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1.
Medicine (Baltimore) ; 100(26): e26519, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190186

RESUMO

BACKGROUND: The catheter-through-needle (CTN) method involves the insertion of a catheter with an outer diameter smaller than the initial puncture hole. We investigated whether the catheter-over-needle (CON) method is more effective than the CTN method in local anesthetic leakage at the catheter insertion site and catheter dislodgement, and how it affects postoperative pain management. METHODS: Seventy patients scheduled to undergo continuous femoral nerve block for pain control following total knee arthroplasty were enrolled and randomized to receive a perineural catheterization with either the CTN method (group CTN) or CON method (group CON). After ultrasound-guided catheterization, the transparent securement dressing was attached. The study compared the CON and CTN methods in terms of leakage at the catheter insertion site, catheter dislodgement, and postoperative analgesic efficacy for 48 hours postoperatively. RESULTS: Leakage at the catheter insertion site was significantly lower in the group CON (P < .05), while catheter dislodgement was not significantly different between the groups. The other adverse events were not different between the groups. The procedure time was significantly shorter in group CON (P < .05). No significant intergroup differences were observed 48 hours postoperatively in the visual analog scales, the number of patients requiring additional analgesics, and the number of times a bolus dose was injected with an injection pump. CONCLUSION: The CON method was able to shorten the procedure time while reducing the incidence of leakage at the catheter insertion site than the CTN method, and showed similar effects in postoperative pain management.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cateterismo , Nervo Femoral , Bloqueio Nervoso , Dor Pós-Operatória , Ultrassonografia de Intervenção/métodos , Idoso , Analgésicos/uso terapêutico , Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/métodos , Cateterismo/instrumentação , Cateterismo/métodos , Feminino , Humanos , Masculino , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Manejo da Dor/métodos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/terapia , Ropivacaina/administração & dosagem , Escala Visual Analógica
2.
Toxins (Basel) ; 13(5)2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065541

RESUMO

The visualization of the human body has frequently been groundbreaking in medicine. In the last few years, the use of ultrasound (US) imaging has become a well-established procedure for botulinum toxin therapy in people with cervical dystonia (CD). It is now undisputed among experts that some of the most relevant muscles in this indication can be safely injected under visual US guidance. This review will explore the method from basic technical considerations, current evidence to conceptual developments of the phenomenology of cervical dystonia. We will review the implications of introducing US to our understanding of muscle function and anatomy of common cervical dystonic patterns. We suggest a flow chart for the use of US to achieve a personalized treatment of people with CD. Thus, we hope to contribute a resource that is useful in clinical practice and that stimulates the ongoing development of this valuable technique.


Assuntos
Toxinas Botulínicas/administração & dosagem , Torcicolo/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Humanos , Fármacos Neuromusculares/administração & dosagem , Medicina de Precisão , Torcicolo/diagnóstico por imagem
3.
Scand J Trauma Resusc Emerg Med ; 29(1): 83, 2021 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-34176508

RESUMO

BACKGROUND: Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. METHODS: In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. RESULTS: Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. CONCLUSION: Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.


Assuntos
Cateterismo Venoso Central/métodos , Competência Clínica , Educação Médica/métodos , Aprendizagem , Ultrassonografia de Intervenção/métodos , Humanos
4.
Am J Med Sci ; 361(6): 731-735, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33947586

RESUMO

BACKGROUND: The relationship between the presence of pleural and pericardial effusion in reference to hemodynamic parameters remains unclear in ambulatory patients with pulmonary hypertension (PH). METHODS: Consecutive patients who underwent right catheterization (RHC) for the evaluation of pulmonary hypertension were enrolled. Point-of- care ultrasound was performed prior to the RHC to determine the presence of pleural effusion and pericardial effusion. We conducted a cross-sectional study to determine the association between presence of pericardial and pleural effusion with pulmonary hemodynamic variables. RESULTS: Twenty-five (78.1%) of 32 patients had evidence of PH by RHC. Mean pulmonary artery pressure of the population was 40.6 mmHg, and 68% (17/25) had WHO group I PH. Six (24.0%) of 25 PH patients had pleural effusions identified, of which 4 out of 6 (66.7%) had a pulmonary artery wedge pressure >15 mmHg. Eleven (44.0%) of the 25 PH patients were also found to have pericardial effusions, and most of those patients 10/11(90.9%) had an elevated right atrial pressure >10 mmHg. The presence of a pleural effusion was associated with a pulmonary artery wedge pressure >15 mmHg (p = 0.032) and the presence of a pericardial effusion was associated with a right atrial pressure >10 mmHg (p = 0.004). Detection of pleural effusion had a poor positive predictive value (67%) for the presence of pulmonary venous hypertension, whereas presence of a pericardial effusion was highly predictive (89%) of the presence of systemic venous hypertension. CONCLUSIONS: Systemic venous hypertension was associated with the presence of pericardial effusions, while pulmonary venous hypertension is associated with pleural effusion development in ambulatory patients with pulmonary hypertension.


