Статті в журналах з теми "Low-invasive procedure"
Щоб переглянути інші типи публікацій з цієї теми, перейдіть за посиланням: Low-invasive procedure.
Оформте джерело за APA, MLA, Chicago, Harvard та іншими стилями
Ознайомтеся з топ-50 статей у журналах для дослідження на тему "Low-invasive procedure".
Біля кожної праці в переліку літератури доступна кнопка «Додати до бібліографії». Скористайтеся нею – і ми автоматично оформимо бібліографічне посилання на обрану працю в потрібному вам стилі цитування: APA, MLA, «Гарвард», «Чикаго», «Ванкувер» тощо.
Також ви можете завантажити повний текст наукової публікації у форматі «.pdf» та прочитати онлайн анотацію до роботи, якщо відповідні параметри наявні в метаданих.
Переглядайте статті в журналах для різних дисциплін та оформлюйте правильно вашу бібліографію.
1
Risteski, Petar, Aleksandra Miskovic, Anton Moritz, Andreas Zierer, and Nadejda Monsefi. "Midterm Results of a Minimally Invasive Approach in David Procedure." Thoracic and Cardiovascular Surgeon 66, no. 04 (June 5, 2017): 301–6. http://dx.doi.org/10.1055/s-0037-1603495.
Повний текст джерелаАнотація:
Background The David procedure is a well-known technique in selected patients with aortic root pathology. A minimally invasive approach in heart surgery increases open interest. Methods From 1991 to 2015, the David technique was performed in 296 patients in our unit. In 90 cases, operations were performed through partial upper sternotomy. The patient mean age was 57 ± 14 years in the minimally invasive group (n = 90) and 58 ± 14 years in the complete sternotomy group (n = 206; p = 0.2). The neosinus modification was performed in 80 patients (89%) in the minimally invasive group and in 79 patients (38%) in the complete sternotomy group (p < 0.01). Mean follow-up was 3 ± 2 years in the minimally invasive group and 8 ± 4 years in the complete sternotomy group. Results Thirty-day mortality was zero in the minimally invasive group and was 3% (n = 6) in the complete sternotomy group (p = 0.1). The need for packed red blood cells was significantly lower in the minimally invasive group (1.6 ± 3 U) than in the complete sternotomy group (3.7 ± 6 U; p < 0.01). Thirty late deaths (2% per patient-year) were observed in the complete sternotomy group versus zero in the minimally invasive group (p < 0.01). One patient (0.5% per patient-year) in the minimally invasive group and 12 patients (0.8% per patient-year) in the complete sternotomy group required reoperation in the follow-up period (p = 0.05). Conclusions Minimally invasive David technique for patients with ascending aortic aneurysm and aortic valve insufficiency offers a good solution with low perioperative blood transfusion rate. Our midterm results show low valve-related complications and reoperation rate. However, long-term follow-up of the minimally invasive group is necessary.
2
Matsuda, Takeru, Ryuichiro Sawada, Hiroshi Hasegawa, Kimihiro Yamashita, Masako Utsumi, Hitoshi Harada, Naoki Urakawa, et al. "Standardized Procedure of Transperineal Minimally Invasive Abdominoperineal Resection for Low Rectal Cancer." Annals of Surgical Oncology 29, no. 5 (January 21, 2022): 3065. http://dx.doi.org/10.1245/s10434-021-11214-4.
Повний текст джерела
3
Chen, Aileen B., Anthony V. D’Amico, Bridget A. Neville, and Craig C. Earle. "Patient and Treatment Factors Associated With Complications After Prostate Brachytherapy." Journal of Clinical Oncology 24, no. 33 (November 20, 2006): 5298–304. http://dx.doi.org/10.1200/jco.2006.07.9954.
Повний текст джерелаАнотація:
PurposeTo assess the prevalence and predictors of complications after prostate brachytherapy in a population-based sample of older men.Patients and MethodsWe analyzed claims for Medicare-enrolled men older than age 65 years living in Surveillance, Epidemiology, and End Results (SEER) surveillance areas diagnosed with prostate cancer from 1991 to 1999 who underwent brachytherapy as initial treatment.ResultsThere were 5,621 men who had brachytherapy with at least 2 years of follow-up. A complication diagnosis or invasive procedure occurred in 54.5% of men within 2 years, with 14.1% undergoing an invasive procedure. Urinary, bowel, and erectile morbidity rates were 33.8%, 21.0%, and 16.7%, respectively, and invasive procedure rates were 10.3%, 0.8%, and 4.0%, respectively. On multivariable analysis, combined urinary diagnoses and invasive procedures (obstruction, incontinence, bleeding, fistula) were associated with older age (P < .01), nonwhite race (odds ratio [OR], 1.30; P = .01), low income (OR, 1.74; P < .01), external-beam radiotherapy (EBRT; OR, 0.85; P = .01), androgen deprivation (OR, 1.31; P < .01), later year of brachytherapy (OR, 1.03/yr; P = .02), higher Charlson comorbidity score (P < .01), and prior transurethral resection of the prostate (OR, 1.65; P < .01). Bowel morbidity (bleeding/proctitis, injury) was associated with older age (P = .04), EBRT (OR, 1.46; P < .01), later year (OR, 1.04/yr; P < .01), higher Charlson score (P = .01), and inflammatory bowel disease (OR, 2.60; P < .01). Erectile morbidity was associated with younger age (P < .01), nonwhite race (OR, 1.37; P < .01), AD (OR, 1.18; P = .04), and later year (OR, 1.08/yr; P < .01). Invasive procedure rates declined with later year of brachytherapy (OR, 0.93/yr; P < .01).ConclusionMorbidity after prostate brachytherapy was common, though invasive procedures were required infrequently. Invasive procedures for complications declined during the 1990s, suggesting technical improvement with experience.
