Comparing Powered Bone Marrow Biopsy Procedures to Manual Bone Marrow Biopsy Procedures Using Healthy Volunteers.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1523-1523
Author(s):  
Larry Miller ◽  
Thomas Philbeck ◽  
Diana Montez ◽  
Tatiana Puga ◽  
Andrew Brenner ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Pain Score ◽  
Bone Marrow Biopsy ◽  
Research Funding ◽  
Statistical Difference ◽  
Biopsy Needle ◽  
Second Look ◽  
Significant Difference ◽  
First Pass ◽  
The Mean

Abstract Abstract 1523 Introduction: A battery-powered bone marrow biopsy system was cleared by the U.S. Food and Drug Administration in 2007 for bone marrow sampling. A study was designed to determine if the powered device has advantages over traditional manual devices in terms of decreased pain, insertion time, and improved sample yield. Methods: The study protocol was approved by IntegReview Institutional Review Board. The study was conducted in a community cancer center. Pain-free adult volunteers, not on analgesics or anxiolytics, were enrolled in the study. Patients were not informed which needle was proprietary or being used with each procedure. Noise cancelling headphones and sham drill sound during manual insertions were employed. They were also uninformed as to which device was proprietary. After history, physical (including complete blood count) and consenting procedures, volunteer subjects were randomized to first pass device type and first-pass procedure side (left or right). Following local anesthesia administration using buffered Lidocaine, device operators (board-certified in hematology/oncology) performed the procedures using a Jamshidi® 11 gauge/4” Manual bone marrow biopsy needle (Havel, Inc. Richmond, VA) and an OnControl™ 11 gauge/102mm Powered bone marrow biopsy needle (Vidacare Corporation, Shavano Park, TX). A 100mm visual analog scale (VAS) was used to assess pain at initial biopsy needle insertion through the cortex, needle advancement for core sample capture, and needle removal—followed by a VAS measurement of the overall procedure pain and a final check 30 minutes after the procedure. After the second procedure, subjects were given a chance to change their overall pain score for the first procedure (“second look overall pain score”). Follow-up assessment for VAS and complications were made 1 day, 2 days, and 7 days after the biopsy procedures. Procedure time was measured from needle-to-skin contact to core specimen ejection from the needle. Core specimens were measured for length and submitted to pathology reference laboratory for grading. Pathology assessment included size measurement, post-fixation quality, medullary component quality, and overall quality. Results: There were 24 evaluable subjects the study. The mean age was 33.8 ± 11.3 years, and 54.2% were male. Mean height and weight were 169.7 ± 10.8cm and 77.0 ± 17.7kg, respectively. Of the 24 evaluable subjects, there were 24 manual insertions and 24 powered insertions. Cores were obtained in 67% of the Manual insertions and 100% of Powered insertions—a significant difference (p=0.002). The mean time to core acquisition was 86 seconds for Manual device and 47 seconds for the Powered device, a significance difference (p<0.001). Using the second look overall pain score (for those that opted to change their score), the mean score for the Manual device was 33.3 and 20.9 for the Powered—a significant difference (p<0.05). There was no statistical or clinical difference in other pain scores between the two devices. The mean biopsy core length was 11.1 ± 4.5mm for the Manual device and 17.0 ± 6.8mm for the Powered device (Figure 1); a statistical difference (p<0.005). Pathology assessment for the Manual device showed mean length of 6.08 ± 5.59mm, width of 0.98 ± 0.74mm, and mean volume of 11.00 ± 10.76mm3. Measurements for the Powered device were mean length of 15.29 ± 6.12mm, width of 1.98 ± 0.31mm, and mean volume of 49.12 ± 21.45mm3. All differences were statistically significant with p-values <0.001. For overall quality, 33.3% of Manual samples and 79.2% of Powered samples were graded adequate—a statistical difference (p=0.002). There were no complications. Conclusions: Results suggest the superior size and overall quality of core specimens delivered by the Powered device may provide more material for pathological evaluation of hematopoietic and oncological disorders. The powered device was significantly faster in obtaining a biopsy than the manual device and its capture rate in obtaining a satisfactory sample was much higher. Use of the Powered bone marrow biopsy device significantly decreases overall procedure pain. Disclosures: Miller: Vidacare Corporation: Employment, Equity Ownership, Patents & Royalties. Philbeck:Vidacare Corporation: Employment. Montez:Vidacare Corporation: Employment. Puga:Vidacare Corporation: Employment. Brenner:Vidacare Corporation: Consultancy, Research Funding. Cohen:Vidacare Corporation: Consultancy, Research Funding.

