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2.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983806

RESUMO

Prone positioning is a mainstay of management for those presenting to the intensive care unit with moderate-to-severe acute respiratory distress syndrome due to COVID-19. While this is a necessary and life-saving intervention in selected patients, careful positioning and meticulous care are required to prevent compression and traction of the brachial plexus, and resultant brachial plexopathy. We describe two patients who developed a brachial plexus injury while undergoing prone positioning for management of COVID-19 pneumonitis. Both patients were diabetic and underwent prolonged periods in the prone position during which the plexopathy affected arm was abducted for 19 and 55 hours, respectively. We discuss strategies to reduce the risk of this rare but potentially disabling complication of prone positioning.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Humanos , Posicionamento do Paciente , Decúbito Ventral , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/terapia , SARS-CoV-2
3.
Eur Radiol ; 32(1): 442-447, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34327574

RESUMO

OBJECTIVE: To assess the influence of breathing state on the accuracy of a 3D camera for body contour detection and patient positioning in thoracic CT. MATERIALS AND METHODS: Patients who underwent CT of the thorax with both an inspiratory and expiratory scan were prospectively included for analysis of differences in the ideal table height at different breathing states. For a subgroup, an ideal table height suggestion based on 3D camera images at both breathing states was available to assess their influence on patient positioning accuracy. Ideal patient positioning was defined as the table height at which the scanner isocenter coincides with the patient's isocenter. RESULTS: The mean (SD) difference of the ideal table height between the inspiratory and the expiratory breathing state among the 64 included patients was 10.6 mm (4.5) (p < 0.05). The mean (SD) positioning accuracy, i.e., absolute deviation from the ideal table height, within the subgroup (n = 43) was 4.6 mm (7.0) for inspiratory scans and 7.1 mm (7.7) for expiratory scans (p < 0.05) when using corresponding 3D camera images. The mean (SD) accuracy was 14.7 mm (7.4) (p < 0.05) when using inspiratory camera images on expiratory scans; vice versa, the accuracy was 3.1 mm (9.5) (p < 0.05). CONCLUSION: A 3D camera allows for accurate and precise patient positioning if the camera image and the subsequent CT scan are acquired in the same breathing state. It is recommended to perform an expiratory planning image when acquiring a thoracic CT scan in both the inspiratory and expiratory breathing state. KEY POINTS: • A 3D camera for body contour detection allows for accurate and precise patient positioning if the camera image and the subsequent CT scan are acquired in the same breathing state. • It is recommended to perform an expiratory planning image when acquiring a thoracic CT scan in both the inspiratory and expiratory breathing state.


Assuntos
Tórax , Tomografia Computadorizada por Raios X , Humanos , Imageamento Tridimensional , Posicionamento do Paciente , Estudos Retrospectivos
5.
Tuberk Toraks ; 69(4): 535-546, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34957747

RESUMO

In the last 50 years, there have been great research and developments in the definition and pathophysiology of acute respiratory distress syndrome (ARDS), the most progressive form of acute hypoxemic respiratory failure. Although there are various discussions and recommendations, the definition of ARDS is still based on the Berlin 2012 diagnostic criteria. Despite various studies in recent years, there is still no effective pharmacotherapeutic agent for the treatment of ARDS. Lung protective mechanical ventilation (low tidal volume, low plateau pressure, low driving pressure) in all ARDS patients, prone position, neuromuscular blockade (cisatracurium) in moderate-severe ARDS patients, and hydrocortisone therapy in sepsis-associated ARDS patients are treatments that contribute to survival. In this review, current changes in the definition and epidemiology of ARDS, recent pharmacotherapeutic research and mesenchymal stem cell therapies will be discussed in the light of newly introduced ARDS phenotypes.


Assuntos
Síndrome do Desconforto Respiratório , Sepse , Humanos , Posicionamento do Paciente , Decúbito Ventral , Respiração Artificial , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/epidemiologia , Síndrome do Desconforto Respiratório/etiologia
6.
Zhongguo Zhen Jiu ; 41(12): 1317-20, 2021 Dec 12.
Artigo em Chinês | MEDLINE | ID: mdl-34936267

RESUMO

OBJECTIVE: To observe the effect of horizontal penetration needling at vertigo auditory area and balance area on residual dizziness after successful repositioning maneuver in patients with benign paroxysmal positional vertigo (BPPV). METHODS: Sixty-six patients with residual dizziness after successful repositioning maneuver for BPPV were randomly divided into an observation group (34 cases, 1 case dropped off) and a control group (32 cases, 2 cases dropped off). The patients in the observation group were treated with horizontal penetration needling at vertigo auditory area and balance area, once every other day; three times were taken as a course of treatment, and two courses of treatment were given. The patients in the control group received no acupuncture and medication. The dizziness handicap inventory (DHI) and visual analogue scale (VAS) scores were observed before treatment and after 1 and 2 courses of treatment. RESULTS: Except for the emotional score of DHI in the control group after 1 course of treatment, the sub item scores and total scores of DHI and VAS scores in the two groups after treatment were lower than those before treatment (P<0.01, P<0.05). After 1 and 2 courses of treatment, the function scores, emotion scores, total scores of DHI and VAS scores in the observation group were lower than those in the control group (P<0.01). CONCLUSION: Whether acupuncture or not, residual dizziness after repositioning maneuver for BPPV can be relieved within 2 weeks; horizontal penetration needling at vertigo auditory area and balance area could improve dizziness symptoms and shorten the course of disease.


Assuntos
Vertigem Posicional Paroxística Benigna , Tontura , Vertigem Posicional Paroxística Benigna/terapia , Tontura/terapia , Humanos , Posicionamento do Paciente , Procedimentos Cirúrgicos Vasculares
7.
BMC Anesthesiol ; 21(1): 280, 2021 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-34773980

RESUMO

BACKGROUND: COVID-19 can induce acute respiratory distress syndrome (ARDS). In patients with congenital heart disease, established treatment strategies are often limited due to their unique cardiovascular anatomy and passive pulmonary perfusion. CASE PRESENTATION: We report the first case of an adult with single-ventricle physiology and bidirectional cavopulmonary shunt who suffered from severe COVID-19 ARDS. Treatment strategies were successfully adopted, and pulmonary vascular resistance was reduced, both medically and through prone positioning, leading to a favorable outcome. CONCLUSION: ARDS treatment strategies including ventilatory settings, prone positioning therapy and cannulation techniques for extracorporeal oxygenation must be adopted carefully considering the passive venous return in patients with single-ventricle physiology.


Assuntos
COVID-19/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Procedimentos Cirúrgicos Cardiovasculares/métodos , Dextrocardia/diagnóstico por imagem , Oxigenação por Membrana Extracorpórea/métodos , Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico por imagem , Síndrome de Heterotaxia/diagnóstico por imagem , Posicionamento do Paciente/métodos , COVID-19/complicações , COVID-19/terapia , Cardiomegalia/complicações , Cardiomegalia/terapia , Dextrocardia/complicações , Dextrocardia/terapia , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Doenças Genéticas Ligadas ao Cromossomo X/terapia , Síndrome de Heterotaxia/complicações , Síndrome de Heterotaxia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
8.
J Int Adv Otol ; 17(5): 417-421, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34617892

RESUMO

OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) as the most common vestibular disorder can affect the quality of life. This study aimed to compare the effectiveness of the half somersault maneuver (HSM) as a treatment to that of the Epley maneuver (EM) as a clinical-based treatment in subjects with PC-BPPV. METHODS: In this randomized study, 43 participants with unilateral posterior canal BPPV were recruited. The experimental group received the HSM, whereas the control group received the EM. All participants were asked to fill in the Vestibular Rehabilitation Benefit Questionnaire (VRBQ), Dizziness Handicap Inventory (DHI), and Vertigo Symptom Scale (VSS) questionnaires at pretreatment and at 48 hours, 1 week, and 1 month posttreatment. The severity of residual dizziness was determined by the visual analog scale (VAS) weekly for up to 4 weeks after treatment. The success rate and the recurrence rate were assessed after the 3-month follow-up. RESULTS: The differences between the results of pretreatment and post-treatment questionnaires for both groups were significant. However, the differences were not significant between the 2 groups for the DHI scores, the total, dizziness, motion-provoked dizziness, and symptom subscale scores of the VRBQ, and the anxiety subscale scores of the VSS. There were significant differences between the 2 groups for VAS, the total VSS and vertigo subscale scores, and the VRBQ anxiety subscale scores. CONCLUSION: Even though both maneuvers are significantly effective in the treatment of PC-BPPV, subjects in the HSM group reported more improvement in terms of psychometric symptoms and residual dizziness compared to the EM group.


