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1.
Medicine (Baltimore) ; 99(6): e19031, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028416

RESUMO

The study was designed to verify if mini-fluid challenge test is more reliable than dynamic fluid variables in predicting stroke volume (SV) and arterial pressure fluid responsiveness during spine surgery in prone position with low-tidal-volume ventilation.Fifty patients undergoing spine surgery in prone position were included. Fluid challenge with 500 mL of colloid over 15 minutes was given. Changes in SV and systolic blood pressure (SBP) after initial 100 mL were compared with SV, pulse pressure variation (PPV), SV variation (SVV), plethysmographic variability index (PVI), and dynamic arterial elastance (Eadyn) in predicting SV or arterial pressure fluid responsiveness (15% increase or greater).An increase in SV of 5% or more after 100 mL predicted SV fluid responsiveness with area under the receiver operating curve (AUROC) of 0.90 (95% confidence interval [CI], 0.82 to 0.99), which was significantly higher than that of PPV (0.71 [95% CI, 0.57 to 0.86]; P = .01), and SVV (0.72 [95% CI, 0.57 to 0.87]; P = .03). A more than 4% increase in SBP after 100 mL predicted arterial pressure fluid responsiveness with AUROC of 0.86 (95% CI, 0.71-1.00), which was significantly higher than that of Eadyn (0.52 [95% CI, 0.33 to 0.71]; P = .01).Changes in SV and SBP after 100 mL of colloid predicted SV and arterial pressure fluid responsiveness, respectively, during spine surgery in prone position with low-tidal-volume ventilation.


Assuntos
Pressão Sanguínea , Monitorização Intraoperatória/métodos , Posicionamento do Paciente , Medula Espinal/cirurgia , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia/métodos , Decúbito Ventral , Estudos Prospectivos , Adulto Jovem
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.
Br J Radiol ; 93(1105): 20190655, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670569

RESUMO

OBJECTIVE: MRI provides clear visualization of spinal cord, tumor, and bone for patient positioning and verification during MRI-guided radiotherapy (MRI-RT). Therefore, we wished to evaluate spine stereotactic ablative radiotherapy (SABR) feasibility with MRI-RT. Given dosimetric limitations of first generation Co-60 MRI-RT, we then evaluated improvements by newer linear accelerator (linac) MRI-RT. METHODS: Nine spinal metastases were treated with Co-60 MRI-RT. Seven received a single 16 Gy fraction, and two received three fractions totaling 24 or 30 Gy. After replanning with linac MRI-RT software, comparisons of organ at risk and dose spillage objectives between Co-60 and linac plans were performed. RESULTS: Spinal cord and cauda equina dose constraints were met in all Co-60 cases. Treatments were delivered successfully with real-time imaging during treatment and no treatment-related toxicities. While limits for dose spillage into surrounding soft tissues were not achieved due to the limitations of the Co-60 system, this could be corrected with linac MRI-RT delivery. CONCLUSIONS: MRI-RT SABR of spinal metastases is feasible with Co-60 MRI-RT. Dose delivery is improved by linac MRI-RT. ADVANCES IN KNOWLEDGE: This is the first report of MRI-RT for SABR of spinal metastases. The enhanced visualization of anatomy by MRI may facilitate RT dose escalation for spine SABR.


Assuntos
Imagem por Ressonância Magnética , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/radioterapia , Algoritmos , Radioisótopos de Cobalto , Fracionamento da Dose de Radiação , Humanos , Órgãos em Risco , Posicionamento do Paciente , Dosagem Radioterapêutica , Neoplasias da Coluna Vertebral/secundário
4.
Int J Radiat Oncol Biol Phys ; 106(1): 185-193, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580928

RESUMO

PURPOSE: Recurrent or previously irradiated head and neck cancers (HNC) are therapeutically challenging and may benefit from high-dose, highly accurate radiation techniques, such as stereotactic ablative radiation therapy (SABR). Here, we compare set-up and positioning accuracy across HNC subsites to further optimize the treatment process and planning target volume (PTV) margin recommendations for head and neck SABR. METHODS AND MATERIALS: We prospectively collected data on 405 treatment fractions across 79 patients treated with SABR for recurrent/previously irradiated HNC. First, interfractional error was determined by comparing ExacTrac x-ray to the treatment plan. Patients were then shifted and residual error was measured with repeat x-ray. Next, cone beam computed tomography (CBCT) was compared with ExacTrac for positioning agreement, and final shifts were applied. Lastly, intrafractional error was measured with x-ray before each arc. Results were stratified by treatment site into skull base, neck/parotid, and mucosal. RESULTS: Most patients (66.7%) were treated to 45 Gy in 5 fractions (range, 21-47.5 Gy in 3-5 fractions). The initial mean ± standard deviation interfractional errors were -0.2 ± 1.4 mm (anteroposterior), 0.2 ± 1.8 mm (craniocaudal), and -0.1 ± 1.7 mm (left-right). Interfractional 3-dimensional vector error was 2.48 ± 1.44, with skull base significantly lower than other sites (2.22 vs 2.77; P = .0016). All interfractional errors were corrected to within 1.3 mm and 1.8°. CBCT agreed with ExacTrac to within 3.6 mm and 3.4°. CBCT disagreements and intrafractional errors of >1 mm or >1° occurred at significantly lower rates in skull base sites (CBCT: 16.4% vs 50.0% neck, 52.0% mucosal, P < .0001; intrafractional: 22.0% vs 48.7% all others, P < .0001). Final PTVs were 1.5 mm (skull base), 2.0 mm (neck/parotid), and 1.8 mm (mucosal). CONCLUSIONS: Head and neck SABR PTV margins should be optimized by target site. PTV margins of 1.5 to 2 mm may be sufficient in the skull base, whereas 2 to 2.5 mm may be necessary for neck and mucosal targets. When using ExacTrac, skull base sites show significantly fewer uncertainties throughout the treatment process, but neck/mucosal targets may require the addition of CBCT to account for positioning errors and internal organ motion.


Assuntos
Neoplasias de Cabeça e Pescoço/radioterapia , Recidiva Local de Neoplasia/radioterapia , Radiocirurgia/métodos , Erros de Configuração em Radioterapia , Idoso , Tomografia Computadorizada de Feixe Cônico/métodos , Fracionamento da Dose de Radiação , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imobilização/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/radioterapia , Posicionamento do Paciente , Estudos Prospectivos , Melhoria de Qualidade , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Reirradiação/métodos , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/radioterapia
5.
Isr Med Assoc J ; 12(21): 773-778, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814338

RESUMO

BACKGROUND: Falls are a common complication in persons with stroke (PwS). Reliable assessment of balance responses to unexpected loss of balance has the potential to identify risk for falls. OBJECTIVES: To examine inter-observer reliability of balance responses to unannounced surface perturbations in PwS and to explore the concurrent validity of a balance recovery assessment protocol. METHODS: Two observers evaluated balance recovery strategies and fall threshold (a fall into a harness system) in 15 PwS and 15 healthy adults who were exposed to forward, backward, right, and left unannounced surface translations in six increasing intensities while standing. RESULTS: Observer agreement was 100% for the fall threshold. Kappa coefficients for step strategies were 0.960-0.988 in PwS and 0.886-0.938 in healthy adults, 0.905-0.988 for arm reactions in PwS and 0.754-0.926 in healthy adults. Significant correlations were found between fall threshold and Berg Balance Scale (r = 0.691), 6-minute walk test (r = 0.599), and fall efficacy scale-international (r= -0.581). CONCLUSIONS: A trained examiner can reliably classify reactive balance responses to surface perturbations. The high frequency of falls observed in PwS highlights the importance of assessing reactive balance responses to different directions and intensities of surface translations.


Assuntos
Acidentes por Quedas/prevenção & controle , Exame Neurológico/métodos , Equilíbrio Postural , Posição Ortostática , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Medição de Risco/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Teste de Caminhada/métodos
6.
Rev. gaúch. enferm ; 40: 1-9, dez., 2019. tab.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1049563

RESUMO

OBJECTIVE: To evaluate the risk of developing perioperative lesions due to surgical positioning in patients submitted to elective surgeries. METHODS: This is an analytical and longitudinal study carried out with 45 patients in a public hospital of medium and high complexity in the state of Piauí. The following data was used: perioperative evaluation instrument, Numerical Visual Scale, Braden Scale and the Risk Assessment Scale for the Development of Injuries from Surgical Positioning (ELPO). RESULTS: Participants aged ≥ 46 years had a higher risk, and there were 33.4% of hypertensives among the 35.6% with comorbidities. The most prevalent position, with 64.5% was supine, with only 2.2% cases of pre-surgical injury. Regarding the risk for positional lesions, 68.9% presented low risk. CONCLUSIONS: 31.1% of the participants were at high risk for developing positional lesions, related to age and comorbidities. (AU)


Assuntos
Enfermagem Perioperatória , Medição de Risco , Posicionamento do Paciente , Segurança do Paciente
7.
Medicine (Baltimore) ; 98(51): e18287, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860976

RESUMO

RATIONALE: Airway management of patients in a lateral decubitus position (LDP), who cannot lie supine is challenging for anesthesiologists. In a previous study, laryngeal mask airway (LMA) was found to be superior to conventional endotracheal intubation in LDP. PATIENT CONCERNS: A 38-year-old man diagnosed with type I neurofibromatosis presented with pain caused by a large hematoma (28 × 8 cm) located in the left upper back. On arrival at the operating theater, he was in a right LDP because of the aggravation of pain in the supine position. DIAGNOSES: Laryngoscopy-guided endotracheal intubation was expected to be difficult in LDP. INTERVENTIONS: After the induction of anesthesia, a non-inflatable LMA was introduced into the laryngopharynx with the patient in LDP. He was then maneuvered into a supine position and removal of the LMA was followed by endotracheal intubation. OUTCOMES: The surgery for the removal of the hematoma was performed in a prone position. The airway intubated with an endotracheal tube was well maintained during the entire surgery. LESSONS: LMA is a useful device for airway management in patients in LDP who cannot lie supine.


Assuntos
Manuseio das Vias Aéreas/métodos , Máscaras Laríngeas , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/instrumentação , Dorso/cirurgia , Hematoma/cirurgia , Humanos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Masculino , Neurofibromatose 1/terapia , Decúbito Dorsal
8.
Medicine (Baltimore) ; 98(51): e18309, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860980

RESUMO

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).Subjects before (n = 78, July 2017-December 2017) and after (n = 114, January 2018-June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ±â€Š19 to 301 ±â€Š14 (P < .001) after HFMEA.HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Síndrome , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/educação , Tireoidectomia/métodos , Adulto Jovem
9.
Kyobu Geka ; 72(12): 989-992, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701908

RESUMO

Mediastinal enteric cysts are very rare among in adults and usually asymptomatic. A 54-year-old male was referred to our hospital due to an abnormal shadow incidentally found on a chest X-ray at health check. Chest computed tomography scan revealed a cystic mass in the posterior and inferior mediastinum surrounded by diaphragm, inferior vena cava, and esophagus. Based on many reports of thoracoscopic esophagectomy in the prone position in recent years, we chose thoracoscopic resection of the mediastinal tumor in the prone position with artificial pneumothorax. The prone position with artificial pneumothorax provided much better exposure of the operating field and the surgery was performed successfully.


Assuntos
Cisto Mediastínico , Pneumotórax Artificial , Esofagectomia , Humanos , Masculino , Cisto Mediastínico/cirurgia , Pessoa de Meia-Idade , Posicionamento do Paciente , Decúbito Ventral , Toracoscopia
10.
Undersea Hyperb Med ; 46(5): 673-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683367

RESUMO

Gas can enter arteries (arterial gas embolism, AGE) due to alveolar-capillary disruption (caused by pulmonary over-pressurization, e.g. breath-hold ascent by divers) or veins (venous gas embolism, VGE) as a result of tissue bubble formation due to decompression (diving, altitude exposure) or during certain surgical procedures where capillary hydrostatic pressure at the incision site is subatmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE usually produces stroke-like manifestations, such as impaired consciousness, confusion, seizures and focal neurological deficits. Small amounts of VGE are often tolerated due to filtration by pulmonary capillaries; however VGE can cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage or right-to-left shunt through a patient foramen ovale. Intravascular gas can cause arterial obstruction or endothelial damage and secondary vasospasm and capillary leak. Vascular gas is frequently not visible with radiographic imaging, which should not be used to exclude the diagnosis of AGE. Isolated VGE usually requires no treatment; AGE treatment is similar to decompression sickness (DCS), with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often causes intracranial hypertension, animal studies have failed to demonstrate a benefit of induced hypocapnia. An evidence based review of adjunctive therapies is presented.


Assuntos
Embolia Aérea/terapia , Oxigenação Hiperbárica/métodos , Algoritmos , Altitude , Artérias , Pressão Atmosférica , Descompressão/efeitos adversos , Doença da Descompressão/complicações , Mergulho/efeitos adversos , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Forame Oval Patente/complicações , Humanos , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Posicionamento do Paciente/métodos , Veias
11.
Clin Nucl Med ; 44(12): 969-970, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689279

RESUMO

A 70-year-old woman with breast cancer underwent F-FDG PET/CT for restaging. An FDG-avid focus corresponding to a rib on CT images was identified and interpreted as suggestive of an osseous metastasis. A PET/CT-guided biopsy was planned with the patient in prone position. Prone images demonstrated the FDG focus "moved" to the anterior chest and corresponding to pleural fluid. The diagnosis was altered from osseous metastases to pleural malignancy, and the bone biopsy was not performed. This case not only emphasizes the sensitivity of PET in the detection of malignancy, but also highlights the difficulty localizing small, mobile, FDG-avid foci.


Assuntos
Neoplasias Ósseas/secundário , Fluordesoxiglucose F18 , Posicionamento do Paciente , Derrame Pleural Maligno/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos
12.
Medicine (Baltimore) ; 98(42): e17650, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626151

RESUMO

INTRODUCTION: Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. PATIENT CONCERNS: Here we describe the anesthetic management of a 67-year-old man with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms. The patient presented with progressive dyspnea that was aggravated in the supine position and was scheduled for total thyroidectomy. DIAGNOSIS: Preoperative computed tomography showed a large goiter extending into the thoracic cavity, with diffuse segmental tracheal narrowing for 6 cm. The diameter at the narrowest portion of the trachea was 4.29 mm. INTERVENTIONS: Before the induction of general anesthesia, we applied extracorporeal membrane oxygenation (ECMO) in preparation for potential difficulties in securing the airway during general anesthesia. Subsequently, anesthesia was successfully induced and maintained. OUTCOMES: After the surgical procedure, fiberoptic bronchoscopy and chest radiography showed resolution of the tracheal narrowing. ECMO was weaned 2 hours after the surgery, and the patient was extubated on the first postoperative day. He was discharged without any complication. CONCLUSION: The findings from this case suggest that the use of ECMO before the induction of general anesthesia is a safe method for maintaining oxygenation in patients with severe tracheal obstruction.


Assuntos
Anestesia Geral/métodos , Oxigenação por Membrana Extracorpórea/métodos , Bócio Subesternal/cirurgia , Posicionamento do Paciente , Tireoidectomia/métodos , Estenose Traqueal/cirurgia , Idoso , Broncoscopia/métodos , Bócio Subesternal/complicações , Bócio Subesternal/diagnóstico , Humanos , Intubação Intratraqueal/métodos , Masculino , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estenose Traqueal/complicações
13.
Tidsskr Nor Laegeforen ; 139(14)2019 10 08.
Artigo em Norueguês | MEDLINE | ID: mdl-31592615

RESUMO

BACKGROUND: Acute dizziness may have a number of causes, including cerebrovascular stroke which can present as isolated acute vestibular syndrome. It is recommended that acute episodic dizziness be assessed using positioning tests, and acute persistent dizziness with a focus on the HINTS (Head Impulse, Nystagmus, Test of Skew) battery of tests, which can distinguish cerebrovascular stroke from vestibular neuritis. We wished to identify the prevalence, diagnostic spectrum and approach to acute dizziness in a neurological department. MATERIAL AND METHOD: We undertook a retrospective review of the medical records of all patients with acute dizziness as the primary symptom who where admitted to the department of neurology at Sørlandet Hospital, Kristiansand in 2015. RESULTS: Of 2 231 patients admitted to the department of neurology in 2015, altogether 243 (11 %) had dizziness as the primary symptom. A total of 106 patients (44 %) were examined using HINTS in its entirety. A cranial CT was performed in 213 (88 %) and MRI in 91 (37 %), and these showed relevant pathology in 1 and 4 patients, respectively. Upon discharge, 122 patients (50 %) were given a non-specific symptom diagnosis, 59 (24 %) received the diagnosis vestibular neuritis, 41 (17 %) benign paroxysmal positional vertigo, and 5 (2 %) were diagnosed with cerebrovascular stroke. Four out of five cases of cerebrovascular stroke could be classified retrospectively as acute vestibular syndrome, whereof three had typical findings determined by the HINTS test. INTERPRETATION: Acute dizziness is a frequent symptom in patients admitted to the department of neurology. Evidence-based diagnostic recommendations for the assessment of acute dizziness were not satisfactorily implemented in practice.


Assuntos
Tontura , Departamentos Hospitalares , Neurologia , Doença Aguda , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/diagnóstico , Tontura/diagnóstico , Tontura/etiologia , Medicina Baseada em Evidências , Medições dos Movimentos Oculares , Teste do Impulso da Cabeça , Humanos , Registros Médicos , Noruega , Nistagmo Patológico/diagnóstico , Admissão do Paciente , Posicionamento do Paciente , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Neuronite Vestibular/complicações , Neuronite Vestibular/diagnóstico
14.
Medicine (Baltimore) ; 98(39): e17316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574861

RESUMO

The purpose of this study was to investigate the effect of intraoperative positions in single-level (L4-5) transforaminal lumbar interbody fusion (TLIF) on segmental and overall lumbar lordosis (LL) in patients with lumbar degenerative disease. Thirty-eight consecutive patients who had undergone single-segment (L4-5) TLIF with 0° polyetheretherketone (PEEK) cage and pedicle screw fixation were evaluated. Twenty patients underwent surgery on the four-poster type frame with hip flexion at 30° (Group I) and 18 patients were operated on a Jackson spinal table to adjust their hip flexion to 0° (Group II). Preoperative standing, intraoperative prone, and postoperative standing lateral radiographs were obtained in each patient. The overall and segmental LL were analyzed according to the position in which the patients were placed for their operation and results compared between Groups I and II. Intraoperative intervertebral segmental LL at L4-5 and L5-S1 was increased in Group II than in Group I, whereas postoperative intervertebral segmental LL at L4-5 (fused level) was increased LL. In Group I intraoperative intervertebral segmental LL at L4-5 did not achieve sufficient lordosis, whereas postoperative intervertebral segmental LL at L3-4 was increased. The overall spinal alignment was unaffected by the decreased segmental LL in the fused level owing to the compensation of the upper adjacent segments. The more the hip was extended intraoperatively, the more the segmental lordosis increased in the lower lumbar spine. Thus, selecting the appropriate surgical table and hip position are very important. Underachievement of segmental lordosis leads to the acceleration of upper adjacent segment load.


Assuntos
Cuidados Intraoperatórios/métodos , Lordose , Vértebras Lombares , Mesas Cirúrgicas , Posicionamento do Paciente/métodos , Fusão Vertebral , Idoso , Feminino , Humanos , Lordose/diagnóstico , Lordose/fisiopatologia , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Amplitude de Movimento Articular , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Espondilolistese/cirurgia
15.
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
16.
Artigo em Alemão | MEDLINE | ID: mdl-31639857

RESUMO

Rapid sequence induction and intubation (RSII) is the appropriate method of inducing general anaesthesia in patients who are at a risk of aspiration. The classical RSII is limited to a few treatment recommendations which are rarely based on evidence-based findings. New techniques (e.g., video laryngoscopy) as well as new means of diagnostics (e.g., sonography) require reevaluation of traditional techniques. In this article non-pharmacological treatment strategies of RSII are described. Furthermore, old and new methods to minimise the risk of aspiration are discussed. This includes gastric tube and gastric sonography as well as modalities for anaesthesia induction, e.g. patient positioning, face mask ventilation, relaxometry, cricoid and left-paratracheal pressure. In-hospital, RSII treatment standards must be familiar to all team members and treatment processes have to be well established and practiced regularly. The aim of this article is to present systematics that can be used as a decision-making basis for local operating procedures.


Assuntos
Intubação Intratraqueal , Laringoscópios , Posicionamento do Paciente , Anestesia Geral , Humanos , Intubação Intratraqueal/efeitos adversos
17.
Med. intensiva (Madr., Ed. impr.) ; 43(7): 402-409, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-ET2-3449

RESUMO

Objective: To evaluate the clinical outcomes of patients with severe acute respiratory distress syndrome (ARDS) subjected to prone positioning before extracorporeal membrane oxygenation (ECMO). Design: A retrospective analysis of a multicenter cohort was carried out. Setting: Patients admitted to the Intensive Care Units of 11 hospitals in Korea. Patients: Patients were divided into those who underwent prone positioning before ECMO (n=28) and those who did not (n=34). Interventions: None. Variables of interest: Thirty-day mortality, ECMO weaning failure rate, mechanical ventilation weaning success rate, mechanical ventilation-free days at day 60. Results: The prone group had lower median peak inspiratory pressure and lower median dynamic driving pressure before ECMO. Thirty-day mortality was 21% in the prone group and 41% in the non-prone group (p=0.098). The prone group also showed a lower ECMO weaning failure rate, and a higher mechanical ventilation weaning success rate and more mechanical ventilation-free days at day 60. In the non-prone group, median dynamic compliance marginally decreased shortly after ECMO, but no significant change was observed in the prone group. Conclusions: Prone positioning before ECMO was not associated to increased mortality and tended to exert a protective effect


Objetivo: Evaluar los resultados clínicos de pacientes con síndrome de dificultad respiratoria aguda (SDRA) quienes fueron colocados en decúbito prono previo a la oxigenación con membrana extracorpórea (ECMO). Diseño: Análisis retrospectivo de una cohorte multicéntrico. Escenario: Pacientes admitidos en las unidades de cuidado intensivo de 11 hospitales en Corea. Pacientes: Los pacientes fueron divididos en aquellos que fueron colocados en decúbito prono antes de la ECMO (n=28) y aquellos que no fueron colocados en decúbito prono antes de la ECMO (n=34). Intervenciones: Ninguna. Variables de interés principales: Mortalidad a los 30 días, tasa de fracaso de retirada gradual de la ECMO, tasa de éxito de retirada gradual de la ventilación mecánica, días sin ventilación mecánica a los 60 días. Resultados: El grupo prono tuvo una mediana más baja de la presión inspiratoria máxima y una mediana más baja de la presión de conducción dinámica antes de la ECMO. La mortalidad a los 30 días fue 21% en el grupo prono y 41% en el grupo no prono (P = 0.098). El grupo prono también mostró un valor numérico menor de tasa de fracaso de retirada progresiva de la ECMO, y valores más altos de tasa de éxito de destete de la ventilación mecánica y días sin ventilación mecánica a los 60 días. En el grupo no prono, la mediana del cumplimiento dinámico descendió marginalmente, poco después de ECMO, pero no se observó un cambio significativo en el grupo prono. Conclusiones: La colocación en decúbito prono antes de la ECMO no se asoció con un incremento en mortalidad y tendió a ser de protección


Assuntos
Humanos , Decúbito Ventral/fisiologia , Oxigenação por Membrana Extracorpórea/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Posicionamento do Paciente/métodos , Estudos de Coortes , Estudos Retrospectivos , Fatores de Risco , Análise Multivariada , Síndrome do Desconforto Respiratório do Adulto/mortalidade
18.
Ned Tijdschr Geneeskd ; 1632019 09 09.
Artigo em Holandês | MEDLINE | ID: mdl-31556492

RESUMO

Since the publication of the results of the Term Breech Trial (TBT) in 2000 the number of planned Caesarean sections for breech presentation has increased dramatically, at the expense of vaginal breech deliveries. The favourable effect of a planned Caesarean section for breech presentation on perinatal outcomes described in the TBT could not, however, be reproduced in later trials. A planned Caesarean section does carry an increased risk of maternal complications; furthermore, a previous Caesarean section leads to higher risks for both mother and child in any subsequent pregnancy. A recent prospective study advocates vaginal breech delivery 'on all fours', a position in which the mother leans on her hands and knees during delivery. A vaginal breech delivery in this position seems to be just as safe for the child as a planned Caesarean section, while a vaginal delivery is safer for the mother than a Caesarean section. This article describes two uncomplicated vaginal breech deliveries in the all fours position.


Assuntos
Apresentação Pélvica/terapia , Parto Obstétrico/métodos , Trabalho de Parto , Posicionamento do Paciente/métodos , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Prospectivos
19.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401573

RESUMO

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.


Assuntos
Intubação Intratraqueal/efeitos adversos , Laringoscopia/métodos , Posicionamento do Paciente/métodos , Adulto , Manuseio das Vias Aéreas/métodos , Pré-Escolar , Evolução Fatal , Feminino , Humanos , Lactente , Intubação Intratraqueal/métodos , Masculino
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