Bone Marrow Biopsy Needle Design Influences the Bone Content of Recovered Specimens.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5292-5292
Author(s):  
Alec Goldenberg ◽  
Priscilla Kelley ◽  
Cynthia Liu ◽  
Filiz Sen ◽  
Sherif Ibrahim
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Control Group ◽  
Computer Assisted ◽  
Needle Age ◽  
Biopsy Needle ◽  
Operator Experience ◽  
Patients Âgés ◽  
The Mean ◽  
Twin Peak

Abstract Introduction: The integrity and composition of bone marrow core biopsies may be influenced by many parameters including patient age, sex, bone density, operator experience, needle selection and biopsy technique. Biopsy needle design impacts on a needle’s performance and the quality of recovered specimens. We studied the effect of modifying the Snarecoil bone marrow biopsy needle tip on the recovery of trabecular bone in core specimens. Methods: 7 patients, ages 35–92, M/F = 4/3, (2 leukemias, 1 lymphoma, 1 cytopenia, 1 anemia, 2 other) underwent a bone marrow biopsy using a 8 gauge Snarecoil needle with a new needle tip (TPNSP). The tip has a twin peak point and more distal Snarecoil position. As a control group, 7 patients biopsied with a standard 8 gauge Snarecoil needle (NTP) were retrospectively identified and matched for age and sex and were ages 37–87, M/F = 5/2, (3 cytopenias, 2 leukemias, 1 lymphoma, 1 other). All biopsies were completed using a minimally manipulative technique from the left posterior superior iliac spine with 2% lidocaine. The length of the specimen and attached clot was measured. The specimens were decalcified for 90 minutes and otherwise processed in the standard fashion. The percentage of bone per core biopsy was determined with computer-assisted morphometry using a BioGenex iVision V3.5 system. Results: The study and control groups were comparable, as the mean age and M/F distribution of the two groups and the mean lengths of the recovered specimens were not statistically significantly different. (TPNSP vs. NTP, 63.8±7.1 vs. 64.7± 6.4 p=0.93, 4/3 vs.5/2 p= 0.57, 2.32± 0.26cm vs. 2.21± 0.26cm p=0.761, respectively). Needle Age M/F Specimen Length % Bone TPNSP 63.8±7.1 4/3 2.32±0.26 (1.2–3.3) 16.3±1.5 (12.1–21.8) NTP 64.7±6.4 5/2 2.21±0.26 (1.3–2.9) 6.8±1.4 (2.9–12.5) However, the mean percentage of bone in the specimens recovered by the new TPNSP needle was greater than that recovered with the NTP needle. (16.3±1.5% vs. 6.8±1.4%, p= 0.0008). Grossly, the TPNSP specimens had a more linear edge than those of the NTP specimens. Also, more (5/7) of the NTP specimens had > 0.5 cm of attached clot then did the TPNSP specimens (0/7), p=0.005 suggesting that the twin peak needle produced less tissue hemorrhage. Conclusions: 1. 8 gauge Snarecoil needles having a sharper tip and more distal Snarecoil recover specimens with as much as 2.5 fold more bone for histopathologic study. 2. The twin peak needle may produce less tissue hemorrhage and disruption.

Use of a New Rotary Powered Device for Bone Marrow Aspiration and Biopsy Yields Excellent Specimens Quickly and Efficiently.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4544-4544
Author(s):  
Ronan T. Swords ◽  
Kevin R. Kelly ◽  
Devalingam Mahalingam ◽  
Stephen C. Cohen ◽  
Larry J. Miller ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Clinical Evaluation ◽  
Research Funding ◽  
Bone Marrow Aspiration ◽  
Swine Model ◽  
Employment Equity ◽  
Equity Ownership ◽  
Specimen Quality ◽  
The Mean

