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/])

Internal Mammarial Lymphoscintigraphy with SPECT after Ultrasound-Guided Injection of 99mTc-Dextran

1990 ◽  
Vol 29 (01) ◽  
pp. 35-39 ◽  
Author(s):  
M. Ünlü ◽  
H. Alanyali ◽  
O. Akhan ◽  
F.C. Bekdik ◽  
T.M. Ercan
Keyword(s):  
Lymph Nodes ◽  
Ultrasound Guidance ◽  
Three Dimensional ◽  
Skin Surface ◽  
Planar Imaging ◽  
Ultrasound Guided ◽  
Tomographic Images ◽  
Internal Mammary ◽  
The Difference ◽  
99Mtc Dextran

Twenty-two women with stage II or III breast cancer were evaluated by SPECT to determine the number, size, three-dimensional localization and depth from skin surface of the internal mammary lymph nodes for accurate radiotherapy portal planning. The results were also compared with those of planar imaging (PI). Two-step injections of 99mTc-dextran were made under ultrasound guidance into the anterior sheath of the M. rectus abdominis first at the ablation side. 1.5 h thereafter an anterior planar view was obtained to evaluate cross drainage (13.6% was observed). Then, the second injection was done at the opposite side in the same manner. Planar and tomographic images were obtained 1.5 h after the second injection. Similar values were obtained for the depth from skin surface, distance from the midline and diameter of the lymph nodes with both PI and SPECT. The total number of nodes in 22 patients detected by SPECT was higher (138) than that from PI (129), the difference being statistically significant (0.005 > p >0.0005).

The role of laboratory processing in determining diagnostic conclusiveness of breast fine needle aspirations: conventional smearing versus a monolayer preparation

2009 ◽  
Vol 62 (10) ◽  
pp. 931-934 ◽  
Author(s):  
C A P Wauters ◽  
B Kooistra ◽  
L J A Strobbe
Keyword(s):  
Ultrasound Guidance ◽  
Needle Aspiration ◽  
Processing Technique ◽  
Benign Lesions ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Malignant Lesions ◽  
The Difference

Aim:To compare breast fine needle aspiration (FNA) specimens prepared by conventional smearing (CS) versus monolayer preparation (MP), with respect to the conclusiveness of the cytopathological diagnosis.Methods:From 1992 to 1996, aspirators prepared aspirates themselves by direct smearing onto 2–4 slides. From 1999 to 2003, aspirate preparation was performed in the laboratory, creating a MP, using a Hettich cytocentrifuge. FNA diagnoses were categorised into inadequate (C1), benign (C2), atypical (C3), suspicious for malignancy (C4) and malignant (C5). The reference standard constituted histological follow-up. A conclusive FNA diagnosis was defined as C2 in lesions benign on follow-up and C5 in lesions malignant on histology.Results:From 1992 to 1996, 692 aspirates were processed by CS, whereas from 1999 to 2003, 1301 aspirates were processed by MP. More FNA were ultrasound-guided in the MP group (85.6% versus 21.5%, p<0.001). When compared with CS, MP-prepared FNA had conclusive diagnoses significantly more often (72.8% versus 58.5%, p<0.001). This effect remained significant when corrected for the difference in ultrasound guidance (adjusted odds ratio 1.7, 95% confidence interval 1.3 to 2.2, p<0.001), and was larger for malignant lesions than for benign lesions (51.7% versus 79.9%, p<0.001).Conclusion:Patients presenting with breast lesions can more often be offered a same-day, conclusive cytopathological diagnosis when FNA are prepared by a manual MP processing technique.

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.

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 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.

Management of Atrial Fibrillation Following Cardiac Surgery: Observational Study and Development of a Standardized Protocol

2020 ◽  
pp. 106002802097399
Author(s):  
Christel Bruggmann ◽  
Mahdieh Astaneh ◽  
Henri Lu ◽  
Piergiorgio Tozzi ◽  
Zied Ltaief ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Best Practices ◽  
Rate Control ◽  
Management Strategy ◽  
Hospital Units ◽  
Standardized Protocol ◽  
The Mean ◽  
The Difference ◽  
Surgery Department

Background Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Guidelines for the management of this complication are scarce, often resulting in differences in treatment strategy use among patients. Objective To evaluate the management of POAF in a cardiac surgery department, characterize the extent of its variability, and develop a standardized protocol. Methods This was an observational retrospective study with data from patients who underwent cardiac surgeries with subsequent POAF between January 1, 2017, and June 1, 2018. We assessed the difference in the proportions of patients whose first POAF episodes were treated with a rate control (RaC) strategy, a rhythm control (RhC) strategy, and both among different hospital units. We also assessed the mean duration of POAF episodes, POAF recurrences, and the management of anticoagulation. Results Data from 97 patients were included in this study. The POAF management strategy differed significantly among the 3 types of hospital units ( P = 0.001). Considering all POAF episodes (including all recurrences), 83 of the 97 patients (85.6%) received amiodarone as part of the RhC strategy. Anticoagulation was used in 58 (59.8%) patients and was suboptimal according to the study criteria in 29.5% of the patients included. Based on these results, a hospital working group developed a standardized protocol for POAF management. Conclusions and Relevance POAF management was heterogeneous at our institution. This article highlights the need for clear practice guidelines based on large prospective studies to provide care according to best practices.

Ultrasound in Renal Pyogenic Infection

1988 ◽  
Vol 29 (6) ◽  
pp. 675-678 ◽  
Author(s):  
T. Vehmas ◽  
M. Päivänsalo ◽  
M. Taavitsainen ◽  
I. Suramo
Keyword(s):  
Renal Abscess ◽  
Ultrasound Guided ◽  
Percutaneous Aspiration ◽  
Drainage Procedure ◽  
Pyogenic Infection ◽  
The Mean ◽  
The Difference ◽  
Difficult Cases ◽  
Collecting System ◽  
Overall Mortality

A series of 34 patients with renal or perirenal pyogenic infection (18 with pyonephrosis, 10 with renal abscess and 6 with perirenal abscess) is presented to evaluate diagnosis with ultrasound and treatment with percutaneous ultrasound guided aspiration/drainage. Specific findings, defined as sediment echoes or dispersed internal echoes in a hydronephrotic renal collecting system, were noted in 39 per cent of pyonephrosis cases. Abscesses were mainly round or oval hypoechoic lesions measuring from 2 to 15 cm in diameter. Two abscesses were multilocular and one showed a septum. The appearance suggested tumor in 25 per cent. Because of this non-specificity of ultrasound we recommend diagnostic aspirations and further radiologic and other examinations in difficult cases. Four patients were treated by conservative means only, 13 with percutaneous aspiration or drainage, 9 with a combined drainage procedure and surgery, and 8 surgically. The length of the mean hospital stay was shortest in the group with the percutaneous drainage procedure (PDP) although the difference was not statistically significant. PDP was not effective in 12 per cent and surgery was used in these two cases to ensure cure. Complications occurred more often in the PDP group than in the surgery group but the most serious complication was a post-operative one. The different modes of treatment are discussed. The overall mortality was 5.9 per cent.

scholarly journals A COMPARATIVE STUDY OF CAUDAL BLOCK AND ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND DEXAMETHASONE AS ADDITIVE IN EXTRAPERITONEAL LOWER ABDOMINAL SURGERIES IN PEDIATRICS

2021 ◽  
pp. 173-176
Author(s):  
SANDHYA GHODKE ◽  
MADHAVI N ◽  
HIREMATH RN
Keyword(s):  
General Anesthesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Caudal Block ◽  
Ultrasound Guided ◽  
Operative Complications ◽  
The Mean ◽  
The Difference ◽  
Post Operative Complications

Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same. Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores. Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (<2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting. Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

The Effect of Vocabulary Intervention on Text Comprehension: Who Benefits?

2019 ◽  
Vol 50 (4) ◽  
pp. 562-578 ◽  
Author(s):  
Dawna Duff
Keyword(s):  
Middle School ◽  
Reading Comprehension ◽  
Text Comprehension ◽  
Classroom Instruction ◽  
Vocabulary Instruction ◽  
Clinical Intervention ◽  
Vocabulary Knowledge ◽  
Vocabulary Intervention ◽  
The Mean ◽  
The Difference

Purpose Vocabulary intervention can improve comprehension of texts containing taught words, but it is unclear if all middle school readers get this benefit. This study tests 2 hypotheses about variables that predict response to vocabulary treatment on text comprehension: gains in vocabulary knowledge due to treatment and pretreatment reading comprehension scores. Method Students in Grade 6 ( N = 23) completed a 5-session intervention based on robust vocabulary instruction (RVI). Knowledge of the semantics of taught words was measured pre- and posttreatment. Participants then read 2 matched texts, 1 containing taught words (treated) and 1 not (untreated). Treated texts and taught word lists were counterbalanced across participants. The difference between text comprehension scores in treated and untreated conditions was taken as a measure of the effect of RVI on text comprehension. Results RVI resulted in significant gains in knowledge of taught words ( d RM = 2.26) and text comprehension ( d RM = 0.31). The extent of gains in vocabulary knowledge after vocabulary treatment did not predict the effect of RVI on comprehension of texts. However, untreated reading comprehension scores moderated the effect of the vocabulary treatment on text comprehension: Lower reading comprehension was associated with greater gains in text comprehension. Readers with comprehension scores below the mean experienced large gains in comprehension, but those with average/above average reading comprehension scores did not. Conclusion Vocabulary instruction had a larger effect on text comprehension for readers in Grade 6 who had lower untreated reading comprehension scores. In contrast, the amount that children learned about taught vocabulary did not predict the effect of vocabulary instruction on text comprehension. This has implications for the identification of 6th-grade students who would benefit from classroom instruction or clinical intervention targeting vocabulary knowledge.

Placental Transfer of Vitamin K1 and Its Implications in Fetal Hemostasis

1988 ◽  
Vol 60 (01) ◽  
pp. 039-043 ◽  
Author(s):  
L Mandelbrot ◽  
M Guillaumont ◽  
M Leclercq ◽  
J J Lefrère ◽  
D Gozin ◽  
...  
Keyword(s):  
Vitamin K ◽  
High Performance ◽  
Ultrasound Guidance ◽  
Placental Transfer ◽  
Vitamin K1 ◽  
Vitamin K Deficiency ◽  
Prothrombin Activity ◽  
Oral Supplementation ◽  
K Deficiency ◽  
The Mean

SummaryVitamin K status was evaluated using coagulation studies and/ or vitamin IQ assays in a total of 53 normal fetuses and 47 neonates. Second trimester fetal blood samples were obtained for prenatal diagnosis under ultrasound guidance. Endogenous vitamin K1 concentrations (determined by high performance liquid chromatography) were substantially lower than maternal levels. The mean maternal-fetal gradient was 14-fold at mid trimester and 18-fold at birth. Despite low vitamin K levels, descarboxy prothrombin, detected by a staphylocoagulase assay, was elevated in only a single fetus and a single neonate.After maternal oral supplementation with vitamin K1, cord vitamin K1 levels were boosted 30-fold at mid trimester and 60 fold at term, demonstrating placental transfer. However, these levels were substantially lower than corresponding supplemented maternal levels. Despite elevated vitamin K1 concentrations, supplemented fetuses and neonates showed no increase in total or coagulant prothrombin activity. These results suggest that the low prothrombin levels found during intrauterine life are not due to vitamin K deficiency.

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