scholarly journals Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe

2021 ◽  
Author(s):  
Thibaut Jacques ◽  
Charlotte Brienne ◽  
Simon Henry ◽  
Hortense Baffet ◽  
Géraldine Giraudet ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gold Standard ◽  
Ultrasound Guidance ◽  
Ultrasound Guided ◽  
Major Complications ◽  
Incision Size ◽  
Contraceptive Implant ◽  
The Mean ◽  
Contraceptive Implants ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to assess the feasibility, performance, and complications of a non-surgical, minimally-invasive procedure of deep contraceptive implant removal under continuous ultrasound guidance. Methods The ultrasound-guided procedure consisted of local anesthesia using lidocaine chlorhydrate 1% (10 mg/mL) with a 21-G needle, followed by hydrodissection using NaCl 0.9% (9 mg/mL) and implant extraction using a Hartmann grasping microforceps. The parameters studied were the implant localization, success and complication rates, pain throughout the intervention, volumes of lidocaïne and NaCl used, duration of the procedure, and size of the incision. Between November 2019 and January 2021, 45 patients were referred to the musculoskeletal radiology department for ultrasound-guided removal of a deep contraceptive implant and were all retrospectively included. Results All implants were successfully removed en bloc (100%). The mean incision size was 2.7 ± 0.5 mm. The mean duration of the extraction procedure was 7.7 ± 6.3 min. There were no major complications (infection, nerve, or vessel damage). As a minor complication, 21 patients (46.7%) reported a benign superficial skin ecchymosis at the puncture site, spontaneously regressing in less than 1 week. The procedure was very well-tolerated, with low pain rating throughout (1.0 ± 1.5/10 during implant extraction). Conclusions Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, effective, and safe. In the present cohort, all implants were successfully removed, whatever the location, with short procedural time, small incision size, low pain levels, and no significant complications. This procedure could become a gold standard in this indication. Key Points • Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance alone is feasible, which led to a success rate of 100% whatever the location (even close to neurovascular structures), with only a small skin incision (2.7 ± 0.5 mm). • The procedure was safe, quick, without any major complications, and very well tolerated in terms of pain. • This minimally invasive ultrasound-guided procedure could become the future gold standard for the removal of deep contraceptive implants, as an alternative to surgical extraction, even for implants in difficult locations such as subfascial ones or those close to neurovascular structures.

Ultrasound-Guided Renal Biopsy with Biopsy Gun Technique — Efficacy and Complications

1995 ◽  
Vol 36 (3) ◽  
pp. 276-279 ◽  
Author(s):  
J. Christensen ◽  
S. Lindequist ◽  
D. Ulrik Knudsen ◽  
R. Smith Pedersen
Keyword(s):  
Renal Biopsy ◽  
Severe Hypertension ◽  
Ultrasound Guided ◽  
Histologic Diagnosis ◽  
Biopsy Technique ◽  
Major Complications ◽  
Renal Biopsies ◽  
The Mean ◽  
Adequate Tissue

One hundred and thirty-one ultrasound-guided renal biopsies performed in 127 patients with automated spring-loaded biopsy technique were evaluated. Adequate tissue for histologic diagnosis was obtained in 92% of the procedures (94% of the patients). The mean glomerular yield was 16.8 glomeruli. Complications were seen in 21% of the patients, 18% having minor and 3% having major complications. Patients with severe hypertension had significantly more complications than the rest of the patients. The rate of complications in patients who had 3 or 4 biopsy passes was not increased compared to patients who had one or 2 biopsy passes. Thus, this study indicates that the risk of complications and the safety of the procedure is not influenced by increasing the number of biopsy passes in order to obtain representative specimens.