Assuntos
Hemodinâmica/fisiologia , Hipertensão Pulmonar/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Cateterismo Cardíaco/métodos , Estudos Transversais , Feminino , Humanos , Hipertensão Pulmonar/epidemiologia , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/fisiopatologia , Derrame Pleural/epidemiologia , Derrame Pleural/fisiopatologia , Testes Imediatos
5.
Cardiovasc Intervent Radiol ; 44(8): 1214-1222, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33987694

RESUMO

PURPOSE: Although hydatid liver cyst (HLC) is a benign disease, treatment is recommended to avoid life-threatening complications. There are several treatment options for HLC: "wait-and-watch," medical or surgical or percutaneous treatment. The purpose of this study was to assess the long-term effectiveness of an alternative of the traditional percutaneous PAIR procedure, called double percutaneous aspiration and ethanol injection (D-PAI). MATERIALS AND METHODS: This prospective, non-randomized study was conducted from 1988 to 2019 using DPAI procedure characterized by no reaspiration of the ethanol injected to replace the aspirated fluid and repetition of the procedure after 3-7 days. RESULTS: Two hundred and three patients with 290 HLCs underwent D-PAI. Two hundred and two HLC (160 patients) were univesicular cysts and 88 (43 patient) were multivesicular. Seventeen patients underwent one D-PAI session, 15 patients two sessions, and 18 up to four sessions. The follow-up ranged 0.9-21 years (median 6.5 years). On ultrasound, 188 cysts (64.8%) disappeared; 57 cysts (19.7%) became solid (inactive) and 45 (15.5%) showed a small inactive residual component. Parasitologic cure was very high. The overall response to D-PAI was higher than 90% considering also the procedures carried out after the first D-PAI at the time of recurrence. One patient died for anaphylactic shock. The hospital stay ranged 1-3 days. Smaller cysts (< 5 cm) healed sooner than larger cysts (p < 0.001). CONCLUSIONS: Long-term analysis showed that D-PAI is a safe and effective option in percutaneous treatment of viable HLC, except for CE2/CE3b in which the recurrences can be observed. This inexpensive and simple procedure can be applied everywhere and especially in developing countries.


Assuntos
Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/cirurgia , Etanol/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Injeções Intralesionais , Tempo de Internação , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sucção/métodos , Resultado do Tratamento , Adulto Jovem
6.
J Clin Neurosci ; 88: 10-15, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992166

RESUMO

BACKGROUND: Microvascular Doppler (MVD) has been widely used for the detection of arterial blood flow in the brain, especially during aneurysm clipping, vascular malformation resection, or bypass surgeries. However, the benefits obtained from early identification of intracranial sinuses and deep draining veins during tumor resection has not been reported. METHODS: We reviewed the clinical data and imaging from our cases and conducted a systemic review of the medical literature using PubMed and keywords. Bibliographies of each result were evaluated to determine if additional reports describing the use of MVD during tumor resection could be found. RESULTS: No reports were found in the literature where MVD was specifically used for venous identification during the resection of deep-seated brain tumors. In our patient cohort, MVD was used successfully to detect and ultimately allow immediate protection of large dural venous sinuses as well as smaller deep cerebral veins during tumor resection. Each patient developed no new venous infarcts and made a satisfactory recovery with no new postoperative neurological deficits. CONCLUSION: MVD is a reliable tool for the intraoperative detection of intracranial venous blood flow to allow for quick identification and protection of venous structures. MVD is an additional safety measure for the patient as its accuracy in detecting venous structures is less susceptible to many of the inherent weaknesses of stereotactic neuro-navigation including the accompanying brain shift or anatomical distortion produced by long duration deep seated brain tumor resection.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Cavidades Cranianas/diagnóstico por imagem , Neuronavegação/métodos , Ultrassonografia de Intervenção/métodos , Neoplasias Encefálicas/irrigação sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Med Educ Online ; 26(1): 1924350, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33960914