Abstract Abstract 4544 Background The importance of bone marrow aspiration and biopsy in the evaluation of hematopoietic and non-hematopoietic disorders is well established. Recently, a new FDA-cleared battery powered bone marrow biopsy system was developed to allow operators access to the bone marrow space quickly and efficiently. Aims The first aim of this study was to evaluate the quality of core specimens using the new powered device compared to specimens obtained using the traditional manual technique in a swine model. The second aim was to evaluate the safety and efficacy of the device in patients presenting for outpatient hematology clinic visits. Materials and Methods For the pre-clinical evaluation of the device, three anesthetized pigs were used for the study. The powered device (OnControl, Vidacare Corporation, San Antonio, TX, USA) was comprised of a battery powered driver and needle set. The manual device used was a T-Handle Jamshidi bone marrow biopsy needle (Cardinal Health, Dublin, OH, USA). Core biopsy samples obtained were assessed for length and sample quality and then submitted for analysis to a pathologist blinded to the device used. The clinical evaluation of the device was conducted in accordance with practice guidelines and directions for use. Data collection included insertion success, time from insertion to removal, specimen quality, operator satisfaction with control/function of the device and overall operator satisfaction based on a scoring system (0-5; 0=totally unacceptable, 5=outstanding). Results Twenty six samples were collected from the swine model (19 samples using the powered device and 9 using the manual technique). No cellular artifact or thermal damage was reported in any of the samples obtained. The mean lengths for samples obtained using the powered and manual techniques were respectively 19.4mm±1.6mm and 18.6mm±5.3mm. For the clinical evaluation of the device, 16 patients were recruited from 2 centers. Mean insertion time was 11.25±3.39 seconds and mean time from needle contact with skin to needle removal was 38.5±13.94 seconds. No complications were reported. Five operators rated the overall use of the device as outstanding in 75% of cases. Conclusions In this study, the manual and powered samples were equivalent in specimen quality. The powered device however, captured longer biopsies when compared to the manual technique. In the patients evaluated, the device was easy to use as well as being safe and effective. The mean procedural time was significantly faster than previously reported with a manual technique. A randomized study of the powered device compared to the manual technique is underway. Disclosures: Swords: Vidacare Corporation: Research Funding. Kelly:Vidacare Corporation: Research Funding. Mahalingam:Vidacare Corporation: Research Funding. Cohen:Vidacare Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding. Miller:Vidacare Corporation: Employment, Equity Ownership. Philbeck:Vidacare Corporation: Employment, Equity Ownership. Brenner:Vidacare Corporation: Consultancy, Research Funding. Giles:Vidacare Corporation: Research Funding.

A New Rotary Powered Device for Bone Marrow Aspiration and Biopsy Yields Superior Specimens with Less Pain: Results of a Randomized Clinical Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1529-1529 ◽  
Author(s):  
Ronan Swords ◽  
Javier Anguita ◽  
Russell A. Higgins ◽  
Andrea Yunes ◽  
Michael Naski ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Research Funding ◽  
Bone Marrow Aspiration ◽  
Morbidity And Mortality ◽  
Procedure Time ◽  
Medullary Bone ◽  
Biopsy Device ◽  
The Mean