Snuff box radial artery access for arteriovenous fistula intervention

2019 ◽  
Vol 21 (2) ◽  
pp. 237-240
Author(s):  
Jeffrey Hull ◽  
Stephanie Workman ◽  
Jean Isabell Heath
Keyword(s):  
Arteriovenous Fistula ◽  
Radial Artery ◽  
Ultrasound Guidance ◽  
Neutral Position ◽  
Extensor Pollicis Longus ◽  
Radial Access ◽  
Major Complications ◽  
The Mean ◽  
Steal Syndrome

Purpose: The aim of this article is to retrospectively compare snuff box radial artery access with direct fistula access for radiocephalic fistula intervention. Materials and Methods: Review of 68 consecutive radiocephalic interventions between April 2013 and April 2017 was performed. The snuff box radial access was performed under ultrasound guidance with the hand in a neutral position (thumb up). The snuff box radial artery was entered distal to the extensor pollicis longus, over the trapezium bone. Hand held pressure was applied for hemostasis. The procedure times, success, and complications of snuff box radial artery access procedures were reviewed. Results: Snuff box radial artery access was used in 25% (17/68) of radiocephalic fistula interventions. All access procedures were successful. Snuff box radial artery access was only used in cases involving the proximal fistula. Lesions treated from snuff box radial artery access approach included 19% (10/54) of fistula stenosis, 50% (1/2) thrombosis, 63% (5/8) immature fistulae, 100% (1/1) steal syndrome, and none of the (0/5) symptomatic outflow occlusions. The mean procedure times for snuff box radial artery access and direct fistula access were not significant at 29.1 ± 16.3 min (range = 10–81) and 26.8 ± 14.0 min (range = 5–70), respectively (p < 0.57). Minor hematoma occurred in 12% (2/17) snuff box radial artery access and 2% (1/51) direct fistula access. There were no major complications. Conclusion: Snuff box radial access was used successfully for radiocephalic fistula intervention with procedure times similar to direct fistula access without major complications.

Mini percutaneous nephrolithotripsy with ultrasound-guided approach in the lateral decubitus position under spinal anesthesia at Viet Duc University Hospital

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Huy Hoàng Nguyễn ◽  
Trường Thành Đỗ ◽  
Ngọc Sơn Đỗ
Keyword(s):  
Minimally Invasive ◽  
Spinal Anesthesia ◽  
Kidney Stones ◽  
Ultrasound Guidance ◽  
Lateral Decubitus Position ◽  
Ultrasound Guided ◽  
Stone Free Rate ◽  
Lateral Decubitus ◽  
Percutaneous Nephrolithotripsy ◽  
Free Rate