RESUMO

Ultrasound (US)-guided central venous catheter (CVC) insertion is a procedure that carries the risk of significant complications. Simulation provides a safe learning atmosphere, but most CVC simulators are not available outside of simulation centers. To explore longitudinal trends in US-guided CVC insertion competency in internal medicine (IM) interns, we studied the use of a low-fidelity, gelatin-based, US-guided CVC insertion simulation model combined with a simulation curriculum. This prospective observational study of IM interns was performed over the course of one academic year. Interns (n = 56) underwent model-based, US-guided procedure simulation training program and a repeated training course prior to their intensive care unit (ICU) rotation. CVC insertion competency at different timepoints was recorded. Survey data about intern experience and attitudes were also collected. Out of the 56 interns initially trained, 40 were included in the final analysis. Across all outcomes, interns experienced skill atrophy between initial training and the beginning of their ICU month. However, by the end of the month, there was a significant improvement in competency as compared to initial procedural training, which then waned by the end of the intern year. Attitudes toward the model were generally positive and self-reported confidence improved throughout the course of the year and correlated with objective measures of competency. Over the course of their intern year, which included simulation training using a gelatin-based model, interns demonstrated consistent competency trends. The use of a gelatin-based CVC insertion simulation model warrants further study as an adjunctive aid to existing simulation training.


Assuntos
Cateterismo Venoso Central/métodos , Medicina Interna/educação , Internato e Residência/métodos , Treinamento por Simulação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Competência Clínica , Currículo , Feminino , Gelatina , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-34019749

RESUMO

Thoracic surgery is still associated with severe postoperative pain. In this video tutorial, we present 2 techniques that could be used as an additional method in a multimodal postoperative analgesia strategy for video-assisted thoracic surgery. We present the combination of an epipleural surgical infiltration of a local anesthetic with an ultrasound-guided erector spinae plane block.


Assuntos
Analgesia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória , Cirurgia Torácica Vídeoassistida , Ultrassonografia de Intervenção/métodos , Idoso , Anestésicos Locais/administração & dosagem , Músculos do Dorso/inervação , Terapia Combinada , Humanos , Masculino , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/terapia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
10.
West J Emerg Med ; 22(2): 369-378, 2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33856325

RESUMO

INTRODUCTION: The ultrasound measurement of inferior vena cava (IVC) diameter change during respiratory phase to guide fluid resuscitation in shock patients is widely performed, but the benefit on reducing the mortality of sepsis patients is questionable. The study objective was to evaluate the 30-day mortality rate of patients with sepsis-induced tissue hypoperfusion (SITH) and septic shock (SS) treated with ultrasound-guided fluid management (UGFM) using ultrasonographic change of the IVC diameter during respiration compared with those treated with the usual-care strategy. METHODS: This was a randomized controlled trial conducted in an urban, university-affiliated tertiary-care hospital. Adult patients with SITH/SS were randomized to receive treatment with UGFM using respiratory change of the IVC (UGFM strategy) or with the usual-care strategy during the first six hours after emergency department (ED) arrival. We compared the 30-day mortality rate and other clinical outcomes between the two groups. RESULTS: A total of 202 patients were enrolled, 101 in each group (UGFM vs usual-care strategy) for intention-to-treat analysis. There was no significant difference in 30-day overall mortality between the two groups (18.8% and 19.8% in the usual-care and UGFM strategy, respectively; p > 0.05 by log rank test). Neither was there a difference in six-hour lactate clearance, a change in the sequential organ failure assessment score, or length of hospital stay. However, the cumulative fluid amount given in 24 hours was significantly lower in the UGFM arm. CONCLUSION: In our ED setting, the use of respiratory change of IVC diameter determined by point-of-care ultrasound to guide initial fluid resuscitation in SITH/SS ED patients did not improve the 30-day survival probability or other clinical parameters compared to the usual-care strategy. However, the IVC ultrasound-guided resuscitation was associated with less amount of fluid used.


