Medical adhesive vs hookwire for computed tomography-guided preoperative localization and risk factors of major complications

2021 ◽  
pp. 20201208
Author(s):  
Weitao Ye ◽  
Chenyu Dong ◽  
Churong Lin ◽  
Qidi Wu ◽  
Jiao Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thoracoscopic Surgery ◽  
Insertion Depth ◽  
Ct Guided ◽  
Pleural Surface ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Medical Adhesive ◽  
Video Assisted Thoracoscopic Surgery

Objective: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. Methods: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. Results: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (β = 1.12, p = 0.018), total insertion depth (β = −0.41, p = 0.013), pleura-needle angle (β = −0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (β = −0.96, p = 0.030) were independently associated with pneumothorax, while age (β = −0.94, p = 0.018), tumor size (β = 0.29, p = 0.007) and its distance from the pleural surface (β = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. Conclusion: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. Advances in knowledge: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.

Ultra-low-dose CT-guided lung biopsy in clinic: radiation dose, accuracy, image quality, and complication rate

2020 ◽  
pp. 028418512091762
Author(s):  
Ting Liang ◽  
Yonghao Du ◽  
Chenguang Guo ◽  
Yuan Wang ◽  
Jin Shang ◽  
...  
Keyword(s):  
Image Quality ◽  
Radiation Dose ◽  
Complication Rate ◽  
Lung Biopsy ◽  
Ct Guided ◽  
Significant Difference ◽  
Group A ◽  
Mode Group ◽  
Dose Accuracy ◽  
Group B

Background Computed tomography (CT)-guided percutaneous lung biopsy is usually performed by helical scanning. However, there are no studies on radiation dose, diagnostic accuracy, image quality, and complications based on axial scan mode. Purpose To determine radiation dose, accuracy, image quality, and complication rate following an ultra-low-dose (ULD) protocol for CT-guided lung biopsy in clinic. Material and Methods A total of 105 patients were enrolled to receive CT-guided lung biopsy. The use of an ULD protocol (axial scan) for CT-guided biopsy was initiated. Patients were randomly assigned to axial mode (Group A) and conventional helical mode (Group B) CT groups. 64-slice CT was performed for CT-guided pulmonary biopsy with an 18-G coaxial cutting biopsy needle. The radiation dose, accuracy, image quality, and complication rate were measured. Results Ninety-seven patients were selected for the final phase of the study. There was no significant difference between the two groups for pulmonary nodule characteristics ( P > 0.05). The mean effective dose in group A (0.077 ± 0.010 mSv) was significantly reduced relative to group B (0.653 ± 0.177 mSv, P < 0.001). There was no significant difference in accuracy, image quality, and complication rate ( P > 0.050) between the two modes. Conclusion An ULD protocol for CT-guided lung nodule biopsy yields a reduction in the radiation dose without significant change in the accuracy, image quality, and complication rate relative to the conventional helical mode scan.