Abstract Abstract 1529 Introduction: The importance of bone marrow aspiration and biopsy in the evaluation of hematopoietic and non-hematopoietic disorders is well established. However, this technique is associated with morbidity and mortality risks.1 Recently, a battery-powered bone marrow biopsy system was developed to allow operators to safely, quickly and efficiently access the marrow space. We previously evaluated this device in swine models and in patients needing routine hematology outpatient evaluation.2 In the current study we compared the powered device to the traditional manual technique by relatively assessing pain scores, procedure times, biopsy capture rates, quality of material retrieved, safety and operator satisfaction. Methods: Two large academic medical centers participated in this trial (San Antonio, TX and Madrid, Spain). The study protocol was approved by each center's institutional review board. Adult patients requiring bone marrow biopsies were considered for the study. Following informed consent, patients were randomized to have procedures using a manual biopsy device (T-handle Jamshidi bone marrow biopsy and aspiration set, Cardinal Health, Dublin, OH) or the Powered device (OnControl 11 gauge/102mm Bone Marrow Biopsy System, Vidacare Corporation, Shavano Park, TX). After infiltration of the skin and medullary bone with local anesthesia, a visual analog scale (VAS) pain score was recorded immediately following skin puncture and once again at the end of the procedure for each patient. Procedure time was measured from skin puncture to core specimen ejection from the needle. Pathologic assessment of 30 randomized samples was carried out. Operator satisfaction with devices was measured on a scale of 0–10, with 10 as the highest rating. Statistics were calculated using t-test and chi-square, with an alpha-level of 0.05. Results: Five operators from 2 sites enrolled 50 patients (Powered, n=25; Manual, n=25). Of those patients, 58% were male and 42% were female; and had a mean age of 56.0±18.0 years. The mean height was 167.5 ± 10.5cm and the mean weight was 78.7 ± 22.7kg. Forty percent were lymphoma patients—the largest diagnostic group. Between patient groups, there were no significant differences in the means for these variables. See Table below for quantitative results, including pathology analysis. For the pathology qualitative analysis, there was no difference between groups for hemorrhage, clot/particle spicules, or smear spicules. Conclusions: Results of this trial suggest that the use of a Powered bone marrow biopsy device significantly reduces needle insertion pain. While not reflected in the results, overall pain may be better tolerated due to the important difference in procedure time. Moreover, the superior size and overall quality of core specimens retrieved by the Powered device provides more material for pathologic evaluation, thereby increasing diagnostic yield and reducing the need for repeat procedures. Cohesiveness of the medullary bone sampled was comparable for both techniques; however, the Powered system was less likely to recover non-hematopoietic tissue (e.g. cortical bone and soft tissue). Artifact was slightly more common with the Powered device (aspiration, hemorrhage and crush) but this did not impact on the diagnostic quality of the sample. No differences in safety data were noted for either technique and operator satisfaction favored the Powered device. 1. Bain BJ. Bone marrow biopsy morbidity and mortality. British Journal of Haematology 2003;121:949-51. 2. Swords RT, Kelly KR, Cohen SC et al. Rotary powered device for bone marrow aspiration and biopsy yields excellent specimens quickly and efficiently. J Clin Pathol 2010;63:562-5. Disclosures: Swords: Vidacare Corporation: Research Funding. Anguita:Vidacare Corporation: Research Funding. Kelly:Vidacare Corporation: Research Funding. Philbeck:Vidacare Corporation: Employment. Miller:Vidacare Corporation: Employment, Equity Ownership. Brenner:Vidacare Corporation: Research Funding.

8 and 11Gauge Bone Marrow Biopsy Needle Performance Characteristics.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5580-5580
Author(s):  
Alec Goldenberg ◽  
Priscilla Kelley ◽  
Sherif Ibrahim ◽  
Filiz Sen ◽  
Cynthia Liu
Keyword(s):  
Bone Marrow ◽  
Frequency Distribution ◽  
Bone Marrow Biopsy ◽  
Distribution Curve ◽  
Patient Characteristics ◽  
Length Frequency Distribution ◽  
Length Frequency ◽  
Specimen Length ◽  
Biopsy Needle ◽  
The Mean