Assuntos
Hidratação , Ressuscitação , Choque Séptico , Ultrassonografia de Intervenção/métodos , Veia Cava Inferior , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hidratação/instrumentação , Hidratação/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Tamanho do Órgão , Avaliação de Processos e Resultados em Cuidados de Saúde , Ressuscitação/instrumentação , Ressuscitação/métodos , Choque Séptico/etiologia , Choque Séptico/mortalidade , Choque Séptico/terapia , Análise de Sobrevida , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia
11.
Int J Comput Assist Radiol Surg ; 16(5): 819-827, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33840037

RESUMO

PURPOSE: Accurate placement of the needle is critical in interventions like biopsies and regional anesthesia, during which incorrect needle insertion can lead to procedure failure and complications. Therefore, ultrasound guidance is widely used to improve needle placement accuracy. However, at steep and deep insertions, the visibility of the needle is lost. Computational methods for automatic needle tip localization could improve the clinical success rate in these scenarios. METHODS: We propose a novel algorithm for needle tip localization during challenging ultrasound-guided insertions when the shaft may be invisible, and the tip has a low intensity. There are two key steps in our approach. First, we enhance the needle tip features in consecutive ultrasound frames using a detection scheme which recognizes subtle intensity variations caused by needle tip movement. We then employ a hybrid deep neural network comprising a convolutional neural network and long short-term memory recurrent units. The input to the network is a consecutive plurality of fused enhanced frames and the corresponding original B-mode frames, and this spatiotemporal information is used to predict the needle tip location. RESULTS: We evaluate our approach on an ex vivo dataset collected with in-plane and out-of-plane insertion of 17G and 22G needles in bovine, porcine, and chicken tissue, acquired using two different ultrasound systems. We train the model with 5000 frames from 42 video sequences. Evaluation on 600 frames from 30 sequences yields a tip localization error of [Formula: see text] mm and an overall inference time of 0.064 s (15 fps). Comparison against prior art on challenging datasets reveals a 30% improvement in tip localization accuracy. CONCLUSION: The proposed method automatically models temporal dynamics associated with needle tip motion and is more accurate than state-of-the-art methods. Therefore, it has the potential for improving needle tip localization in challenging ultrasound-guided interventions.


Assuntos
Movimento (Física) , Redes Neurais de Computação , Cirurgia Assistida por Computador/métodos , Ultrassonografia de Intervenção/métodos , Ultrassonografia/métodos , Algoritmos , Animais , Artefatos , Biópsia , Bovinos , Galinhas , Agulhas , Reprodutibilidade dos Testes , Suínos
12.
Int J Comput Assist Radiol Surg ; 16(6): 1069-1074, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33864188

RESUMO

PURPOSE: Augmented reality (AR) technology improves the learning process in interventional radiology. This study hypothesized that using AR to train for central venous access is superior to using ultrasound alone. METHODS: This study used an AR central venous catheterization phantom with an internal jugular vein (IJV) and subclavian vein (SCV) made of resin body and soft tubing. Ten radiologists attempted to punctuate, using needle placement simulation, under three conditions (ultrasound-, augmented reality-, and ultrasound and AR-guided methods; US-only, AR-only, and US+AR, respectively) using a smart-glass device (HoloLens, Microsoft, Redmond, WA, USA). Subjective (anatomical understanding and self-confidence for procedure) and objective evaluations (optimized needle position and time) were recorded for each condition. RESULTS: The subjective IJV evaluation showed no difference among the guiding methods (p = 0.26 and p = 0.07 for anatomical understanding and self-confidence for procedure, respectively). Conversely, there were significant improvements in subjective and objective evaluations for SCV using the AR-only and US+AR methods (p < 0.05) and US+AR method (p < 0.05), respectively. The AR-only method reduced the time required to fix the needle position to puncture the SCV (p < 0.05), but its objective evaluation did not improve compared with the US-only method (p = 0.20). CONCLUSION: Adding the AR-guided method to the US-guided method improved subjective and objective evaluations in the SVC procedure. The AR technology-assisted training may be more beneficial for use in difficult procedures. Though the AR-only method saved time, no time saving is expected with AR+US method.