Antibiotic Prophylaxis Before Dental Procedures Can Reduce ONJ Incidence.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3613-3613 ◽  
Author(s):  
Vittorio Montefusco ◽  
Francesca Gay ◽  
Francesco Spina ◽  
Maria Teresa Ambrosini ◽  
Massimo Maniezzo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Low Risk ◽  
Dental Procedure ◽  
Dental Procedures ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Osteonecrosis of the jaw (ONJ) is a frequent complication in bisphosphonate-treated multiple myeloma (MM) patients. The pathogenesis is unclear, and major risk factors are duration of bisphosphonate treatment and dental procedures. The histology of osteonecrotic bone shows osteomyelitis and inflammatory infiltrates, and, in most cases, presence of Actynomycetes. Since dental procedures are a major risk factor for ONJ development and oral microflora can be involved in the pathogenesis of the disease, we conducted a retrospective observational trial comparing ONJ occurrence and related risk factors in two groups of MM patients, who received zoledronic acid treatment at two Italian hematological centres. In one centre all patients systematically received as antibiotic prophylaxis amoxicillin-clavulanate 1 gm bid or levofloxacin 500 mg once a day starting from one day before to 3 days after any dental procedure (group A, 52 patients), while in the other centre patients did not receive any prophylaxis (group B, 61 patients). Dental procedures were categorized according to their invasivity and their supposed probability to cause ONJ. Extractions, implants, and professional cleanings were considered at high risk, while fillings were considered low risk procedures. Thirty-three group A patients (63%) and 32 group B patients (52%) received high risk procedures; 4 group A patients (8%) and 5 group B patients (8%) received low risk procedures, while 15 (29%) and 24 (39%) patients, respectively, had a denture. The duration of zoledronic acid exposure differed significantly between the two groups, with a median of 26 months for A patients and 12 months for B patients (p&lt;0.0001). In group A no cases of ONJ were observed, while in group B 8 cases (13%) of ONJ were diagnosed, with a significant difference between the two groups (p=0.007). There was a temporal correlation between dental procedure and ONJ, with a median time of 60 days (range 37–990). The relative risk of ONJ after a dental procedure was 4.8 (p=0.01). The pooled analysis of the two groups showed that age, sex, transplant procedure, and thalidomide therapy did not correlate with ONJ. In both groups the presence of dentures was not associated with ONJ. While in group B incidence of ONJ is consistent with data reported in the literature, which range between 7% and 11%, group A patients had an unexpected low occurrence of this complication, despite a significantly longer exposure to zoledronic acid. This finding suggests a possible role of antibiotic prophylaxis in protecting from ONJ after dental procedures. Further, our observation, along with the correlation between dental procedures and ONJ development, can contribute to the proposal of a comprehensive model of ONJ pathogenesis: trauma of the alveolar bone modified by bisphosphonates induces a bacterial translocation with a subsequent induction of infection, inflammation and necrosis. In this perspective, since antibiotic prophylaxis is a simple and low cost precaution, it’s reasonable to propose it as part of standard care to zoledronic acid treated MM patients before any dental procedure.

Single-needle Celiac Plexus Block 

1997 ◽  
Vol 87 (6) ◽  
pp. 1301-1308 ◽  
Author(s):  
Marcello De Cicco ◽  
Mira Matovic ◽  
Luca Balestreri ◽  
Augusto Fracasso ◽  
Sandro Morassut ◽  
...  
Keyword(s):  
Pain Relief ◽  
Celiac Artery ◽  
Celiac Plexus ◽  
Celiac Plexus Block ◽  
Ct Guided ◽  
Needle Position ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Plexus Block

Background The "single-needle" celiac plexus block is becoming a popular technique. Despite different approaches and methods used to place the needle, the success of the block depends on adequate spread of the injectate in the celiac area. In the present retrospective study, the influence of needle tip position in relation to the celiac artery on injectate spread was evaluated. Methods Among 138 cancer patients subjected, via an anterior approach, to computed tomography (CT)-guided single-needle neurolytic celiac plexus block, a radiologist, blinded to the aim of the study, retrospectively selected 53 cases with normal anatomy of the celiac area as judged by CT. The decision was based on images obtained before the block. Patients were then classified into either group A (29 patients), in whom the needle tip was caudad to the celiac artery, and group B (24 patients), in whom it was cephalad. To evaluate CT patterns of neurolytic (mixed with contrast) spread, the celiac area was divided on the frontal plane into four quadrants: upper right and left and lower right and left, as related to the celiac artery. Patient assessments by visual analog scale were reviewed to evaluate the degree of pain relief. Pain relief 30 days after block was judged as long-lasting. The patterns of contrast spread in relation to the needle position and pain relief according to the number of quadrants with contrast were analyzed. Results The percentage of cases with four quadrants with contrast was higher when the needle tip was cephalad (58%, group B) than when it was caudad (14%, group A) to the celiac artery (P &lt; 0.01). The percentage of patients with four and three quadrants with contrast was also higher in group B at 79% than in group A at 38% (P &lt; 0.01). A significant difference in long-lasting pain relief was observed between patients with four quadrants with contrast (18 of 18, 100%; 95% confidence interval [CI], 81-100%) and patients with three quadrants with contrast (5 of 12, 42%; 95% CI, 15-72%) (P &lt; 0.01). No patients showing two or one quadrant with contrast had long-lasting pain relief. Conclusions These findings suggest that, when the celiac area is free from anatomic distortions, and the single-needle neurolytic celiac plexus block technique is used, the needle tip should be positioned cephalad to the celiac artery to achieve a wider neurolytic spread. It also appears that only a complete (four quadrants) neurolytic spread in the celiac area can guarantee long-lasting analgesia.

