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1.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(6): 503-507, 2020 Dec 08.
Artigo em Chinês | MEDLINE | ID: mdl-33314858

RESUMO

According to the actual requirements of pediatric intensive care, a suction detection system of pediatric oral secretions integrated with monitoring function is designed. The system has the function of adjustable intermittent attraction. The duration and proportion of intermittent attraction can be adjusted according to the individualized needs of pediatric intensive care. The suction head of pacifier can reduce the mechanical damage to pediatric oral mucosa as much as possible. Meanwhile, the system can detect and monitor the real-time biochemical indexes of the collected oral secretions, which can be used to help the judgement of aspiration and quantitatively evaluate the microcirculation dysfunction.


Assuntos
Secreções Corporais , Boca , Sucção/instrumentação , Criança , Humanos
2.
Neurol India ; 68(5): 1170-1171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109869

RESUMO

Coronavirus disease (COVID-19) has posed immense challenges for healthcare workers, among them are procedures related to suctioning of bodily fluids during surgery or intensive care. These procedures are potentially aerosol-generating and can lead to disease transmission. We have modified the usual suction apparatus in a simple and easy to do manner so that all suctioned material first passes through the 0.1% sodium hypochlorite solution, which is virucidal and decontaminates the suctioned material. This innovation may help in addressing the safety concerns of all healthcare providers working in operation rooms and intensive care units.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sucção/instrumentação , Betacoronavirus , Infecções por Coronavirus/transmissão , Cuidados Críticos , Humanos , Controle de Infecções/métodos , Pneumonia Viral/transmissão , Hipoclorito de Sódio , Sucção/métodos , Procedimentos Cirúrgicos Operatórios
3.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(5): 318-325, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197610

RESUMO

INTRODUCCIÓN: Las infecciones osteoarticulares representan una complicación mayor en cirugía ortopédica. Se pretende identificar el porcentaje de cánulas de succión colonizadas y determinar la relación entre el tiempo de uso en cirugía y la colonización de estas. MATERIALES Y MÉTODOS: Estudio descriptivo y prospectivo que analiza 546 cánulas de succión utilizadas en cirugía ortopédica limpia en un centro de trauma, entre noviembre del 2017 a marzo del 2018. El extremo distal de la cánula fue cultivado para determinar la proporción de colonización. RESULTADOS: El 7,3% de las cánulas cultivadas tuvieron cultivos positivos para gérmenes patógenos, de los cuales el más frecuente fue Staphylococcus epidermidis con 27,5%. Además, se encontró asociación entre la colonización y el tiempo de uso de la cánula. La posibilidad de colonización de cánulas usadas entre 60 minutos o más, es mayor que en las que se usaron menos de 60 minutos; entre 60 y 90 minutos la posibilidad es dos veces mayor OR= 2,2 (IC:95% 1,1 - 4,1) y en las cánulas usadas por más de 90 minutos es 8 veces mayor OR= 8,49 (IC:95% 1,77 - 40,86). CONCLUSIONES: La proporción de colonización de las cánulas es menor a lo reportado en la literatura. El mayor tiempo de uso de la cánula en la cirugía aumenta el riesgo de la colonización de estas. Se considera realizar estudios de seguimiento para determinar si la colonización de las cánulas de succión se asocia a un incremento de infección postoperatoria


INTRODUCTION: Osteoarticular infections represent a major complication in orthopaedic surgery. The aim is to identify the percentage of suction cannulas colonised and to determine the relationship between the time they are used in surgery and the colonisation of these cannulas. MATERIALS AND METHODS: Descriptive and prospective study that analysed 546 suction cannulas used in clean orthopaedic surgery in a trauma centre, between November 2017 and March 2018. The distal end of the cannula was cultured to determine the colonisation rate. RESULTS: 7.3% of the cultured cannulas were positive for pathogens, the most frequent being Staphylococcus epidermidis at 27.5%. In addition, an association was found between colonisation and the length of time the cannula was used. The possibility of colonisation of cannulas used for between 60minutes or more, is greater than those used for less than 60 minutes; between 60 and 90 minutes the possibility is twice as high OR= 2.2 (CI:95% 1.1 - 4.1) and in cannulas used for more than 90 minutes it is 8 times higher OR= 8.49 (CI:95% 1.77 - 40.86). CONCLUSIONS: The colonisation rate of cannulas is lower than reported in the literature. The longer the cannula is used in surgery increases the risk of their colonisation. Follow-up studies are being considered to determine whether suction cannula colonisation is associated with increased postoperative infection