Abstract Introduction. An ideal biopsy needle consistently recovers representative specimens of adequate length with minimal dependence on patient characteristics. We have shown that bone marrow biopsy needle gauge influences the length and quantity of recovered specimens. A needle that performs independently of patient characteristics should yield specimens demonstrating a normal distribution of specimen lengths. We evaluated the influence of age and needle gauge on the specimen length distribution curves of patients undergoing bone marrow biopsies using SNARECOIL needles. Methods. 88 bone marrow core specimens were recovered from 72 patients using 11G SNARECOIL bone marrow biopsy needles. The mean age of the patients was 61.4 and the m/f ratio was 45/27. 53 specimens were recovered from 39 patients (mean age = 47.1, m/f = 27/12) ≤ 64 and 35 specimens were recovered from 33 patients (mean age = 78.6, m/f = 18/15) ≥ 65. 106 patients underwent 127 bone marrow biopsy procedures using 8G SNARECOIL needles. The m/f ratio was 56/50 and the mean age of the patients was 63.1 years. 72 specimens were recovered from 56 patients (mean age = 51.4, m/f = 30/26) ≤ 64 years old and 55 specimens were recovered from 49 patients (mean age = 76.1, m/f = 26/23) ≥ 65. 40 additional specimens were prospectively recovered from 39 patients ≥ 65 (mean age = 74.3, m/f = 19/20) with 8G SNARECOIL needles. Results. The mean specimen lengths of the 11G and 8G specimens were statistically the same (mean±SEM, 1.97±0.07 cm vs. 1.99±0.05 cm, respectively, p = 0.8). However the 11G specimen length frequency distribution curve deviated markedly from a normal distribution (skewness(skw) = 0.52) while the 8G specimen distribution was nearly normal (skw = 0.04). While the frequency distribution curves of older patients (≥ 65) biopsied with 8G needles showed minimal deviation from normality (skw = 0.12,) the distribution curve of older patients (≥65) biopsied with 11G needles deviated markedly from a normal curve (skw = 0.64). 40 specimens prospectively obtained from patients ≥ 65 demonstrated a mean specimen length of 1.77±0.09 cm with a near normal specimen length frequency distribution curve (skw = 0.07). Conclusions. 1. Although commonly reported, mean specimen lengths do not completely characterize the performance of biopsy needles. 2.0 Specimen length frequency distribution curves provide added characterization of needle performance in defined patient cohorts. 3.0 In the older patient population, near-normal 8G specimen frequency distributions and skewed 11G distributions suggest that 8G specimens may provide more representative sampling.

The Powered Bone Marrow Biopsy Technique Is Superior to the Standard Manual Technique for Hematologists-In-Training: A Prospective, Randomized Comparison

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3133-3133
Author(s):  
Louis Juden Reed ◽  
Radha Raghupathy ◽  
Marianna Strakhan ◽  
Thomas Philbeck ◽  
Mimi Y. Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Primary Endpoint ◽  
Research Funding ◽  
Teaching Hospitals ◽  
Procedure Time ◽  
Biopsy Specimens ◽  
Patient Pain ◽  
The Mean

Abstract Abstract 3133 The human bone marrow is often evaluated in patients with various hematological disorders. Multiple bone marrow procedures are often required in patients with hematological malignancies to guide their treatment. The instrument customarily employed, the Jamshidi needle, which involves manual rotary insertion into the marrow cavity of the posterior aspect of the iliac bone produces both an aspirate and a biopsy. Bone marrow biopsy procedure has changed very little in the last 40 years and is regarded by patients and physicians alike as a painful and uncomfortable procedure. In addition, suboptimal specimens including dilute aspirates and small core biopsies are often obtained, limiting the diagnostic potential of the procedure. Initial clinical studies utilizing a new powered bone marrow (PBM) device (OnControl, Vidacare Corporation, Shavano Park, TX), indicated that it was faster and easier to use for bone marrow aspirations than the traditional method. While the duration of the procedure has been consistently shorter, and the core samples larger for patients undergoing PBM in these reports, no studies have been carried out in teaching hospitals to determine whether or not the PBM system will be more readily mastered by hematologists-in-training. We conducted a prospective, randomized study to compare PBM with standard bone marrow procedure (SBM) in adults. PBM utilizes a battery-powered drill to insert the marrow needle into the iliac bone of adult hematology patients. This study was performed in 2 teaching hospitals employing hematologists-in-training. The primary endpoint of the study, the mean length of the marrow biopsy specimens, a surrogate for marrow quality, was determined by a pathologist in a blinded manner. Linear mixed effects models were fit to the data to compare the two techniques and adjust for the correlation in outcomes of procedures performed by the same fellow. 54 bone marrows (26 SBM and 28 PBM) were performed by 11 fellows under the observation and supervision of 3 attending hematologists and 1 research technologist. The primary endpoint was met. The mean length of the marrow biopsy specimens was found to be significantly longer (56%) for the PBM group (15.3 mm) than for the SBM group (9.8 mm), p<0.003. An objectively determined secondary endpoint; mean procedure time, skin-to-skin; also favored the PBM group (175 seconds) versus the SBM group (292 seconds), p<0.007. According to Kuball et al, bone marrow procedure time is particularly relevant to patient pain. Patients are generally willing to undergo biopsy and a reasonable level of pain, provided that the procedure time is relatively short. After each procedure, questionnaires were completed by the study patient, the fellow performing the procedure, and the attending hematologist/research technologist observing the procedure. The numerical questionnaires, on a scale of 0–10 evaluated the perceived level of pain, ease/difficulty of the procedure, quality of marrow obtained and patient willingness to have a repeat biopsy if medically indicated. Questionnaire analysis indicated the level of patient pain perceived by the fellow and attending was significantly less in the PBM group than the SBM group (a result subject to observer bias). Our study has confirmed as well that patients in the PBM group have experienced a trend towards less pain than the control group, although the difference was not statistically significant (p=0.11). In addition, patients in the PBM group were more agreeable to undergoing repeat bone marrow biopsy if needed as compared to the SBM group (p=0.03). Fellows experienced more difficulty with the SBM than with the PBM procedure (p=0.002). Refusal by patients to undergo bone marrow biopsy procedures, especially in diseases like myeloma, leukemia and lymphoma, lead to delays in the diagnosis and treatment which may have fatal consequences. Any device, such as PBM, which promotes greater patient acceptance of a painful, but necessary, procedure, may be anticipated to improve quality of care and to enhance favorable clinical outcomes. It was concluded that bone marrow biopsies performed by hematologists-in-training were significantly faster and superior in quality when performed with the PBM compared to the SBM. These data suggest that the PBM may be considered a new standard of care for adult hematology patients. PBM also appears to be a superior method for training hematology fellows. Disclosures: Reed: Vidacare Corporation: Research Funding, Travel expenses. Raghupathy:Vidacare Corporation: Research Funding. Strakhan:Vidacare Corporation: Travel expenses. Philbeck:Vidacare Corporation: Employment. Kim:Vidacare Corporation: Research Funding. Hussain:Vidacare Corporation: Travel Expenses. Pacello:Vidacare Corporation: Technologist Fees.