scholarly journals Epinephrine in the Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Preliminary Study

2018 ◽  
Vol 12 (1) ◽  
pp. 125-136 ◽  
Author(s):  
Behzad Hatami ◽  
Seyed Mohammad Hossein Kashfi ◽  
Mohammad Abbasinazari ◽  
Ehsan  Nazemalhosseini Mojarad ◽  
Mohammad Amin Pourhoseingholi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Univariate Analysis ◽  
Combination Group ◽  
Endoscopic Retrograde ◽  
Significant Difference ◽  
Blinded Manner ◽  
Group A ◽  
Group B ◽  
Double Blinded

Background: Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The incidence of post-ERCP pancreatitis (PEP) ranges between 15 and 20% among patients at high risk of developing PEP. The efficacy of indomethacin administration in the prevention of PEP is rather debatable. In the present randomized trial study, we evaluated whether or not the combination of indomethacin and epinephrine in comparison to the single administration of indomethacin differs in the pathogenesis and prevention of post-ERCP pancreatitis. Patients and Methods: One hundred and ninety-two patients were randomized in a double-blinded manner into 3 groups: the epinephrine group (group A), the indomethacin group (group B), and the combined epinephrine and indomethacin group (group C). After the procedure, patients were evaluated for the PEP development. Results: During the procedure, 66 patients were randomized to the epinephrine group (group A), 68 cases to the indomethacin group (group B), and 58 individuals to the indomethacin-epinephrine group (group C). The mean age of patients in the epinephrine group was 59.59 ± 15.680 years, in the indomethacin group it was 58.06 ± 17.125 years, and in the combination group it was 59.62 ± 15.369 years. In the present study, we did not observe a significant difference between the 3 groups in sex, age, pre-ERCP amylase, lipase, and patient and procedure risk factors including pancreatic duct (PD) dilation (p = 0.404), PD cannulation (p = 0.329), and difficult cannulation (p = 0.076) among others. PEP developed in 7 of the 192 individuals (3.6%), 6 PEP cases occurred in the indomethacin group and 1 in the epinephrine group (p = 0.016). Univariate analysis of risk factors for PEP in patients with and without pancreatitis revealed no significant difference between the pancreatitis group and the non-pancreatitis group. Conclusion: In comparison to the administration of indomethacin alone, a single application of epinephrine and the combination of epinephrine and indomethacin seem to be effective in reducing the cases of PEP. A further randomized clinical trial with a larger sample size is required to confirm the efficacy of our medication in the prevention of pancreatitis after ERCP.

scholarly journals Comparison of Extended Segmentectomy with Traditional Segmentectomy for Stage I Lung Cancer

2021 ◽  
Author(s):  
Ya-Fu Cheng ◽  
Yueh-Che Hsieh ◽  
Yu-Jun Chang ◽  
Ching-Yuan Cheng ◽  
Chang-Lun Huang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Resection Margin ◽  
Thoracoscopic Surgery ◽  
Stage I ◽  
Tumor Diameter ◽  
Surgical Methods ◽  
Group A ◽  
Stage I Lung Cancer ◽  
Group B ◽  
Video Assisted Thoracoscopic Surgery

Abstract Background For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC. Methods This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed. Results There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026). Conclusions The iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule’s diameter is less than 10 mm.

scholarly journals Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

2017 ◽  
Vol 6 (10) ◽  
pp. 2522
Author(s):  
Ritu Bala ◽  
Harminder Singh ◽  
. Rupali ◽  
Kuhu Verma
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
P Value ◽  
Biochemical Tests ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Hypertension is the most prevalent cardiovascular disease and the relevant data suggest that the burden, risk factors and co-morbidities associated with the essential hypertension is increasing with every passing day. It is one of the major chronic diseases resulting in high mortality and morbidity in today’s world. Aim: The aim of the study was to compare effects of cilnidipine and amlodipine on the blood pressure (BP), heart rate and proteinuria among patients of hypertension with chronic kidney disease.Methods: 100 patients were included in this study. Patients were randomly assigned into two groups Group A and Group B (50 each). Group A: Patients received Cilnidipine (5-10mg/day). Group B: Patients received amlodipine (5-10mg/day).Results: No significant difference in SBP, DBP, MBP and proteinuria while comparing both the groups of patients taking cilnidipine and amlodipine at baseline i.e. 0 to 12 week, 12 to 24 weeks and 0 to 24 weeks. Cilnidipine caused decrease in HR 0 to 12 week (p value 0.001), 12 to 24 weeks (p value 0.001) and 0 to 24 weeks (p value 0.0001). Amlodipine had increased heart rate from baseline to 12 weeks (p value 0.0001), 12 to 24 weeks (p value 0.051) and 0 to 24 weeks (p value 0.001). No significant difference was seen in any biochemical readings.Conclusions: There was a significant change in all the parameters including BP, heart rate, proteinuria and other biochemical tests when they compared within the group but no significant difference while comparing both the groups.

scholarly journals Complications rate and risk factors in unplanned reoperation of degenerative lumbar spondylolisthesis in geriatric patients: a retrospective single-center cohort study of 33 patients

2019 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaoji Luo ◽  
Tianji Huang ◽  
Zhengxue Quan
Keyword(s):  
Risk Factors ◽  
Neurological Deficit ◽  
Geriatric Patients ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Screw Misplacement ◽  
Group A ◽  
Group B ◽  
Lumbar Spondylolisthesis ◽  
Complications Rate

Abstract Background: The study aimed to investigate the complications rate and risk factors in unplanned reoperation among geriatric patients who underwent posterior lumbar fusion(PLF) for degenerative lumbar spondylolisthesis(DLS).Methods: 1100 DLS patients who were older than 60 years were reviewed from January 2006 to December 2016 and 33 patients underwent unplanned reoperations who were analyzed and divided to two groups(Group A: posteriolateral fusion, Group B: intervertebral fusion). Gender, body mass index (BMI), radiographic data and clinical outcomes data were analyzed to evaluate complications rate and the risk factors for unplanned reoperations.Results: 33 patients were performed by the unplanned reoperations(3%).The patients were followed up for an average of 4.20±2.25 years (Group A)and 4.32±2.54 years(Group B)without significant difference. The significant difference was found in mean age, levels involved levels, hospital stay, surgery time, blood loss between the groups. The causes of unplanned operation were: wound infection, screw misplacement, neurological deficit, nonunion, screw fracture which were significant except the wound infection between the groups. Higher BMI (obesity), diabetes mellitus(DM), more bleeding and gender(female) were the risk factors of the complications. The cases of the screw misplacement, neurological deficit, nonunion and screw fracture in group A were more significantly than in group B.Conclusion: The patients of higher BMI, DM, age, posteriolateral fusion, female predicted higher incidence of unplanned reoperations. The spine surgeons maybe need to pay more attention in their preoperative training and in improving surgical technique which could reduce the reoperation rate.

