scholarly journals Location of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone III Using External Landmark Without Fluoroscopy: A CTA-based Retrospective Study

2020 ◽  
Author(s):  
Danlei Weng ◽  
Anyu Qian ◽  
Qijing Zhou ◽  
Jiefeng Xu ◽  
Shanxiang Xu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Average Length ◽  
Safety Margin ◽  
Balloon Occlusion ◽  
University Hospital ◽  
Xiphoid Process ◽  
Significant Difference ◽  
The Right ◽  
External Landmark ◽  
Endovascular Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) can timely prevent the wounded from massive hemorrhage. We aim to study whether the combination of the xiphoid process and the umbilicus could guide the placement of REBOA in zone III without fluoroscopy. Methods We conducted a retrospective study in a university hospital that included 57 subjects who underwent contrast-enhanced computed tomography (CT) from April to December in 2019. External distances and intravascular lengths were measured by three-dimensional reconstruction CT images on the workstation, including the distances from the femoral artery to the xiphoid process (FA-Xi), the midpoint between the xiphoid process and the umbilicus (FA-mXU), the umbilicus (FA-Ui), the midpoint of the zone III (FA-mZIII), the lowest renal artery (FA-LRA), and aortic bifurcation (FA-AB). The relationship between external landmarks and REBOA catheter positioning in zone III was studied, involving the quartering distances between the xiphoid process and the umbilicus, the distance below the xiphoid process and that above the umbilicus. The predicted accuracy and safety margin of the balloon (distal and proximal) were calculated by curvature plane reconstruction. The probability of balloon positioning in zone III using these three methods was compared by Chi square test. Results The average length of aortic zone III was 9.4 cm (SD = 10.0), and that of FA-mZIII on the right and left sides were 24.4 cm (SD = 2.1) ,23.8 cm (SD = 2.1), respectively. FA-Xi was significantly longer than FA-LRA, and FA-Ui was significantly shorter than FA-AB (P < 0.05). Using the quartering distances between the xiphoid and the umbilicus, the distance below the xiphoid, the distance above the umbilicus to predict the length of REBOA catheter positioning in zone III showed no statistically significant difference. Using FA-mXU to predict the accuracy of catheter positioning in zone III on the left and right sides were 84.2% and 86%. Although there was a little difference between the left side of FA-mZIII and FA-mXU, there were no statistical differences on the right side. Conclusions The midpoint between the xiphoid process and the umbilicus is a good external landmark to guide the placement of REBOA in zone III without fluoroscopy.

914 A Comparison of Mortality, Indicators of Treatment Success and Complications of Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA): A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H J Ko ◽  
H F Koo ◽  
S Froghi ◽  
N Al-Saadi
Keyword(s):  
Hospital Mortality ◽  
Meta Analysis ◽  
Treatment Success ◽  
Estimation Method ◽  
Kidney Injury ◽  
Balloon Occlusion ◽  
Random Effects Model ◽  
Resuscitative Thoracotomy ◽  
Significant Difference ◽  
Endovascular Balloon Occlusion

Abstract Introduction This study aims to provide an updated review on in-hospital mortality rates in patients who underwent Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) versus Resuscitative thoracotomy (RT) or standard care without REBOA, to identify potential indicators of REBOA use and complications. Method Cochrane and PRISMA guidelines were used to perform the study. A literature search was done from 01 January 2005 to 30 June 2020 using EMBASE, MEDLINE and COCHRANE databases. Meta-analysis was conducted using a random effects model and the DerSimonian and Laird estimation method. Results 25 studies were included in this study. The odds of in-hospital mortality of patients who underwent REBOA compared to RT was 0.18 (p &lt; 0.01). The odds of in-hospital survival of patients who underwent REBOA compared to non-REBOA was 1.28 (p = 0.62). There was a significant difference found between survivors and non-survivors in terms of their pre-REBOA systolic blood pressure (SBP) (19.26 mmHg, p &lt; 0.01), post-REBOA SBP (20.73 mmHg, p &lt; 0.01), duration of aortic occlusion (-40.57 mins, p &lt; 0.01) and ISS (-8.50, p &lt; 0.01). Common complications of REBOA included acute kidney injury, multi-organ dysfunction and thrombosis. Conclusions Our study demonstrated lower in-hospital mortality of REBOA versus RT. Prospective multi-centre studies are needed for further evaluation of the indications, feasibility, and complications of REBOA.

scholarly journals Patients in intensive care unit for COVID-19 pneumonia: the lung ultrasound patterns at admission and discharge. An observational pilot study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Persona Paolo ◽  
Valeri Ilaria ◽  
Zarantonello Francesco ◽  
Forin Edoardo ◽  
Sella Nicolò ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Ultrasound ◽  
Low Cost ◽  
Low Frequency ◽  
Specific Pattern ◽  
University Hospital ◽  
Left Hemithorax ◽  
Significant Difference ◽  
The Right ◽  
B Lines

