Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 631
Filtrar
1.
Medicine (Baltimore) ; 98(38): e17211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567974

RESUMO

This study aims to evaluate the feasibility and effectiveness of minimally invasive puncture treatment by positioning the simple bedside for spontaneous cerebellar hemorrhage.From January 2017 to March 2018, the investigators applied simple bedside positioning to perform the intracranial hematoma minimally invasive surgery for 21 patients with cerebellar hemorrhage.For these 21 patients, the bleeding amount and Glasgow Coma Scale (GCS) score before the operation were 18.5 ±â€Š5.0 cc and 9.5 ±â€Š3.3, respectively; 24 hours after the operation, the GCS score was 11.0 ±â€Š4.6. Five patients died within 7 days of the operation and the head computed tomography (CT) was re-examined. It was found that the average bleeding amount was 3.4 ±â€Š0.9 cc, the operation success rate was 76.2%, and the accurate puncture rate was 100%. Six months later, the Modified Rankin Scale (MRS) score was 2.5 ±â€Š2.0. The postoperative recovery was good. The situation shows that patients with favorable outcomes (MRS score 0-2) accounted for 38.1% (8/21), and the fatality rate was 33.3% (7/21).The efficacy of the intracranial hematoma minimally invasive surgery by positioning the simple bedside for spontaneous cerebellar hemorrhage with severe brainstem dysfunction is good.


Assuntos
Tronco Encefálico/fisiopatologia , Doenças Cerebelares/cirurgia , Hemorragia Cerebral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paracentese/métodos , Posicionamento do Paciente , Idoso , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Feminino , Humanos , Masculino , Neuroimagem , Posicionamento do Paciente/métodos , Tomografia Computadorizada por Raios X
2.
Eur Arch Otorhinolaryngol ; 276(9): 2595-2601, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300842

RESUMO

PURPOSE: The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. METHODS: A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. RESULTS: Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2-4) in the aspiration group versus 2.0 days (IQR 2-3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. CONCLUSION: Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.


Assuntos
Paracentese , Abscesso Peritonsilar/cirurgia , Complicações Pós-Operatórias , Tonsilectomia , Adulto , Anestesia Local/métodos , Drenagem/métodos , Feminino , França/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Paracentese/efeitos adversos , Paracentese/métodos , Abscesso Peritonsilar/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos
3.
Indian J Ophthalmol ; 67(7): 1204-1206, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238466

RESUMO

Aqueous misdirection (AM) is a dreaded complication, but fortunately quite rare. It usually occurs after intervention for angle closure glaucoma. When pharmacotherapy and/or laser interventions are unsuccessful, then the surgical management hitherto most commonly undertaken is pars plana posterior vitrectomy. We describe the management of recurrent AM via the anterior route, when it occurred following relapse as pars plana posterior vitrectomy failed to result in long-term normalization of anterior chamber and intraocular pressure. Anterior vitrector with anterior vitrectomy settings was used by a glaucoma specialist to carry out the procedure.


Assuntos
Segmento Anterior do Olho/cirurgia , Humor Aquoso , Glaucoma de Ângulo Fechado/cirurgia , Pressão Intraocular/fisiologia , Paracentese/métodos , Complicações Pós-Operatórias/cirurgia , Vitrectomia/efeitos adversos , Segmento Anterior do Olho/diagnóstico por imagem , Feminino , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Iridectomia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Reoperação , Acuidade Visual
4.
Clinics (Sao Paulo) ; 74: e435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994702

RESUMO

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.


Assuntos
Cistostomia/educação , Avaliação Educacional , Modelos Anatômicos , Desenvolvimento de Programas/métodos , Treinamento por Simulação/métodos , Análise Custo-Benefício , Cistostomia/instrumentação , Cistostomia/métodos , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Masculino , Paracentese/educação , Paracentese/instrumentação , Paracentese/métodos , Estudos Prospectivos , Distribuição Aleatória , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Gravação em Vídeo/métodos
5.
BMJ Case Rep ; 12(3)2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30852497

RESUMO

A 65-year-old patient presenting with left labial and perirectal pain was diagnosed with bilateral Tarlov cysts. Upon treatment of the left Tarlov cyst (the right was asymptomatic) using image-guided aspiration and subsequent injection of the cyst with fibrin sealant, the cyst reduced in size. To our knowledge, there are currently no other documented cases in which the Tarlov cyst reduced in size following this procedure. This case would seem to suggest that clinicians are poorly informed with regard to Tarlov cysts. These cysts are more common in Caucasian women, many of whom are told their cysts are not responsible for their pain or that they are not treatable. However, there is clear evidence that some Tarlov cysts are symptomatic and minimally invasive procedures have been developed to treat them. As they primarily occur in women, it is possible gender bias may also play a role in the delayed diagnosis of the patient's pain.