Determination some Immunological Aspects in Pulmonary Tuberculosis Patients in Qadisiyah Province

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Syoof Khowman Alramahy ◽  
Akram Hadi Hamza
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Statistical Difference ◽  
Positive Culture ◽  
Control Group ◽  
Tuberculosis Patients ◽  
Significant Difference ◽  
Lowenstein Jensen ◽  
The Mean ◽  
Igg Level

This study was carried out to study of some immunological aspects among the pulmonary Tuberculosis patients infected with causative agent, Mycobacterium tuberculosis. A Total of 200 sputum samples were collected from patients attending the consultant Clinic for Chest and Respiratory disease center, Diwaniya. Control group (No=15) also included. According to acid fast stain of sputum, the patients were classified as positive (No=91,45.5%) and negative (No=109,54.5, Lowenstein Jensen medium used for the cultivation of samples, on which 70% of sputum samples where positive culture for this microorganism. The grown microorganism were identified as M. tuberculosis, based on positive A.F.B, Niacin producers ,negative for catlase at 68c. The mean IgG level was l184.053±76.684 mg/100 ml in tuberculosis group compared with 1016.533 ± 44.882 mg/100ml in control group, rendering the statistical difference significant. For IgA and IgM levels, they were at mean of 315.880±38.552 mg/100 ml and 119.527±8.464 mg/100 ml in control group compared with 396.358±38.776 mg/100 ml and 134.207±11.696 mg/100 ml in patients group respectively with significant difference

scholarly journals Complex Regional Pain Syndrome: Current Practice Management and Referral Trends in a Closed Healthcare System

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 39-47
Author(s):  
Connor Zale ◽  
Joshua Hansen ◽  
Paul Ryan
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Healthcare System ◽  
Pain Syndrome ◽  
Occupational Outcomes ◽  
Mean Delay ◽  
Significant Difference ◽  
The Mean ◽  
Over Time

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

scholarly journals Inadvertent arterial & venous injury by bone marrow biopsy needle: case report on rescue embolization techniques

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Chris Siu-Chun Tsai ◽  
Simon Chun-Ho Yu
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Vascular Injury ◽  
Iliac Artery ◽  
Morbidity And Mortality ◽  
Biopsy Needle ◽  
Venous Injury ◽  
Patient Morbidity ◽  
Internal Iliac ◽  
Life Threatening