Tóm tắt Đặt vấn đề: Can thiệp xâm lấn tối thiểu hiện nay đã thay thế phần lớn phẫu thuật mở trong điều trị bệnh sỏi thận. Nghiên cứu nhằm đánh giá hiệu quả của | phẫu thuật tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn của siêu âm với người bệnh (NB) ở tư thế nằm nghiêng và gây tê tuỷ sống tại khoa Tiết niệu bệnh viện Việt Đức. Phương pháp nghiên cứu: Mô tả tiến cứu 250 trường hợp sỏi thận được tán sỏi qua da đường hầm nhỏ tại khoa Tiết niệu bệnh viện Việt Đức từ tháng 3/2017 | đến tháng 8/2017. NB được gây tê tuỷ sống, đặt tư thế nằm nghiêng. Chọc dò, tạo đường hầm qua da dưới hướng dẫn siêu âm với nong Amplatz 18 Fr. Sử dụng ống soi niệu quản bán cứng tán sỏi thận bằng Holmium laser 80W. Đánh giá tỷ lệ sạch sỏi và biến chứng sau mổ. Kết quả: 250 NB gồm 176 nam (70,4%) và 74 nữ (29,6%). Tuổi trung bình là 47,13 + 24,31 tuổi (22 - 85). Sỏi bể thận chiếm 34,4%, sỏi đài thận dưới gặp 7,6%, sỏi bể thận và 1 đài 35,6%, sỏi san hô chiếm 22,4%. Sỏi bên phải 38,8% và sỏi bên trái 61,2%, 69 NB (27,6%) có sỏi thận bên đối diện. Phát hiện ứ nước thận trên chụp cắt lớp vi tính (MSCT) trước mổ: 37 đài bể thận bình thường (14,8%); độ 1 gặp 120 (48%), độ 2 gặp 58 (23,2%), độ 3 gặp 35 (14%). Kích thước sỏi: Chiều dài trung bình (TB): 2,41 + 0,86cm (1 - 4,8cm), chiều rộng TB: 1,62 + 0,56cm (1 - 3,2cm). Vị trí đường hầm vào đài giữa 82,4%, đài dưới 16,8%, đài trên 0,8%. Thời gian mổ trung bình: 69,53 + 27,18 phút (35 - 120). Tất cả sỏi thận đều được tán qua da thành công. Biến chứng trong mổ gặp | 9 NB chảy máu (3,6%) không cần truyền máu. Biến chứng sau mổ gặp 5,2% gồm: 1 chảy máu sau mổ được nút mạch chọn lọc, 8 NB sốt sau mổ, 3 NB sốc nhiễm trùng được điều trị tích cực ổn định, 1 NB tử vong do sốc nhiễm trùng và chảy máu. Thời gian nằm viện TB: 4,57 + 2,64 ngày (2 - 8). Dẫn lưu thận | rút sau 2 - 5 ngày (TB: 2,87 + 1,43 ngày). Tỷ lệ sạch sỏi sớm sau mổ: 80,7%. Theo dõi sau mổ: 249 NB khám lại sau 1 tháng và rút ống thông JJ với tỷ lệ sạch sỏi đạt 97,2%. Kết luận: Tán sỏi thận qua da đường hầm nhỏ dưới hướng dẫn siêu âm NB ở tư thế nằm nghiêng và gây tê tuỷ sống mang lại nhiều lợi ích, nên là phương pháp được chọn lựa để điều trị bệnh lý sỏi thận. Abstract Introduction: Minimally invasive treatments have almost completely replaced open surgery in the management of the kidney stone disease. Our study aimed to evaluated the effectiveness of mini percutaneous nephrolithotripsy (mini-PCNL) with ultrasound-guided access in the lateral decubitus position under spinal anesthesia. Material and Methods: Prospective study of 250 kidney stones cases treated by mini-PCNL management at Urology Department of Viet Duc hospital from March 2017 to August 2017. Patients underwent & lyed spinal anesthesia, lying on the side. Small percutaneous renal access tract was performed under the ultrasound guidance with Amplatz dilation sheath 18Fr. Holmium laser nephrolithotripsy was used with semi-rigidureteroscope. Objective: Evaluate the postoperative stone free rate and complication rate. Results: 176 males (70,4%) and 74 females (29,6%) with the average age of 47,13 + 24,31 (range from 22 to 85 years old). Stone site: Renal pelvis: 34,4%; lower calyx 7,6%; pelvis and 1 calyx: 35,6% and staghorn calculi: 22,4%. Right kidney stones:38,8%; Left kidney stones: 61,2% and associate opposite kidney stones: 69 (27,6%). The finding of Hydronephrosis on preoperative MSCT includes: normal: 37 cases (14,8%); grade 1: 120cases (48%); grade 2: 58 (23,2%) and grade 3: 35 (14%). Stone size: mean length: 2,41 +0,86cm (1 - 4,8); mean width: 1,62 = 0,56cm (1 - 3,2). Renal access tract:middle calyx 82,4%; lower calyx 16,8%; upper calyx 0,8%. Average operative time: 69,53 + 27,18 minutes (35 - 120). Laser lithotripsy and stone removal are successful in 100% cases. Peroperative complications: 9 cases of haemorrhage (3,6%) with out blood transfusion requirement. The rate of postoperative early complication was 5,2%: 1 case of haemorrhage requiring embolization, 8 cases have fever. 3 patients with septicemia shock was medically treated and stabilized. 1 patient died from infection and bleeding. The mean of hospital stay: 4,57 = 2,64 day (2 -8). Nephrostomy tube removal after: 2,87 = 1,43 days (2 - 5). Stone free rate: 80,7%. At the postoperative follow-up 1 months, renal function is recovered well and JJ is removed. Stone free rate after 1 month: 97,2%. Conclusion: Mini-PCNL using ultrasound guidance in the lateral decubitus position under spinal anesthesia offers many advantages and should be the chosen method in the treatment of kidney stones. Keyword: Kidney stones, Mini-PCNL, Minimally invasive treatment, spinal anesthesia.

scholarly journals Daily Stereotactic Ultrasound Prostate Targeting: Inter-user Variability