Assuntos
Adesivo Tecidual de Fibrina/administração & dosagem , Paracentese/métodos , Cistos de Tarlov/terapia , Adesivos Teciduais/administração & dosagem , Idoso , Feminino , Humanos , Resultado do Tratamento
6.
Expert Rev Gastroenterol Hepatol ; 13(4): 293-305, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791777

RESUMO

INTRODUCTION: Ascites commonly complicates cirrhosis, becoming refractory to treatment with diuretics and sodium restriction in approximately 10% of patients. Pathogenesis of refractory ascites (RA) is multifactorial, the common final pathway being renal hypoperfusion and avid sodium retention. Refractory ascites has a negative prognostic implication in the natural history of cirrhosis. Management of RA include sodium restriction and regular large volume paracentesis (LVP) with albumin infusions, preventing paracentesis-induced circulatory dysfunction. In appropriate setting, transjugular intrahepatic porto-systemic shunt (TIPS) can be considered. Ascites clearance with TIPS can lead to nutritional improvement, avoiding sarcopenia. Liver transplantation (LT) remains the definitive treatment for eligible candidates. Areas covered: Our review summarizes current updates on pathogenesis and clinical management of RA including potential future therapeutic options such as the automated slow-flow ascites pump, chronic outpatient albumin infusion and cell-free and concentrated ascites reinfusion therapy. Expert commentary: Standard of care in patients with RA include LVP with albumin replacement and prompt referral for LT where indicated. Other novel therapeutic options on the horizon include automated low-flow ascites pump and cell-free, concentrated albumin reinfusion therapy.


Assuntos
Albuminas/administração & dosagem , Ascite/terapia , Dieta Hipossódica , Cirrose Hepática/terapia , Transplante de Fígado , Paracentese/métodos , Derivação Peritoneovenosa , Derivação Portossistêmica Transjugular Intra-Hepática , Albuminas/efeitos adversos , Ascite/diagnóstico , Ascite/etiologia , Ascite/fisiopatologia , Dieta Hipossódica/efeitos adversos , Hemodinâmica , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Transplante de Fígado/efeitos adversos , Paracentese/efeitos adversos , Derivação Peritoneovenosa/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Fatores de Risco , Circulação Esplâncnica , Resultado do Tratamento
7.
J Vasc Interv Radiol ; 30(2): 259-264, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30717961

RESUMO

PURPOSE: To evaluate the rate and risk factors for hemorrhage in patients undergoing real-time, ultrasound-guided paracentesis by radiologists without correction of coagulopathy. MATERIALS AND METHODS: This was a retrospective study of all patients who underwent real-time, ultrasound-guided paracentesis at a single institution over a 2-year period. In total, 3116 paracentesis procedures were performed: 757 (24%) inpatients and 2,359 (76%) outpatients. Ninety-five percent of patients had a diagnosis of cirrhosis. Mean patient age was 56.6 years. Mean international normalized ratio (INR) was 1.6; INR was > 2 in 437 (14%) of cases. Mean platelet count was 122 x 103/µL; platelet count was < 50 x 103/µL in 368 (12%) of patients. Seven hundred seven (23%) patients were dialysis dependent. Patients were followed for 2 weeks after paracentesis to assess for hemorrhage requiring transfusion or rescue angiogram/embolization. Univariate analysis was performed to determine risk factors for hemorrhage. Blood product and cost saving analysis were performed. RESULTS: Significant post-paracentesis hemorrhage occurred in 6 (0.19%) patients, and only 1 patient required an angiogram with embolization. No predictors of post-procedure bleeding were found, including INR and platelet count. Transfusion of 1125 units of fresh frozen plasma and 366 units of platelets were avoided, for a transfusion-associated cost savings of $816,000. CONCLUSIONS: Without correction of coagulation abnormalities with prophylactic blood product transfusion, post-procedural hemorrhage is very rare when paracentesis is performed with real-time ultrasound guidance by radiologists.


