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1.
Ann Vasc Surg ; 70: 370-377, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32603847

RESUMO

BACKGROUND: Arterial access and device delivery in endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have evolved from open femoral or iliac artery exposure to selective percutaneous arterial access. Although regional application of percutaneous access for these 2 procedures varies widely, the use of this technique continues to increase. Currently, differences in the use of percutaneous access between EVAR and TEVAR have not been well explored. The Gore Global Registry for Endovascular Aortic Treatment (GREAT) registry collected relevant data for evaluation of these issues and the comparative results between open and percutaneous approaches in regard to complication rates and length of stay (LOS). METHODS: This study was performed via a retrospective review of patients from the GREAT registry (Clinicaltrials.gov no. NCT01658787). The primary variable of this study was access site complications including postoperative hematoma, vessel dissection, and pseudoaneurysm. Patients were categorized by abdominal (EVAR) and thoracic (TEVAR) aortic procedures using percutaneous-only, cutdown-only, and combined vascular access techniques for a total of 6 groups. Standard statistical methodology was used to perform single-variable and multivariable analysis of a variety of covariates including LOS, geographical location of procedure, procedural success rate, and access sheath size. RESULTS: Of 4,781 patients from the GREAT registry, 3,837 (80.3%) underwent EVAR and 944 (19.7%) underwent TEVAR with percutaneous-only access techniques being used in 2,017 (42.2%) and cutdown-only in 2,446 (51.2%). There was variable application of percutaneous access by geographic region with Australia and New Zealand using this technique more frequently and Brazil using percutaneous access the least. No significant difference in the rate of access site complications was detected between the 6 groups of patients in the study; however, significantly lower rates of access site complications were associated with percutaneous-only compared with both cutdown-only and combined techniques (P = 0.03). In addition, associated with significantly higher rates of access site complications was longer LOS (P < 0.01). Average LOS was 5.2 days and was higher in the TEVAR group (10.1 days) than that in EVAR (4.0 days, P < 0.05). Increased sheath size does not appear to increase the risk of access site complication. CONCLUSIONS: There was no significant difference found in the complication rate between percutaneous and cutdown access techniques. This analysis demonstrates that percutaneous-only access is safe, has low complication rates, and has lower LOS compared with open access or combined access techniques.


Assuntos
Doenças da Aorta/cirurgia , Implante de Prótese Vascular , Cateterismo Periférico , Procedimentos Endovasculares , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Punções , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
2.
Ann Vasc Surg ; 70: 555-558, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32800886

RESUMO

One of the difficulties of the subintimal arterial flossing with antegrade-retrograde intervention technique (SAFARI) technique is to properly achieve a rendezvous between both antegrade and retrograde accesses. We propose a new technique to overcome this difficulty. It consists of directly percutaneously puncturing 2 loop snares, placed via each access, which are then both used to snare an externally introduced guidewire introduced through the needle. The snares are then moved en bloc, bringing both snares and the wire into the same channel.


Assuntos
Angioplastia com Balão , Artéria Femoral , Doença Arterial Periférica/terapia , Artéria Poplítea , Idoso de 80 Anos ou mais , Angioplastia com Balão/instrumentação , Constrição Patológica , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Punções , Resultado do Tratamento , Dispositivos de Acesso Vascular , Grau de Desobstrução Vascular
3.
Zhonghua Nan Ke Xue ; 26(1): 31-35, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33345474

RESUMO

Objective: To compare the efficiency and complications of transrectal ultrasound (TRUS)-guided prostate biopsy with a 16-gauge (16G) or an 18G puncture needle in the diagnosis of PCa. METHODS: This prospective randomized controlled study included 142 male patients undergoing TRUS-guided prostate biopsy in our hospital, 71 with the 16G and the other 71 with the 18G puncture needle. We compared the post-puncture incidence rates of hematuria, bleeding and infection between the two groups of patients and classified the complications according to the Clavien-Dindo scores. RESULTS: The detection rate of PCa was significantly lower in the 18G than in the 16G group (12.68% vs 36.62%, χ2 = 10.958, P = 0.001), even with f/tPSA ≤ 0.15 (8.51% vs 44.44%, χ2 = 12.617, P = 0.001), but showed no statistically significant difference between the two groups with f/tPSA > 0.15 (P<0.05). No post-puncture infection was observed in any of the patients. There were no statistically significant differences between the 18G and 16G groups in the incidence rates of rectal bleeding (21.13% vs 15.49%, χ2 = 0.753, P = 0.385) and urethral bleeding (18.31% vs 16.90%, χ2 = 0.049, P = 0.826), nor in Clavien-Dindo grades (26 vs 20 cases of grade I; no grade II in either group; 2 vs 3 cases of grade III ; Z = -0.698, P = 0.458). CONCLUSIONS: The 16G puncture needle can achieve a higher detection rate of PCa than the 18G needle in TRUS-guided prostate biopsy without increasing the incidence of complications.


Assuntos
Biópsia/instrumentação , Agulhas , Neoplasias da Próstata , Ultrassonografia de Intervenção , Humanos , Masculino , Estudos Prospectivos , Neoplasias da Próstata/diagnóstico , Punções
4.
BMC Infect Dis ; 20(1): 949, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308190

RESUMO

BACKGROUND: Intracranial infection after puncture of cerebral hematoma in patients with intracerebral hemorrhage is very common in the department of neurosurgery, yet the relevant risks remain unknown. We attempted to analyze the risk factors of intracranial infection after puncture of cerebral hematoma, to provide insights into the management of patients with intracerebral hemorrhage after puncture of cerebral hematoma. METHODS: Patients with intracerebral hemorrhage after puncture of cerebral hematoma treated in our hospital from January 2017 to January 2020 were selected, the related characteristics of intracranial infection and no infection patients were compared. Logistic regression analyses were conducted to analyze the risk factors for intracranial infection after puncture of cerebral hematoma. RESULTS: A total of 925 patients with puncture of cerebral hematoma were included. The incidence of postoperative intracranial infection was 7.03%. There were significant statistical differences between the infected group and the no infection group in the American Association of Anesthesiologists (ASA) grade, length of hospital stay, consecutive operation, duration of surgery, extra-ventricular drainage (EVD) use (all p < 0.05). There was statistically significant difference in the duration of EVD between the infection and no infection groups (p = 0.002), and there was no significant difference in the frequency of EVD insertion between the two groups (p = 0.094). The length of hospital stay≥10 days (OR1.832, 1.062-3.158), consecutive operation (OR2.158, 1.358-3.430), duration of surgery≥4 h (OR1.581, 1.031-2.425), EVD use (OR1.694, 1.074-2.670), and duration of EVD ≥ 7 days (OR2.699, 1.689-4.311) were the risk factors of intracranial infection in patients with intracerebral hemorrhage after puncture of cerebral hematoma (all p < 0.05). CONCLUSION: Clinical medical workers should take corresponding preventive measures against the different risk factors for prevention of intracranial infection in patient with puncture of cerebral hematoma.


Assuntos
Hemorragia Cerebral/cirurgia , Hematoma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Punções/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento , Adulto Jovem
5.
Zhonghua Yi Xue Za Zhi ; 100(46): 3684-3688, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33342145

RESUMO

Objective: To investigate the success rate, safety and repeatability of gadolinium (Gd)-enhanced inner ear magnetic resonance (MR) by tympanic membrane puncture. Methods: The imaging and clinical data of 1 126 cases with Gd-enhanced inner ear MR by tympanic membrane puncture from February 2010 to June 2020 were retrospectively analyzed. All cases were reexamined in the outpatient clinic after MR gadolinium contrast to check the tympanic membrane and external auditory canal. The success rate was identified by whether there was gadolinium contrast in the labyrinth. Meanwhile, the pure tone hearing threshold data of asymptomatic ears before and after gadolinium contrast was collected and compared. The consistency in the scores of the asymptomatic ears in patients who underwent twice Gd-enhanced MR was analyzed, in which the scores of vestibular, cochlea, and semicircular canals were acquired respectively. Results: Among 1 126 patients [including 506 males and 620 females, aged (54±17) years old], 45 were reviewed once, while 4 patients were reviewed twice. There were 958 cases who were examined on both sides, and 168 cases were checked only on one side. There were 166 cases of Meniere's disease (14.7%), 219 cases of sudden sensorineural hearing loss (19.5%) and 741 cases of being remained to be investigated (65.8%), respectively. A total of 2 084 ears underwent first gadolinium angiography, of which 63 ears had no contrast agent in the labyrinth, with a success rate of 97.0% (2 021/2 084). Only 1 case had tympanic membrane perforation while the rest had no complications. The hearing threshold before and after otography in 57 asymptomatic ears had no differences at any frequency (all P>0.05). Moreover, the consistency in the scores of two radiography within the 21 asymptomatic ears in vestibular and cochlea was good [both intraclass correlation coefficient (ICC) values>0.75]. Conclusion: The success rate and safety of Gd-enhanced inner ear MR is high by tympanic membrane puncture, and the results can be repeated well.


Assuntos
Gadolínio , Membrana Timpânica , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Membrana Timpânica/diagnóstico por imagem
6.
J Vasc Interv Radiol ; 31(12): 2098-2103, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33261744

RESUMO

PURPOSE: To investigate an augmented reality (AR)-guided endovascular puncture to facilitate successful transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: An AR navigation system for TIPS was designed. Three-dimensional (3D) liver models including portal and hepatic vein anatomy were extracted from preoperative CT images. The 3D models, intraoperative subjects, and electromagnetic tracking information of the puncture needles were integrated through the system calibration. In the AR head-mounted display, the 3D models were overlaid on the subjects, which was a liver phantom in the first phase and live beagle dogs in the second phase. One life-size liver phantom and 9 beagle dogs were used in the experiments. Imaging after puncture was performed to validate whether the needle tip accessed the target hepatic vein successfully. RESULTS: Endovascular punctures of the portal vein of the liver phantom were repeated 30 times under the guidance of the AR system, and the puncture needle successfully accessed the target vein during each attempt. In the experiments of live canine subjects, the punctures were successful in 2 attempts in 7 beagle dogs and in 1 attempt in the remaining 2 dogs. The puncture time of needle from hepatic vein to portal vein was 5-10 s in the phantom experiments and 10-30 s in the canine experiments. CONCLUSIONS: The feasibility of AR-based navigation facilitating accurate and successful portal vein access in preclinical models of TIPS was validated.


Assuntos
Realidade Aumentada , Procedimentos Endovasculares/instrumentação , Veias Hepáticas/cirurgia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Radiografia Intervencionista , Cirurgia Assistida por Computador/instrumentação , Animais , Angiografia por Tomografia Computadorizada , Cães , Estudos de Viabilidade , Veias Hepáticas/diagnóstico por imagem , Humanos , Modelos Animais , Flebografia , Veia Porta/diagnóstico por imagem , Derivação Portossistêmica Transjugular Intra-Hepática/instrumentação , Valor Preditivo dos Testes , Punções , Radiografia Intervencionista/instrumentação , Óculos Inteligentes
7.
No Shinkei Geka ; 48(11): 1029-1033, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199660

RESUMO

When it is difficult to approach the brachial or femoral artery during endovascular surgery, an alternative approach is the direct puncture of the carotid artery. In this case of a giant cerebral aneurysm, we punctured the carotid artery directly and performed flow diverter stent placement and endosaccular coil embolization. Although the procedure required two thick access routes, it was performed after administering two antiplatelet drugs and an anticoagulant in order to achieve reliable hemostasis of the puncture sites after the operation. Direct common carotid artery puncture through a cervical skin incision is useful, because it ensures multiple access routes safely and provides secure hemostasis of the puncture sites.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Prótese Vascular , Artéria Carótida Primitiva , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Punções , Stents
8.
Semin Vasc Surg ; 33(1-2): 16-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33218612

RESUMO

Both transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are competing endovascular alternatives to carotid endarterectomy for the treatment of atherosclerotic carotid artery stenosis. TF-CAS is an endovascular procedure associated with a long learning curve and higher periprocedural stroke and death rates during an operator's early experience. Estimates suggest that more than 50 cases are required to achieve outcomes similar to carotid endarterectomy. TCAR is a novel hybrid procedure combining direct common carotid artery access and cerebral blood flow reversal with carotid stent placement. In distinction from TF-CAS, TCAR has a rather short learning curve. A multi-institutional analysis showed that operators achieved technical proficiency after approximately 10 to 15 cases. This was reinforced by a large Society for Vascular Surgery, Vascular Quality Initiative Transcarotid Artery Revascularization Surveillance Project analysis that demonstrated that expertise peaked after approximately 20 cases. Both studies found that TCAR was not associated with an increased rate of stroke or death during operator's early experience. These data suggest that TCAR is readily learned and patients are not at increased risk during a surgeon's early experience.


Assuntos
Angioplastia com Balão , Estenose das Carótidas/terapia , Cateterismo Periférico , Competência Clínica , Artéria Femoral , Curva de Aprendizado , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/instrumentação , Cateterismo Periférico/efeitos adversos , Dispositivos de Proteção Embólica , Humanos , Punções , Fatores de Risco , Stents , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(44): e22468, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126302

RESUMO

RATIONAL: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES: The patient was diagnosed with a L1 VCF. INTERVENTIONS: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/lesões , Neuronavegação/métodos , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Cimentos para Ossos , Feminino , Humanos , Cifoplastia/métodos , Pessoa de Meia-Idade , Punções/métodos , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-33003591

RESUMO

Chronic renal failure patients undergoing hemodialysis complain of moderate pain from repeated punctures of the arteriovenous fistula. This study examined the optimal application time of thermotherapy for reducing pain, anxiety, and side effects during arteriovenous fistula puncture. This study was conducted as a single-blinded randomized controlled trial. The participants were arteriovenous fistula puncture patients with chronic renal failure who were divided into two thermotherapy groups and one control group. This study was approved by the institutional review board and registered with the Clinical Research Information Service (KCT0003768). Differences between groups regarding pain, anxiety, and side effects were analyzed using one-way ANOVA, the χ2 test, and the Scheffé test. A significant difference was observed between the 10-min and 20-min thermotherapy groups and the control group in terms of the pain they experienced. Additionally, more side effects were encountered in the 20-min thermotherapy group than in the 10-min group. The 10-min application of thermotherapy for an arteriovenous fistula puncture showed the same pain-reducing effect as the conventional 20-min application. The study confirmed a 10-min application of thermotherapy to be an effective nursing intervention for pain relief without side effects.


Assuntos
Ansiedade/prevenção & controle , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Hipertermia Induzida/métodos , Manejo da Dor/métodos , Dor Processual/prevenção & controle , Punções/efeitos adversos , Fístula Arteriovenosa , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Medição da Dor , Dor Processual/diagnóstico , Dor Processual/etiologia , Diálise Renal , Tempo , Resultado do Tratamento
13.
Anaesth Intensive Care ; 48(5): 381-388, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33021807

RESUMO

The reported incidence of post--dural puncture headache (PDPH) after neuraxial anaesthesia varies widely, depending on patient and procedural risk factors. Most previous studies have had small sample sizes and focused on obstetric patients. This study aimed to investigate the incidence of PDPH and factors associated with PDPH in non-obstetric and obstetric patients after neuraxial anaesthesia. We identified patients who underwent surgery with neuraxial anaesthesia between July 2010 and December 2017 from a Japanese nationwide inpatient administrative claims and discharge database. Factors associated with PDPH (body mass index (BMI), depression, spinal abnormalities, academic hospital and location of epidural anaesthesia) were examined using multivariable logistic analyses. The incidence of PDPH in non-obstetric patients after spinal anaesthesia, epidural anaesthesia and combined spinal epidural anaesthesia was 0.16%, 0.13% and 0.23% and in obstetric patients was 1.16%, 0.99% and 1.05%, respectively. Higher BMI was associated with decreased incidence of PDPH in non-obstetric patients receiving spinal anaesthesia and obstetric patients receiving epidural anaesthesia. In female patients receiving spinal anaesthesia, a history of depression was associated with increased incidence of PDPH. Being in an academic hospital was associated with decreased incidence of PDPH in male patients receiving spinal anaesthesia and female patients receiving spinal or epidural anaesthesia, but increased incidence of PDPH in male patients receiving epidural anaesthesia. Lumbar epidural anaesthesia was associated with increased incidence of PDPH in male patients, but decreased incidence of PDPH in obstetric patients compared with thoracic epidural anaesthesia. The present study identified several potential new risk factors for PDPH, and revealed that the incidence of PDPH in non-obstetric patients after neuraxial anaesthesia was lower than in obstetric patients.


Assuntos
Anestesia Obstétrica , Raquianestesia , Cefaleia Pós-Punção Dural , Anestesia Obstétrica/efeitos adversos , Raquianestesia/efeitos adversos , Placa de Sangue Epidural , Feminino , Cefaleia , Humanos , Incidência , Pacientes Internados , Japão/epidemiologia , Masculino , Cefaleia Pós-Punção Dural/epidemiologia , Cefaleia Pós-Punção Dural/etiologia , Gravidez , Punções , Fatores de Risco
14.
No Shinkei Geka ; 48(10): 895-901, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071224

RESUMO

We report the initial experience of the distal radial approach(DRA)via the anatomical snuffbox for various neuroendovascular procedures. DRA was attempted in 16 patients and catheterization of the targeted vessel was successfully performed in 15. In one patient, the puncture was successful, but the wire could not be advanced into the radial artery and a switch to the conventional transradial approach was needed. Among the 15 patients who underwent successful DRA, five patients underwent diagnostic cerebral angiography, five underwent coil embolization of a cerebral aneurysm, three underwent carotid artery stenting, one underwent liquid embolization of an arteriovenous malformation, and one underwent liquid embolization of a chronic subdural hematoma. Operability during the procedures was favorable and good hemostasis was obtained in all cases. There were no complications related to this approach. Our initial experience demonstrates that DRA is technically feasible for various neuroendovascular procedures. It can be a less invasive alternative to the conventional approach.


Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Humanos , Punções , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Stents
15.
Rev Med Suisse ; 16(711): 1970-1973, 2020 Oct 21.
Artigo em Francês | MEDLINE | ID: mdl-33085252

RESUMO

Arterial punctures are frequent procedures performed by hospital internists. It provides crucial information on acid-base status, oxygenation and the quality of gas exchanges. Nevertheless, this intervention is often painful and carries potential risks. This review aims to summarize the literature about this subject and to address the accuracy of the results obtained by point-of-care analysis.


Assuntos
Artérias/metabolismo , Gasometria/métodos , Punções/efeitos adversos , Humanos , Dor/etiologia , Sistemas Automatizados de Assistência Junto ao Leito
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 870-874, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047721

RESUMO

OBJECTIVE: To investigate the clinical effect of a modified arthroscopic outside-in suture technique in the treatment of meniscus tear using a spinal needle. METHODS: From January 2015 to October 2017, 95 patients treated with this method were followed-up. Among these cases, there were 36 males and 59 females. The age of the patients ranged from 16 to 77 years, (46.79±18.07) years in average. Among them, there were 28 patieats aged 16-35, 53 patients aged 36-65, and 14 patients aged over 65 years old. 28 cases were diagnosed with medial meniscus tear, 43 cases with lateral meniscus tear and 24 cases with both medial and lateral meniscus tear. Causes of the injury included sports, sprain, etc. According to Barrett standard, the clinical healing of meniscus tear was judged. Lysholm score, knee range of motion, visual simulation score (VAS) and magnetic resonance imaging (MRI) were used to evaluate the postoperative knee function and recovery of the patients. RESULTS: The 95 patients were followed up for 22 to 36 months, with an average of (28.32±3.98) months. According to Barrett standard, 90 patients (94.7%) obtained meniscus clinical healing. Meniscal healing rates were 96.43%, 96.23% and 85.71% in the three age groups, respectively. The meniscal healing rate was lower in the elderly group, but there was no significant difference in statistical results (P=0.262). Five patients had deep tenderness in the joint space of the injured side, and the overstretch test was positive. The preoperative and postoperative VAS scores, Lysholm scores and knee motion were compared in each group, and the differences were statistically significant (P < 0.01). At the end of the last follow-up, there were no cases of knee joint effusion, swelling and interlocking, and the joint function was effectively improved in most patients. No surgical site infection, periarticular vascular/nerve injury or knotting reaction was found during the follow-up. CONCLUSION: This modified arthroscopic outside-in suture technique using a spinal needle has the characteristics of simple operation, small trauma and rapid recovery, and the mid-term follow-up results were satisfactory. Therefore, we consider this method to be a safe and efficient method for the treatment of meniscus anterior horn and body tear.


Assuntos
Traumatismos do Joelho , Lesões do Menisco Tibial , Idoso , Artroscopia , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/cirurgia , Masculino , Punções , Técnicas de Sutura , Lesões do Menisco Tibial/cirurgia
18.
Herzschrittmacherther Elektrophysiol ; 31(4): 414-416, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33026472

RESUMO

The loss of a guidewire in the subclavian vein represents an unpleasant complication during pacemaker implantation with venous access by puncture in Seldinger's technique. Using another venous puncture and a gooseneck snare, this problem can be solved quickly and without any trace.


Assuntos
Marca-Passo Artificial , Veia Subclávia , Marca-Passo Artificial/efeitos adversos , Punções , Veia Subclávia/diagnóstico por imagem
19.
BMC Cardiovasc Disord ; 20(1): 398, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867684

RESUMO

BACKGROUND: Iatrogenic acute aortic dissection (AD) is an extremely rare but devastating complication during cardiac catheterization. It can be treated conservatively if it develops in a retrograde form or manifests as an intramural hematoma (IMH) with a micro-intimal tear in the absence of instability. However, only a few reports exist on its natural course and long-term outcomes. CASE PRESENTATION: A 78-year-old woman presented to the emergency department with acute chest discomfort. Elective cardiac catheterization was performed via the right radial artery. The patient's brachiocephalic artery was so tortuous that the hydrophilic soft guidewire had to be exchanged for a stiffer one. However, the stiff wire caused the dissection of a tortuous brachiocephalic artery that extended from the sinuses of Valsalva to the proximal descending aorta. Emergent computed tomography showed crescentic aortic wall thickening without a dissection flap. The patient had cardiac tamponade and a gradually thickening thrombosed false lumen. Although the patient was unstable during the first 2 weeks, she was stabilized during hospital stay with only conservative treatment. Consequently, she has been well for over 5 years. CONCLUSIONS: Even though the patient showed ominous findings, a good prognosis was expected because the AD was mainly retrograde. Furthermore, the thrombosed false lumen mimicked an IMH on imaging. To the best of our knowledge, this is the first report of an extensive iatrogenic AD originating from the brachiocephalic artery during right transradial catheterization that was treated conservatively despite clinical instability.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Aórtico/etiologia , Tronco Braquiocefálico/lesões , Cateterismo Cardíaco/efeitos adversos , Cateterismo Periférico/efeitos adversos , Doença Iatrogênica , Artéria Radial , Lesões do Sistema Vascular/etiologia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/terapia , Tronco Braquiocefálico/diagnóstico por imagem , Tratamento Conservador , Feminino , Humanos , Punções , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia
20.
Sci Rep ; 10(1): 15316, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943679

RESUMO

Sepsis is a major clinical challenge with unacceptably high mortality. The signal transducers and activators of transcription (STAT) family of transcription factors is known to activate critical mediators of cytokine responses, and, among this family, STAT3 is implicated to be a key transcription factor in both immunity and inflammatory pathways. We investigated whether in vivo introduction of synthetic double-stranded STAT3 decoy oligodeoxynucleotides (ODNs) can provide benefits for reducing organ injury and mortality in mice with cecal ligation and puncture (CLP)-induced polymicrobial sepsis. We found that STAT3 was rapidly activated in major end-organ tissues following CLP, which was accompanied by activation of the upstream kinase JAK2. Transfection of STAT3 decoy ODNs downregulated pro-inflammatory cytokine/chemokine overproduction in CLP mice. Moreover, STAT3 decoy ODN transfection significantly reduced the increases in tissue mRNAs and proteins of high mobility group box 1 (HMGB1) and strongly suppressed the excessive elevation in serum HMGB1 levels in CLP mice. Finally, STAT3 decoy ODN administration minimized the development of sepsis-driven major end-organ injury and led to a significant survival advantage in mice after CLP. Our results suggest a critical role of STAT3 in the sepsis pathophysiology and the potential usefulness of STAT3 decoy ODNs for sepsis gene therapy.


Assuntos
Ceco/metabolismo , Oligodesoxirribonucleotídeos/metabolismo , Fator de Transcrição STAT3/metabolismo , Sepse/metabolismo , Animais , Quimiocinas/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Regulação da Expressão Gênica/fisiologia , Proteína HMGB1/metabolismo , Inflamação/metabolismo , Janus Quinase 2/metabolismo , Ligadura/métodos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Punções/métodos , RNA Mensageiro/metabolismo , Transfecção/métodos
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