USAGE OF PARAMEDIAN APPROACH FOR CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETER INSERTION TECHNIQUE AND COMPLICATION

Objective: This study aims to review the usage and complication of paramedian approach for CAPD catheter insertion. Material & Methods: This is a retrospective study. All ESRD patients ongoing CAPD at the Dialysis Clinic of Zainoel Abidin General Hospital in Aceh, Indonesia between January 1, 2009 and December 31, 2018 were included in the present study. Complication outcomes included mechanical and infectious complications are documented and reviewed. Results: A total of 190 ESRD patients had been performed CAPD catheter insertion using paramedian approach in this period. Out of these patients, complication occurred in 31 cases (16.32%). All the complication that occurred in this study are 5 cases of leakage (2.63%), 9 cases of infection (4.74%), 8 cases of drainage problem (4.21%), 9 cases of malposition (4.74%), and no case of bowel perforation. From total of 9 cases of infections, 1 patient had peritonitis from the catheter insertion. The other infection was exit site infection. Conclusion: CAPD catheter insertion using paramedian approach is safe with low complication rates. It could decrease post-operative complications and can be recommended for CAPD catheter insertion technique due to its safety.

A Modified Adventitial Inversion With Graft Insertion Technique in Acute Type A Aortic Dissection

Acute type A aortic dissection may originate from a primary intimal tear located in the ascending aorta and often extends retrogradely into the aortic root. How to prevent bleeding in the aortic root and eliminate false lumen is very important in aortic dissection. We have developed a modified anastomotic technique that involves inverting adventitial and graft into aorta and reinforcing with a felt strip on the external border of the aortic wall. 45 consecutive patients had undergone this surgical procedure for aortic root reconstruction in aortic dissection, there had been no reoperations either for bleeding or remnant dissection so far.

Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer

Background Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

A comparative study between direct safety trocar insertion versus veress needle technique for creating pneumoperitoneum in laparoscopic surgeries

Background: There are two methods of trocar insertion in laparoscopic surgeries one is direct insertion and second is Veress needle insertion. In this study we compared these two methods.Methods: In this study we divided 50 patients equally into two group group A for in group A patients, direct trocar insertion technique was used for creation of pneumoperitoneum whereas amongst patients of group B, pneumoperitoneum was created using Veress needle insertion technique.Results: The incidence of visceral injuries, vascular injuries and other post-operative complications were similar in both the groups. The present study observed no significant difference in failure rates between two methods.Conclusions: Both the techniques i.e.; Direct trocar insertion (DTI) and Veress needle technique are equally effective, safe and feasible for creation of pneumoperitoneum during laparoscopic procedure.

The Rapid Atrial Swirl Sign for Ultrasound-Guided Tip Positioning of Retrograde-Tunneled Hemodialysis Catheters: A Cross-Sectional Study from a Single Center

Background: Chronic kidney disease (CKD) is a common medical problem in patients worldwide, with an increasing prevalence of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). In patients requiring RRT for more than two weeks or those who develop ESKD, tunneled hemodialysis catheter (HDC) insertion is preferred, based on a lower risk for infectious complications. While the efficacy of ultrasound (US)-guided tip positioning in antegrade-tunneled HDCs has previously been shown, its application for the insertion of retrograde-tunneled HDCs has not been described yet. This is especially important, since the retrograde-tunneled technique has several advantages over the antegrade-tunneled HDC insertion technique. Therefore, we here report our first experience of applying the rapid atrial swirl sign (RASS) for US-guided tip positioning of retrograde-tunneled HDCs. Methods: We performed a cross-sectional study to assess the feasibility of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs. We performed a total number of 24 retrograde-tunneled HDC insertions in 23 patients (requiring placement of a HDC for the temporary or permanent treatment of ESKD) admitted to our Department of Nephrology and Rheumatology at the University Medical Center Göttingen, Germany. Results: The overall success rate of applying the RASS for US-guided tip positioning of retrograde-tunneled HDCs was 24/24 (100%), with proper tip position in the right atrium in 18/23 (78.3%), or cavoatrial junction in 5/23 (21.7%) when RASS was positive and improper position when RASS was negative in 1/1 (100%), confirmed by portable anterior-posterior chest radiography, with only minor post-procedural bleeding in 2/24 (8.3%). In addition, this insertion technique allows optimal HDC flow, without any observed malfunction. Conclusion: This is the first study to investigate the efficacy of the RASS for US-guided tip positioning of retrograde-tunneled HDCs in patients with ESKD. Application of the RASS for US-guided tip positioning is an accurate and safe procedure for the proper placement of retrograde-tunneled HDCs.

Preparation, Characterization, and Biodistribution of Glutathione PEGylated Nanoliposomal Doxorubicin for Brain Drug Delivery with A Post-insertion Approach

Brain cancer treatments have been largely unsuccessful due to the blood-brain barrier. Several publications support the presence of glutathione (GSH) receptors on the surface of the BBB and consequently the products such as the 2B3-101, which is almost 5% pre-inserted GSH PEGylated liposomal doxorubicin, is under process in clinical studies. Here we conducted the PEGylated nanoliposomal doxorubicin particles that are covalently attached to the glutathione using the post-insertion technique. The post-insertion methodology is noticeably simpler, faster, and more cost-effective compared to the pre-insertion method which makes it desirable for large-scale pharmaceutical manufacturing. The 25, 50, 100, 200, and 400 ligands of the DSPE PEG(2000) Maleimide-GSH complexes were incorporated into the available Caelyx. According to the animal studies such as biodistribution, fluorescent microscopy, and pharmacokinetic studies, the 200L and 400L treatment arms were the most promising formulations compared to the Caelyx. They proved that post-inserted nanocarriers with 40 times lower levels of GSH micelles compared to the 2B3-101 have significantly increased the penetrance through the blood-brain barrier. Other tissue analysis showed that the doxorubicin will likely accumulate in the liver, spleen, heart, and lung in comparison with the Caelyx due to the expressed GSH receptors on tissues as an endogenous antioxidant. In conclusion, as was expected, the post-insertion technique was found a successful approach with more pharmaceutical aspects for large-scale production. Moreover, it is highly recommended further investigations to determine the efficacy of 5% post-inserted GSH targeted nanoliposomes versus the 2B3-101 as a similar formulation with a different preparation method.

DIRECT PEDICLE SCREW INSERTION PULLOUT STRENGTH

ABSTRACT Objective: Study the in vitro pullout strength of SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct Screw (DSG Screw), a screw pedicle designed to be inserted using a direct insertion technique. Methods: DSG Screws of 5.5 mm and 6.5 mm were introduced into polyurethane blocks with a density of 10 PCF (0,16 g/cm3). According to the experimental group, screws were inserted without pilot hole, with pilot without tapping, undertapping and line-to-line tapping. Screw pullout tests were performed using a universal test machine after screw insertion into polyurethane blocks. Results: Screws inserted directly into the polyurethane blocks without pilot hole and tapping showed a statistically higher pullout strength. Insertion of the screw without tapping or with undertapping increases the pullout screw strength compared to line-to-line tapping. Conclusion: DSG Screw showed the highest pullout strength after its insertion without pilot hole and tapping. Level of Evidence V, Expert Opinion.

Effects of Preheating and Sonic Delivery Techniques on the Internal Adaptation of Bulk-fill Resin Composites

Clinical Relevance The internal adaptation of resin composites that are recommended to be placed with the conventional insertion technique could be improved when the resin composites are preheated prior to their placement. SonicFill 2 and VisCalor bulk show the best internal adaptation when they are inserted as per the manufacurer's recommended techniques. SUMMARY Objective: To compare the effects of conventional (hand-placed), sonic, or preheated insertion techniques on the internal adaptation of bulk-fill resin composites. Methods and Materials: A total of 150 freshly extracted human third molars were used to prepare standardized cylindrical occlusal cavities. Teeth were divided into five main groups according to the resin composites: 1 incremental (Clearfil Majesty Posterior [CMP]) and four paste-like bulk-fill (SonicFill 2 [SF2], VisCalor bulk [VCB], Filtek One bulk-fill restorative [FBR], and Tetric EvoCeram bulk-fill [TEB]). Each main group was divided into three subgroups according to the placement technique: conventional, preheating, and sonic delivery (n=10). In the conventional placement technique, cavities were filled manually. In the sonic insertion technique, a specific handpiece (SonicFill Handpiece; Kerr Corporation) was used. In the preheating technique, a heating device (Caps Warmer, Voco, Cuxhaven, Germany) was used to warm the resin composites before placement. Internal voids (%) of the completed restorations were calculated with microcomputed tomography. Data was analyzed with two-way analysis of variacne followed by Tukey’s multiple comparisons test (α=0.05). Results: All resin composites showed fewer internal gaps with preheating compared with the conventional placement (p<0.05). For all resin composites other than SF2, preheating provided fewer internal gaps than that of the sonic placement (p<0.05). Sonic placement led to fewer internal gaps compared with the conventional placement, but only for SF2 and FBR (p<0.05). For the conventional placement, the lowest gap percentage was observed with the incremental resin composite (CMP, p<0.05). Among all groups, the lowest gap percentages were observed for preheated VCB followed by sonically inserted SF2 (p<0.05). Conclusion: The best internal adaptation was observed in sonically inserted SF2 and preheated VCB, which were the manufacturers’ recommended insertion techniques. Preheating considerably improved the internal adaptation of all resin composites, except for that of SF2.