Assuntos
Cateterismo Venoso Central/métodos , Veias Jugulares/diagnóstico por imagem , Imagens de Fantasmas , Punções/métodos , Ultrassonografia de Intervenção/métodos , Realidade Aumentada , Humanos
13.
Medicine (Baltimore) ; 100(16): e25466, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879679

RESUMO

RATIONALE: Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears. PATIENT CONCERNS: A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever. DIAGNOSES: The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN. INTERVENTIONS AND OUTCOMES: EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy. LESSONS: In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Drenagem/métodos , Neoplasias Pancreáticas/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Complicações Pós-Operatórias/cirurgia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia/efeitos adversos , Biópsia/métodos , Carcinoma Ductal Pancreático/tratamento farmacológico , Carcinoma Ductal Pancreático/patologia , Drenagem/instrumentação , Endossonografia/efeitos adversos , Endossonografia/instrumentação , Endossonografia/métodos , Fluoruracila/uso terapêutico , Humanos , Irinotecano/uso terapêutico , Leucovorina/uso terapêutico , Masculino , Oxaliplatina/uso terapêutico , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/patologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
14.
Medicine (Baltimore) ; 100(14): e24877, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832067

RESUMO

BACKGROUND: De Quervain's disease is a kind of aseptic inflammation caused by repeated frictions of tendons in the tendon sheath of the styloid process of the radius. The main symptoms are protuberance and pain of the styloid process of the radius, accompanied by aggravation of pain during the movement of the wrist and thumb. The advantages of needle-knife are simple operation, obvious therapeutic effect and high safety. It can also be used to treat De Quervain's disease. Ultrasound gives a precise visualization of the thickness. The purpose of this study is to evaluate the efficacy and safety of ultrasound-guided needle-knife in the treatment of De Quervain's disease and to provide the latest basis for clinical application. METHODS: The computer will be used to search all randomized controlled trials (RCTs) about ultrasound-guided needle-knife treatment of De Quervain's disease in the following database: PubMed, Web of Science, Cochrane Library, Cochrane Central controlled Trials Registry (CENTER), EMBASE, China National knowledge Infrastructure (CNKI), Wanfang data, Chinese Biomedical Literature Database (CBM), VIP Database (VIP). The effectiveness and safety of ultrasound-guided needle-knife in the treatment of De Quervain's disease were evaluated with pain intensity, wrist function as the main index and wrist range of motion, adverse events and quality of life as the secondary index. Revman5.3 software was used for data processing. RESULTS: This study will provide the latest evidence for the Ultrasound-guided needle-knife for De Quervain's disease. CONCLUSION: The conclusion of this study is to evaluate the effectiveness and safety of ultrasound-guided needle-knife in the treatment of De Quervain's disease. UNIQUE INPLASY NUMBER: INPLASY202110094.


Assuntos
Terapia por Acupuntura/métodos , Doença de De Quervain/cirurgia , Ultrassonografia de Intervenção/métodos , Humanos , Metanálise em Rede , Revisões Sistemáticas como Assunto
15.
Medicine (Baltimore) ; 100(14): e25400, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832135

RESUMO

ABSTRACT: Ultrasound (US)-guided core needle biopsy (CNB) has been recognized as a crucial diagnostic tool for breast cancer. However, there is a lack of guidance for hospitals that are not equipped with adjunctive US. The aim of this study was to assess the sensitivity, specificity, and experience of freehanded CNB in the outpatient department, and to determine the minimum number of tissue strips required to obtain concordance for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER2), and tumor grade with the excised specimen.A prospective study was performed on 95 patients undergoing CNB and subsequent surgical procedures. The reliability of immunohistochemical assessments of the pathological type, tumor grade, ER, PR, and HER2 status in CNBs was compared with that of surgical specimens. Concordance between the CNBs and surgical samples was estimated as a percentage agreement, and analyzed using the chi-square test. A P < .05 was considered significant.The concordance rates of ER, PR, and HER2 status and tumor grade status between CNBs and surgically excised specimens were 97.9%, 91.6%, 82.1%, and 84.2%, respectively. The reliability of taking 2 tissue strips was similar to that of taking six tissue strips in distinguishing malignancy from benignancy, and determining the pathological type without the aid of US. Four tissue strips obtained by CNB showed good accuracy comparable to those obtained by surgical specimens in assessing ER, PR, and HER2 status and tumor grade.Two tissue strips obtained by CNB showed good accuracy in differentiating malignancy from benignancy, while at least 4 strips are recommended to obtain overall conformity of pathological biomarkers.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Neoplasias da Mama/patologia , Biópsia Guiada por Imagem/instrumentação , Cuidados Pré-Operatórios/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , China/epidemiologia , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Período Pós-Operatório , Estudos Prospectivos , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Manejo de Espécimes/tendências , Ultrassonografia de Intervenção/métodos
16.
Curr Probl Cardiol ; 46(6): 100822, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33752064

