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2.
J Clin Neurosci ; 90: 251-255, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275558

RESUMO

OBJECTIVE: To explore the clinical significance of intraoperative ultrasound in neurosurgery for hypertensive intracerebral hemorrhage (ICH). METHODS: Patients with hypertensive ICH who required to undergo surgical treatment were assigned into treatment group (126 cases), who were assisted by intraoperative ultrasound, and control group (122 cases), who were not assisted by intraoperative ultrasound. In the treatment group, intraoperative ultrasound was used for real-time positioning after opening the bone flap, so as to guide the surgery. After surgery, conventional treatment and follow-up were conducted, and the statistical analysis was eventually performed to compare the therapeutic efficacy of the two groups. RESULTS: The mean rate of hematoma clearance was (95.20 ± 5.18)% in the treatment group and (86.20 ± 4.85)% in the control group (P<0.05); the average time required for intraoperative hematoma clearance was 44.5±3.2 min in the treatment group and 66.3±5.1 min in the control group (P < 0.05). Finally, the treatment group was superior to the control group in terms of therapeutic efficacy and overall prognosis (P = 0.03 and 0.025, respectively). CONCLUSIONS: Intraoperative ultrasound possessed the features of precise positioning, real-time guidance, and being user-friendly, which can shorten the operation time, increase the efficacy of surgery, and improve patients' overall prognosis, highlighting high clinical significance of intraoperative ultrasound in neurosurgery.


Assuntos
Craniectomia Descompressiva/métodos , Hemorragia Intracraniana Hipertensiva/cirurgia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Feminino , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Emerg Med Clin North Am ; 39(3): 529-554, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215401

RESUMO

Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.


Assuntos
Medicina de Emergência Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia de Intervenção , Abscesso/diagnóstico por imagem , Abscesso/cirurgia , Artrocentese/métodos , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Criança , Drenagem/métodos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Articulação do Quadril/diagnóstico por imagem , Humanos , Intubação Intratraqueal/métodos , Bloqueio Nervoso/métodos , Paracentese/métodos , Nervos Periféricos/diagnóstico por imagem , Abscesso Peritonsilar/diagnóstico por imagem , Abscesso Peritonsilar/terapia , Punção Espinal/métodos
4.
Medicine (Baltimore) ; 100(27): e26394, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232171

RESUMO

INTRODUCTION: Immersive virtual reality (IVR)-based training is gaining ground as an educational tool in healthcare. When combined with well-established educational methods, IVR can potentially increase competency and autonomy in ultrasound (US)-guided peripheral venous cannulation.The aim of this study was to examine the impact of adding IVR training to a course in US-guided peripheral venous cannulation. METHODS: Medical students (n = 19) from the University of Southern Denmark with no former standardized US education were recruited to voluntarily participate in a pilot study, designed as a randomized controlled trial. The primary outcome was the proportion of successful peripheral venous cannulations on a phantom. Secondary outcomes included the proportion of surface punctures on the phantom and procedure time. Participants received e-learning on the basic US before randomization to either IVR (n = 10) or no further training (n = 9). The additional IVR training comprised 10 virtual scenarios for US-guided peripheral venous catheter (PVC) placement. Students were subsequently evaluated in peripheral venous cannulation by a blinded assessor. RESULTS: The proportion of successful peripheral venous cannulations was significantly higher in the IVR group (P ≤ .001). The proportions of successful cannulations were significantly higher in the IVR group compared to the control group for the 1st and 2nd PVC (P = .011, P = .023), but not for the 3rd PVC (P = .087). Similar results were found for the proportion of surface punctures (1st: P ≤ .001, 2nd: P = .001, and 3rd: P = .114). No significant differences in procedure times were found between the groups. CONCLUSION: This pilot study showed that adding an IVR-based training simulation to an existing e-learning curriculum significantly increased the learning efficacy of US-guided PVC placement for medical students.