Abstract Background During COVID-19 pandemic, optimization of the diagnostic resources is essential. Lung Ultrasound (LUS) is a rapid, easy-to-perform, low cost tool which allows bedside investigation of patients with COVID-19 pneumonia. We aimed to investigate the typical ultrasound patterns of COVID-19 pneumonia and their evolution at different stages of the disease. Methods We performed LUS in twenty-eight consecutive COVID-19 patients at both admission to and discharge from one of the Padua University Hospital Intensive Care Units (ICU). LUS was performed using a low frequency probe on six different areas per each hemithorax. A specific pattern for each area was assigned, depending on the prevalence of A-lines (A), non-coalescent B-lines (B1), coalescent B-lines (B2), consolidations (C). A LUS score (LUSS) was calculated after assigning to each area a defined pattern. Results Out of 28 patients, 18 survived, were stabilized and then referred to other units. The prevalence of C pattern was 58.9% on admission and 61.3% at discharge. Type B2 (19.3%) and B1 (6.5%) patterns were found in 25.8% of the videos recorded on admission and 27.1% (17.3% B2; 9.8% B1) on discharge. The A pattern was prevalent in the anterosuperior regions and was present in 15.2% of videos on admission and 11.6% at discharge. The median LUSS on admission was 27.5 [21–32.25], while on discharge was 31 [17.5–32.75] and 30.5 [27–32.75] in respectively survived and non-survived patients. On admission the median LUSS was equally distributed on the right hemithorax (13; 10.75–16) and the left hemithorax (15; 10.75–17). Conclusions LUS collected in COVID-19 patients with acute respiratory failure at ICU admission and discharge appears to be characterized by predominantly lateral and posterior non-translobar C pattern and B2 pattern. The calculated LUSS remained elevated at discharge without significant difference from admission in both groups of survived and non-survived patients.

Comparison of Bone-Conducted Vibration for Eliciting Ocular Vestibular-Evoked Myogenic Potentials

2011 ◽  
Vol 146 (2) ◽  
pp. 289-294 ◽  
Author(s):  
Chia-Chen Tseng ◽  
Shou-Jen Wang ◽  
Yi-Ho Young
Keyword(s):  
Prospective Study ◽  
Study Design ◽  
Healthy Subjects ◽  
University Hospital ◽  
Vestibular Evoked Myogenic Potentials ◽  
Ménière’S Disease ◽  
Asymmetry Ratio ◽  
Significant Difference ◽  
The Asymmetry ◽  
The Right

Objective. This study compared bone-conducted vibration (BCV) stimuli at forehead (Fz) and mastoid sites for eliciting ocular vestibular-evoked myogenic potentials (oVEMPs). Study Design. Prospective study. Setting. University hospital. Methods. Twenty healthy subjects underwent oVEMP testing via BCV stimuli at Fz and mastoid sites. Another 50 patients with unilateral Meniere’s disease also underwent oVEMP testing. Results. All healthy subjects showed clear oVEMPs via BCV stimulation regardless of the tapping sites. The right oVEMPs stimulated by tapping at the right mastoid had earlier nI and pI latencies and a larger nI-pI amplitude compared with those stimulated by tapping at the Fz and left mastoid. Similar trends were also observed in left oVEMPs. However, the asymmetry ratio did not differ significantly between the ipsilateral mastoid and Fz sites. Clinically, tapping at the Fz revealed absent oVEMPs in 28% of Meniere’s ears, which decreased to 16% when tapping at the ipsilesional (hydropic) mastoid site, exhibiting a significant difference. Conclusion. Tapping at the ipsilateral mastoid site elicits earlier oVEMP latencies and larger oVEMP amplitudes when compared with tapping at the Fz site. Thus, tapping at the Fz site is suggested to screen for the otolithic function, whereas tapping at the ipsilesional mastoid site is suitable for evaluating residual otolithic function.

scholarly journals Assessment of the hemogram parameters in patients with paroxysmal supraventricular tachycardia: a retrospective study

2020 ◽  
Vol 66 (10) ◽  
pp. 1371-1375
Author(s):  
Mehmet Cosgun ◽  
Yilmaz Gunes ◽  
Isa Sincer ◽  
Asli Kurtar Mansiroglu
Keyword(s):  
Retrospective Study ◽  
Supraventricular Tachycardia ◽  
University Hospital ◽  
Control Group ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Monocyte Count ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Markers Of Inflammation ◽  
Significant Difference