Assuntos
Humanos , Cânula/microbiologia , Sucção/instrumentação , Procedimentos Ortopédicos/estatística & dados numéricos , Doenças Ósseas Infecciosas/cirurgia , Contagem de Colônia Microbiana/métodos , Infecções Relacionadas a Cateter/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia
4.
J Int Med Res ; 48(8): 300060520949772, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32844707

RESUMO

OBJECTIVE: This study was performed to introduce an easy method of surgical smoke evacuation for patients with confirmed or suspected COVID-19 undergoing emergency surgery. METHODS: An easy, inexpensive, protective, and practical surgical smoke evacuation device/system was developed and is herein described. RESULTS: The use of this surgical smoke evacuation device/system in open surgery is convenient and effective. It allows for easy, economic, useful, and protective surgical smoke evacuation. CONCLUSIONS: COVID-19 infection causes direct mortality and morbidity, and its incidence has recently increased. Protection from electrosurgery-related smoke is recommended particularly during the current pandemic. This surgical smoke evacuation device/system is easy to use and provides a convenient and effective method of smoke evacuation during both open surgery and all cauterization interventions.


Assuntos
Infecções por Coronavirus/cirurgia , Eletrocoagulação/instrumentação , Eletrocirurgia/instrumentação , Pneumonia Viral/cirurgia , Sucção/instrumentação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Eletrocoagulação/métodos , Eletrocirurgia/métodos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Fumaça/prevenção & controle
8.
J Card Surg ; 35(7): 1492-1497, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436655

RESUMO

BACKGROUND: A new, self-contained, digital, continuous pump-driven chest drainage system is compared in a randomized control trial to a traditional wall-suction system in cardiac surgery. METHODS: One hundred and twenty adult elective cardiac patients undergoing coronary artery bypass graft and/or valve surgery were randomized to the study or control group. Both groups had similar pre/intra-operative demographics: age 67.8 vs 67.0 years, Euroscore 2.3 vs 2.2, and body surface area 1.92 vs 1.91 m2 . Additionally, a satisfaction assessment score (0-10) was performed by 52 staff members. RESULTS: Given homogenous intra-operative variables, total chest-tube drainage was comparable among groups (566 vs 640 mL; ns), but the study group showed more efficient fluid collection during the early postoperative phase due to continuous suction (P = .01). Blood, cell saver transfusions and postoperative hemoglobin values were similar in both groups. The study group experienced drain removal after 29.8 vs 38.4 hours in the control group (ns). Seven crossovers from the Study to the Control group were registered but no patient had drain-related complications. The Personnel Satisfaction Assessment scored above 5 for all questions asked. CONCLUSIONS: The new, digital, chest drainage system showed better early drainage of the chest cavity and was as reliable as conventional systems. Quicker drain removal might impact on intensive care unit (ICU) stay and reduce costs. Additional advantages are portable size, battery operation, patient mobility, noiseless function, digital indications and alarms. The satisfaction assessment of the new system by the staff revealed a higher score when compared to the traditional wall suction chest drainage system.


Assuntos
Ponte de Artéria Coronária , Valvas Cardíacas/cirurgia , Cuidados Pós-Operatórios/instrumentação , Sucção/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança , Sucção/economia , Cavidade Torácica , Adulto Jovem
9.
Am Surg ; 86(4): 346-353, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391759

RESUMO

Enterocutaneous fistulas (ECFs) requiring admission to ICU is a serious surgical complication. A growing number of patients survive ECFs but remain chronically critically ill. The aim of our study was to investigate the risk factors of hospital death in patients with chronic critical illness attributed to ECFs. A retrospective single-center study was conducted in 163 ECF patients between 2013 and 2017. Patient-specific baseline characteristics, outcomes, and process of care variables were collected. Risk factors for hospital mortality were determined using univariate and multivariate analyses. Patients were divided into the following two groups according to the hospital discharge outcome: group survivors (n = 106) and group nonsurvivors (n = 57). Patients who received active irrigation-suction drainage (AISD) within 24 hours after the diagnosis of ECFs had a significantly lower hospital mortality rate than those who received AISD after more than 24 hours (17.9% vs 46.9%, P < 0.001). Multivariate logistic regression analysis demonstrated that delayed AISD (adjusted odds ratio [AOR], 10.24; 95% confidence interval [CI], 3.03-34.59; P < 0.001) and no rehabilitation therapy (AOR, 4.77; 95% CI, 1.43-15.98; P = 0.011) were independently associated with a greater risk of hospital mortality. The hospital mortality rate in patients with more than or equal to four risk factors was 92.6 per cent (n = 57), compared with a mortality rate of 9.4 per cent (n = 106) in patients who did not have these risk factors (P < 0.001). The risk of hospital death is exceptionally high among patients with chronic critical illness attributed to ECFs. Efforts aimed at early AISD and rehabilitation therapy are likely to be associated with improved clinical outcomes.


Assuntos
Fístula Cutânea/terapia , Fístula Intestinal/terapia , Lavagem Peritoneal , Sucção , Adulto , Idoso , Doença Crônica , Estado Terminal , Fístula Cutânea/complicações , Feminino , Mortalidade Hospitalar , Humanos , Fístula Intestinal/complicações , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Lavagem Peritoneal/instrumentação , Estudos Retrospectivos , Fatores de Risco , Sucção/instrumentação
10.
World Neurosurg ; 138: 174-177, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147546

RESUMO

BACKGROUND: Resection of vestibular schwannomas with good functional outcome remains a neurosurgical challenge. In this study, we report on our initial experience with a suction spatula, which allows free bimanual dissection of small tumors in a clear, bloodless surgical field in supine position. METHODS: Forty-one patients underwent vestibular schwannoma surgery in supine position, using a suction spatula. To analyze its feasibility, 11 aspects of the device were compared with the regular retractor. RESULTS: The suction spatula was successfully applied in all surgeries. Compared with a common spatula, the suction spatula showed superior performance during meatotomy, microsurgical and endoscopic tumor dissection, and management of bleedings. We noted no difference in ergonomics, compatibility, instrumental conflict, costs, reusability, and sterilization issues. Minor performance was related to its thickness/size. There were no significant disadvantages according to our data. There were no surgical complications related to this device. CONCLUSIONS: The main advantage of the suction spatula is in the treatment of small, mainly intrameatal vestibular schwannomas in supine patient position. It gives the surgeon a "third hand" while enabling a continuous bimanual dissection with 2 microinstruments without the use of a regular suction tip.


Assuntos
Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Sucção/instrumentação , Adulto , Idoso , Feminino , Humanos , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Decúbito Dorsal
11.
Plast Reconstr Surg ; 145(4): 734e-743e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221207