Assuntos
Cateterismo Periférico/métodos , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Treinamento por Simulação/métodos , Estudantes de Medicina , Ultrassonografia de Intervenção , Realidade Virtual , Adulto , Feminino , Humanos , Aprendizagem , Masculino , Projetos Piloto , Adulto Jovem
5.
Medicine (Baltimore) ; 100(27): e26527, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232187

RESUMO

ABSTRACT: Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The purpose of our study was to evaluate the appropriate local anesthetic volume by comparing intraoperative analgesics and hemodynamic changes in ISB in arthroscopic shoulder surgery.Overall, 1007 patients were divided into groups 1, 2, and 3 according to the following volume of local anesthetics: 10-19, 20-29, and 30-40 mL, respectively. The use of intraoperative analgesics and sedatives, and the reduction in intraoperative maximum blood pressure and heart rate were compared through retrospective analysis.Fentanyl was used in 55.6% of patients in group 1, which was significantly higher than in those groups 2 and 3 (22.3% and 30.7%, respectively); furthermore, it was also higher than those in groups 2 and 3 in dose-specific comparisons (P < .05). The percent of the maximum reduction in intraoperative systolic blood pressure and heart rate in group 3 was significantly higher than those in groups 1 and 2. Ephedrine administration was lower in group 2 than that in other groups (P < .05). The incidence of hypotensive bradycardic events was lowest (9.1%) at the local anesthetic volume of 24 mL as revealed by the quadratic regression analysis (R2 = 0.313, P = .003).Decreasing the local anesthetic volume to less than 20 mL for ultrasound-guided ISB as the sole anesthesia increases the opioid consumption during shoulder arthroscopic surgery. Local anesthetics >30 mL or increased opioid consumption with <20 mL of local anesthetics could increase the risk of cardiovascular instability intraoperatively. Our findings indicate that 24 mL of local anesthetic could be used to lower the incidence of hypotensive bradycardic events.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Artropatias/cirurgia , Dor Pós-Operatória/prevenção & controle , Articulação do Ombro/cirurgia , Anestesia Local , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção
6.
Zhonghua Yi Xue Za Zhi ; 101(27): 2147-2151, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34275250

RESUMO

Objective: To investigate the serratus anterior plane block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy. Methods: From October 2020 to February 2021, Sixty-four patients of Beijing Tongren Hospital, Capital Medical University scheduled for radical mastectomy with general anesthesia,were divided into two groups (n = 32 each) using a random number table method: thoracic paravertebral block group (TPVB group) and serratus anterior plane block combined with pectoral nerves block I group (S&P group). All patients received patient controlled intravenous analgesia (PCIA) postoperatively. The numerical rating scale (NRS) at post anesthesia care unit (PACU), 4, 8, 12, 24, 48 h after operation were compared between the two groups. Sufentanil cumulative dosage of PCIA in 24 h and 48 h, first press time after operation, total press times, the dosage of propofol, remifentanil and vasoactive drugs during operation, intraoperative blood pressure and heart rate, the operation time of block and adverse effects were all compared. Non-inferiority could be claimed if the difference of sufentanil cumulative dosage in 24 h between S&P group and TPVB group is higher than the negative value (-3.8) of the non-inferiority effect. Results: There was no significant difference in postoperative NRS at PACU, 4, 8, 12, 24, 48 h after operation, first press time after operation, total press times, propofol and remifentanil dosage, sufentanil cumulative dosage of PCIA in 24 h and 48 h, and adverse effects (all P>0.05). The sufentanil cumulative dosage of PCIA in 24 h of S&P group and of TPVB group were (15.8±4.7) µg and (15.2±3.2) µg. The 95% confidence interval (CI) of the difference between S&P group and of TPVB group was -1.478 to 2.694, and the lower limit was greater than non-inferiority margin -3.8. The mean arterial pressure of TPVB patients after induction and at the beginning of the operation were (63±7) mmHg and (70±7) mmHg, which were significantly lower than the (77±5) mmHg and (79±8) mmHg at the same time in the combination group (both P<0.05). The frequency of vasoactive drugs usage in TPVB group was 56.3%, which was statistically significant higher than the 18.8% in S&P group (P<0.01). Nerve block time in TPVB group was 10 (9, 11) min, which was significantly longer than 8 (6, 10) min in S&P group (P<0.01). Conclusion: The serratus anterior block combined with pectoral nerves block I can produce a non-inferior analgesic effect compared with thoracic paravertebral block for radical mastectomy, and the intraoperative hemodynamics is more stable and the block time is shorter than that of thoracic paravertebral block for radical mastectomy.