Assuntos
Transtornos da Coagulação Sanguínea/sangue , Coagulação Sanguínea , Hemorragia/etiologia , Paracentese/efeitos adversos , Paracentese/métodos , Radiologistas , Ultrassonografia de Intervenção , Adulto , Idoso , Assistência Ambulatorial , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/economia , Transfusão de Sangue , Redução de Custos , Análise Custo-Benefício , Hemorragia/sangue , Hemorragia/economia , Hemorragia/terapia , Custos Hospitalares , Humanos , Coeficiente Internacional Normatizado , Pessoa de Meia-Idade , Paracentese/economia , Contagem de Plaquetas , Radiologistas/economia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção/economia
8.
J Pediatr Orthop ; 39(3): 130-135, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30730417

RESUMO

BACKGROUND: Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration. METHODS: Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children's tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration. RESULTS: A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L. CONCLUSIONS: Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L. LEVEL OF EVIDENCE: Level III.


Assuntos
Artrite Infecciosa/cirurgia , Articulação do Joelho , Paracentese/métodos , Tempo para o Tratamento , Fatores Etários , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Proteína C-Reativa/análise , Pré-Escolar , Descompressão Cirúrgica/métodos , Intervenção Médica Precoce/métodos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Hepatol Int ; 13(1): 1-21, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30656520

RESUMO

The Chinese Society of Hepatology developed the current guidelines for the Management of Ascites and Its Related Complications in Cirrhosis based on the published evidences and the panelists' consensus. The guidelines provided recommendations for the diagnosis and management of cirrhotic ascites emphasizing a step-wise approach with the first-, second-, and third-line therapy. For refractory ascites, vasoconstrictors and albumin are recommended for splanchnic vasodilation and selective vasopressin (V2) receptor antagonists for moderate-to-severe hyponatremia. For spontaneous bacterial peritonitis, empirical anti-infection treatment was recommended based on the local microbiological examination of community- or hospital-acquired infections. For hepatorenal syndrome, the administration of vasopressor terlipressin and albumin is recommended.


Assuntos
Ascite/terapia , Anti-Infecciosos/uso terapêutico , Ascite/complicações , Ascite/diagnóstico , Infecções Bacterianas/etiologia , Diagnóstico Diferencial , Dieta Hipossódica , Previsões , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/terapia , Apoio Nutricional , Paracentese/métodos , Peritonite/etiologia , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Vasoconstritores/uso terapêutico
10.
Clin Respir J ; 13(4): 195-201, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615303

RESUMO

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.


Assuntos
Pneumotórax/fisiopatologia , Pneumotórax/terapia , Fumar/efeitos adversos , Vesícula/complicações , Bronquiolite/complicações , Tubos Torácicos/efeitos adversos , Gerenciamento Clínico , Humanos , Masculino , Agulhas/efeitos adversos , Paracentese/métodos , Pleura/anatomia & histologia , Pleurodese/métodos , Pneumotórax/epidemiologia , Guias de Prática Clínica como Assunto , Enfisema Pulmonar/complicações , Recidiva , Fatores de Risco , Talco/administração & dosagem , Talco/uso terapêutico , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos
11.
J Fr Ophtalmol ; 42(1): 49-56, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30611541

RESUMO

PURPOSE: To compare performance on the EyeSi surgical simulator in 3 training modules by users with different levels of experience in ophthalmology. METHODS: We included 18 surgeons (6 residents with no cataract experience, 6 residents with little experience (1 to 10 cases) and 6 experienced cataract surgeons (over 500 cases). Three modules were selected (capsulorhexis, phacoemulsification-cracking and irrigation and aspiration). All subjects completed 12 levels of increasing difficulty twice, and the results of the second trial were analyzed according to the surgeon's experience. RESULTS: For the capsulorhexis module, experienced surgeons achieved higher total scores than the other 2 groups in exercise 1 (P=0.0102). For the phaco-cracking module, experienced surgeons achieved higher total scores in exercise 8 (P=0.0495) and a tendency toward significance in exercises 3 (P=0.0934) and 5 (P=0.0938). Participants with greater experience had lower total task time in exercises 1 (P=0.0444), 4 (P=0.06) and 5 (P=0.0189). CONCLUSION: Experienced surgeons outperformed residents with regard to overall score in 4 exercises of the capsulorhexis and phaco-cracking modules. Our results confirm previously demonstrated construct validity for these modules on the EyeSi simulator. These findings will help in the development of relevant training programs that could potentially be applied to the standard ophthalmological curriculum.