Video-Assisted Thoracoscopic Surgery as a Primary Intervention in Pediatric Parapneumonic Effusion and Empyema

2010 ◽  
Vol 76 (9) ◽  
pp. 957-961 ◽  
Author(s):  
Christopher R. Schneider ◽  
Michael W.L. Gauderer ◽  
Dawn Blackhurst ◽  
John C. Chandler ◽  
Randel S. Abrams
Keyword(s):  
Thoracoscopic Surgery ◽  
Fluid Collection ◽  
Laboratory Data ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Video Assisted ◽  
Thoracic Drainage ◽  
Group A ◽  
Group B ◽  
Video Assisted Thoracoscopic Surgery

The use and effectiveness of video-assisted thoracoscopic surgery (VATS) for the treatment of empyema and complex parapneumonic collections in pediatric patients is well documented. Timing of this intervention still remains controversial. We reviewed our experience with VATS to determine if it should be used as the initial procedure in children with pleural collections. We reviewed all pediatric (age younger than 17 years) patients with a diagnosis of pneumonia admitted between July 1998 and June 2008. Demographics, comorbidities, laboratory data, and hospital length of stay (LOS) were evaluated. Patients were divided into groups: those who only had thoracentesis or thoracostomy (Group A), those who underwent a procedure and then required VATS (Group B), and those who went directly to VATS (Group C). We identified 382 patients admitted with pneumonia. Of these, 79 (21%) required a thoracic drainage procedure. Overall, 49 (67%) of patients with a thoracic fluid collection underwent VATS at some point. With regard to type of intervention, there was no statistical difference noted in clinical variables. Thirty (38%) patients were in Group A, 18 (22%) in Group B, and 31 (39%) in Group C. LOS for Group C (10.5 days) was significantly ( P < 0.05) shorter than for both Group A (14.8 days) and Group B (15 days). Only two (6%) patients required conversion to open thoracotomy. A high percentage of children initially treated by tube thoracostomy eventually require additional interventions, leading to increased LOS. As a result of its simplicity, safety, and efficacy, VATS pleural evacuation can be recommended as the initial intervention in pediatric parapneumonic effusions and empyema in patients who do not require emergent drainage.

scholarly journals Short and mid-term results of thoracoscopic surgery for esophageal atresia in low birth weight infants:A single-center clinical experience

2021 ◽  
Author(s):  
Lei Yan ◽  
MingKun Liu ◽  
Bing Zhang ◽  
Yu Lin ◽  
Dianming Wu ◽  
...  
Keyword(s):  
Birth Weight ◽  
Postoperative Complications ◽  
Low Birth Weight ◽  
Thoracoscopic Surgery ◽  
Low Birth Weight Infants ◽  
Low Weight ◽  
Significant Difference ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Purpose: To evaluate the short-term safety and long-term efficacy of thoracoscopic surgery for esophageal atresia(EA) in low birth weight infants. Methods: From January 2011 to December 2019,a retrospective analysis on clinical data of 48 cases of low birth weight infants of EA. The clinical data were divided according to surgical methods: Thoracoscopy group A and thoracotomy group B. Variables of intra-operation, postoperative complications and mid-term postoperative complications were compared between the two groups.Results: 3 were discharged due to treatment abandoning. there were 17 cases in thoracoscopy group A and 28 cases in thoracotomy group B. The operation time of group A(172.41±20.00min)was longer than B(149.82±13.91min),the difference was statistically significant (P<0.05).the intraoperative blood loss of group A(7.41±2.83ml) was less than B(18.61±3.60ml),the difference was statistically significant (P<0.05).postoperative mechanical ventilation time, thoracic drainage time, hospital stay were not significantly different between the two groups. the incidence of anastomotic stenosis in group B(58.82%) was higher than in A(28.57%),the difference was statistically significant (P=0.045).There was no significant difference in the incidence of esophageal anastomotic fistula and recurrent tracheoesophageal fistula. After 3 years of follow-up, the incidence of thoracic deformity in group B(25%) was higher than in A(0%).The difference was significant(P=0.034).However, no significant difference was observed among the gastroesophageal reflux, symptomatic stenosis, tracheomalacia. Conclusion: Compared with thoracotomy, thoracoscopy in low weight infants with EA has the advantages of smaller incision, fewer intraoperative bleeding, and less incidence of thoracic deformities. Thoracoscopy might be a feasible surgical option for low weight infants when performed by a surgeon who has rich experience. The major mid-term complications after surgery are esophageal stenosis, gastroesophageal reflux and tracheomalacia.

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