventive maintenance plan is developed, equipment users are graded, and a training system is established. RESULTS: The user of the device can skillfully analyze the cause of the malfunction and timely deal with the sudden failure of the diagnosis and treatment, thereby reduce the risk of diagnosis and treatment and the investment in hospital maintenance. CONCLUSIONS: Through the analysis and processing of the digestive electron microscope system, point detection leakage, grading training, preventive maintenance can significantly improve the equipment integrity rate, reduce the risk of clinical diagnosis and treatment, effectively reduce the number of equipment failures, and reduce maintenance costs.


Assuntos
Serviço Hospitalar de Engenharia e Manutenção , Microscopia Eletrônica , Falha de Equipamento , Microscopia Eletrônica/instrumentação
12.
Aust Endod J ; 45(3): 400-406, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31562682

RESUMO

The purpose of this study was to compare cyclic fatigue (CF) resistance of reciprocating instruments at body temperature and relate the findings to their martensitic transformation temperatures. Contemporary nickel-titanium (NiTi) reciprocating instruments WaveOne Primary, WaveOne Gold Primary and EdgeFile X1 (n = 20 each and #25 tip diameter) were tested for CF resistance at body temperature (37 ± 1°C). Instruments were actioned according to manufacturer guidelines until fracture occurred in a simulated canal (angle of curvature = 60°, radius of curvature = 3 mm and centre of curvature = 5 mm from the tip). Time to fracture was recorded, and data analysed using Weibull analysis. Two instruments of each were tested using differential scanning calorimetry (DSC) to assess phase transformation temperatures. Reciprocating instruments manufactured with new alloys seem to be safer to CF than those manufactured with traditional M-Wire at body temperature. Martensitic transformation temperatures seem not to relate with fatigue behaviour for reciprocating motions.


Assuntos
Instrumentos Odontológicos , Preparo de Canal Radicular , Temperatura Corporal , Ligas Dentárias , Desenho de Equipamento , Falha de Equipamento , Teste de Materiais , Temperatura Ambiente , Titânio
13.
Pan Afr Med J ; 33: 107, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489085

RESUMO

Twiddler's syndrome is a rare but potentially lethal complication of pacemaker implantation. It is usually diagnosed within 1 year after implantation. It is characterized by device malfunction caused by pacemaker lead displacement due to twisting of the box on part of the patient. Twiddler's syndrome has been described by in 1968 as a complication of pacemaker implantation. It has also been reported after defibrillator implantation and cardiac resynchronization therapy. We here report the case of a 89-year old female patient admitted with Twiddler's syndrome leading to pacemaker malfunction secondary to pacemaker lead displacement. She underwent lead repositioning and received appropriate advice.


Assuntos
Falha de Equipamento , Marca-Passo Artificial/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Humanos , Síndrome
15.
J Endod ; 45(10): 1253-1257, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31409495

RESUMO

INTRODUCTION: The present study aimed to compare the torsional resistance of ProGlider (Dentsply Sirona, Ballaigues, Switzerland), Hyflex EDM (Coltene-Whaledent, Altstätten, Switzerland), and One G (Micro-Mega, Besancon, France) glide path instruments. METHODS: Fifteen ProGlider (16.02∼08), 15 Hyflex EDM (10.05), and 15 One G (14.03) instruments were collected and tested for torsional strength using a custom-designed testing device. Data were analyzed using 1-way analysis of variance and Tukey post hoc tests with 5% significance level. The tested specimens were examined under a scanning electron microscope. RESULTS: There was no significant difference between Hyflex EDM and ProGlider regarding their torsional resistance values (P > .05). One G showed the lowest torsional resistance (P < .05). Hyflex EDM exhibited the highest angle of rotation values among the instruments (P < .05). CONCLUSIONS: Hyflex EDM and ProGlider instruments had significantly higher torsional fatigue resistance than One G instruments, whereas Hyflex EDM showed the highest angle of rotation values. The differences in the torsional resistances might be associated with their different design features and manufacturing processes.


Assuntos
Instrumentos Odontológicos , Preparo de Canal Radicular , Desenho de Equipamento , Falha de Equipamento , Teste de Materiais , Rotação , Torção Mecânica
16.
J Clin Nurs ; 28(23-24): 4488-4495, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410906

RESUMO

AIMS AND OBJECTIVES: To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. BACKGROUND: Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. DESIGN: Prospective, observational study. We have complied with the STROBE checklist of items. METHODS: This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. RESULTS: A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. CONCLUSIONS: The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. RELEVANCE TO CLINICAL PRACTICE: The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Adulto , Cateterismo Periférico/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
17.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 303-306, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460728

RESUMO

OBJECTIVE: To explore the high-risk fault risk of CT simulator and the main causes of the risk, and to put forward effective risk management strategies. METHODS: The failure mode and effect analysis method was used to identify and control the operational fault risk of CT simulator. RESULTS: 5 major fault components, 8 fault failure models and 17 failure causes were analyzed. The top 5 failure causes are:anode target surface burn caused by direct scanning without warming up the tube (590.4), tube failure (518.2), burnout of joints caused by aging of high voltage cables (424.2), motor carbon brush wear (304.8) and belt break (296.4). CONCLUSIONS: The failure mode and effect analysis method can effectively identify the risk of equipment failure, and thus specifically formulate risk management and control measures to ensure the normal operation of equipment and the safety of doctors and patients.


Assuntos
Falha de Equipamento , Gestão de Riscos , Tomografia Computadorizada por Raios X , Falha de Equipamento/estatística & dados numéricos , Humanos , Gestão de Riscos/métodos , Tomografia Computadorizada por Raios X/normas
18.
World Neurosurg ; 132: e514-e519, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31449998

RESUMO

BACKGROUND: Surgical site infection (SSI) remains a complication of spine deformity surgery. Although fusion/instrumentation failure in the setting of SSI has been reported, few studies have investigated the relationship between these entities. We examine the relationship between early SSI and fusion/instrumentation failure after instrumented fusion in patients with thoracolumbar scoliosis. METHODS: A retrospective review of a prospectively maintained case series for patients undergoing spine surgery between January 1, 2006, and October 3, 2017. Inclusion criteria included age ≥18 years and surgery performed for correction of thoracolumbar scoliosis. Data collected included various demographic, clinical, and operative variables. RESULTS: 532 patients met inclusion criteria, with 20 (4%) experiencing SSI. Diabetes mellitus was the only demographic risk factor for increased SSI (P = 0.026). Number of fused levels, blood volume loss, and operative time were similar between groups. Fusion/instrumentation failure occurred in 68 (13%) patients, 10 of whom (15%) had SSI, whereas of the 464 patients with no fusion/instrumentation failure, only 10 (2%) had SSI (P < 0.001). Of the 20 patients with SSI, 10 (50%) had fusion/instrumentation failure, whereas in the 512 patients with no infection, only 58 (11%) had fusion/instrumentation failure (P < 0.001). Patients with infection also experienced significantly shorter time to fusion/instrumentation failure (P = 0.025), higher need for revision surgery (P < 0.001), and shorter time to revision surgery (P = 0.012). CONCLUSIONS: Early SSI significantly increases the risk of fusion/instrumentation failure in patients with thoracolumbar scoliotic deformity, and it significantly shortens the time to failure. Patients with early SSI have a significantly higher likelihood of requiring revision surgery and after a significantly shorter time interval.


