scholarly journals Flexible ureteroscope with ultrasound guidance for treatment of parapelvic renal cysts: A complementary approach to locate the cystic wall

2021 ◽  
Author(s):  
Kun-Wu Yan ◽  
XIao-Fei Tian ◽  
Na Meng ◽  
Wen-Zhan Liu ◽  
Zhi-Min Lu ◽  
...  
Keyword(s):  
Renal Cysts ◽  
Ultrasound Guided ◽  
Modified Technique ◽  
Incision And Drainage ◽  
Cystic Wall ◽  
Complementary Approach ◽  
Flexible Ureteroscope ◽  
The Mean ◽  
Intraoperative Localization ◽  
Mean Time

Abstract Background The main treatment of parapelvic cysts is flexible ureteroscope currently. Considering the intraoperative localization of the cyst may fail with flexible ureteroscope, we tend to use an innovative method by ultrasound-guided for easily locating cystic wall during flexible ureteroscopic surgery Methods We retrospectively reviewed 17 consecutive cases of parapelvic renal cysts treated by ultrasound-guided flexible ureteroscope between March 2017 and May 2020. The differences of simple flexible ureteroscopic technique and ultrasound-guided flexible ureteroscopic technique were compared. The surgical procedures, postoperative complications, results and patients’ follow-ups were evaluated. Results The cysts wall were seen clearly in 10 patients with ureteroscopic vision. Another 7 patients changed to ultrasound-guided flexible ureteroscopic surgery since it was difficult to identify the cyst wall. Mean operative time were 25.9 ± 8.7 minutes and 37.1 ± 10.1 minutes for conventional and modified technique respectively (P =0.004), of which 17.6 ± 5.8 minutes and 26.5 ± 8.4 minutes to search the cysts, respectively (P = 0.002), and the mean time of the incising were 7.1 ± 4.9 minutes and 12.1 ± 5.6 minutes, respectively (P = 0.000). All of the patients were followed-up 12 months, there were no serious complications and recurrence observed. Conclusions We demonstrated that it is feasible and safe to treat parapelvic renal cyst by ultrasound-guided flexible ureteroscopic incision and drainage. The less sample size and further studies were the limitations of our study.

scholarly journals Laparoscopic treatment of symptomatic simple renal cysts in children: single-center experience

2018 ◽  
Author(s):  
Antonio Marte ◽  
Lucia Pintozzi
Keyword(s):  
Operating Time ◽  
Case Series ◽  
Renal Cysts ◽  
Laparoscopic Treatment ◽  
Ultrasound Guided ◽  
Cytological Examination ◽  
Single Center Experience ◽  
Urinary Tract Symptoms ◽  
The Mean

Simple renal cysts, although common in adults, are rare in children. They are usually discovered incidentally in the course of the study of other urinary tract symptoms, although they are not always asymptomatic. Renal cysts can be classified as being either simple or complex. The purpose of this review is to present our case series of simple symptomatic renal cysts treated with laparoscopy. Nineteen patients with symptomatic renal cysts (6 to 13.5 cm) were referred to our institution between January 2006 and January 2017. They comprised 12 (40.5%) females and seven (59.5%) males, aged 8 to 15, with a mean age of 12.2 years. Of these patients, nine had previously been treated unsuccessfully by ultrasound-guided aspiration/alcoholization with 95%-ethanol, between 9 and 13 months prior to the laparoscopy. Five patients had undergone one treatment and four had undergone two treatments. All of the patients were treated by laparoscopic threetrocar deroofing. The cysts were opened and the wall excised using scissors and a monopolar hook. In most cases, to better handle the edges of the cyst and obtain a better grip, a needle was used to aspirate a small amount of fluid (used for cytological examination). The wall of the cyst was excised, the cyst edges were sealed, and the perirenal fat was placed on the bottom of the cyst (wadding technique). The mean operating time was 95 minutes (range 50- 150). The postoperative course was uneventful for all of the patients. The hospital stay ranged from one to three days. All of the patients were asymptomatic following the treatment. At a mean follow-up time of 3.6 years, none of the patients had experienced a recurrence. Renal function, as assessed by a MAG3 renal scintigraphy scan, was well-preserved in all of the patients, and all of them undergo an annual ultrasound scan.

scholarly journals Ultrasound Guided Popliteal Nerve Block For Various Ankle & Foot Surgeries

2021 ◽  
Vol 23 (2) ◽  
pp. 39-57
Author(s):  
Dipti Anandani ◽  
Manisha Kapdi ◽  
Bhakti Rajani
Keyword(s):  
General Anaesthesia ◽  
Nerve Block ◽  
Age Groups ◽  
Neurological Complications ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
The Mean ◽  
Ultrasonographic Guidance ◽  
Time Required ◽  
Mean Time

Background: Ankle& foot surgeries are very common surgeries in various age groups like young & geriatric as well as in patients with comorbidities. Popliteal nerve block is one of multimodal Anaesthesia & analgesia for same. we have used ultrasound guided block to prevent complications &precise volume at a site for improving Characteristics of block. Aims of study: To study the technique of giving popliteal nerve blocks with ultrasonographic guidance and evaluate it in terms of: No of attempts, Time required for sensory and motor blockade, Quality of Intra operative analgesia, Duration for post-operative analgesia, Supplementation required in form of sedo analgesia/general anaesthesia & Complications encountered. Methods: We performed ultrasonography guided popliteal nerve block in 60 adult patients of ASA grade I/II/III undergoing foot and ankle surgeries. The volume of drug used was 20ml consisting of Lignocaine (1.5%) 10ml and Bupivacaine (0.5%) 10ml; Results: The mean time taken to conduct the block was 4.3±1.4 mins. The mean time taken for sensory onset was 3.8±1.1 mins. The mean time taken for motor onset was 7.0± 1.4 mins. The mean time taken for completing the surgery was 39.2±5.0 mins. The mean time taken for complete motor regression was 143.8±13.5 mins. The mean time taken for complete sensory regression was 184.8± 16.8 mins. The patients first complained of pain at the mean time of 239±22.4 mins. The patients have stable haemodynamic parameters: pulse rate, SBP, DBP throughout the operation. Failure of block was seen in 4 patients where supplementation in the form of Injection Midazolam 1mg IV and Injection Fentanyl 50microgm IV was given in 2 patients and general anaesthesia was given in 2 patients. No other neurological complications were noticed in our study. Conclusion: ultrasound guided Popliteal nerve block is safe& effective block for various ankle &foot surgeries.

scholarly journals Anterior Submandibular Approach for Transmylohyoid Endotracheal Intubation: A Reappraisal with Prospective Study in 206 Cases of Craniomaxillofacial Fractures

2017 ◽  
Vol 10 (4) ◽  
pp. 255-262 ◽  
Author(s):  
Nitin Bhola ◽  
Anendd Jadhav ◽  
Atul Kala ◽  
Rahul Deshmukh ◽  
Umesh Bhutekar ◽  
...  
Keyword(s):  
Prospective Study ◽  
Dental Occlusion ◽  
Withdrawal Time ◽  
Incision And Drainage ◽  
Ventilation Support ◽  
The Mean ◽  
Long Term Ventilation ◽  
A Prospective Study ◽  
Mean Time

Despite a paradigm shift in anesthesia and trauma airway management, the craniomaxillofacial fracture (CMF) patients continue to pose a challenge. A prospective study was planned between April 2007 and March 2015 to investigate the safety, efficacy, utility, and complications of anterior submandibular approach for transmylohyoid intubation (TMI) in CMFs using an armored endotracheal tube (ETT). Out of 1,207 maxillofacial trauma cases reported, this study recruited 206 patients (152 males and 54 females) aged between 21 and 60 years. No episode of oxygen desaturation was noted intraoperatively. Mean time to perform TMI was 6 ± 2 minutes. The mean transmylohyoid ETT withdrawal time/disconnection time from ventilator was approximately 1.5 minutes. Accidental partial extubation of ETT was noted in two patients (0.97%), and three patients (1.45%) developed abscess formations at anterior submandibular site which were managed by incision and drainage. The anterior submandibular approach for TMI was successfully used and provided stable airway in all elective CMF surgery cases, where oral or nasal intubations were not indicated/feasible and long-term ventilation support was not required. It permitted simultaneous dental occlusion-guided reduction and fixation of all the facial fractures without interference from the tube during the surgery with unhindered maintenance of the anesthesia and airway. The advantages include easy, swift, efficient, and reliable approach with a small learning curve.

scholarly journals Comparison of dexamethasone and midazolam in improving the efficacy of 0.5% bupivacaine in ultrasound guided supraclavicular brachial plexus block.

2020 ◽  
Vol 27 (06) ◽  
pp. 1176-1181
Author(s):  
Umar Iqbal ◽  
Muhammad Akram ◽  
Ahsan Khan ◽  
Amna Qureshi ◽  
Fareeha Sheikh
Keyword(s):  
Brachial Plexus ◽  
Brachial Plexus Block ◽  
Sensory Block ◽  
Ultrasound Guided ◽  
Upper Limb Surgery ◽  
Supraclavicular Brachial Plexus Block ◽  
The Mean ◽  
Plexus Block ◽  
Time To Onset ◽  
Mean Time

Objectives: The objective of this study was to compare the additive effect of dexamethasone versus midazolam as an adjuvant to bupivacaine for the mean duration of onset of sensory block and duration of analgesia with ultrasound guided supraclavicular block. Study Design: Randomized control trail. Setting: Research was jointly conducted at Arif Memorial Hospital affiliated with Rashid Latif Medical College and KEMU/Mayo Hospital Lahore under the auspices of Department of Anesthesiology. Period: 01/02/2017 to 30/06/2017. Material & Methods: Involved 264 patients of either sex, aged between 20-60 years undergoing upper limb surgery under ultrasound guided supraclavicular brachial plexus block. After obtaining informed consent, patients were randomly allocated into two treatment groups. Along with 0.5% bupivacaine, patients in Group-I received dexamethasone while those in Group-II received midazolam. Outcome variables were mean time to onset of sensory block and mean duration of analgesia which were noted and compared among the groups. Results: The mean age of the patients was 38.90±11.92 years. There were 201 (76.1%) male and 63 (23.9%) female patients in the study group. Majority (79.2%) of the patients belonged to ASA Class-I followed by ASA Class-II (20.8%). Mean time to onset of sensory block was significantly shorter with dexamethasone (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) as compared to midazolam and this difference was significant across all age, gender and ASA groups. Mean duration of analgesia was also significantly longer with dexamethasone (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam and this difference was also significant across all age, gender and ASA groups. Conclusion: Addition of dexamethasone to bupivacaine in ultrasound guided supraclavicular brachial plexus block resulted in early onset of sensory block (10.02±1.26 vs. 11.07±1.38 minutes; p<0.001) and longer duration of analgesia (19.11±1.32 vs. 13.07±1.43 hours; p<0.001) as compared to midazolam in patients undergoing upper limb surgery irrespective of patient’s age, gender and ASA status.

scholarly journals A New Technique for Simple Renal Cyst: Cystoretroperitoneal Shunt

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Onder Canguven ◽  
Cemal Goktas ◽  
Faruk Yencilek ◽  
Cihangir Cetinel ◽  
Selami Albayrak
Keyword(s):  
Renal Cyst ◽  
Renal Cysts ◽  
Simple Renal Cyst ◽  
Ultrasound Guided ◽  
Cyst Volume ◽  
Mean Size ◽  
The Mean ◽  
A New Technique ◽  
A Prospective Study

Purpose. To evaluate the results of patient symptoms and radiologic outcomes of cystoretroperitoneal shunt (CRS) technique in the treatment of symptomatic simple renal cysts.Patients and Methods. In a prospective study, 37 patients with a simple renal cyst were treated with ultrasound-guided percutaneous CRS-catheter. Radiological success was indicated as no recurrence of the cyst or a reduction in cyst volume by at least half.Results. CRS technique was performed successfully in 36 patients with a simple renal cyst. The mean size of all cysts decreased from 8.8 cm (range 7 to 14) to 1.7 cm (range 0 to 9; ). Symptomatic success (pain relief) was achieved in 29/36 (80.5%) of patients, and radiographic success was achieved in 23/36 (63.8%) of patients, with a median follow-up of 16 months (range 6 to 24).Conclusion. Ultrasound-guided percutaneous CRS technique for simple renal cysts is fast, safe, effective, and inexpensive.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

2021 ◽  
pp. 107815522110160
Author(s):  
Bernadatte Zimbwa ◽  
Peter J Gilbar ◽  
Mark R Davis ◽  
Srinivas Kondalsamy-Chennakesavan
Keyword(s):  
Checkpoint Inhibitors ◽  
Anticancer Therapy ◽  
Mortality Rates ◽  
Feedback Process ◽  
Time To Death ◽  
Cancer Centre ◽  
Haematology Patients ◽  
The Mean ◽  
Regional Cancer Centre ◽  
Mean Time

Purpose To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. Method All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Results Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). Conclusion The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

2021 ◽  
pp. 1-7
Author(s):  
Naomi Vather-Wu ◽  
Matthew D. Krasowski ◽  
Katherine D. Mathews ◽  
Amal Shibli-Rahhal
Keyword(s):  
Vitamin D ◽  
Retrospective Cohort ◽  
Vitamin D Supplementation ◽  
Hydroxyvitamin D ◽  
Frequent Monitoring ◽  
25 Hydroxyvitamin D ◽  
The Mean ◽  
Stable Maintenance ◽  
Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to <  30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

scholarly journals Surveillance System in Smart Cities: A Dependability Evaluation Based on Stochastic Models

Electronics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 876
Author(s):  
Igor Gonçalves ◽  
Laécio Rodrigues ◽  
Francisco Airton Silva ◽  
Tuan Anh Nguyen ◽  
Dugki Min ◽  
...  
Keyword(s):  
Surveillance System ◽  
Smart Cities ◽  
Heterogeneous Data ◽  
Time To Failure ◽  
Video Streams ◽  
Dependability Evaluation ◽  
The Mean ◽  
Mean Time ◽  
The Internet Of Things

Surveillance monitoring systems are highly necessary, aiming to prevent many social problems in smart cities. The internet of things (IoT) nowadays offers a variety of technologies to capture and process massive and heterogeneous data. Due to the fact that (i) advanced analyses of video streams are performed on powerful recording devices; while (ii) surveillance monitoring services require high availability levels in the way that the service must remain connected, for example, to a connection network that offers higher speed than conventional connections; and that (iii) the trust-worthy dependability of a surveillance system depends on various factors, it is not easy to identify which components/devices in a system architecture have the most impact on the dependability for a specific surveillance system in smart cities. In this paper, we developed stochastic Petri net models for a surveillance monitoring system with regard to varying several parameters to obtain the highest dependability. Two main metrics of interest in the dependability of a surveillance system including reliability and availability were analyzed in a comprehensive manner. The analysis results show that the variation in the number of long-term evolution (LTE)-based stations contributes to a number of nines (#9s) increase in availability. The obtained results show that the variation of the mean time to failure (MTTF) of surveillance cameras exposes a high impact on the reliability of the system. The findings of this work have the potential of assisting system architects in planning more optimized systems in this field based on the proposed models.

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