Assuntos
Vertigem Posicional Paroxística Benigna , Qualidade de Vida , Vertigem Posicional Paroxística Benigna/terapia , Tontura/terapia , Humanos , Posicionamento do Paciente , Inquéritos e Questionários
13.
Diving Hyperb Med ; 51(3): 303-305, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34547783

RESUMO

Only a few clinical cases of cerebral arterial gas embolism during spinal surgery are published. It seems important not to overlook this diagnosis in order to initiate rapid appropriate treatment. This was a suspected case of paradoxical gas embolism revealed postoperatively by neurological deficits and whose recovery was noted during hyperbaric oxygen treatment. Unfortunately, no complementary examination showed gas embolism and only the context, the clinical picture and the case evolution evoke this diagnosis. The diagnostic difficulty in the immediate postoperative period is highlighted.


Assuntos
Embolia Aérea , Oxigenação Hiperbárica , Embolia Intracraniana , Embolia Aérea/diagnóstico por imagem , Embolia Aérea/etiologia , Embolia Aérea/terapia , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/etiologia , Embolia Intracraniana/terapia , Oxigênio , Posicionamento do Paciente , Decúbito Ventral
14.
Phys Med ; 90: 1-5, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34521015

RESUMO

PURPOSE: Electronic portal imaging detector (EPID)-based patient positioning verification is an important component of safe radiotherapy treatment delivery. In computer simulation studies, learning-based approaches have proven to be superior to conventional gamma analysis in the detection of positioning errors. To approximate a clinical scenario, the detectability of positioning errors via EPID measurements was assessed using radiomics analysis for patients with thyroid-associated ophthalmopathy. METHODS: Treatment plans of 40 patients with thyroid-associated ophthalmopathy were delivered to a solid anthropomorphic head phantom. To simulate positioning errors, combinations of 0-, 2-, and 4-mm translation errors in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions were introduced to the phantom. The positioning errors-induced dose differences between measured portal dose images were used to predict the magnitude and direction of positioning errors. The detectability of positioning errors was assessed via radiomics analysis of the dose differences. Three classification models-support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost-were used for the detection of positioning errors (positioning errors larger or smaller than 3 mm in an arbitrary direction) and direction classification (positioning errors larger or smaller than 3 mm in a specific direction). The receiver operating characteristic curve and the area under the ROC curve (AUC) were used to evaluate the performance of classification models. RESULTS: For the detection of positioning errors, the AUC values of SVM, KNN, and XGBoost models were all above 0.90. For LR, SI, and AP direction classification, the highest AUC values were 0.76, 0.91, and 0.80, respectively. CONCLUSIONS: Combined radiomics and machine learning approaches are capable of detecting the magnitude and direction of positioning errors from EPID measurements. This study is a further step toward machine learning-based positioning error detection during treatment delivery with EPID measurements.


Assuntos
Oftalmopatia de Graves , Radioterapia de Intensidade Modulada , Simulação por Computador , Oftalmopatia de Graves/diagnóstico por imagem , Oftalmopatia de Graves/radioterapia , Humanos , Posicionamento do Paciente , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
16.
Sci Rep ; 11(1): 17684, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34480073

RESUMO

Positional brain shift (PBS), the sagging of the brain under the effect of gravity, is comparable in magnitude to the margin of error for the success of stereotactic interventions ([Formula: see text] 1 mm). This non-uniform shift due to slight differences in head orientation can lead to a significant discrepancy between the planned and the actual location of surgical targets. Accurate in-vivo measurements of this complex deformation are critical for the design and validation of an appropriate compensation to integrate into neuronavigational systems. PBS arising from prone-to-supine change of head orientation was measured with magnetic resonance imaging on 11 young adults. The full-field displacement was extracted on a voxel-basis via digital volume correlation and analysed in a standard reference space. Results showed the need for target-specific correction of surgical targets, as a significant displacement ranging from 0.52 to 0.77 mm was measured at surgically relevant structures. Strain analysis further revealed local variability in compressibility: anterior regions showed expansion (both volume and shape change), whereas posterior regions showed small compression, mostly dominated by shape change. Finally, analysis of correlation demonstrated the potential for further patient- and intervention-specific adjustments, as intra-cranial breadth and head tilt correlated with PBS reaching statistical significance.