Assuntos
Capsulorrexe , Paracentese , Facoemulsificação , Treinamento por Simulação/métodos , Cirurgia Assistida por Computador , Irrigação Terapêutica , Capsulorrexe/instrumentação , Capsulorrexe/métodos , Competência Clínica , Simulação por Computador , Avaliação Educacional , Humanos , Internato e Residência , Curva de Aprendizado , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/métodos , Oftalmologia/educação , Oftalmologia/instrumentação , Oftalmologia/métodos , Paracentese/instrumentação , Paracentese/métodos , Facoemulsificação/instrumentação , Facoemulsificação/métodos , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos , Interface Usuário-Computador
12.
J Neurointerv Surg ; 11(2): 190-195, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30061368

RESUMO

BACKGROUND: Navigable, large diameter aspiration catheters demonstrate markedly improved recanalization rates over smaller lumen devices in suction embolectomy. We evaluated the performance of a novel aspiration catheter system designed to maximize lumen size, and compare it to other commercially available aspiration catheters. METHODS: The 6F R4Q aspiration catheter system comprises a proximal pusher wire of 117 cm length connected to a distal catheter of 25 cm length. When placed through standard guide catheters and into the cerebral circulation, the proximal catheter makes a tight seal between its outer surface and the guide catheter's inner surface. During aspiration, in vitro flow rates and tip suction force under gentle retraction were compared among 10 commercially available aspiration catheters and the R4Q system. RESULTS: The R4Q 6F, 5F, 4F, and 3F catheters achieved flow rates at least 21.9%, 24.7%, 61.9%, and 244.7% greater than the other catheters tested respectively and the R4Q 6F produced a 140.2% higher tip force than a catheter of similar size. Fluid flow rate in the R4Q 6F increased on retraction into the guide catheter, delivering a 58.2% increase from fully extended to fully retracted. CONCLUSION: The R4Q design demonstrates a substantial increase in aspirated flow rate and suction force due to an increased effective diameter than standard tubular catheter designs tested. The prominent increase in the aspiration parameters measured in vitro supports the potential for improved clinical results during stroke thrombectomy procedures.


Assuntos
Cateteres/tendências , Desenho de Equipamento/tendências , Acidente Vascular Cerebral/cirurgia , Trombectomia/tendências , Desenho de Equipamento/métodos , Humanos , Paracentese/métodos , Paracentese/tendências , Sucção/métodos , Resultado do Tratamento
13.
World J Pediatr Congenit Heart Surg ; 10(3): 357-359, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30354929

RESUMO

Recurrent ascites is a common manifestation of failing Fontan circulation. We present the hemodynamic response to large-volume paracentesis in a patient with Fontan circulation and Fontan-associated liver disease, documenting an immediate and substantial decline in systemic venous pressure and increase in cardiac output. These preliminary observations may have implications for the management of ascites in adults with Fontan circulation.


Assuntos
Ascite/cirurgia , Técnica de Fontan/métodos , Cardiopatias Congênitas/cirurgia , Hemodinâmica/fisiologia , Paracentese/métodos , Adulto , Ascite/etiologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos
15.
J Neurointerv Surg ; 11(7): 631-636, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30472676

RESUMO

BACKGROUND: Mechanical thrombectomy with stent retrievers has proved to be safe and effective in endovascular treatment of acute ischemic stroke. Direct aspiration has shown revascularization rates comparable to those of stent retrievers in the recent ASTER and COMPASS trials. However, the efficacy of aspiration in routine clinical practice has not yet been shown. OBJECTIVE: To show that aspiration has clinical and technical outcomes equal to those of stent retriever thrombectomy in daily clinical practice. METHODS: We analysed data of patients with a large vessel occlusion of the anterior circulation registered in the Dutch MR CLEAN Registry between March 2014 and June 2016. Primary outcome was functional outcome measured with the modified Rankin Scale (mRS) score. Secondary outcomes were reperfusion grade, periprocedural complication rate, and procedure duration. Association of treatment technique with functional outcome was estimated with univariable and multivariable ordinal logistic regression analysis and expressed as a common OR (cOR) for a shift towards better outcome on the mRS. RESULTS: As first-line treatment, 207 of 1175 patients (17.6%) were treated with direct aspiration, and 968 (82.4%) by a stent retriever. We observed no differences in functional outcome (adjusted cOR=1.020 (95% CI 0.68 to 1.52)) and periprocedural complications. Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b) was similar. Duration of the procedure was shorter with aspiration (57 min (IQR 35-73) vs 70 min (IQR 47-95), p<0.0001). CONCLUSION: Direct aspiration shows clinical outcomes equal to those of stent retriever thrombectomy in our large multicenter real-life cohort. We found no difference in complication rates and shorter procedure times for aspiration.


Assuntos
Remoção de Dispositivo/métodos , Paracentese/métodos , Stents/efeitos adversos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Prospectivos , Sistema de Registros , Reperfusão/métodos , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento
17.
J Zoo Wildl Med ; 49(4): 1007-1011, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30592930

RESUMO

Computed tomography (CT)-guided percarapacial ovocentesis in an Eastern box turtle ( Terrapene carolina) was performed after medical management failed to resolve dystocia related to an irregular, oversized egg (38 × 30 × 35 mm). A 2.38-mm Steinmann pin was drilled through the carapace at the dorsal aspect of the seventh marginal scute, allowing introduction of an 18-ga needle through the carapace and oviduct into the egg using CT guidance. Contents of the egg (8 ml) were evacuated and CT reconstructions confirmed involution. The animal was administered oxytocin immediately after the procedure and passed the collapsed egg within 3 hr. The animal displayed no adverse effects from the procedure and the carapacial wound healed quickly without complication. CT-guided needle aspiration and biopsy techniques are common in human medicine, but less frequently utilized in veterinary medicine. This technique represents a novel, minimally invasive approach to ovocentesis that was used as an alternative to surgical intervention, in this case to resolve dystocia.


Assuntos
Distocia/veterinária , Paracentese/veterinária , Tomografia Computadorizada por Raios X/veterinária , Animais , Distocia/terapia , Feminino , Ovário , Óvulo , Paracentese/métodos , Gravidez , Tomografia Computadorizada por Raios X/métodos , Tartarugas
18.
Intern Med J ; 48(12): 1524-1528, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30517990

RESUMO

Large volume paracentesis is effective in relieving the symptoms of malignant ascites, but frequent procedures are often required. Permanent peritoneal ports are an alternative to repeated procedures. We describe our experience with the use of peritoneal ports in patients at Middlemore Hospital (Auckland, New Zealand) who had a port inserted for the drainage of malignant ascites. Twenty-eight ports were inserted in 26 patients and accessed a total of 257 times with acceptably low rates of complications including cellulitis, peritonitis and wound dehiscence.


Assuntos
Paracentese , Cavidade Peritoneal , Complicações Pós-Operatórias , Ascite/diagnóstico , Ascite/etiologia , Ascite/cirurgia , Líquido Ascítico/patologia , Cateteres de Demora , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Nova Zelândia , Paracentese/efeitos adversos , Paracentese/métodos , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/patologia , Cavidade Peritoneal/cirurgia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Dispositivos de Acesso Vascular
20.
Crit Care ; 22(1): 321, 2018 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-30466472

RESUMO

BACKGROUND: Infected pancreatic necrosis, which occurs in about 40% of patients admitted for acute necrotizing pancreatitis, requires combined antibiotic therapy and local drainage. Since 2010, drainage by open surgical necrosectomy has been increasingly replaced by less invasive methods such as percutaneous radiological drainage, endoscopic necrosectomy, and laparoscopic surgery, which proved effective in small randomized controlled trials in highly selected patients. Few studies have evaluated minimally invasive drainage methods used under the conditions of everyday hospital practice. The aim of this study was to determine whether, compared with conventional open surgery, minimally invasive drainage was associated with improved outcomes of critically ill patients with infection complicating acute necrotizing pancreatitis. METHODS: A single-center observational study was conducted in patients admitted to the intensive care unit for severe acute necrotizing pancreatitis to compare the characteristics, drainage techniques, and outcomes of the 62 patients managed between September 2006 and December 2010, chiefly with conventional open surgery, and of the 81 patients managed between January 2011 and August 2015 after the introduction of a minimally invasive drainage protocol. RESULTS: Surgical necrosectomy was more common in the early period (74% versus 41%; P <0.001), and use of minimally invasive drainage increased between the early and late periods (19% and 52%, respectively; P <0.001). The numbers of ventilator-free days and catecholamine-free days by day 30 were higher during the later period. The proportions of patients discharged from intensive care within the first 30 days and from the hospital within the first 90 days were higher during the second period. Hospital mortality was not significantly different between the early and late periods (19% and 22%, respectively). CONCLUSION: In our study, the implementation of a minimally invasive drainage protocol in patients with infected pancreatic necrosis was associated with shorter times spent with organ dysfunction, in the intensive care unit, and in the hospital. Mortality was not significantly different. These results should be interpreted bearing in mind the limitations inherent in the before-after study design.


Assuntos
/normas , Pancreatite Necrosante Aguda/cirurgia , Paracentese/métodos , Idoso , Estado Terminal/terapia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Escores de Disfunção Orgânica , /estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA