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2.
Br J Radiol ; 93(1107): 20190595, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31687833

RESUMO

OBJECTIVE: Accurate patient positioning is crucial in particle therapy due to the geometrical selectivity of particles. We report and discuss the National Center for Oncological Hadrontherapy (CNAO) experience in positioning accuracy and stability achieved with solid thermoplastic masks fixed on index base plates and assessed by daily orthogonal X-ray imaging. METHODS: Positioning data were retrospectively collected (between 2012 and 2018) and grouped according to the treated anatomical site. 19696 fractions of 1325 patients were evaluated.The study was designed to assess:(i) the number of fractions in which a single correction vector was applied(SCV);(ii) the number of fractions in which further setup verification was performed (SV);(iii) the number of fractions in which SV lead to an additional correction within (MCV<5min) or after (MCV>5min) 5 minutes from the first setup correction;(iv) the systematic (Σ) and random (σ) error components of the correction vectors applied. RESULTS: A SCV was applied in 71.5% of fractions, otherwise SV was required. In 30.6% of fractions with SV, patient position was not further revised. In the remaining fractions, MCV<5min and MCV>5min were applied mainly in extracranial and cranial sites respectively.Interfraction Σ was ≤ 1.7 mm/0.7° and σ was ≤ 1.2 mm/0.6° in cranial sites while in extracranial sites Σ was ≤ 5.5 mm/0.9° and σ was ≤4.4 mm/0.9°. Setup residuals were submillimetric in all sites. In cranial patients, maximum intrafractional Σ was 0.8 mm/0.4°. CONCLUSION: This report extensively quantifies inter- and intrafraction setup accuracy on an institutional basis and confirms the need of image guidance to fully benefit from the geometrical selectivity of particles. ADVANCES IN KNOWLEDGE: The reported analysis provides a board institutional data set on the evaluation of patient immobilization and bony anatomy alignment for several particle therapy clinical indications.


Assuntos
Imobilização/instrumentação , Máscaras , Neoplasias/radioterapia , Posicionamento do Paciente/métodos , Erros de Configuração em Radioterapia/prevenção & controle , Institutos de Câncer , Fracionamento da Dose de Radiação , Feminino , Humanos , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Incerteza
3.
J Vasc Access ; 21(1): 103-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232211

RESUMO

Peripherally inserted central catheters are usually inserted in supine patients. What should we do when facing a patient who cannot tolerate this position? In this article, we are describing a particularly difficult patient: not only supine decubitus was intolerable to her but lying on the side was unbearable, too. That is why, to manage a patient who required a central access but could not tolerate the usual position for placing it, we tried to do that in prone position.


Assuntos
Neoplasias do Ânus/complicações , Carcinoma de Células Escamosas/complicações , Cateterismo Venoso Central , Cateterismo Periférico , Dor/etiologia , Posicionamento do Paciente/métodos , Decúbito Ventral , Feminino , Humanos , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos
4.
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
5.
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
6.
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
7.
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
8.
Artigo em Inglês | MEDLINE | ID: mdl-31751009

RESUMO

Minimally invasive pulmonary segmentectomy allows adequate oncologic treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay.  Most lung segments can be resected as segmentectomies or as part of bisegmentectomies (as is the case for the lingula). However, the resection of individual basal segments can be particularly challenging. Although several variations of minimally invasive pulmonary segmentectomy have been described, I favor a fully thoracoscopic multiport approach that offers direct access to the segmental structures, and is straightforward and versatile enough to allow for adaptation in case of unexpected intraoperative findings (such as conversion to lobectomy in the case of positive margins). Key aspects of anterobasal segmentectomy include proper patient positioning, appropriate positioning of operating trocars, standardized technique to expose and dissect the segmental artery and bronchus, and accurate division of the intersegmental plane.


Assuntos
Neoplasias Colorretais/patologia , Nódulos Pulmonares Múltiplos , Neoplasias Primárias Múltiplas/patologia , Pneumonectomia/métodos , Toracoscopia/métodos , Idoso , Humanos , Masculino , Mastectomia Segmentar , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Posicionamento do Paciente/métodos
9.
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
10.
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
11.
Med. intensiva (Madr., Ed. impr.) ; 43(7): 402-409, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185867

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
12.
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
13.
BMC Musculoskelet Disord ; 20(1): 406, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484527

RESUMO

BACKGROUND: Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table. Moreover, some femoral neck fractures may be treated with total hip arthroplasty using a direct anterior approach and a traction table. Fracture and traction tables both use a boot tightly fitted to the patient's foot in order to: 1) obtain fracture reduction by traction and adequate rotation exerted on the slightly abducted or adducted extremity; or 2) adequately expose the hip joint using traction, rotation and extension to implant total hip arthroplasty components. In some instances, multiply injured patients may present with both a proximal or diaphyseal femur fracture and a diaphyseal or distal tibia or ankle fracture necessitating an ankle spanning external fixator on the same limb. Frequently, the tibia or ankle fracture has to be treated first, and standard use of the fracture or traction table may be thereafter difficult due to the external fixator construct preventing tight fitting of the boot to the patient's foot. CASE PRESENTATION: In order to address this situation, the authors describe a simple technique allowing rigid fixation of the limb with an ankle spanning external fixator to the traction or fracture table, providing accurate control of the position of the lower limb in all planes for adequate fracture reduction and fixation or total hip arthroplasty. The technique is exemplified with a clinical case. CONCLUSIONS: This technique allows an efficient way to: 1) timely stabilize diaphyseal or distal tibia or ankle fractures; and 2) subsequently use all the advantages of a fracture or traction table to adequately reduce and fix proximal or diaphyseal femur fractures, or optimally expose femoral neck fractures for total hip arthroplasty using a direct anterior approach.


Assuntos
Acidentes de Trânsito , Traumatismos do Tornozelo/cirurgia , Fixação de Fratura/métodos , Fraturas Múltiplas/cirurgia , Posicionamento do Paciente/métodos , Traumatismos do Tornozelo/etiologia , Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas Múltiplas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Orthop Surg Res ; 14(1): 304, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488181

RESUMO

BACKGROUND: Lateral lumbar interbody fusion (LLIF) and bilateral percutaneous pedicle fixation are valuable, minimally invasive lateral approaches used to treat symptomatic degenerative disc disease. In the current procedure, the patient's position on the operating table is changed after LLIF surgery from the lateral decubitus to the prone position. The ability to perform both approaches with the patient in the same position should reduce operation time. Use of a guide wire is problematic during percutaneous pedicle screw (PPS) insertion using fluoroscopy with the patient in the lateral decubitus position. A new guide wire-less PPS system may solve this problem and reduce operation time. Here, we evaluated the operative data and efficacy for this technique. METHODS: This study included 30 patients (aged 70.8 ± 8.5 years; 17 men, 13 women) who underwent a combined operation (indirect decompression) using extreme lateral interbody fusion (XLIF) with only a single level for lumbar spinal canal stenosis and lumbar degenerative spondylolisthesis. Patient demographics and operative data were compared between two groups: patients who remained in the lateral decubitus position for pedicle screw fixation (L group) and those turned to the prone position (P group). Radiographic assessment was performed using pre- and postoperative anteroposterior and lateral lumbar films with measurement of lumbar lordosis, segmental lordosis, and segmental translation. RESULTS: We analyzed 18 patients in the P group and 12 in the L group. Age, sex, height, body weight, body mass index, estimated blood loss, and length of stay did not differ between groups. The operation time was 34 min shorter for the L group (P group 111.9 ± 25.0 vs. L group 77.5 ± 22.2 min, p < 0.01). Pre- and postoperative lordosis, segmental lordosis, and segmental translation did not differ significantly between groups. CONCLUSIONS: A single position after XLIF surgery is a feasible modification to the standard procedure when used with fluoroscopy and a guide wire-less PPS system. The time saved is the main advantage of inserting the PPS with the patient in the lateral decubitus position without repositioning. Use of the lateral PPS with a guide wire-less technique may help improve operative efficiency and reduce cost.


Assuntos
Fios Ortopédicos , Posicionamento do Paciente/métodos , Parafusos Pediculares , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/instrumentação
15.
Arch Orthop Trauma Surg ; 139(12): 1785-1796, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541274

RESUMO

PURPOSE: To investigate the efficacy of non-tranexamic acid (TXA) on reducing blood loss and requirements of allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA). METHODS: The PubMed, EMBASE, and the Cochrane Library databases were researched since incipiency to June 2018. Only randomized controlled trials (RCTs) involved with non-TXA hemostatic techniques in TKA met the inclusion criteria. RESULTS: A total of 36 RCTs, including 1511 patients, were recruited for analysis. The results of subgroup analysis revealed that hemostatic techniques, which could substantially decrease the rate of ABT, were cell salvage with the transfusion trigger of 9 mg/dl, fibrin sealant with a dosage of 10 ml, and postoperative flexion position. CONCLUSION: The available evidence in this meta-analysis suggests that postoperative flexion position, fibrin sealant, and cell salvage can substantially decrease the rate of ABT in TKA. Further studies, including more hemostatic methods and high-quality research, are expected.


Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Técnicas Hemostáticas , Posicionamento do Paciente/métodos , Ácido Tranexâmico/uso terapêutico , Administração Intravenosa , Transfusão de Sangue/estatística & dados numéricos , Humanos , Cuidados Pós-Operatórios/métodos
16.
Int J Comput Assist Radiol Surg ; 14(11): 1871-1879, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31388959

RESUMO

PURPOSE: For many years, deep convolutional neural networks have achieved state-of-the-art results on a wide variety of computer vision tasks. 3D human pose estimation makes no exception and results on public benchmarks are impressive. However, specialized domains, such as operating rooms, pose additional challenges. Clinical settings include severe occlusions, clutter and difficult lighting conditions. Privacy concerns of patients and staff make it necessary to use unidentifiable data. In this work, we aim to bring robust human pose estimation to the clinical domain. METHODS: We propose a 2D-3D information fusion framework that makes use of a network of multiple depth cameras and strong pose priors. In a first step, probabilities of 2D joints are predicted from single depth images. These information are fused in a shared voxel space yielding a rough estimate of the 3D pose. Final joint positions are obtained by regressing into the latent pose space of a pre-trained convolutional autoencoder. RESULTS: We evaluate our approach against several baselines on the challenging MVOR dataset. Best results are obtained when fusing 2D information from multiple views and constraining the predictions with learned pose priors. CONCLUSIONS: We present a robust 3D human pose estimation framework based on a multi-depth camera network in the operating room. Depth images as only input modalities make our approach especially interesting for clinical applications due to the given anonymity for patients and staff.


Assuntos
Imagem Tridimensional/instrumentação , Salas Cirúrgicas , Posicionamento do Paciente/métodos , Desenho de Equipamento , Humanos , Iluminação
17.
Urology ; 133: 245-246, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376473

RESUMO

INTRODUCTION: Ultrasound guidance for percutaneous nephrolithotomy (PCNL) has gained acceptance amongst urologists given its numerous advantages over fluoroscopy. While traditionally performed in the prone position, this video demonstrates a step-by-step approach to performing PCNL in the supine position, solely under ultrasound guidance. MATERIALS AND METHODS: Once in the modified supine (Galdakao-modified Valdivia) position, important anatomic landmarks are identified. It is important to first orient the ultrasound probe such that its cranial side corresponds to the left of the ultrasound screen. After optimizing a target calyx, keeping the needle in the imaging plane of the probe facilitates renal access. Tract dilation under ultrasound guidance is then achieved by keeping the wire and dilators in the same imaging plane. RESULTS: The 11th and 12th ribs, paraspinous muscle, iliac crest, midaxillary line, and costal margin are the anatomic landmarks that orient the probe to the location of the kidney. Placing the ultrasound probe in the midaxillary line, parallel to the 11th rib allows the operator to identify key renal landmarks: the renal cortex, peri-pelvic fat, collecting system, kidney stone with its associated postacoustic shadow, and the intended target calyx. Controlling the needle is easiest in the longitudinal view, as the needle can be visualized from skin to target. Dilation under ultrasound relies on keeping the wire in view. The tip of the 10-French dilator is based on the location where the wire image disappears as the dilator advances. The balloon dilator tip is visualized on ultrasound reaching the appropriate depth just inside the collecting system, at which time balloon inflation results in complete dilation of the tract. CONCLUSIONS: This video provides a step-by-step approach demonstrating that PCNL can be performed in the supine position using only ultrasound-guidance. This approach facilitates renal access in this position and obviates the need for radiation exposure.


Assuntos
Nefrolitotomia Percutânea/métodos , Posicionamento do Paciente/métodos , Ultrassonografia de Intervenção , Dilatação , Humanos , Decúbito Dorsal
18.
Phys Med ; 65: 46-52, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31430586

RESUMO

AIM: Ultrasound-based repositioning and real-time-monitoring aim at the improvement of the precision of SBRT in deep inspiration breath-hold (DIBH). Accuracy of ultrasound-based daily repositioning was estimated by comparison with DIBH-cone-beam-CT. Intrafraction motion during beam-delivery was assessed by ultrasound-real-time-monitoring. PATIENTS/METHODS: Residual error after ultrasound-based interfractional repositioning (85 fractions, 16 SBRT-series; 14 patients) was assessed by marker-based (7 series) or liver-contour-based (9 series) matching in DIBH-CBCT. During beam-delivery, the percentage of 3D misalignment vector below 2 mm, between 2 and 5 mm, 5-7 mm and over 7 mm was estimated. Percentage of relevant target-displacements was analyzed as a function of DIBH-duration. RESULTS: Residual error after ultrasound-based positioning was 0.4 ±â€¯3.3 mm in LR (left-right), 0.2 ±â€¯4.3 mm in CC (cranio-caudal) and 1.0 ±â€¯3.0 mm in AP (anterior-posterior) directions (vector magnitude 5.4 ±â€¯3.3 mm, MV ±â€¯SD). Over 544 DIBHs, target displacement was 1.3 ±â€¯0.5 mm, 0.7 ±â€¯0.3 mm, 1.6 ±â€¯0.6 mm for CC, LR and AP directions, respectively (3D-vector 2.5 ±â€¯0.7 mm). 3D misalignment vector length was below 2 mm in 49.8%, between 2 and 7 mm in 46.3%, and over 7 mm in 3.9% of the beam-delivery-time. During the first 5 s of the DIBH, 3D-misalignment vector length was always below 10 mm. Percentage of target displacements over 10 mm was 0.2%, 0.5% and 0.8% for 10 s, 15 s and 20 s DIBH-duration. CONCLUSIONS: Ultrasound-based interfractional repositioning is an accurate method for daily localization of abdominal DIBH-SBRT targets. Residual motion is <7 mm in 96% of the beam-delivery-time. Deviations >10 mm occur rarely and can be avoided by gating the beam at a predefined threshold. Ideal DIBH-duration should not exceed 15 s.


Assuntos
Abdome/diagnóstico por imagem , Abdome/efeitos da radiação , Suspensão da Respiração , Posicionamento do Paciente/métodos , Doses de Radiação , Radiocirurgia/métodos , Cirurgia Assistida por Computador/métodos , Idoso , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Movimento , Fatores de Tempo , Ultrassonografia
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
20.
Anesth Analg ; 129(3): 896-904, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425235

RESUMO

BACKGROUND: Hypotension is associated with acute kidney injury, but vasopressors used to treat hypotension may also compromise renal function. We therefore tested the hypothesis that vasopressor infusion during complex spine surgery is not associated with impaired renal function. METHODS: In this retrospective cohort analysis, we considered adults who had complex spine surgery between January 2005 and September 2014 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative estimated glomerular filtration rate. Secondarily, we evaluated renal function using Acute Kidney Injury Network criteria. We obtained data for 1814 surgeries, including 689 patients (38%) who were given intraoperative vasopressors infusion for ≥30 minutes and 1125 patients (62%) who were not. Five hundred forty patients with and 540 patients without vasopressor infusions were well matched across 32 potential confounding variables. RESULTS: In matched patients, vasopressor infusions lasted an average of 173 ± 100 minutes (SD) and were given a median dose (1st quintile, 3rd quintile) of 3.4-mg (1.5, 6.7 mg) phenylephrine equivalents. Mean arterial pressure and the amounts of hypotension were similar in each matched group. The postoperative difference in mean estimated glomerular filtration rate in patients with and without vasopressor infusions was only 0.8 mL/min/1.73 m (95% CI, -0.6 to 2.2 mL/min/1.73 m) (P = .28). Intraoperative vasopressor infusion was also not associated with increased odds of augmented acute kidney injury stage. CONCLUSIONS: Clinicians should not avoid typical perioperative doses of vasopressors for fear of promoting kidney injury. Tolerating hypotension to avoid vasopressor use would probably be a poor strategy.


Assuntos
Lesão Renal Aguda/diagnóstico , Pressão Sanguínea/efeitos dos fármacos , Posicionamento do Paciente/métodos , Decúbito Ventral , Vasoconstritores/administração & dosagem , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/fisiopatologia , Adulto , Idoso , Pressão Sanguínea/fisiologia , Estudos de Coortes , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Decúbito Ventral/fisiologia , Estudos Retrospectivos , Vasoconstritores/efeitos adversos
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