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1.
Instr Course Lect ; 69: 53-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017719

RESUMO

Proximal femoral replacement is the salvage procedure for the most severe hip arthroplasty problems. We presented a straightforward approach to this complex procedure using the direct anterior approach to the hip. This allows for accurate fluoroscopic confirmation of acetabular implant placement and direct comparison of leg lengths. It also allows the patient to be supine during the surgery which facilitates the anesthesia care of this challenging patient population.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Acetábulo , Fluoroscopia , Humanos
2.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 69-75, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939238

RESUMO

Objective: To compare the effectiveness and screw planting accuracy of percutaneous reduction and internal fixation with robot and traditional fluoroscopy-assisted in the treatment of single-level thoracolumbar fractures without neurological symptoms. Methods: The clinical data of 58 patients with single-level thoracolumbar fractures without neurological symptoms between December 2016 and January 2018 were retrospectively analysed. According to different surgical methods, the patients were divided into group A (28 cases underwent robot-assisted percutaneous reduction and internal fixation) and group B (30 cases underwent fluoroscopy-assisted percutaneous reduction and internal fixation). There was no neurological symptoms, other fractures or organ injuries in the two groups. There was no significant difference in general data of age, gender, fracture location, AO classification, time from injury to surgery, and preoperative vertebral anterior height ratio, sagittal Cobb angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI) score between the two groups ( P>0.05). The screw placement time, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization time, operation cost, postoperative complications, VAS score, ODI score, anterior vertebral height ratio, and sagittal Cobb angle before operation, at 3 days, 6 months after operation, and at last follow-up were recorded and compared between the two groups. The accuracy of the pedicle screw placement was evaluated by Neo's criteria. Results: The screw placement time, operation time, and intraoperative fluoroscopy frequency of group A were significantly less than those of group B, and the operation cost was significantly higher than that of group B ( P<0.05). But there was no significant difference in intraoperative blood loss and hospitalization time between the two groups ( P>0.05). Both groups were followed up 12-24 months, with an average of 15.2 months. The accuracy rate of screw placement in groups A and B was 93.75% (150/160) and 84.71% (144/170), respectively, and the difference was significant ( χ 2=5.820, P=0.008). Except for 1 case of postoperative superficial infection in group A and wound healing after dressing change, there was no complication such as neurovascular injury, screw loosening and fracture in both groups, and there was no significant difference in the incidence of complications between the two groups ( χ 2=0.625, P=0.547). The anterior vertebral height ratio, sagittal Cobb angle, VAS score, and ODI score of the two groups were significantly improved ( P<0.05); there was no significant difference between the two groups at all time points after operation ( P>0.05). Conclusion: The spinal robot and traditional fluoroscopy-assisted percutaneous reduction and internal fixation can both achieve satisfactory effectiveness in the treatment of single-level thoracolumbar fractures without neurological symptoms. However, the former has higher accuracy, fewer fluoroscopy times, shorter time of screw placement, and lower technical requirements for the operator. It has wide application potential.


Assuntos
Fixação Interna de Fraturas , Parafusos Pediculares , Robótica , Fraturas da Coluna Vertebral , Fluoroscopia , Humanos , Vértebras Lombares , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
4.
Artigo em Japonês | MEDLINE | ID: mdl-31956188

RESUMO

PURPOSE: It is very important to manage the radiation dose of cardiovascular interventional (CVI) procedures. Overseas, the diagnostic reference levels for cardiac interventional procedures were established with the air kerma at the patient entrance reference point (Ka,r) and the air kerma-area product (PKA). Although the Japan DRLs 2015 was established by the Japan Network for Research and Information on Medical Exposure (J-RIME), the Japan DRL for CVIs were established by fluoroscopic dose rates of 20 mGy/min at the patient entrance reference point with 20 cm thickness polymethyl methacrylate (PMMA) phantom. In the present our study, we performed a questionnaire survey of indicated values of angiographic parameters in CVI procedures. METHODS: A nationwide questionnaire was sent by post to 765 facilities. Question focused on angiographic technology, exposure parameters and radiation doses as the displayed dosimetric parameters on the angiographic machine. RESULTS: The recovery rate was 22.8% at 175 out of 765 facilities. In total 1728 cases of the coronary angiography (CAG), 1703 cases of the percutaneous coronary intervention (PCI), 962 cases of the radiofrequency catheter ablation (RFCA) and 377 cases of pediatric CVI. The 75th percentile value of Ka,r, PKA, fluoroscopy time (FT) and number of cine images (CI) for CAG, PCI, RFCA and pediatric CVI were 702, 2042, 644, and 159 mGy, respectively, 59.3, 152, 81.3, and 14.9 Gy・cm2, respectively, 10.2, 35.6, 61.1, and 35.6 min, respectively and 1503, 2672, 722, and 2378 images, respectively. Our investigation showed that the angiographic parameters were different in several CVI procedures. CONCLUSIONS: The displayed dosimetric parameters on the angiographic machine in CVI procedures showed different values. We should classify the dosimetric parameters for each procedure.


Assuntos
Intervenção Coronária Percutânea , Doses de Radiação , Exposição à Radiação , Criança , Fluoroscopia , Humanos , Japão , Radiografia Intervencionista , Inquéritos e Questionários
5.
Medicine (Baltimore) ; 99(1): e18627, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895821

RESUMO

To study the safety and efficacy of fluoroscopic removal of self-expandable metallic stent for airway stenosis.We conducted a retrospective analysis of 67 consecutive patients, 39 male and 28 female, who underwent fluoroscopic stent removal from March 2011 to April 2017. The patients ranged in age from 12 to 85 years. Seventy-six airway stents were implanted, 70 covered stents and 6 bare stents, including 9 stents for second stent implantation after removal. All patients underwent chest computed tomography scans with/without bronchoscopy before stent removal. The indication of stent removal and postinterventional complications were analyzed retrospectively.Seventy-four of 76 airway stents were successfully removed, only 2 stent showed retained struts after removal, for a technical success rate of 97.4%. Two patients died of complications (1 hemorrhage and 1 respiratory failure), resulting in a clinical success rate of 94.7%. Five stents showed strut fracture and the remaining 71 stents were removed in 1 piece. Indications for stent removal include planned removal (n = 40), excessive granulation tissue (n = 15), intolerance of stenting (n = 6), inadequate expansion and deformation (n = 5), stent migration (n = 5), replacement of bare stent (n = 4), and strut fracture (n = 1). There were 17 complications of stent removal: death from massive bleeding (n = 1), restenosis requires stenting (n = 9), strut fracture or residue (n = 5), dyspnea requires mechanical ventilation (n = 2). The survival rates were 83.8%, 82.1%, and 82.1% for 0.5, 3, and 6 years.Fluoroscopic removal of airway stent is technically feasible and effective. Stents are recommended for removal within 3 months for treating airway stenosis.


Assuntos
Broncopatias/terapia , Remoção de Dispositivo/métodos , Radiografia Intervencionista/mortalidade , Stents , Estenose Traqueal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Remoção de Dispositivo/mortalidade , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Int Braz J Urol ; 45(6): 1153-1160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808403

RESUMO

PURPOSE: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. MATERIALS AND METHODS: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fl uoroscopy time. RESULTS: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fl uoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. CONCLUSIONS: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be benefi cial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.


Assuntos
Fluoroscopia/métodos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Índice de Massa Corporal , Intervalo Livre de Doença , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Exposição à Radiação , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(50): e18233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852086

RESUMO

Percutaneous epidural neuroplasty (PEN) is an effective interventional treatment for radicular pain. However, in some cases, contrast runoff to the spinal nerve root does not occur. We investigated whether contrast runoff to the spinal nerve root affects the success rate of PEN and whether additional transforaminal epidural blocks for intentional contrast runoff affect the success rate of PEN in cases in which contrast runoff is absent.This study was registered at ClinicalTrials.gov (Identifier: NCT03867630) in March 2019. We reviewed the medical records of 112 patients who underwent PEN with a wire-type catheter from May 2016 to August 2018. Patients were divided in 3 groups (Runoff group, Non-runoff group, Transforaminal group).Patients with low back pain and leg radicular pain who did not respond to lumbar epidural steroid injectionsPEN was performed in 112 patients with a wire-type catheter in target segment. We compared the success rate of PEN betweenThe success rate was significantly different between the Runoff group and the Non-runoff group (P < .0007) and between the Non-runoff group and the Transforaminal group (P = .0047), but not between the Runoff group and the Transforaminal group (P = .57).Contrast runoff influenced the success rate of PEN. In cases without contrast runoff, additional transforaminal epidural blocks for intentional contrast runoff increased the success rate of PEN with a wire-type catheter.


Assuntos
Anestesia Epidural/instrumentação , Cateteres , Dor Lombar/terapia , Procedimentos Neurocirúrgicos/métodos , Manejo da Dor/métodos , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Seguimentos , Humanos , Injeções Epidurais/métodos , Dor Lombar/diagnóstico , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
10.
Acta otorrinolaringol. esp ; 70(6): 327-335, nov.-dic. 2019. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-184877

RESUMO

Introducción y objetivos: El objetivo de este trabajo es mostrar nuestra experiencia y consideraciones al cuantificar el desplazamiento hioideo, así como observar su correlación con las escalas cualitativas de valoración de la disfagia. Métodos: Se mide el desplazamiento hioideo mediante el método descrito por el grupo de Molfenter y Steele 2014 en una serie de 14 pacientes con disfagia orofaríngea antes y después del tratamiento, y se valora su correlación con la Escala de penetración y aspiración de Rosenbek de 1996, y con la Functional Oral Intake Scale de Crary de 2005. Resultados: Todos los pacientes variaron el desplazamiento total del hioides tras el tratamiento aplicado. Esta variación se correlacionó con las variaciones de la Escala de penetración y aspiración en todos los pacientes que presentaban aspiración o penetración. Sin embargo, las modificaciones del desplazamiento total hioideo no se correlacionaron con las variaciones de la Functional Oral Intake Scale. Conclusiones: La mejora en el desplazamiento total del hioides es un indicador clínico de la mejora en la aspiración del paciente con disfagia orofaríngea, y puede ser utilizado en su diagnóstico y seguimiento. Sin embargo, no lo es como indicador de la tolerancia de la dieta oral


Introduction and objectives: The objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia. Methods: Hyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment. Results: All patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale. Conclusions: The improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Transtornos de Deglutição/diagnóstico por imagem , Avaliação da Deficiência , Orofaringe/fisiopatologia , Transtornos de Deglutição/etiologia , Orofaringe/diagnóstico por imagem , Fluoroscopia , Gravação em Vídeo
11.
Actas urol. esp ; 43(10): 521-525, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185257

RESUMO

Objetivos: El objetivo de este estudio fue evaluar el rol de la aplicación de fluoroscopia en pacientes intervenidos mediante cirugía retrógrada intrarrenal y su efecto sobre los resultados quirúrgicos. Material y métodos: Los pacientes que ingresaron en nuestro centro con diagnóstico de cálculos renales se dividieron en 2 grupos. En el grupo 1 se utilizó fluoroscopia de rutina en todos los casos (n: 58). En el grupo 2 se ejecutó el mismo procedimiento sin fluoroscopia (n: 67). Posteriormente se compararon los resultados de los 2 grupos. Resultados: No hubo diferencias estadísticamente significativas entre los 2 grupos en términos de tiempo quirúrgico, tasa libre de cálculos, complicaciones, necesidad de analgésicos, requerimiento de nuevo tratamiento y escala visual analógica. Conclusión: El uso de fluoroscopia no altera la frecuencia de complicaciones ni la tasa libre de cálculos. Creemos que el uso de fluoroscopia no es indispensable en los casos en los que se consigue acceso a la pelvis renal (especialmente en procedimientos de ureteroscopia semirrígida) y que su uso debe ser limitado para evitar un aumento innecesario de exposición a la radiación


Objectives: The aim of this study was to evaluate the role of the use of fluoroscopy in patients undergoing retrograde intrarenal surgery and the effect on surgical outcomes. Material and methods: The patients who were admitted to our center with the diagnosis of kidney stones were divided into 2 groups. In group 1, routine fluoroscopy was used in all cases (n: 58). In group 2, the same procedure was performed without fluoroscopy (n: 67) and the results of the 2 groups were compared. Results: There were no statistically significant differences between the 2 groups in terms of operation time, stone-free rate, complication rate, need for analgesic and re-treatment requirement and Visual Analogic Scale score. Conclusion: The use of fluoroscopy does not alter the complication frequency and stone-free rate. We think that the use of fluoroscopy is not mandatory in cases in which renal pelvis access is achieved especially with semirigid ureteroscopy and that unnecessary fluoroscopy increases radiation exposure


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Fluoroscopia , Cálculos Renais/cirurgia , Avaliação de Resultado de Intervenções Terapêuticas , Nefrostomia Percutânea/métodos , Escala Visual Analógica , Ureteroscopia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Urológicos/métodos
12.
Surg Technol Int ; 35: 410-416, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687775

RESUMO

PURPOSE: Surgical treatment of hip osteonecrosis with stem cell therapy is a new procedure in which cells are injected with a trocar under fluoroscopic guidance. Proper surgical technique to obtain appropriate placement of the trocar in the center of the osteonecrosis is sometimes difficult and can require additional radiation exposure until the surgeon is satisfied with the trocar position. This study describes an improvement of this procedure using computer-assisted navigation. METHODS: A prospective, randomized study was conducted on cadavers using surgical trainees with no experience and one expert surgeon in surgical core decompression. During a training session, 3 novice surgeons underwent a test by performing the surgical task (core decompression) on a cadaver hip using fluoroscopic guidance. These trainee surgeons then placed the Kirschner wire under computer-assisted navigation. Osteonecrosis was defined as a target volume situated on the superior and anterior part of the femoral head. Performance during the tests was evaluated by radiographic analysis of trocar placement and by the measurement of radiation exposure. RESULTS: During the cadaver session, computer-assisted navigation achieved a better match to the ideal position of the trocar, with better trocar placement in terms of the tip-to-subchondral distance and the ideal center position. Computer-assisted navigation was associated with fewer attempts to position the trocar, a shorter duration of fluoroscopy, and decreased radiation exposure compared to surgery performed under conventional fluoroscopy. CONCLUSIONS: The findings suggest that computer-assisted navigation may be safely used to train surgical novices in core decompression. This technique avoids the use of both live patients and harmful radiation. For expert surgeons, computer-assisted navigation might improve precision with less radiation, which might be desirable in cell therapy.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos , Osteonecrose , Cirurgia Assistida por Computador , Fluoroscopia , Humanos , Osteonecrose/cirurgia , Estudos Prospectivos
13.
Tex Heart Inst J ; 46(3): 167-171, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708696

RESUMO

Exposure to ionizing radiation during cardiac catheterization can have harmful consequences for patients and for the medical staff involved in the procedures. Minimizing radiation doses during the procedures is essential. We investigated whether fine-tuning the radiation protocol reduces radiation doses in the cardiac catheterization laboratory. In January 2016, we implemented a new protocol with reduced radiation doses in the Hospital de Jerez catheterization laboratory. We analyzed 170 consecutive coronary interventional procedures (85 of which were performed after the new protocol was implemented) and the personal dosimeters of the interventional cardiologists who performed the procedures. Overall, the low-radiation protocol reduced air kerma (dose of radiation) by 44.9% (95% CI, 18.4%-70.8%; P=0.001). The dose-area product decreased by 61% (95% CI, 30.2%-90.1%; P <0.001) during percutaneous coronary interventions. We also found that the annual deep (79%, P=0.026) and shallow (62.2%, P=0.035) radiation doses to which primary operators were exposed decreased significantly under the low-radiation protocol. These dose reductions were achieved without increasing the volume of contrast media, fluoroscopy time, or rates of procedural complications, and without reducing the productivity of the laboratory. Optimizing the radiation safety protocol effectively reduced radiation exposure in patients and operators during cardiac catheterization procedures.


Assuntos
Cateterismo Cardíaco/métodos , Angiografia Coronária/efeitos adversos , Fluoroscopia/efeitos adversos , Exposição Ocupacional/efeitos adversos , Exposição à Radiação/efeitos adversos , Lesões por Radiação/prevenção & controle , Medição de Risco/métodos , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
14.
Tex Heart Inst J ; 46(3): 195-198, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708702

RESUMO

The MitraClip system can be used to control regurgitant blood flow in patients with mitral regurgitation who cannot tolerate open surgery to replace the mitral valve. Technical limitations make the right femoral vein the standard access point for placing the MitraClip. However, this route is not always suitable. We present the case of an 85-year-old woman in whom we successfully used a left-sided approach for inserting a MitraClip because her right femoral vein was occluded. This apparently novel left femoral approach merits consideration as an option for device insertion when right femoral vein access is precluded.


Assuntos
Cateterismo Cardíaco/métodos , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Veia Femoral , Fluoroscopia , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Resultado do Tratamento
15.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
16.
Zhonghua Gan Zang Bing Za Zhi ; 27(10): 777-781, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31734992

RESUMO

Objective: To investigate the safety, feasibility, and preliminary clinical experience of ultrasonic guided percutaneous portal vein punctures combined bi-directional angiography in the treatment by transjugular intrahepatic portosystemic shunt(TIPS). Methods: From January 2016 to June 2018, 15 patients with TIPS from our hospital who were treated by ultrasonic guided percutaneous portal vein punctures combined with bi-directional angiography were enrolled,and were recruited as experimental group. During the same period, 30 patients who were treated by TIPS combined with traditional methods were enrolled, and were recruited as control group. There was no statistical difference in baseline characteristics between the two groups (P > 0.05). The portal pressure difference in preoperative and postoperative, the fluoroscopy time, the number of puncture needles and complications were recorded. After treatment, the patients were followed up through outpatient service or telephone method. Results: The technical success rate was 100% in experimental group, and 96.7% in control group. In the experimental group, number of percutaneous transhepatic portal vein puncture by needle was 1-3 (average, 2.13 ± 0.74), and the number of portal vein puncture needles in the control group were 1-11 (average, 4.16 ± 2.13). The number of puncture needles in the experimental group were significantly decreased than in the control group (P < 0.001). In the experimental group, the fluoroscopy time was 18 ~ 46 (average 29.64 ± 8.79) minutes. In the control group, the fluoroscopy time was 12 ~ 150 (average 44.57 ± 26.84) minutes.The fluoroscopy time was significantly reduced in the experimental group compared with the control group(P = 0.023). Conclusion: Ultrasound-guided portal vein combined with bidirectional angiog-raphy is safe, feasible, and reliable in the treatment by TIPS. Compare with traditional TIPS, it can reduce the fluoroscopy time, the number of puncture needles and the liver injury.


Assuntos
Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática , Angiografia , Fluoroscopia , Humanos , Agulhas , Pressão na Veia Porta , Punções , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia
17.
Medicine (Baltimore) ; 98(46): e17959, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725656

RESUMO

Observational phantom study.This study aimed to evaluate the radiation exposure dose of practitioner's hands when performing C-arm guided procedures and to determine the usefulness of our newly designed radiation shielding device.C-arm guided procedures including lumbar transforaminal epidural steroid injections (TFESIs) are commonly used for pain control induced by lumbar radiculopathy. The practitioner's hands are vulnerable to radiation exposure because of the long exposure time and short distance from the radiation resource. No studies to date have reported the cumulative exposure of the physician's hands according to location and exposure time.Using a chest phantom irradiated with X-rays under lumbar TFESI conditions, cumulative scatter radiation dose was measured at 36 points using a dosimeter. The measurements were checked at 1, 3, 5, 10 minutes of radiation exposure. The experiment was repeated using our newly designed shielding device.Significant radiation accumulation was observed in the field where the practitioner's hands might be placed during C-arm guided procedures. The further the distance from the radiation resource and the shorter the exposure time, the smaller was the cumulative radiation expose dose. The new shielding device showed an excellent shielding rate (66.0%-99.9%) when the dosimeter was within the shielding range. However, at some points, increased accumulated radiation exposure dose was observed, although the dosimeter was within the range of the shielding device.To reduce radiation exposure of the practitioner's hands when performing C-arm-guided procedures, the radiation exposure time should be decreased and a greater distance from the radiation resource should be maintained. When using our shielding device, placing the hand close to the device surface and minimizing the time using fluoroscopy minimized the radiation exposure of the hand.


Assuntos
Fluoroscopia/métodos , Mãos/efeitos da radiação , Exposição Ocupacional/análise , Exposição à Radiação/análise , Tomografia Computadorizada por Raios X/métodos , Humanos , Imagens de Fantasmas , Doses de Radiação , Proteção Radiológica , Processo Xifoide/diagnóstico por imagem
18.
EuroIntervention ; 15(10): 857-866, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31746752

RESUMO

Transcatheter aortic valve implantation (TAVI) has, in less than 20 years, become the dominant interventional treatment for aortic stenosis in developed countries. Its development has been characterised by the growth of procedural expertise and device improvement. Every aspect of this therapy has been investigated, increasing clinical evidence and leading to continued optimisation. The purpose of this review article is to provide an overview of the rapidly changing field of TAVI therapy, briefly describing key past achievements and discussing residual challenges.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Fluoroscopia , Humanos , Resultado do Tratamento
19.
EuroIntervention ; 15(10)2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31746757

RESUMO

AIMS: This study sought to analyse multislice computed tomography (MSCT) data of patients with tricuspid regurgitation and to report the variability of fluoroscopic viewing angles for several right-sided heart structures, as well as chamber views of the right heart in order to determine the optimal fluoroscopic viewing angles of six right-sided heart structures and right-heart chamber views. METHODS AND RESULTS: The MSCT data of 44 patients with mild to severe tricuspid regurgitation (TR) were retrospectively analysed. For each patient, we determined the optimal fluoroscopic viewing angles of the annulus/orifice en face view of the tricuspid valve, atrial septum, superior vena cava (SVC), inferior vena cava (IVC), coronary sinus (CS) and pulmonary valve. In this TR patient cohort, the average fluoroscopic viewing angle for the en face view of the tricuspid valve annulus was LAO 54-CAUD 15; RAO 10-CAUD 66 for the SVC orifice; LAO 27-CRA 59 for the IVC orifice; RAO 28-CRA 19 for the CS orifice; RAO 33-CAUD 33 for the atrial septum and LAO 13-CAUD 52 for the pulmonary valve annulus. The average viewing angle for right-heart chamber views was LAO 55-CAUD 15 for the one-chamber view; RAO 59-CAUD 54 for the two-chamber view; RAO 27-CRA 19 for the three-chamber view and LAO 5-CRA 60 for the four-chamber view. CONCLUSIONS: MSCT can provide patient-specific fluoroscopic viewing angles of right-sided heart structures. This information may facilitate transcatheter right-heart interventions.


Assuntos
Tomografia Computadorizada Multidetectores , Insuficiência da Valva Tricúspide , Fluoroscopia , Humanos , Estudos Retrospectivos , Valva Tricúspide , Insuficiência da Valva Tricúspide/diagnóstico
20.
Tech Hand Up Extrem Surg ; 23(4): 176-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738739

RESUMO

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.


Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Adulto , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino
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