Assuntos
Falha de Equipamento , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Infecção da Ferida Cirúrgica/complicações , Adulto , Idoso , Pinos Ortopédicos , Parafusos Ósseos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Risco
19.
Vet Surg ; 48(7): 1287-1298, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31441092

RESUMO

OBJECTIVE: To report the long-term outcome of nine dogs treated for caudal cervical spondylomyelopathy (CCSM) with surgical spinal fusion. STUDY DESIGN: Short case series. ANIMALS: Nine large-breed dogs. METHODS: Medical records of dogs treated for disc-associated CCSM (2013-2016) were reviewed. The surgery objective was spinal distraction by implantation of a SynCage and fixation with two Unilock plates. Follow-up included the Helsinki pain score questionnaire, neurological grading, radiography, computed tomography (CT), and micro-CT (µCT) with subsequent histopathology (two dogs). RESULTS: Clinical follow-up was obtained between 9 and 51 months (27.4 ± 13.4 months). The Helsinki pain score and neurological Griffith score improved (P < .01) in all dogs and in eight of nine dogs, respectively. According to CT, the volume of bone (mean ± SD) through the cage was 79.5% ± 14.3%, including compact bone (53.0% ± 23.4%). Subsidence was seen in one of nine dogs. Implant failure was evident in four dogs, and plates were removed in two dogs. In seven of nine dogs, infraclinical pathology was observed in adjacent segment, associated with implants engaging adjacent intervertebral discs. Radiographic evidence of bony fusion between vertebral bodies was noted in all dogs. Spinal fusion was confirmed by µCT and histopathology in two cervical spine segments that became available at 22 and 40 months postoperatively. CONCLUSION: Instrumented spinal fusion in dogs with disc-associated CCSM resulted in owner satisfaction and radiographic evidence of interbody spinal fusion in all dogs. CLINICAL SIGNIFICANCE: The fusion distraction technique reported here can be used to achieve spinal fusion with a good long-term outcome.


Assuntos
Vértebras Cervicais/cirurgia , Doenças do Cão/cirurgia , Doenças da Medula Espinal/veterinária , Doenças da Coluna Vertebral/veterinária , Fusão Vertebral/veterinária , Animais , Doenças do Cão/patologia , Cães , Falha de Equipamento , Feminino , Humanos , Disco Intervertebral/cirurgia , Masculino , Próteses e Implantes , Radiografia , Doenças da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
J Endod ; 45(10): 1237-1241, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420109

RESUMO

INTRODUCTION: The goal of this study was to compare the cyclic fatigue resistance of 5 heat-treated nickel-titanium files in reciprocating movement with the same tip size and different cross sections. METHODS: Five groups (WaveOne [Dentsply, Ballaigues, Switzerland], WaveOne GOLD [Dentsply], RECIPROC [VDW, Munich, Germany], RECIPROC BLUE [VDW GmbH, Munich, Germany], and TF [Sybron Endo, Glendora, CA] Adaptive) of 24 files each of the rotary files were examined. Cyclic fatigue resistance was compared between groups by determining the time needed to fracture and the number of cycles to failure in a cyclic fatigue testing device with 2 different curvatures, the first with a 5-mm radius of curvature and a 60° angle and the second with a double curvature, coronal curvature of 60° angle and a radius of 5 mm, and an apical curvature of 70° angle and a 2-mm radius. Scanning electron microscopic evaluation was performed at the fracture sites to investigate the types of fracture. RESULTS: RECIPROC BLUE group had a higher mean time to fracture followed by RECIPROC and WaveOne GOLD for both single and double curvature. WaveOne had a higher mean time to fracture in a single curvature canal than TF Adaptive, whereas the opposite was true for a double curvature canal. Both RECIPROC groups were significantly greater in cyclic fatigue resistance in comparison with all other groups (P < .05). WaveOne GOLD was significantly greater than the WaveOne and TF Adaptive groups (P < .05). CONCLUSIONS: RECIPROC BLUE files exhibited significantly greater cyclic fatigue resistance compared with other files tested in an S-shaped artificial canal.


Assuntos
Instrumentos Odontológicos , Níquel , Preparo de Canal Radicular , Titânio , Desenho de Equipamento , Falha de Equipamento , Alemanha , Temperatura Alta , Teste de Materiais , Estresse Mecânico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA