scholarly journals Safe use of subdermal needles for intraoperative monitoring with MRI

2016 ◽  
Vol 40 (3) ◽  
pp. E19 ◽  
Author(s):  
Terrance M. Darcey ◽  
Erik J. Kobylarz ◽  
Michael A. Pearl ◽  
Patricia J. Krauss ◽  
Stephanie A. Ferri ◽  
...  
Keyword(s):  
Intraoperative Monitoring ◽  
Image Artifacts ◽  
Rf Coil ◽  
Safe Site ◽  
Site Specific ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Needle Tract ◽  
Heating Effects ◽  
Conventional Stainless Steel

OBJECTIVE The purpose of this study was to develop safe, site-specific procedures for placing and leaving subdermal needle leads for intraoperative monitoring (IOM) during intraoperative MRI procedures. METHODS The authors tested a variety of standard subdermal needle electrodes designed and FDA-approved for IOM in the conventional operating room. Testing was used to determine the conditions necessary to avoid thermal injury and significant image artifacts with minimal disruption of IOM and MRI procedures. Phantom testing was performed with a fiber optic (lead) temperature monitoring system and was followed by testing of leads placed in a healthy volunteer. The volunteer testing used electrode placements typical of standard IOM cases, together with radiofrequency (RF) coil placement and imaging sequences routinely employed for these case types. Lead length was investigated to assess heating effects for electrodes placed within the RF coil. RESULTS The authors found that conventional stainless steel (SS) and platinum/iridium (Pt/Ir) subdermal needles can be used safely without significant heating when placed outside the RF coil, and this accounts for the majority or entirety of electrode placements. When placed within the RF coil, Pt/Ir leads produced minimal image artifacts, while SS leads produced potentially significant artifacts. In phantom testing, significant heating was demonstrated in both SS and Pt/Ir leads placed within the RF coil, but only during high-resolution T2-weighted scanning. This problem was largely, but not completely, eliminated when leads were shortened to 25 cm. Human testing was unremarkable except for nonpainful heating detected in a few electrodes during thin-slice (1.5 mm) FLAIR scanning. Transient irritation (skin reddening along the needle tract) was noted at 2 of the electrodes with detectable heating. CONCLUSIONS The authors were satisfied with the safety of their site-specific procedures and have begun with off-label use (following institutional review board approval and obtaining patient informed consent) of tested monitoring leads in cases that combine IOM and MRI. The authors recommend that all facilities perform their own site-specific testing of monitoring leads before proceeding with their routine use.

The Mobile Thriving Respite With and for the Street Community

2021 ◽  
pp. 002216782110467
Author(s):  
Robert McInerney ◽  
Kelsey Long ◽  
Rachel Stough
Keyword(s):  
Lived Experiences ◽  
Institutional Review Board ◽  
Short Term ◽  
Community Based ◽  
Bearing Witness ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Emergent Strategy ◽  
The Creation ◽  
Theoretical Foundations

We report on our work with the street community of Pittsburgh, specifically, a community-based action initiative we call the Mobile Thriving Respite (Institutional Review Board approval was obtained from our university). For 5 years, student advocate ethnographers from Point Park University have gathered data (e.g., long- and short-term interviews, participant-observations generating fieldnotes). The data revealed and supported the need for thriving beyond surviving homelessness. The data endorsed the creation of the mobile thriving respite. In the first part of this work, we will discuss some critical concepts regarding homelessness as a phenomenon and then argue that while surviving as enduring is necessary, there are some for whom survival is a perpetual, lethal state of being. We will discuss the theoretical foundations to the respite and offer researchers’ ethnographic accounts of the respite’s process and progress (We had to temporarily end the respite during the Covid-19 pandemic. To date, the respite has returned with “pop up” events outside at various locations). We will outline how the mobile thriving respite is a praxis as site of resistance as well as an emergent strategy, and an instantiation of communitas. We will then revisit surviving as collectively bearing witness and testifying to the lived experiences of those living outside.

scholarly journals Bone Mineral Density in Gravida: Effect of Pregnancies and Breast-Feeding in Women of Differing Ages and Parity

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ehud Lebel ◽  
Yuri Mishukov ◽  
Liana Babchenko ◽  
Arnon Samueloff ◽  
Ari Zimran ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Institutional Review Board ◽  
Mineral Density ◽  
X Ray ◽  
Normal Limits ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
History Of ◽  
Breast Fed

Changes of bone during pregnancy and during lactation evaluated by bone mineral density (BMD) may have implications for risk of osteoporosis and fractures. We studied BMD in women of differing ages, parity, and lactation histories immediately postpartum for BMD,T-scores, andZ-scores. Institutional Review Board approval was received. All women while still in hospital postpartum were asked to participate. BMD was performed by dual-energy X-ray absorptiometry (DXA) machine at femoral neck (FN) and lumbar spine (LS) by a single technician. Of 132 participants, 73 (55.3%) were ≤30 years; 27 (20.5%) were primiparous; 36 (27.3%) were grand multiparous; 35 (26.5%) never breast fed. Mean FNT-scores andZ-scores were higher than respective mean LS scores, but all means were within the normal limits. Mean LST-scores andZ-scores were highest in the grand multiparas. There were only 2 (1.5%) outliers with lowZ-scores. We conclude that, in a large cohort of Israeli women with BMD parameters assessed by DXA within two days postpartum, meanT-scores andZ-scores at both the LS and FN were within normal limits regardless of age (20–46 years), parity (1–13 viable births), and history of either no or prolonged months of lactation (up to 11.25 years).

scholarly journals Left Retrosigmoid Craniotomy for Resection of Cavernous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E2-E2
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Preoperative Planning ◽  
Cavernous Malformation ◽  
Video Recording ◽  
Close Inspection ◽  
Middle Cerebellar Peduncle ◽  
Cavernous Malformations ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Surgical Field ◽  
Cerebellar Peduncle

Abstract Pontine cavernous malformations are highly morbid lesions that require thorough preoperative planning of the surgical approach and meticulous surgical technique to successfully remove. The patient in this case has a large pontine cavernous malformation coming to the parenchymal surface along the pontine–middle cerebellar peduncle interface. The depth of the surgical field and narrow trajectory of approach require use of lighted suction, lighted bipolar forceps, and stereotactic neuronavigation to successfully locate and remove the entire lesion. The cavernous malformation is removed in a piecemeal manner with close inspection of the resection cavity for any remnants. Postoperative imaging demonstrates gross total resection of the lesion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Mammary and extramammary myofibroblastoma: multimodality imaging features with clinicopathologic correlation, management and outcomes in a series of 23 patients

2020 ◽  
pp. 20201019
Author(s):  
Mark Wickre ◽  
Elizabeth Valencia ◽  
Malvika Solanki ◽  
Katrina Glazebrook
Keyword(s):  
Multimodality Imaging ◽  
Case Series ◽  
Mass Effect ◽  
Imaging Features ◽  
Palpable Mass ◽  
Radiology Reports ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
T2 Hyperintensity ◽  
Irregular Mass

Objective: The purpose of this study was to describe the imaging appearance, diagnosis, and management of mammary and extramammary myofibroblastoma (MFB) in a series of 23 patients. Methods and materials: Following institutional review board approval, cases were identified by searching for “myofibroblastoma” in radiology reports. Multimodality imaging and pathological features were assessed. Results: 23 cases of myofibroblastoma were identified in 15 males and 8 females. Most cases were in the breast (20/23, 87%), presenting as a palpable mass or discovered incidentally on mammography in females or chest CT in males. Extramammary MFB lesions (3/23, 13%) presented with symptoms related to mass effect. At imaging, MFB most often demonstrated an oval or irregular mass that was hypoechoic or heterogeneously echogenic with variable margins. MRI showed T2 hyperintensity, diffusion restriction, and plateau kinetics. Extramammary MFB appeared as an enhancing mass with variable fat content and T2 intensity. Conclusion: Here we describe imaging and clinicopathological features of mammary and extramammary myofibroblastoma. Advances in knowledge: Imaging description of this rare tumor is limited in the literature, and to date this is the largest case series describing the imaging findings.

Narcotrend Monitoring Allows Faster Emergence and a Reduction of Drug Consumption in Propofol–Remifentanil Anesthesia

2003 ◽  
Vol 99 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Sascha Kreuer ◽  
Andreas Biedler ◽  
Reinhard Larsen ◽  
Simone Altmann ◽  
Wolfram Wilhelm
Keyword(s):  
Demographic Data ◽  
Clinical Parameters ◽  
Standard Practice ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Target Values ◽  
Recovery Times ◽  
The Impact ◽  
To Receive ◽  
Written Informed Consent

Background The Narcotrend is a new electroencephalographic monitor designed to measure depth of anesthesia, based on a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. This study was designed to investigate the impact of Narcotrend monitoring on recovery times and propofol consumption in comparison to Bispectral Index (BIS) monitoring or standard anesthetic practice. Methods With institutional review board approval and written informed consent, 120 adult patients scheduled to undergo minor orthopedic surgery were randomized to receive a propofol-remifentanil anesthetic controlled by Narcotrend, by BIS(R), or solely by clinical parameters. Anesthesia was induced with 0.4 micro x kg-1 x min-1 remifentanil and a propofol target-controlled infusion at 3.5 microg/ml. After intubation, remifentanil was reduced to 0.2 micro x kg-1 x min-1, whereas the propofol infusion was adjusted according to clinical parameters or to the following target values: during maintenance to D(0) (Narcotrend) or 50 (BIS); 15 min before the end of surgery to C(1) (Narcotrend) or 60 (BIS). Recovery times were recorded by a blinded investigator, and average normalized propofol consumption was calculated from induction and maintenance doses. Results The groups were comparable for demographic data, duration of anesthesia, and mean remifentanil dosages. Compared with standard practice, patients with Narcotrend or BIS monitoring needed significantly less propofol (standard practice, 6.8 +/- 1.2 mg x kg-1 x h-1 vs. Narcotrend, 4.5 +/- 1.1 mg x kg-1 x h-1 or BIS(R), 4.8 +/- 1.0 mg x kg-1 x h-1; P < 0.001), opened their eyes earlier (9.3 +/- 5.2 vs. 3.4 +/- 2.2 or 3.5 +/- 2.9 min), and were extubated sooner (9.7 +/- 5.3 vs. 3.7 +/- 2.2 or 4.1 +/- 2.9 min). Conclusions The results indicate that Narcotrend and BIS monitoring are equally effective to facilitate a significant reduction of recovery times and propofol consumption when used for guidance of propofol titration during a propofol-remifentanil anesthetic.

Patient Symptoms Correlate Poorly with Objective Measures among Patients with Gastroesophageal Reflux Disease

2014 ◽  
Vol 80 (9) ◽  
pp. 901-905
Author(s):  
Salomon Levy ◽  
Margaret Plymale ◽  
Daniel L. Davenport ◽  
Oscar I. Moreno Ponte ◽  
J. Scott Roth
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Office Visit ◽  
Categorical Variables ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Patient Questionnaires ◽  
Patient’S Perception ◽  
Gerd Symptoms

Presentation of gastroesophageal reflux disease (GERD) varies among patients. To attempt to understand the patient's perception of the severity of their reflux symptoms, we developed a questionnaire on which patients rated symptom severity at each office visit. After receiving Institutional Review Board approval, we retrospectively reviewed patient charts of all patients seen by one surgeon for GERD symptoms and/or presence of hiatal hernia (HH) from September 2012 to April 2013. Data from patient questionnaires combined with objective findings from subsequent or prior workup and eventual operative information were recorded. A total of 144 questionnaires were reviewed from 108 patients. Frequencies were calculated for categorical variables. Patients were divided into four categories based on size of the HH on the endoscopic report; 10 patients had no HH, 15 had small HH, 20 had medium HH, and 31 patients had large HH. Size of HH was not available for three patients. Pre- and postoperative questionnaire responses were obtained for 15 patients. A combined reflux score was calculated using the median for each symptom. Patient perception of severity of symptoms does not necessarily predict presence of pathological reflux or HH nor is there a perfect combination of symptoms to predict the presence of pathological reflux or HH based on our sample. The workup of this pathology must be comprehensive, and the confirmation of reflux is imperative when the diagnosis is unclear.

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