RESUMO

Ultrasound utilization during access enables precise vessel cannulation. We sought to evaluate the outcomes of ultrasound guided dorsal distal radial artery (DDRA), radial, and ulnar cardiac catheterization (CC) and percutaneous coronary intervention (PCI). We performed a prospective observational study of 224 patients (58 ± 12 years) at an academic medical center from October 2016 to March 2020 (median follow-up of 13 months) and compared the outcomes of ultrasound guided DDRA, ulnar, or radial artery CC and PCI. Groups were divided into DDRA (n = 18, 8.0%), ulnar (n = 94, 42.0%) and radial access (n = 112, 50.0%). Primary endpoints included the number of access attempts and conversion to femoral access. Secondary endpoints included all-cause mortality, cardiac mortality, acute myocardial infarction (AMI), stroke, repeat revascularization, stent thrombosis, in-stent restenosis, and access site complications. In the primary endpoints, no significant difference was found amongst groups in the number of access attempts (P = 0.272) or conversion to femoral access (P = 0.381). In the radial group (59 ± 11 years, median follow-up of 16 months), 2 cardiac mortalities (1 lymphocytic myocarditis, 1 AMI) and 2 noncardiac mortalities occurred. None of the secondary endpoints occurred in the DDRA (66 ± 17 years, median follow-up of 13 months) or ulnar group (56 ± 11 years, median follow-up of 14 months). DDRA and ulnar PCI was safe and efficacious with no complications. Femoral conversion or the number of access attempts was not different between DDRA, ulnar, or radial. Therefore, DDRA and ulnar are viable alternatives for PCI, which can preserve radial for future use.


Assuntos
Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea/métodos , Artéria Radial , Artéria Ulnar , Ultrassonografia de Intervenção , Idoso , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/cirurgia , Resultado do Tratamento , Artéria Ulnar/diagnóstico por imagem , Artéria Ulnar/cirurgia , Ultrassonografia de Intervenção/métodos
17.
Pain Res Manag ; 2021: 6644262, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33727997

RESUMO

Background and Objectives. Several anesthesia techniques were applied to hemorrhoidectomy, but postoperative pain and urinary retention were still two unsolved problems. The aim of this prospective randomized study was to evaluate the effect of ultrasound-guided pudendal nerve block (PNB) combined with deep sedation compared to spinal anesthesia for hemorrhoidectomy. Methods. One hundred and twenty patients undergoing Milligan-Morgan hemorrhoidectomy were randomized to receive PNB combined with deep sedation using propofol (Group PNB, n = 60) or spinal anesthesia (Group SA, n = 60). Pain intensity was assessed using the visual analogue scale (0: no pain to 10: worst possible pain). The primary outcome was pain scores recorded at rest at 3, 6, 12, 24, 36, and 48 h and on walking at 12, 24, 36, and 48 h postoperatively. Secondary outcomes were analgesic consumption, side effects, and patient satisfaction after surgery. Results. Ultrasound-guided bilateral PNB combined with deep sedation using propofol could successfully be applied to Milligan-Morgan hemorrhoidectomy. Postoperative pain intensity was significantly lower in Group PNB compared to Group SA at rest at 3, 6, 12, 24, 36, and 48 h (p < 0.001) and during mobilization at 12, 24, 36, and 48 h (p < 0.001) postoperatively. Sufentanil consumption in Group PNB was significantly lower than that in Group SA, during 0-24 h (p < 0.001) and during 24-48 h (p < 0.001) postoperatively. Urinary retention was significantly lower in Group PNB compared to Group SA (6.9% vs 20%, p=0.034). The patients in Group PNB had higher satisfaction compared to Group SA (p < 0.001). Conclusions. Ultrasound-guided PNB combined with propofol sedation is an effective anesthesia technique for Milligan-Morgan hemorrhoidectomy.