SUMMARY OBJECTIVE: Inflammation has been suggested as a potential mechanism in the pathogenesis of arrhythmia. Hemogram parameters such as monocyte count to high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) have been considered to be markers of inflammation and new cardiovascular risk predictors. This retrospective study aimed to investigate the relationship between MHR, NLR, and MLR in patients with paroxysmal supraventricular tachycardia (PSVT). METHODS: A retrospective study conducted at a university hospital in Bolu, Turkey, between 2017 and 2019. Our study included 196 patients who underwent electrophysiological study (EPS) due to palpitation or documented PSVT on electrocardiography (ECG). Patients having documented atrioventricular nodal re-entrant tachycardia (AVNRT) on ECG or inducible AVNRT on EPS were included in the PSVT group (n=130), and patients with palpitation but without inducible arrhythmia on EPS (n=66) were included in the control group. Routine biochemical and hemogram tests were performed before the EPS procedure. RESULTS: When hemogram parameters were compared, there was no statistically significant difference in MHR values [0.010 (0.001-0.030) vs 0.010 (0.001-0.020) p =0.67]. Additionally, both NLR [2.21(0.74-11.36) vs 1.98(0.72-24.87) p=0.13] and MLR [0.25 (0.03-1.05) vs 0.24(0.07-1.39) p=0.41] were not statistically significant between the two groups. CONCLUSION: There is no significant difference in PSVT patients regarding hemogram parameters including white blood cell subtypes, MLR, NLR, and MHR. Therefore the evaluation of hemogram parameters may not be clinically relevant for PSVT patients.

scholarly journals 665. Key Clinical and Laboratory Features in Early Diagnosis of Ehrlichiosis in an Endemic Area of Long Island, New York

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S240-S241
Author(s):  
Olga Kaplun ◽  
Kalie Smith ◽  
Teresa Khoo ◽  
Eric Spitzer ◽  
Fredric Weinbaum ◽  
...  
Keyword(s):  
New York ◽  
Clinical Presentation ◽  
Average Length ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Suffolk County ◽  
University Hospital ◽  
Laboratory Findings ◽  
Significant Difference

Abstract Background Human monocytic ehrlichiosis (HME) is a tick-borne disease caused by Ehrlichia chafeensis in the northeast United States. Suffolk County, New York has the highest amount of HME cases in NY (176 from 2010 to 2014). Our aim is to identify risk factors for HME and compare clinical presentation and laboratory findings of young vs. older adults. Methods A retrospective chart review from January 1, 2014 to December 31, 2017 was performed on all patients ≥18 years who presented to the ER at Stony Brook University Hospital (SBUH) or Stony Brook Southampton Hospital (SBSH) with (i) ICD-9 code 082.4 or ICD-10 code A77.40 and (ii) a positive E. Chafeensis PCR. Data were collected on demographics, clinical presentation, and laboratory results. Results Twenty-seven cases of HME were found and separated into Group 1 (G1, n = 10) or Group 2 (G2, n = 17) based on age (Table 1). G1 had a significantly higher chance of being Hispanic than G2. Twenty-four of the 27 patients (89%) were hospitalized with an average length of stay of 3.4 days (range 1–14 days).The only significant difference in clinical presentation was that G1 was more likely to have myalgia (P = 0.02). 40% or more of patients in both groups presented with an acute kidney injury and the average length of hospital stay in days was 4.0 ± 2.9 and 3.2 ± 3.1 for G1 and G2, respectively. The number of cases overall have increased 6.0% per year between 2014 and 2017. Thrombocytopenia presented in all cases. Conclusion. HME is prevalent in Suffolk County. Clinical presentation and laboratory findings were largely similar between the two groups, except the younger population more often presented with myalgia. A risk factor in this study was to be young and Hispanic, likely due to occupational exposure. Disclosures All authors: No reported disclosures.

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

3 Safely landing a resuscitative endovascular balloon occlusion of the aorta (REBOA) device in zone one

2018 ◽  
Vol 164 (3) ◽  
pp. 224.3-225
Author(s):  
O Jefferson ◽  
JJ Morrison
Keyword(s):  
Traumatic Injury ◽  
Emergency Situation ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Height Range ◽  
Fixed Distance ◽  
Significant Difference ◽  
Insertion Algorithm ◽  
Study Population ◽  
Endovascular Balloon Occlusion