Assuntos
Neoplasias da Mama , Bloqueio Nervoso , Nervos Torácicos , Analgésicos , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Mastectomia Radical , Dor Pós-Operatória , Ultrassonografia de Intervenção
7.
Am J Case Rep ; 22: e933002, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34276044

RESUMO

BACKGROUND Elevated liver enzymes is a common clinical problem with many possible etiologies, yet some are rare and can be missed. Patients with sickle cell disease (SCD) may be at risk of liver disease due to recurrent blood transfusion predisposing to viral hepatitis. Furthermore, recurrent transfusions can increase the risk of iron overload, which can create deposits in the liver, eventually resulting in chronic liver disease. Liver biopsy is an essential tool to establish a diagnosis of liver disease in many patients with unexplained elevation of liver enzymes. Recently, endosocpic ultrasound (EUS)-guided liver biopsy has been shown to be safe and effective in obtaining adequate liver tissue. However, the safety and efficacy has not been established in patients with SCD. CASE REPORT A 59-year-old man with SCD and beta-thalassemia minor was evaluated for persistently elevated liver enzymes (mainly cholestatic). He had a background history of treated hepatitis C virus infection. He had multiple blood transfusions in the past for sickle cell crisis. A diagnostic work-up revealed negative viral and autoimmiune serology and no evidence of biliary obstruction on abdominal imaging. The iron profile was elevated, consistent with iron overload. An EUS-guided liver biopsy confirmed a diagnosis hepatic hemosiderosis secondary to long-term blood transfusions. CONCLUSIONS This report emphasizes the importance of careful monitoring of iron levels in patients with hematological conditions requiring long-term blood transfusions. In addition, it highlights the emerging role of EUS-guided liver biopsy as a safe and accurate alternative to percutaneous liver biopsy.


Assuntos
Anemia Falciforme , Sobrecarga de Ferro , Hepatopatias , Anemia Falciforme/complicações , Humanos , Biópsia Guiada por Imagem , Fígado/diagnóstico por imagem , Hepatopatias/etiologia , Masculino , Pessoa de Meia-Idade , Ultrassonografia de Intervenção
8.
J Interv Cardiol ; 2021: 9915759, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220369

RESUMO

Background: Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes. Methods: Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions. Results: 72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm2 vs. 5.05 ± 1.39 mm2 vs. 4.85 ± 1.76 mm2; P < 0.01), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; P < 0.01), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; P < 0.01). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, P=0.004) or positive remodeling lesions (4.8%, P=0.06). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542-15.251, P=0.007). Conclusion: IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Ultrassonografia de Intervenção , Remodelação Vascular , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/terapia , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos
9.
Artigo em Chinês | MEDLINE | ID: mdl-34304490

RESUMO

Objective:To compare the efficacy and safety of ultrasound-guided local injection of the mixture of dexamethasone(DEX) with lidocaine and oral prednisolone(PSL) in treating patients with subacute thyroiditis. Methods:Ninety-three patients with subacute thyroiditis were divided into group A(n=48) and Group B(n=45). Group A was treated with ultrasound-guided subcapsular injection in thyroid lesion area, while group B was treated with oral medication. The pain relief time, the duration of treatment, thyroid function recovery, recurrence rate, concurrent hypothyroidism, and drug side effects were compared between the two groups. Results:After 6 months of follow-up, the pain relief time, the duration of treatment and thyroid function recovery in group A were significantly shorter than those in group B (P<0.05), but not the recurrence rate and hypothyroidism(P>0.05). Conclusion:Compared with oral PSL treatment, ultrasound-guided local injection of DEX and lidocaine mixture can quickly relieve pain, shorter the duration of treatment and lower adverse reactions.