RESUMO

BACKGROUND: Long-term aesthetic reduction of the legs in Asians is gaining increasing popularity among cosmetic patients. Current treatment options include botulinum toxin injection, radiofrequency, neurectomy, and total, subtotal, or partial muscle resection of the gastrocnemius. Partial resection using Kelly forceps was introduced in 2000. This article presents the use of a suction-assisted cartilage shaver to perform partial resection, describing the procedures and shaver modifications and evaluating its use. METHODS: A retrospective review of 71 cases with a minimum 6-month follow-up (average, 36.5 months; range, 6 to 160 months) was performed. Twenty partial calf reductions were performed with a short shaver, 27 with a long shaver, and 24 with an endoscope-guided long shaver. RESULTS: Mean reduction of calf circumference was 2 cm (range, -1 to 6 cm); the mean preoperative and postoperative calf circumferences were 35.8 cm and 33.8 cm, respectively. Mean tissue reduction per calf was 110 g (range, 25 to 300 g).Two patients developed larger calves after surgery, one because of weight gain and the other because of weight training. Complications included surface irregularity (n = 4, 5.6 percent), numbness over the lateral ankle or lateral foot (n = 9, 12.7 percent), hematoma clot requiring surgical evacuation (n = 11, 15.5 percent), prolonged seroma (n = 2, 2.8 percent), and left ankle plantar-flexion contracture due to tight, sustained postsurgery bandaging (n = 1, 1.5 percent). Scar-related complications were hyperpigmentation (n = 6, 8.5 percent), depressed scars (n = 5, 7 percent), and hypertrophic scars (n = 2, 2.8 percent). CONCLUSIONS: Short, long, and endoscope-guided long suction-assisted cartilage shavers for partial resection of calf muscles can be used effectively to reduce the calf. Several mostly treatable complications were noted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Contorno Corporal/instrumentação , Endoscopia/instrumentação , Músculo Esquelético/cirurgia , Miotomia/instrumentação , Complicações Pós-Operatórias/epidemiologia , Adulto , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Cicatriz/epidemiologia , Cicatriz/etiologia , Cicatriz/terapia , Contratura/epidemiologia , Contratura/etiologia , Contratura/terapia , Endoscopia/efeitos adversos , Endoscopia/métodos , Estética , Feminino , Seguimentos , Hematoma/epidemiologia , Hematoma/etiologia , Hematoma/terapia , Humanos , Hiperpigmentação/epidemiologia , Hiperpigmentação/etiologia , Hiperpigmentação/terapia , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Miotomia/efeitos adversos , Miotomia/métodos , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/etiologia , Seroma/terapia , Sucção/efeitos adversos , Sucção/instrumentação , Sucção/métodos , Adulto Jovem
12.
BJU Int ; 125(6): 898-904, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32077229

RESUMO

OBJECTIVE: To compare the safety and effectiveness of using a conventional nephrostomy sheath (NS) vs using a new NS with suction and evacuation functions in minimally invasive percutaneous nephrolithotomy (MPCNL) for the treatment of staghorn stones. PATIENTS AND METHODS: A prospective and randomised study of 60 patients with staghorn stones randomly assigned into two groups of 30 patients. One group underwent MPCNL using conventional NS, whereas the other group underwent MPCNL with suction-evacuation NS (SENS). Patient demographics, stone characteristics, intraoperative data, perioperative data, and surgical results were collected and analysed. RESULTS: The patient demographics and stone characteristics were similar amongst the two groups. The SENS group had a significantly lower peak and a significantly lower average renal pelvic pressure (RPP) throughout the procedure. The SENS group was more efficient for stone removal and had a much shorter stone treatment time, a lesser use of the stone extractor, and ultimately a higher stone-free rate (SFR). The effects of a lower RPP and shorter stone treatment time translated into less severe postoperative complications as measured per modified Clavien grade. CONCLUSION: Using SENS in MPCNL for the treatment of staghorn stones has the advantages of lower RPP, increased effectiveness in stone retrieval, decreased surgery related complications, and an improved SFR.


Assuntos
Nefrostomia Percutânea , Cálculos Coraliformes/cirurgia , Adulto , Desenho de Equipamento , Feminino , Humanos , Pelve Renal/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/instrumentação , Nefrostomia Percutânea/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Sucção/instrumentação
13.
Ann Vasc Surg ; 66: 362-369, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31931125

RESUMO

BACKGROUND: This study set out to assess the feasibility, effectiveness, and safety of percutaneous AngioJet aspiration thrombectomy combined with transcatheter thrombolysis for treating acute portal venous systemic thrombosis (APVST). METHODS: Clinical data of 13 patients with APVST who were treated by AngioJet aspiration thrombectomy combined with transcatheter thrombolysis from March 2017 to July 2018 were analyzed retrospectively. The effect of portal venous recanalization was evaluated by intraoperative angiography and postoperative surveillance of clinical findings, portal venous ultrasound, or computed tomography. RESULTS: Successful puncture of the portal vein (PV) was performed in all patients. The PV was punctured successfully in 7 patients via the transjugular intrahepatic route, 2 patients failed to be punctured and then had successful percutaneous transhepatic puncture, and 4 patients underwent percutaneous transhepatic PV puncture directly. The duration of thrombus aspiration was 238.46 ± 89.89 sec (range, 120-360), and the amount of urokinase in thrombus aspiration was 353,000 ± 87,700 IU (range, 200,000-400,000). Portal venous thrombosis was dissolved by the AngioJet thrombectomy device (Boston Scientific, Marlborough, MA) in all patients. After aspiration, angiography showed that grade III lysis was achieved in 8 patients, grade II lysis in 1 patient, and grade I lysis in 4 patients. The length of transcatheter thrombolysis was 3.07 ± 1.75 days (range, 1-7), and the total urokinase dose via an indwelling catheter was 1,230,000 ± 706,000 IU (range, 200,000-2,800,000). Four patients had a transjugular intrahepatic portosystemic shunt, 1 patient with stenosis of the superior mesenteric vein (SMV) achieved balloon angioplasty, and 1 patient with stenosis of the SMV was stented. Operative complications were transient hematuria (4 patients), palpitation (1 patient), and bowel resection (1 patient). No patients died within 30 days. Patients were discharged at 12.00 ± 5.83 days (range, 6-27) after admission. All patients survived, and no recurrence developed during the follow-up of 9.15 ± 3.18 months (range, 4-15). CONCLUSIONS: Percutaneous AngioJet aspiration thrombectomy combined with thrombolytic therapy is feasible and effective for APVST. This treatment is beneficial for APVST in dissolving thrombus, improving SMV flow, and relieving symptoms of PV hypertension.


Assuntos
Fibrinolíticos/administração & dosagem , Veia Porta , Trombectomia/instrumentação , Terapia Trombolítica , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Trombose Venosa/terapia , Doença Aguda , Adulto , Idoso , Terapia Combinada , Estudos de Viabilidade , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Punções , Estudos Retrospectivos , Sucção/instrumentação , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia
14.
Semin Thorac Cardiovasc Surg ; 32(2): 357-366, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31610232

RESUMO

In patients with alveolar-to-pleural air leak due to recent surgery or trauma, clinicians tend to manage chest tubes with suction therapy. Nonsuction therapy is associated with shorter chest tube duration but also a higher risk of pneumothorax. We sought to develop an intrapleural electrical impedance sensor for continuous, real-time monitoring of pneumothorax development in a porcine model of air leak as a means of promoting nonsuction therapy. Using thoracoscopy, 2 chest tubes and the pleural impedance sensor were introduced into the pleural space of 3 pigs. Continuous air leak was introduced through 1 chest tube by carbon dioxide insufflation. The second chest tube was placed to suction then transitioned to no suction at increasingly higher air leaks until pneumothorax developed. Simultaneously, real-time impedance measurements were obtained from the pleural sensor. Fluoroscopy spot images were captured to verify the presence or absence of pneumothorax. Statistical Analysis Software was used throughout. With the chest tube on suction, a fully expanded lung was identified by a distinct pleural electrical impedance respiratory waveform. With transition of the chest tube to water seal, loss of contact of the sensor with the lung resulted in an immediate measurement of infinite electrical impedance. Pneumothorax resolution by restoring suction therapy was detected in real time by a return of the normal respiratory impedance waveform. Pleural electrical impedance monitoring detected pneumothorax development and resolution in real time. This simple technology has the potential to improve the safety and quality of chest tube management.


Assuntos
Pleura/fisiopatologia , Pneumotórax/diagnóstico , Transdutores , Animais , Tubos Torácicos , Modelos Animais de Doenças , Impedância Elétrica , Desenho de Equipamento , Pneumotórax/fisiopatologia , Pneumotórax/terapia , Valor Preditivo dos Testes , Sucção/instrumentação , Sus scrofa , Fatores de Tempo
15.
Ann Vasc Surg ; 63: 458.e1-458.e6, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31648033

RESUMO

The aim of this study is to report the outcome of immediate and direct revascularization by mechanical thrombectomy in acute limb ischemia due to thrombosed popliteal artery aneurysm (PAA). Two patients with acute limb ischemia due to PAA thrombosis were admitted at our hospital, and immediately treated by mechanical thrombectomy (Indigo System). The first patient had a complete recanalization after thrombectomy, while the second one required urokinase infusion (12 hr) due to a suboptimal result. After revascularization, both patients were treated by a polytetrafluoroethylene bypass to definitively exclude PAA. Follow-up showed the patency of the femoropopliteal bypass with good distal outflow. In these 2 reported cases, the Indigo System® has proven to be safe and effective, allowing an immediate limb reperfusion, reducing the necessity for thrombolytic drug infusion.


Assuntos
Aneurisma/terapia , Isquemia/terapia , Artéria Poplítea , Trombectomia/instrumentação , Trombose/terapia , Doença Aguda , Idoso , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/fisiopatologia , Sucção/instrumentação , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
Ann Thorac Surg ; 109(1): e63-e65, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31518590

RESUMO

Proper positioning of the heart through a small left thoracotomy is the main challenge during off-pump minimally invasive cardiac coronary artery bypass grafting. Here we report a novel technique for target vessel exposure using the Tentacles NEO (Sumitomo Bakelite, Co Ltd, Tokyo, Japan) multisuction heart positioner, a device with 3 independent small suction cups that can be applied to various surfaces of the heart and pulled toward any direction using attached traction cords. The armless design of the device enables the use of flexible exposure techniques and contributes to the safety and feasibility of minimally invasive coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/instrumentação , Toracotomia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Desenho de Equipamento , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Sucção/instrumentação , Toracotomia/métodos
17.
Rofo ; 192(3): 257-263, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31514211

RESUMO

PURPOSE: A first-pass, direct aspiration technique and stent retrieval with a balloon guide catheter represent advanced thrombectomy techniques that are increasingly being used in the clinical routine. The purpose of this experimental study was to evaluate whether the techniques' effectiveness depended on the clot composition and to visualize the interaction between the devices and the clot. MATERIALS AND METHODS: Erythrocyte-rich (red) and fibrin-rich (white) clots were placed into the M1-segment of the middle cerebral artery in a transparent vascular phantom with physiological architecture. Physiological hemodynamic conditions were maintained with a programmable pump. On the one hand direct aspiration with a 5F aspiration catheter (ADAPT) and on the other hand stent retrieval with a balloon guide catheter (flow arrest/reversal) was performed. The experiments were made under direct visual control to observe the interaction between the devices and the clot. The primary end points were the number of passes/maneuvers and the occurrence of distal emboli and emboli in a new territory (anterior cerebral artery), until full recanalization was achieved. The experiment was filmed with a full high-definition camera identifying emboli. RESULTS: Six experiments were conducted for each technique and clot model. Red clots were retrieved by ADAPT with fewer passes and distal emboli, and could usually be aspirated directly at the occlusion site. White clots clogged the tip of the 5F aspiration catheter in every experiment. The catheter had to be pulled back into the long sheath in the cervical internal carotid artery, producing distal emboli. White clots were retrieved by the stent retriever and balloon guide catheter with fewer distal emboli. There was no difference in the number of passes. The stent-thrombus interaction was superficial in both clot models. Successful retrieval was granted by the flow arrest and proximal aspiration/flow reversal. One embolus in a new territory developed when using each technique in white clots. CONCLUSION: This experimental study showed that the efficacy of advanced thrombectomy techniques might depend on clot composition. Identifying the right technique for the right clot might improve the results of thrombectomy. In a clinical setting the thrombus morphology in non-enhanced CT could be used as a marker for patient selection. KEY POINTS: · The efficacy of thrombectomy seems to depend on thrombus composition.. · ADAPT might be more effective for rbc-rich clots.. · Thrombectomy with BGC might be more effective for fibrin-rich clots.. CITATION FORMAT: · Madjidyar J, Pineda Vidal L, Larsen N et al. Influence of Thrombus Composition on Thrombectomy: ADAPT vs. Balloon Guide Catheter and Stent Retriever in a Flow Model. Fortschr Röntgenstr 2020; 192: 257 - 263.


Assuntos
Embolectomia com Balão/instrumentação , Infarto da Artéria Cerebral Média/terapia , Stents , Sucção/instrumentação , Trombectomia/instrumentação , Desenho de Equipamento , Eritrócitos , Humanos , Modelos Cardiovasculares , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
J Neurointerv Surg ; 12(1): 72-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273074

RESUMO

INTRODUCTION: Improved functional outcomes after mechanical thrombectomy for emergent large vessel occlusion depend on expedient reperfusion after clinical presentation. Device technology has improved substantially over the years, and several commercial options exist for both large-bore aspiration catheters and suction pump systems. OBJECTIVE: To compare various vacuum pumps and examine the aspiration forces they generate as well as the force of catheter tip detachment from an artificial thrombus. METHODS: Using an artificial thrombus made from polyvinyl alcohol gel, we tested various mechanical characteristics of commercially available suction pumps, including the Penumbra Jet Engine, Penumbra Max, Stryker Medela AXS, Microvention Gomco, and a 60 cc syringe. Both aspiration pressure and tip force generated were analyzed. Subsequently, a cohort of thrombectomy catheters were assessed using the Penumbra Jet Engine to determine tip forces generated on an artificial thrombus. One-way analysis of variance was used to assess statistical significance. RESULTS: The Penumbra Jet Engine system generated both the highest maximum aspiration pressures (28.8 inches Hg) and the highest tip force (23.68 grams force (gf)) on an artificial thrombus, with statistical significance compared with the other pump systems. Using the Jet Engine, the largest-bore catheter was associated with the highest tip force (32.12 gf). The overall correlation coefficient between catheter inner diameter and tip force was 0.98. CONCLUSIONS: The Penumbra Jet Engine pump generates significantly higher vacuum pressures and tip forces than the other commercially available aspiration pump systems. Furthermore, catheters with a larger inner diameter generate higher tip suction forces on aspiration. Whether these mechanical features lead to improved clinical outcomes is yet to be determined.


Assuntos
Trombectomia/instrumentação , Trombectomia/métodos , Curetagem a Vácuo/instrumentação , Curetagem a Vácuo/métodos , Cateteres , Humanos , Sucção/instrumentação , Sucção/métodos , Seringas , Resultado do Tratamento
19.
Ann Thorac Surg ; 110(1): e55-e57, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31862493

RESUMO

We describe a patient with polytrauma that included anterior chest flail caused by a fall while climbing. As the situation was similar to a pectus excavatum, we attempted to stabilize the depressed chest wall by using a vacuum bell. Deep breath, peak flow, and pectus index were increased when the patient used the vacuum bell. Conservative treatment with a vacuum bell during the day and continuous positive airway pressure during the night was undertaken for 6 weeks. This report documents stabilization of an anterior flail chest using a vacuum bell.


Assuntos
Tórax Fundido/terapia , Sucção/instrumentação , Desenho de Equipamento , Feminino , Tórax Fundido/diagnóstico , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Vácuo
20.
Medicine (Baltimore) ; 98(51): e18511, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861038

RESUMO

BACKGROUND: Peri-prosthetic seroma after implant insertion for breast reconstruction is a common but difficult-to-manage complication. This study aimed to compare peri-prosthetic seroma duration and the number of aspirations associated with intravenous cannula with those associated with conventional needle. METHODS: Seventy-one patients who underwent skin- or nipple-sparing mastectomy and implant insertion were treated for peri-prosthetic seroma. When peri-prosthetic seroma was detected, ultrasound-guided aspiration was performed either by using an intravenous cannula (n = 35) or a conventional needle (n = 36); however, the method adopted was randomly selected. We analyzed the participants' clinicopathologic factors after medical record review. RESULTS: There were no significant intergroup differences in mean age (P = .052), mean body mass index (P = .601), total clinical tumor size (P = .107), pathologic tumor size (P = .269), specimen weight (P = .147), implant size (P = .313), or operation time (P = .595). However, the mean total peri-prosthetic seroma volume was significantly higher (105.80 vs 88.58, P = .015) but the number of aspirations was lower (4.48 vs 5.80, P = .043) in the intravenous cannula group than in the conventional needle group. Mean peri-prosthetic seroma volume per aspiration was nonsignificantly higher in the intravenous cannula group (26.92 vs 19.14, P = .291). CONCLUSION: Ultrasound-guided aspiration performed using an intravenous cannula was comparable to the procedure performed using a conventional needle. Furthermore, the former method can be safer and effective alternative to manage peri-prosthetic seroma.


Assuntos
Doenças Mamárias/cirurgia , Implante Mamário/efeitos adversos , Seroma/cirurgia , Ultrassonografia de Intervenção/instrumentação , Adulto , Doenças Mamárias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Seroma/etiologia , Sucção/instrumentação , Sucção/métodos
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