Assuntos
Raquianestesia/métodos , Sedação Profunda/métodos , Hemorroidectomia/métodos , Bloqueio Nervoso/métodos , Propofol/uso terapêutico , Nervo Pudendo/efeitos dos fármacos , Nervo Pudendo/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Propofol/farmacologia , Estudos Prospectivos , Adulto Jovem
18.
AJR Am J Roentgenol ; 216(6): 1574-1578, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33787293

RESUMO

OBJECTIVE. The aim of this study was to evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) for recurrent tumor in the central compartment after hemithyroidectomy. MATERIALS AND METHODS. The medical records of patients who underwent RFA for recurrent tumor after hemithyroidectomy between January 2008 and December 2018 were reviewed. Eight patients who underwent RFA for 10 recurrent tumors after hemithyroidectomy were included in our study population. Patients underwent follow-up US 1, 6, and 12 months after treatment and annually thereafter. The tumor volume reduction rate (VRR) was calculated as follows: VRR = ([initial volume - final volume] × 100) / initial volume. All patients were advised to undergo contrast-enhanced CT after tumor ablation. Complete tumor disappearance was defined as no visible treated tumor on follow-up US or CT. RESULTS. Mean tumor VRR was 97.8% ± 7.0% (SD) (range, 77.8-100%). Complete tumor ablation was achieved for all 10 recurrent tumors. Complete disappearance was confirmed in nine recurrent tumors, and one recurrent tumor showed a VRR of 77.8% on US but there was no enhancement on CT. All eight patients achieved no evidence of disease during mean follow-up of 33.0 months. RFA was tolerated by all patients; there were no major complications or procedure-related deaths. One patient experienced transient voice change during RFA. CONCLUSION. RFA can be considered to be an effective and safe alternative treatment method for recurrent tumor in the central compartment after hemithyroidectomy.


Assuntos
Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ablação por Radiofrequência , Estudos Retrospectivos , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento
19.
Best Pract Res Clin Anaesthesiol ; 35(1): 135-140, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33742573

RESUMO

Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Medicina Baseada em Evidências/métodos , Ultrassonografia de Intervenção/métodos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/diagnóstico por imagem , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/diagnóstico por imagem , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais/microbiologia , Cateteres Venosos Centrais/normas , Medicina Baseada em Evidências/normas , Humanos , Ultrassonografia de Intervenção/normas
20.
J Laparoendosc Adv Surg Tech A ; 31(5): 517-523, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33651631

RESUMO

Background: Indocyanine green (ICG) fluorescence imaging has been extensively used in a variety of applications in visceral surgery. In minimally invasive liver resections, the detection of small superficial hepatic lesions using an intravenous injection of ICG before surgery represents a promising application. Methods: We analyzed 18 consecutive patients who underwent laparoscopic liver resection for superficial malignant tumors, namely 11 patients with hepatocellular carcinoma (HCC), 5 patients with colorectal liver metastases (CRLM), 1 patient with intrahepatic cholangiocarcinoma (ICC), and 1 patient with thyroid cancer metastasis, using ICG fluorescence as an adjuvant tool to intraoperative laparoscopic ultrasound (LUS). Results: An optimal ICG 15-minute clearance retention rate (R15 < 10%) and ICG plasma disappearance rate (<18%/minute) were present in 11 patients (61.1%) and in 14 patients (77.7%), respectively. Liver tumors were 29 in total, including 14 HCCs (48.3%), 13 CRLMs (44.8%), 1 ICC (3.4%), and 1 thyroid cancer metastasis (3.4%). Twenty-nine tumors (100%) were correctly visualized with ICG/fluorescence, as compared with 21 tumors identified with LUS (72.4%). After complete liver mobilization, ICG staining allowed to identify more superficial lesions (early HCC and small CRLM) in posterolateral segments (Segments 6 and 7) as compared with LUS (14 versus 10 lesions). In addition, in segments usually treated laparoscopically (e.g., left lateral segments), ICG was superior to LUS (10 versus 6 lesions) to identify superficial early HCC in patients with macronodular cirrhosis. Conclusions: ICG visual feedback might substitute the tactile feedback of the hand and might in some cases act as a "booster" of LUS for superficial hepatic lesions.


Assuntos
Corantes Fluorescentes , Hepatectomia/métodos , Verde de Indocianina , Laparoscopia/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Imagem Óptica/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Endossonografia/métodos , Feminino , Humanos , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade
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