BackgroundNon-compressible torso haemorrhage is a leading cause of potentially preventable death following trauma. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a technique to temporise haemorrhage. Areas for potential inflation have been characterised as zones I – III. Placement superior to zone I may cause harm. Fluoroscopy, used to confirm position, is often unavailable. The literature shows disagreement about whether a fixed insertion distance would be safe. Some papers advocate using a multi-variable insertion formula.MethodsThree cohorts of patients underwent retrospective analysis of their aortic morphometry. The patients had undergone CT imaging of their torsos when they presented to one of three centres following serious traumatic injury. Aortic reconstructions were performed and measurements taken. Virtual balloons were inserted to both fixed distances and distances calculated using previously reported formulae.ResultsThe study population consisted of trauma patients presenting to Camp Bastion, Afghanistan [n=177]; St Mary’s Hospital, London, UK [n=100]; Wilford Hall Hospital, Texas, US [n=88]. When compared, the 3 cohorts were sufficiently similar for combined analysis (n=365). The two fixed insertion distances (444 mm and 418 mm) each conveyed virtual balloon placement accuracies of 98.4% (359/365). The placements proximal to Zone I occurred in those patients with the smallest 2% of torso heights. The 2 formulae for calculating zone I insertion length each conveyed accuracy of 99.7% (364/365). Statistical analysis found no significant difference between formulaic and fixed insertion distance accuracies (p=0.07).ConclusionFixed distance insertion is more practical in an emergency situation; formulae conveyed no greater accuracy. Fixed distances may not suit a minority of patients who are in the extreme of a population’s height range. These findings support the trial of a zone I fixed distance insertion algorithm.

scholarly journals CT facilitates improved diagnosis of adult intestinal malrotation: a 7-year retrospective study based on 332 cases

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ziman Xiong ◽  
Yaqi Shen ◽  
John N. Morelli ◽  
Zhen Li ◽  
Xuemei Hu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Mesenteric Artery ◽  
Superior Mesenteric Vein ◽  
Clinical Information ◽  
Classification Criteria ◽  
Intestinal Malrotation ◽  
Abdominal Ct ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
The Right

Abstract Objective To classify adult intestinal malrotation by CT. Methods This retrospective study enrolled adults diagnosed with intestinal malrotation who underwent abdominal CT at our institution between June 1, 2013, and August 30, 2020. All patients’ clinical information was recorded. Patients were divided into groups undergoing surgical and conservative management. The duodenum (nonrotation, partial rotation, and malrotation), jejunum, cecum, and the superior mesenteric artery/superior mesenteric vein relationship were reviewed on the CT images of each patient, and classification criteria developed based on the first three items. For each patient, each item was assessed separately by three radiologists. Consensus was required from at least two of them. Results A total of 332 eligible patients (218 men and 114 women; mean age 51.0 ± 15.3 years) were ultimately included and classified into ten types of malrotation. Duodenal partial rotation was present in most (73.2%, 243/332) with only 25% (83/332) demonstrating nonrotation. The jejunum was located in the right abdomen in 98.2% (326/332) of cases, and an ectopic cecum was found in only 12% (40/332, 29 cases with a left cecum, 7 pelvic, and 4 at midline). Asymptomatic patients comprised 56.6% (188/332) of cases, much higher than that in previous studies (17%, n = 82, p < .001), comprised mainly of patients with duodenal partial rotation (80.3%, 151/188). In 91 patients with detailed clinical data available (12 managed surgically and 79 conservatively), a significant difference in malrotation CT categorization was identified (p = .016). Conclusions CT enables greater detection of asymptomatic intestinal malrotation, enabling classification into multiple potentially clinically relevant subtypes.

scholarly journals Determining the Size of the Mental Foramen: A Cone-Beam Computed Tomography Study

2017 ◽  
Vol 7 (2) ◽  
pp. 20
Author(s):  
Seda Falakaloglu ◽  
Artemisa Veis
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Cone Beam Computed Tomography ◽  
Mental Foramen ◽  
Axial Plane ◽  
Cone Beam ◽  
Coronal Image ◽  
Significant Difference ◽  
Student’S T ◽  
The Right

Aim: Knowledge of the position of the mental foramen is important to prepare strategy when administering regional anesthesia, performing dental surgical procedures, endodontic treatments. Also, it is critical to analyze diameter of mental foramen in sagittal, coronal, and axial images.  The aim of this retrospective study was to determine the diameter of the MF in different planes from CBCT images. Methodology: This study was designed at Department of Endodontics, Dicle University, Diyarbakır, Turkey. One hundred twenty three (67 female, 56 male) CBCT scans that met the study criteria were obtained. All images were obtained from i-CAT (Imaging Sciences International, Hatfield, PA). Data were analyzed using Student’s t-tests and Tukey HSD tests. Results: For the analysis of age, data were divided into four groups: 12–17, 18–29, 30–49, and ≥50 years. The data were also divided into two groups by gender. Axial and coronal image measurements were also divided into right and left. There was a statistical difference compared with females and males (p<0.05). In the coronal plane, the right region showed significant differences in measurements between the groups (p<0.05). In the axial plane, there was no statistically significant difference between them (p>0.05). The differences between the groups in the left region in the axial plane measurements were significant (p<0.05). Conclusions: Using CBCT imaging superimposition of anatomical structures can be eliminated. It is important that determine that the size of the mental foramen. This study is a retrospective study using CBCT from patient and find that the size of the mental foramen. How to cite this article: Falakaloglu S, Veis A. Determining the size of the mental foramen: A cone-beam computed tomography study. Int Dent Res 2017;7:20-25. 

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