RESUMO
OBJECTIVE: To describe four ultrasound-guided approaches to the lumbar and thoracic spine to aid spinal canal puncture in the dog and to evaluate the feasibility of the technique. STUDY DESIGN: Prospective experimental study. ANIMAL POPULATION: Two canine cadavers. METHODS: In the first part of the study, the ultrasonographic appearance of the interlaminar space in the lumbosacral, lumbar and thoracic regions was described. In the second part of the study, four operators attempted a real-time, ultrasound-guided approach to the vertebral canal. Each operator performed the technique 20 times in total: five times at the lumbosacral junction, five in the thoracic region, five in the lumbar region with an in-plane approach, and five in the lumbar region with an out-of-plane approach. Computed tomography (CT) was used to confirm the position of the needle. The procedure was considered successful when the tip of the needle was observed within the vertebral canal. The success rate was calculated for each approach and operator. Fisher's exact test was used to compare differences between approaches and operators. RESULTS: In all cases, visualization of a ventral, parallel and straight hyperechoic line (floor of the vertebral canal) was considered a necessary prerequisite for successful positioning of the needle within the vertebral canal. A straight hyperechoic line (ligamentum flavum or dura mater) closer to the ultrasound probe was visualized in both the median lumbosacral approach and the transverse lumbar approach. The success rate overall was 81%; for the lumbosacral approach, 100%; for the thoracic approach, 80%; for the in-plane lumbar approach 95%; and for the out-of-plane lumbar approach, 45%. These differences were statistically significant (p < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE: The sonographic description of these approaches was considered adequate for performing spinal canal puncture. In-plane techniques achieved a higher success rate than out-of-plane ones. Further studies are needed to evaluate them in a clinical setting.
Assuntos
Punções/veterinária , Canal Medular/cirurgia , Ultrassonografia de Intervenção/veterinária , Animais , Cadáver , Cães , Estudos de Viabilidade , Vértebras Lombares , Região Lombossacral , Estudos Prospectivos , Punções/métodos , Vértebras Torácicas , Ultrassonografia de Intervenção/métodosRESUMO
This report describes the case of a patient who developed a subcapsular hepatic hematoma 48 hours after endoscopic retrograde cholangiopancreatography. She was treated by embolizing the sites of bleeding and by surgically resecting the area. We review the literature and discuss the potential mechanisms that cause this complication.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hematoma/etiologia , Hepatopatias/etiologia , Idoso , Feminino , Hematoma/cirurgia , Humanos , Hepatopatias/cirurgiaRESUMO
INTRODUCTION AND AIMS: We propose that branded and non-branded product placements in movies are interpreted differently and that a movie with unbranded alcohol portrayals influences audiences' alcohol-related beliefs and choices indirectly, through the process of narrative transportation, whereas a movie with branded alcohol placements impacts audiences' alcohol beliefs and choices via a more basic social-cognitive process of influence. DESIGN AND METHODS: Ordinary moviegoers (N = 758) attended a showing of The Snows of Kilimanjaro (2011) in a popular theatre in Tacna, Peru. Subjects were randomly assigned to watch the original movie, with branded alcohol portrayals, or a brand-free, control version. Reactions to the movie and alcohol-related beliefs were collected in a survey immediately after the film exposure and real beverage choices were measured. RESULTS: The findings reveal that exposure to unbranded positive portrayals of alcohol produces story-consistent beliefs and alcohol choices through the process of narrative transportation and that exposure to branded positive alcohol portrayals produces direct effects in terms of alcohol expectancies and brand choice, despite lowering narrative transportation. Although viewers disengage more from the characters, and experience lesser enjoyment and perceived realism when exposed to actual brands in a movie, they still hold positive alcohol expectancies and are more likely to select the placed brand, a process consistent with social cognitive theory. DISCUSSION AND CONCLUSIONS: The findings suggest caution about the recommended policy of removing branding from alcohol placements, such as in the case with plain packaging in tobacco, and instead call for effective policies to constrain alcohol product placement, as was done with tobacco placements.
Assuntos
Publicidade , Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas , Marketing , Filmes Cinematográficos , Comunicação Persuasiva , HumanosAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Esôfago/complicações , Doenças do Esôfago/diagnóstico , Radiografia Torácica/métodos , Radiografia Torácica/tendências , Gastroscopia/métodos , Gastroscopia/tendências , Perfuração Esofágica/complicações , Perfuração Esofágica , Mediastinite/complicações , Mediastinite/diagnóstico , Perfuração Esofágica/fisiopatologia , Perfuração Esofágica/cirurgia , Esôfago/lesões , Esôfago/patologia , EsôfagoRESUMO
Resumen Se presenta una paciente que desarrolló un hematoma hepático a las 48 horas de una CPRE. Para su tratamiento se realizó una embolización de los puntos sangrantes y posteriormente una resección quirúrgica de la zona. Se revisa la bibliografía y se discute sus posibles mecanismos de producción (AU)
Abstract This report describes the case of a patient who developed a subcapsular hepatic hematoma 48 hours after endoscopic retrograde cholangiopancreatography. She was treated by embolizing the sites of bleeding and by surgically resecting the area. We review the literature and discuss the potential mechanisms that cause this complication (AU)