Assuntos
Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , Posicionamento do Paciente , Técnicas Estereotáxicas , Cirurgia Assistida por Computador/métodos , Adulto , Feminino , Humanos , Imageamento Tridimensional , Masculino , Neuronavegação , Orientação , Adulto Jovem
17.
Phys Med ; 89: 243-249, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34428608

RESUMO

PURPOSE: To assess the effectiveness of SGRT in clinical applications through statistical process control (SPC). METHODS: Taking the patients' positioning through optical surface imaging (OSI) as a process, the average level of process execution was defined as the process mean. Setup errors detected by cone-beam computed tomography (CBCT) and OSI were extracted for head-and-neck cancer (HNC) and breast cancer patients. These data were used to construct individual and exponentially weighted moving average (EWMA) control charts to analyze outlier fractions and small process shifts from the process mean. Using the control charts and process capability indices derived from this process, the patient positioning-related OSI performance and setup error were analyzed for each patient. RESULTS: Outlier fractions and small shifts from the process mean that are indicative of setup errors were found to be widely prevalent, with the outliers randomly distributed between fractions. A systematic error of up to 1.6 mm between the OSI and CBCT results was observed in all directions, indicating a significantly degraded OSI performance. Adjusting this systematic error for each patient using setup errors of the first five fractions could effectively mitigate these effects. Process capability analysis following adjustment for systematic error indicated that OSI performance was acceptable (process capability index Cpk = 1.0) for HNC patients but unacceptable (Cpk < 0.75) for breast cancer patients. CONCLUSION: SPC is a powerful tool for detecting the outlier fractions and process changes. Our application of SPC to patient-specific evaluations validated the suitability of OSI in clinical applications involving patient positioning.


Assuntos
Neoplasias da Mama , Neoplasias de Cabeça e Pescoço , Radioterapia Guiada por Imagem , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Tomografia Computadorizada de Feixe Cônico , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Posicionamento do Paciente , Planejamento da Radioterapia Assistida por Computador , Erros de Configuração em Radioterapia
18.
Crit Care ; 25(1): 305, 2021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429131

RESUMO

BACKGROUND: Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease (COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV. METHODS: We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th-75th percentile range. RESULTS: From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement [96 (94-97)% supine vs 98 (96-99)% prone, p = 0.008], turning to prone position induced a worsening in comfort score from 7.0 (6.0-8.0) to 6.0 (5.0-7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7-40.5)% to 41.5 (29.8-50.0)% (p = 0.025). CONCLUSIONS: In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731 .


Assuntos
COVID-19/terapia , Ventilação não Invasiva/métodos , Posicionamento do Paciente , Decúbito Ventral , Respiração Artificial/métodos , Vigília , Adulto , Diafragma , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Estudos Prospectivos
20.
J Appl Clin Med Phys ; 22(9): 360-370, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34347933

RESUMO

PURPOSE: We investigated the immobilization accuracy of a new type of thermoplastic mask-the Double Shell Positioning System (DSPS)-in terms of geometry and dose delivery. METHODS: Thirty-one consecutive patients with 1-5 brain metastases treated with stereotactic radiotherapy (SRT) were selected and divided into two groups. Patients were divided into two groups. One group of patients was immobilized by the DSPS (n = 9). Another group of patients was immobilized by a combination of the DSPS and a mouthpiece (n = 22). Patient repositioning was performed with cone beam computed tomography (CBCT) and six-degree of freedom couch. Additionally, CBCT images were acquired before and after treatment. Registration errors were analyzed with off-line review. The inter- and intrafractional setup errors, and planning target volume (PTV) margin were also calculated. Delivered doses were calculated by shifting the isocenter according to inter- and intrafractional setup errors. Dose differences of GTV D99% were compared between planned and delivered doses against the modified PTV margin of 1 mm. RESULTS: Interfractional setup errors associated with the mouthpiece group were significantly smaller than the translation errors in another group (p = 0.03). Intrafractional setup errors for the two groups were almost the same in all directions. PTV margins were 0.89 mm, 0.75 mm, and 0.90 mm for the DSPS combined with the mouthpiece in lateral, vertical, and longitudinal directions, respectively. Similarly, PTV margins were 1.20 mm, 0.72 mm, and 1.37 mm for the DSPS in the lateral, vertical, and longitudinal directions, respectively. Dose differences between planned and delivered doses were small enough to be within 1% for both groups. CONCLUSIONS: The geometric and dosimetric assessments revealed that the DSPS provides sufficient immobilization accuracy. Higher accuracy can be expected when the immobilization is combined with the use of a mouthpiece.


Assuntos
Planejamento da Radioterapia Assistida por Computador , Erros de Configuração em Radioterapia , Encéfalo , Humanos , Imobilização , Posicionamento do Paciente , Erros de Configuração em Radioterapia/prevenção & controle
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