Assuntos
Lidocaína , Tireoidite Subaguda , Dexametasona/uso terapêutico , Humanos , Injeções , Lidocaína/uso terapêutico , Tireoidite Subaguda/tratamento farmacológico , Ultrassonografia de Intervenção
10.
Artigo em Chinês | MEDLINE | ID: mdl-34304533

RESUMO

Objective:To explore the application value of high frequency ultrasound and ultrasound-guided fine needle aspiration biopsy(US-FNAB) in the diagnosis of papillary thyroid microcarcinoma(PTMC), and to compare the characteristics and value of the two methods, so as to find a more convenient and non-invasive diagnostic method of PTMC, reduce unnecessary puncture and operation. Methods:The data of 190 postoperative pathologically confirmed PTMC patients admitted to Henan Province Cancer Hospital and Henan Provincial Hospital from January to June 2020 were retrospectively analyzed, with a total of 305 nodules, including 198 PTMC nodules and 107 benign thyroid nodules(BTN). According to the postoperative pathological results, they were divided into groups, and the relationship between the ultrasound appearance of the nodules and whether the cervical lymph nodes could be explored and PTMC was analyzed by chi-square test and logistic regression, and its diagnostic value was evaluated. The Kappa consistency test was used to analyze the consistency between ultrasound, FNAB and surgical pathological diagnosis results. The accuracy, sensitivity and specificity of high-frequency ultrasound and US-FNAB were compared, and the ROC curve was used to calculate the maximum area under the curve to evaluate its effectiveness. Results:The chi-square test showed that there were statistically significant differences in the morphology, margin, internal echo, echo uniformity, calcification, aspect ratio, blood flow signal, and whether the cervical lymph nodes can be detected and other ultrasound signs between the PTMC group and the BTN group. Logistic regression analysis showed that irregular shape, unclear edges, internal hypoechoic, intranodular calcification are independent risk factors for PTMC. By consistency test, the consistency between high-frequency ultrasound, US-FNAB examination and surgical pathological diagnosis was good, Kappa value was 0.802 and 0.893(P<0.05). Each nodule was examined by high-frequency ultrasound, and the diagnostic sensitivity, specificity, accuracy and AUC were 95.45%, 83.18%, 91.15% and 0.877 respectively. US-FNAB was performed on 189 of 305 thyroid nodules, and the diagnostic sensitivity, specificity, accuracy and AUC were 96.03%, 93.65%, 95.24% and 0.948 respectively. Conclusion:High frequency ultrasonic features such as internal hypoechoic, calcification in the nodules, unclear edges, and irregular morphology are of high value for the diagnosis of PTMC. Through data analysis, both high-frequency ultrasound and US-FNAB examination have high diagnostic value for PTMC. Compared with US-FNAB, high-frequency ultrasound has the advantages of low examination cost, non-invasive, simple operation and so on. For some patients with PTMC who do not have high risk factors, ultrasound can be used to actively monitor disease progression to avoid some unnecessary surgery.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Carcinoma Papilar , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia de Intervenção
11.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(7): 1044-1049, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34308854

RESUMO

OBJECTIVE: To investigate the efficacy and safety of intravascular ultrasound (IVUS)-guided rotational atherectomy (RA) combined with cutting balloon for pretreatment of severe calcified lesions in the coronary artery before stent placement. METHODS: A total of 120 patients with severe coronary artery calcifications detected by IVUS that required percutaneous coronary intervention (PCI) were recruited from our hospital between January, 2016 to January, 2019. The patients were randomized into two groups for pretreatment of the lesions with semicompliant balloon (SB group, 60 cases) or RA combined with CB (RA+CB group, 60 cases), and drug-eluting stents were implanted after the procedure. The immediate success rate of PCI, vascular parameters detected by IVUS after PCI, and the rates of residual stenosis < 10% were compared between the two groups. The incidences of intraoperative complications and major adverse cardiac events (MACE) within 24 months after the surgery were also observed in the two groups. RESULTS: The immediate success rate was significantly higher in RA+CB group than in SB group (P=0.032). After pretreatment and stent placement, the minimum stent lumen diameter (P=0.035), minimum stent lumen cross-sectional area (P=0.029), immediate lumen acquisition, immediate lumen cross-sectional area acquisition and the rate of residual stenosis < 10% were all significantly higher in RA+CB group than in SB group (P < 0.001). The patients in RA+ CB group showed obviously less residual stenosis of lumen cross-sectional area than those in SB group after the surgery (χ2= 7.859, P=0.005). The incidences of intraoperative complications (χ2=5.997, P=0.014) and MACE within 24 months after the operation (χ2=4.285, P=0.038) were significantly lower in RA+CB group than in SB group. CONCLUSION: For patients with severe coronary artery calcifications eligible for PCI, RA combined with CB angioplasty can significantly improve the success rate of immediate PCI, expand the lumen diameter and cross-sectional area of the stent after PCI, enhance immediate lumen gain, and reduce the incidence of intraoperative complications and MACE after the operation.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Calcificação Vascular , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Resultado do Tratamento , Ultrassonografia de Intervenção , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/cirurgia
12.
Sensors (Basel) ; 21(11)2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34198822

RESUMO

Intravascular ultrasound (IVUS) is a valuable imaging modality for the diagnosis of atherosclerosis. It provides useful clinical information, such as lumen size, vessel wall thickness, and plaque composition, by providing a cross-sectional vascular image. For several decades, IVUS has made remarkable progress in improving the accuracy of diagnosing cardiovascular disease that remains the leading cause of death globally. As the quality of IVUS images mainly depends on the performance of the IVUS transducer, various IVUS transducers have been developed. Therefore, in this review, recently developed mechanically rotating IVUS transducers, especially ones exploiting piezoelectric ceramics or single crystals, are discussed. In addition, this review addresses the history and technical challenges in the development of IVUS transducers and the prospects of next-generation IVUS transducers.


Assuntos
Transdutores , Ultrassonografia de Intervenção , Estudos Transversais , Desenho de Equipamento , Ultrassonografia
13.
Medicina (Kaunas) ; 57(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205371

RESUMO

Background and Objectives: Ultrasound (US)-guided cervical selective nerve root block (SNRB) is a widely used treatment for upper limb radicular pain. The long thoracic nerve (LTN) passes through the middle scalene muscle (MSM) at the C7 level. The needle trajectory of US-guided C7 SNRB pierces the MSM, therefore indicating a high probability of injury to the LTN. We aimed to identify the LTN and to investigate the risk of needle injury to the nerve during US-guided C7 SNRB. Materials and Methods: This retrospective observational study included 30 patients who underwent US-guided SNRB at the C7 level in a university hospital. We measured the maximal cross-sectional diameter (MCSD) of the LTN and cross-sectional area (CSA) of the C7 nerve root and assessed the injury risk of LTN during US-guided C7 SNRB by simulating the trajectory of the needle in the ultrasound image. Results: The LTN was detectable in all the cases, located inside and outside the MSM in 19 (63.3%) and 11 (36.7%) of cases, respectively. The LTN's mean MCSD was 2.10 mm (SD 0.13), and the C7 root's CSA was 10.78 mm2 (SD 1.05). The LTN location was within the simulated risk zone in 86.7% (26/30) of cases. Conclusion: Our findings suggest a high potential for LTN injury during US-guided C7 SNRB. The clear visualization of LTNs in the US images implies that US guidance may help avoid nerve damage and make the procedure safer. When performing US-guided C7 SNRB, physicians should take into consideration the location of the LTN.