Abstract Background Bone marrow biopsy is a common medical procedure for diagnosis and characterization of haematological diseases. It is generally regarded as a safe procedure with low rate of major complications. Inadvertent vascular injury is however an uncommon but important complication of bone marrow biopsy procedure. The knowledge of a safe and effective embolization method is crucial for interventional radiologists to reduce significant patient morbidity and mortality, shall such inadvertent vascular injury occurs. Case presentation Bedside bone marrow biopsy was performed for an elderly gentleman to evaluate for his underlying acute leukaemia. Biopsy needle inadvertently injured the internal iliac artery and vein during the procedure. Coil embolization was carefully performed across injured arterial segment via the culprit biopsy needle until contrast cessation. Concomitant venous injury was subsequently confirmed on angiography when the needle was withdrawn for a short distance from the iliac artery. This venous injury was tackled by further withdrawing the biopsy needle to distal end of the bone marrow tract for tract embolization with coils and gelatin sponges. High caution was made to avoid coil dislodgement into the iliac vein, to prevent pulmonary embolism. Patient was clinically stable throughout the procedure. Post-procedure contrast CT shows no pelvic haematoma or contrast extravasation. Conclusions This case illustrates rescue embolization techniques for rare life-threatening concomitant internal iliac arterial and venous injuries by a bone marrow biopsy needle. Interventional radiologists can play an important role in carrying out precise embolization to avoid significant patient morbidity and mortality in the case of life-threatening haemorrhage.

Ventricular volume change in childhood

2002 ◽  
Vol 97 (3) ◽  
pp. 584-590 ◽  
Author(s):  
Chris Xenos ◽  
Spyros Sgouros ◽  
Kalyan Natarajan
Keyword(s):  
Statistical Difference ◽  
Linear Regression Analysis ◽  
Ventricular Volume ◽  
Intracranial Volume ◽  
Normal Children ◽  
Content Type ◽  
Ventricular Volumes ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The aim of this study was to construct a model of age-related changes in ventricular volume in a group of normal children ages 1 month to 15 years, which could be used for comparative studies of cerebrospinal fluid circulation disorders and cerebral atrophy developmental syndromes. Methods. A magnetic resonance imaging—based segmentation technique was used to measure ventricular volumes in normal children; each volume was then plotted against the child's age. In addition, intracranial volumes were measured and the ratio of ventricular to intracranial volume was calculated and plotted against age. The study group included 71 normal children, 39 boys and 32 girls, whose ages ranged from 1 month to 15.3 years (mean 84.9 months, median 79 months). The mean ventricular volume was 21.3 cm3 for the whole group, 22.7 cm3 in boys and 19.6 cm3 in girls (p = 0.062, according to t-tests). The mean ventricular volume at 12 months for the whole group was 17 cm3 (20 cm3 in boys and 15 cm3 in girls), representing 65% of the volume achieved by 15 years of age (87% in boys and 53% in girls). The volume increased by a factor of 1.53, to 26 cm3 (23 cm3 in males and 28 cm3 in females, increase factors of 1.15 and 1.86, respectively) at 15 years of age. The change in ventricular volume with age is not linear, but follows a segmental pattern. These age periods were defined as: 0 to 3, 4 to 6, 7 to 10, and 11 to 16 years. A statistical difference based on sex was only demonstrated in the first 6 years of life. The mean ventricular volume for the first 6-year period was 22.4 cm3 in boys and 15.7 cm3 in girls, and the difference was significant for the two sexes (linear regression analysis for age and sex, significant according to analysis of variance regression at 0.007, p = 0.108 for age, p = 0.012 for sex). Thereafter, there was no significant difference in ventricular volume between boys and girls with further growth. The ratio of ventricular volume to intracranial volume was 0.0175 for the whole group, 0.017 in boys and 0.018 in girls (p = 0.272, according to t-tests). At 12 months of age the ratio was 0.019; it stabilized to 0.015 at 8 years of age, and increased to 0.018 at 15 years of age. No statistical difference based on sex was demonstrated with growth. Conclusions. The ventricular volume in normal children increases with age by a factor of 1.5; the increase is in a nonlinear segmental pattern. Boys have significantly higher ventricular volumes only in the first 6 years of life. The ventricular/intracranial volume ratio remains stable throughout childhood.

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