2003 ◽  
Vol 2 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Martin Fuss ◽  
Sean X. Cavanaugh ◽  
Cristina Fuss ◽  
Dennis A. Cheek ◽  
Bill J. Salter
Keyword(s):  
Prostate Cancer ◽  
Gold Standard ◽  
Setup Error ◽  
Radiation Oncologist ◽  
Ultrasound Guided ◽  
Prostate Radiotherapy ◽  
Average Improvement ◽  
The Mean ◽  
Patient Setup ◽  
Planning Ct

We analyzed the inter-user variability of patient setup for prostate radiotherapy using a stereotactic ultrasound-targeting device. Setup variations in 20 prostate cancer patients were analyzed. Users were a radiation oncologist, a medical physicist, four radiation technologists (RTT) and a radiologist. The radiation oncologist, radiologist, physicist and two RTTs were experienced users of the system (>18 months of experience); two RTTs were users new to the system. Gold standard for this analysis was a control CT acquired immediately following ultrasound targeting. For inter-user variability assessments, the radiation oncologist provided a set of axial and sagittal freeze-frames (standard freeze-frames) for virtual targeting by all users. Additionally each user acquired individual freeze-frames for target alignments. We analyzed the range of virtual setups in each patient along the principal room axes based on standard and individual freeze-frames. The magnitude of residual setup error and percentage of setup change for each user was assessed by control CT/planning CT comparison with individual virtual shifts. A total of 184 alignments were analyzed. The range of virtual shifts between users was 2.7±1.4, 3.6±1.1, and 4.4±1.4 mm (mean±SD) in x, y and z-direction for setups based on standard freeze-frames and 3.9±2.6, 6.0±4.7, and 5.4±2.7 mm for setups based on individual freeze-frames. When only virtual shifts of experienced users were analyzed, the mean ranges were reduced by up to 2.4 mm. Average magnitude of initial setup error before ultrasound targeting was 14.3 mm. Average improvement of prostate setup was 63.1±23.4% in experienced and 35.14±37.7% in inexperienced users, respectively (p<0.0001). Only 5 of 184 (2.7%) virtual alignments would have introduced new larger setup errors (mean 3.2 mm, range 0.2 to 9.5 mm) than the magnitude of the initial setup error. We conclude that ultrasound guided treatment setup for patients treated for prostate cancer can be performed with high inter-user consistency and does lead to improved treatment setup in more than 97% of attempted setups. Experienced use is correlated with a reduced range of setups between users and higher degree of setup improvement when compared with users new to the system.

scholarly journals Experiences of Renal Stone Fragmentation with the Use of the Ultrasound-guided Mini-percutaneous Nephrolithotipsy in 650 Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 36-41
Author(s):  
Trung Duong ◽  
Trinh Hoang Hoan ◽  
Hoang Nguyen ◽  
Quan Tran
Keyword(s):  
Renal Stone ◽  
Ultrasound Guidance ◽  
Renal Stones ◽  
Lateral Position ◽  
Ureteral Stones ◽  
Ultrasound Guided ◽  
Stone Fragmentation ◽  
Results Of Treatment ◽  
The Mean ◽  
Tract Infections

AIM: This study assesses the results of treatment using the mini-percutaneous nephrolithotipsy (PCNL) procedure on renal stone patients in a lateral position under ultrasound guidance, performed at the Ha Noi Hospital of Post and Telecommunications. METHODS: The study was conducted with 650 kidney stone patients who were treated using the ultrasound-guided mini-PCNL procedure in a lateral position, at the Ha Noi Hospital of Post and Telecommunications, over the period from June 2018 to June 2019. RESULTS: For the 650 patients, the mean age was 47.3 ± 7.6 (from 21 to 91 years old); the mean size of stones: 19.4 ± 1.2 mm (from 12 mm to 60 mm); the mean operative time: 49.3 minutes (from 37 to 90 min); the mean period of hospitalization: 3.9 days (from 3 to 12 days); the mean stone-free rate (SFR): 90.6%; the rate of second surgery: 1.07%; hemorrhage complication: 0.8%; urinary tract infections: 7.7%; septicemia: 0.6%; administered open surgery: 0.46%; and administered other methods: 0.76%. CONCLUSION: Renal stone fragmentation using the mini-PCNL procedure, performed on patients placed in lateral position under ultrasound guidance, is a method that is effective, beneficial, and safe for patients with renal stones and upper ureteral stones.

scholarly journals Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Abdallah El-Sayed Allam ◽  
Adham Aboul Fotouh Khalil ◽  
Basma Aly Eltawab ◽  
Wei-Ting Wu ◽  
Ke-Vin Chang
Keyword(s):  
Trigeminal Nerve ◽  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Ultrasound Guided ◽  
Facial Bones ◽  
Target Region ◽  
Bony Landmarks ◽  
Injection Techniques ◽  
Trigeminal Nerves ◽  
Neurovascular Structures

Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves.

scholarly journals Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas

2018 ◽  
Vol 44 (4) ◽  
pp. E7 ◽  
Author(s):  
Malte Ottenhausen ◽  
Kavelin Rumalla ◽  
Andrew F. Alalade ◽  
Prakash Nair ◽  
Emanuele La Corte ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Cribriform Plate ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Incision Size ◽  
The Mean ◽  
Skull Base Meningiomas

OBJECTIVEAnterior skull base meningiomas are benign lesions that cause neurological symptoms through mass effect on adjacent neurovascular structures. While traditional transcranial approaches have proven to be effective at removing these tumors, minimally invasive approaches that involve using an endoscope offer the possibility of reducing brain and nerve retraction, minimizing incision size, and speeding patient recovery; however, appropriate case selection and results in large series are lacking.METHODSThe authors developed an algorithm for selecting a supraorbital keyhole minicraniotomy (SKM) for olfactory groove meningiomas or an expanded endoscopic endonasal approach (EEA) for tuberculum sella (TS) or planum sphenoidale (PS) meningiomas based on the presence or absence of olfaction and the anatomical extent of the tumor. Where neither approach is appropriate, a standard transcranial approach is utilized. The authors describe rates of gross-total resection (GTR), olfactory outcomes, and visual outcomes, as well as complications, for 7 subgroups of patients. Exceptions to the algorithm are also discussed.RESULTSThe series of 57 patients harbored 57 anterior skull base meningiomas; the mean tumor volume was 14.7 ± 15.4 cm3 (range 2.2–66.1 cm3), and the mean follow-up duration was 42.2 ± 37.1 months (range 2–144 months). Of 19 patients with olfactory groove meningiomas, 10 had preserved olfaction and underwent SKM, and preservation of olfaction in was seen in 60%. Of 9 patients who presented without olfaction, 8 had cribriform plate invasion and underwent combined SKM and EEA (n = 3), bifrontal craniotomy (n = 3), or EEA (n = 2), and one patient without both olfaction and cribriform plate invasion underwent SKM. GTR was achieved in 94.7%. Of 38 TS/PS meningiomas, 36 of the lesions were treated according to the algorithm. Of these 36 meningiomas, 30 were treated by EEA and 6 by craniotomy. GTR was achieved in 97.2%, with no visual deterioration and one CSF leak that resolved by placement of a lumbar drain. Two patients with tumors that, based on the algorithm, were not amenable to an EEA underwent EEA nonetheless: one had GTR and the other had a residual tumor that was followed and removed via craniotomy 9 years later.CONCLUSIONSUtilizing a simple algorithm aimed at preserving olfaction and vision and based on maximizing use of minimally invasive approaches and selective use of transcranial approaches, the authors found that excellent outcomes can be achieved for anterior skull base meningiomas.

scholarly journals Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986601 ◽  
Author(s):  
Brennan J. Boettcher ◽  
John H. Hollman ◽  
Michael J. Stuart ◽  
Jonathan T. Finnoff
Keyword(s):  
Translational Research ◽  
Ultrasound Guidance ◽  
Chronic Groin Pain ◽  
Ultrasound Guided ◽  
Longus Tendon ◽  
Adjacent Structures ◽  
Experienced Physician ◽  
Time Away ◽  
Adductor Longus ◽  
Neurovascular Structures

Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m2 (range, 16.8-29.6 kg/m2) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.

scholarly journals Real-time ultrasound-guided endoscopic surgery for putaminal hemorrhage

2015 ◽  
Vol 123 (5) ◽  
pp. 1151-1155 ◽  
Author(s):  
Hirokazu Sadahiro ◽  
Sadahiro Nomura ◽  
Hisaharu Goto ◽  
Kazutaka Sugimoto ◽  
Akinori Inamura ◽  
...  
Keyword(s):  
Real Time ◽  
Endoscopic Surgery ◽  
Ultrasound Guidance ◽  
Temporal Region ◽  
Ultrasound Guided ◽  
Endoscopic View ◽  
Artificial Cerebrospinal Fluid ◽  
Putaminal Hemorrhage ◽  
The Mean ◽  
Navigation Method

OBJECT Endoscopic surgery plays a significant role in the treatment of intracerebral hemorrhage. However, the residual hematoma cannot be measured intraoperatively from the endoscopic view, and it is difficult to determine the precise location of the endoscope within the hematoma cavity. The authors attempted to develop real-time ultrasound-guided endoscopic surgery using a bur-hole-type probe. METHODS From November 2012 to March 2014, patients with hypertensive putaminal hemorrhage who underwent endoscopic hematoma removal were enrolled in this study. Real-time ultrasound guidance was performed with a bur-hole-type probe that was advanced via a second bur hole, which was placed in the temporal region. Ultrasound was used to guide insertion of the endoscope sheath as well as to provide information regarding the location of the hematoma during surgical evacuation. Finally, the cavity was irrigated with artificial cerebrospinal fluid and was observed as a low-echoic space, which facilitated detection of residual hematoma. RESULTS Ten patients with putaminal hemorrhage > 30 cm3 were included in this study. Their mean age (± SD) was 60.9 ± 8.6 years, and the mean preoperative hematoma volume was 65.2 ± 37.1 cm3. The mean percentage of hematoma that was evacuated was 96% ± 3%. None of the patients exhibited rebleeding after surgery. CONCLUSIONS This navigation method was effective in demonstrating both the real-time location of the endoscope and real-time viewing of the residual hematoma. Use of ultrasound guidance minimized the occurrence of brain injury due to hematoma evacuation.

scholarly journals Can ultrasound guidance reduce the risk of pneumothorax following thoracentesis?

2014 ◽  
Vol 40 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Alessandro Perazzo ◽  
Piergiorgio Gatto ◽  
Cornelius Barlascini ◽  
Maura Ferrari-Bravo ◽  
Antonello Nicolini
Keyword(s):  
Ultrasound Guidance ◽  
Volume Of Fluid ◽  
Ultrasound Guided ◽  
Clinical Trial Registry ◽  
Fluid Removal ◽  
Standardized Protocol ◽  
Iatrogenic Complications ◽  
Support Team ◽  
The Mean ◽  
The Difference

OBJECTIVE: Thoracentesis is one of the bedside procedures most commonly associated with iatrogenic complications, particularly pneumothorax. Various risk factors for complications associated with thoracentesis have recently been identified, including an inexperienced operator; an inadequate or inexperienced support team; the lack of a standardized protocol; and the lack of ultrasound guidance. We sought to determine whether ultrasound-guided thoracentesis can reduce the risk of pneumothorax and improve outcomes (fewer procedures without fluid removal and greater volumes of fluid removed during the procedures). In our comparison of thoracentesis with and without ultrasound guidance, all procedures were performed by a team of expert pulmonologists, using the same standardized protocol in both conditions. METHODS: A total of 160 participants were randomly allocated to undergo thoracentesis with or without ultrasound guidance (n = 80 per group). The primary outcome was pneumothorax following thoracentesis. Secondary outcomes included the number of procedures without fluid removal and the volume of fluid drained during the procedure. RESULTS: Pneumothorax occurred in 1 of the 80 patients who underwent ultrasound-guided thoracentesis and in 10 of the 80 patients who underwent thoracentesis without ultrasound guidance, the difference being statistically significant (p = 0.009). Fluid was removed in 79 of the 80 procedures performed with ultrasound guidance and in 72 of the 80 procedures performed without it. The mean volume of fluid drained was larger during the former than during the latter (960 ± 500 mL vs. 770 ± 480 mL), the difference being statistically significant (p = 0.03). CONCLUSIONS: Ultrasound guidance increases the yield of thoracentesis and reduces the risk of post-procedure pneumothorax. (Chinese Clinical Trial Registry identifier: ChiCTR-TRC-12002174 [http://www.chictr.org/en/])

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