Assuntos
Minorias Sexuais e de Gênero , Nervos Torácicos , Homossexualidade Masculina , Humanos , Masculino , Medição de Risco , Ultrassonografia de Intervenção
14.
Sensors (Basel) ; 21(10)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34069613

RESUMO

As a well-known medical imaging methodology, intravascular ultrasound (IVUS) imaging plays a critical role in diagnosis, treatment guidance and post-treatment assessment of coronary artery diseases. By cannulating a miniature ultrasound transducer mounted catheter into an artery, the vessel lumen opening, vessel wall morphology and other associated blood and vessel properties can be precisely assessed in IVUS imaging. Ultrasound transducer, as the key component of an IVUS system, is critical in determining the IVUS imaging performance. In recent years, a wide range of achievements in ultrasound transducers have been reported for IVUS imaging applications. Herein, a comprehensive review is given on recent advances in ultrasound transducers for IVUS imaging. Firstly, a fundamental understanding of IVUS imaging principle, evaluation parameters and IVUS catheter are summarized. Secondly, three different types of ultrasound transducers (piezoelectric ultrasound transducer, piezoelectric micromachined ultrasound transducer and capacitive micromachined ultrasound transducer) for IVUS imaging are presented. Particularly, the recent advances in piezoelectric ultrasound transducer for IVUS imaging are extensively examined according to their different working mechanisms, configurations and materials adopted. Thirdly, IVUS-based multimodality intravascular imaging of atherosclerotic plaque is discussed. Finally, summary and perspectives on the future studies are highlighted for IVUS imaging applications.


Assuntos
Doença da Artéria Coronariana , Ultrassonografia de Intervenção , Doença da Artéria Coronariana/diagnóstico por imagem , Desenho de Equipamento , Humanos , Transdutores , Ultrassonografia
15.
Medicine (Baltimore) ; 100(19): e25338, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106585

RESUMO

ABSTRACT: This retrospective study investigated the effect of ultrasound-guided pulsed radiofrequency (UGPRF) on intercostal neuralgia (ICN) after lung cancer surgery (LCS).This retrospective observational study analyzed the outcome data of UGPRF on ICN in 80 patients with LCS. All those patients were allocated into a treatment group (n = 40) and a control group (n = 40). All patient data were collected between January 2018 and November 2019. The primary outcome was pain intensity (measured by numerical rating scale, NRS). The secondary outcomes were sleep quality (measured by Pittsburgh Sleep Quality Index, PSQI), anesthetic consumption, and treatment-related adverse events.After treatment, patients in the treatment group showed better outcomes in NRS (P < .01), PSQI (P < .01), and anesthetic consumption (P < .01), than patients in the control group. No treatment-related adverse events were documented in both groups in this study.The results of this study found that UGPRF may benefit patients for pain relief of ICN after LCS.


Assuntos
Nervos Intercostais , Neoplasias Pulmonares/cirurgia , Neuralgia/terapia , Dor Pós-Operatória/terapia , Pneumonectomia/efeitos adversos , Tratamento por Radiofrequência Pulsada , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/diagnóstico por imagem , Neuralgia/etiologia , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Ultrassonografia de Intervenção
16.
J Clin Anesth ; 73: 110372, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34098394

RESUMO

STUDY OBJECTIVE: This study aimed to evaluate the efficacy of ultrasound-guided transmuscular quadratus lumborum block (QLB) combined with local infiltration analgesia (LIA) for pain management and recovery in patients who have undergone total hip arthroplasty (THA) via a posterolateral approach. DESIGN: This was a prospective, randomized controlled trial. SETTING: We collected data in the preoperative area, operating room, and bed ward. PATIENTS: A total of 80 patients with American Society of Anesthesiology functional status scores of II-III were included and assigned to two groups, and all 80 patients were included in the final analysis. INTERVENTIONS: All included patients were randomly assigned to the nerve block (group N) or the control group (group C). Patients in the group N received transmuscular QLB combined with LIA, while patients in the group C received only LIA. MEASUREMENTS: The primary outcome was postoperative pain during the first active motion: it was measured at six hours after surgery and assessed using a visual analog scale (VAS). Secondary outcomes were the resting VAS scores in the post-anesthesia care unit (PACU) and at 2, 6, 12, 24, 48, and 72 h after surgery; VAS scores during motion at 12, 24, 48, and 72 h after surgery; intraoperative consumption of opioids; postoperative consumption of morphine hydrochloride; frequency of sleep interruption due to pain on the night of surgery; time until the first "walk out of the bed" after surgery; muscle strength of the quadriceps femoris; and postoperative adverse effects. MAIN RESULTS: Compared to the group C, patients in the group N had significantly lower VAS scores during motion at 6, 12, and 24 h after surgery, as well as lower resting VAS scores in the PACU and at 2, 6, 12, and 24 h after surgery. Patients in the group N also consumed significantly smaller amounts of intraoperative opioids and morphine after surgery. Patients in the group N reported significantly fewer interruptions in sleep due to pain on the night of surgery and were able to "walk out of the bed" significantly earlier than those in the group C. There was no significant difference between the two groups in muscle strength of the quadriceps femoris or incidence of postoperative adverse effects. CONCLUSIONS: Compared to treatment with LIA alone, ultrasound-guided transmuscular QLB combined with LIA can provide better postoperative pain relief and enhance the recovery of THA patients, since it does not cause quadriceps femoris muscle weakness and is associated with significantly lower need for intraoperative opioids.


Assuntos
Analgesia , Artroplastia de Quadril , Bloqueio Nervoso , Anestésicos Locais , Artroplastia de Quadril/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversos , Manejo da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ultrassonografia de Intervenção
19.
Int J Comput Assist Radiol Surg ; 16(8): 1243-1254, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34125391

RESUMO

PURPOSE: Intravascular ultrasound (IVUS) imaging is crucial for planning and performing percutaneous coronary interventions. Automatic segmentation of lumen and vessel wall in IVUS images can thus help streamlining the clinical workflow. State-of-the-art results in image segmentation are achieved with data-driven methods like convolutional neural networks (CNNs). These need large amounts of training data to perform sufficiently well but medical image datasets are often rather small. A possibility to overcome this problem is exploiting alternative network architectures like capsule networks. METHODS: We systematically investigated different capsule network architecture variants and optimized the performance on IVUS image segmentation. We then compared our capsule network with corresponding CNNs under varying amounts of training images and network parameters. RESULTS: Contrary to previous works, our capsule network performs best when doubling the number of capsule types after each downsampling stage, analogous to typical increase rates of feature maps in CNNs. Maximum improvements compared to the baseline CNNs are 20.6% in terms of the Dice coefficient and 87.2% in terms of the average Hausdorff distance. CONCLUSION: Capsule networks are promising candidates when it comes to segmentation of small IVUS image datasets. We therefore assume that this also holds for ultrasound images in general. A reasonable next step would be the investigation of capsule networks for few- or even single-shot learning tasks.


Assuntos
Vasos Sanguíneos/crescimento & desenvolvimento , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Ultrassonografia de Intervenção/métodos , Humanos
20.
J Int Med Res ; 49(6): 3000605211023701, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34139874

RESUMO

Achondroplasia is a type of disproportionate dwarfism with short limbs and a normal-sized torso. This condition results in a potential spinal abnormality and a difficult airway may increase the anesthetic risk, not only in neuraxial anesthesia, but also in general anesthesia. We report a 25-year-old primigravida with achondroplasia who underwent cesarean section under epidural anesthesia with the assistance of real-time ultrasound guidance. A total dose of 17 mL 2% lidocaine with 7.5 µg sufentanil was administered via epidural catheter intermittently. The level of anesthesia reached T4. No other anesthetic was administered during the operation and the procedure was uneventful. The mother and her newborn were routinely discharged without any adverse events. During the follow-up at 10 months postoperatively, the patient did not have any discomfort. We suggest that titrated epidural anesthesia at the time of real-time ultrasound-guidance is a safe and effective epidural anesthesia for patients with achondroplasia.


Assuntos
Acondroplasia , Anestesia Epidural , Anestesia Obstétrica , Raquianestesia , Complicações na Gravidez , Acondroplasia/complicações , Acondroplasia/diagnóstico por imagem , Adulto , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Ultrassonografia de Intervenção
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