4
Lupanov, V. P. "Selection of non-invasive load procedure in diagnosis of ischemic heart disease (review)." Medical Council, no. 16 (September 27, 2018): 62–70. http://dx.doi.org/10.21518/2079-701x-2018-16-62-70.
Повний текст джерелаАнотація:
The diagnosis of stable ischemic heart disease begins with a careful clinical examination of the patient and non-invasive testing to identify the disease. Patients with very low and very high pretest probability should not undergo various non-invasive tests. Various non-invasive tests are available to assess the presence of coronary heart disease in patients with an intermediate probability of ischemic heart disease (15–65%). The combination of anatomical with functional non-invasive tests helps improve diagnostic capabili of the disease.
5
Cobo, Roxana. "Use of Polydioxanone Threads as an Alternative in Nonsurgical Procedures in Facial Rejuvenation." Facial Plastic Surgery 36, no. 04 (August 2020): 447–52. http://dx.doi.org/10.1055/s-0040-1714266.
Повний текст джерелаАнотація:
AbstractMinimally invasive cosmetic procedures are in increasing demand worldwide. Patients are constantly searching for office-based techniques that can help improve the signs of aging but without the morbidity of a surgical procedure. Thread lifting with polydioxanone (PDO) sutures is a cosmetic procedure where lax tissue is lifted and repositioned trying to create a more youthful looking facial contour. The threads are absorbable and come in different shapes and lengths. The rate of complications and the downtime of the procedure are low, which are something patients are looking for. Ideally, these procedures should be performed by trained specialists who have complete knowledge of the facial anatomy, thus enhancing and improving results. Thread lifting with PDO absorbable threads has become an excellent option for minimally invasive facial rejuvenation procedures with a high satisfaction among patients and very few complications. It is a new tool that can be introduced in the armamentarium of specialists who work in the field of facial plastic surgery and who can offer this option to their patients with improved outcomes.
6
Le Chevallier, Delphine, and Hugo Van Oostrom. "Falsely low arterial blood pressure due to pressure transducer damage in three horses." Veterinary Record Case Reports 8, no. 1 (February 2020): e000985. http://dx.doi.org/10.1136/vetreccr-2019-000985.
Повний текст джерелаАнотація:
Three horses undergoing general anaesthesia for orthopaedic procedures between August 2018 and January 2019 at Langford Veterinary Equine Services, Bristol University had falsely low arterial blood pressures due to damage of the non-disposable invasive arterial blood pressure transducer interface. The invasive arterial blood pressure transducer interface is not currently a component that is checked during the anaesthetic machine check prior starting a general anaesthetic procedure. Starting treatment for hypotension based on incorrect information due to faulty equipment can have severe negative consequences for the patient, such as extreme hypertension, increased myocardial workload and oxygen demand, and reduced perfusion of splanchnic and muscle tissue due to vasoconstriction. Therefore, we recommend routinely using the square wave test and checking the integrity of the blood pressure transducer interface before starting a general anaesthetic procedure, and when unexpected hypotensive readings are obtained and/or a state of hypotension is not responsive to treatment.
7
Blome-Eberwein, Sigrid A., Lisa Lepage, and Sophia Starner. "636 Subcutaneous Contracture Band Release in Burn Scars." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S174. http://dx.doi.org/10.1093/jbcr/irab032.286.
Повний текст джерелаАнотація:
Abstract Introduction Contracture scars post-burn injury often develop in areas near joints and can restrict movement as well as cause cosmetic deformities.1,2 The goal of subcutaneous scar release is to maximize mobility and minimize the need for invasive procedures which can require more recovery time and cause less aesthetically pleasing outcomes, although this new minimally invasive technique may also be used in conjunction with invasive procedures or after more invasive reconstructions to yield the best functional and cosmetic outcome. Methods Retrospective data from May 2016 to July 2019 were collected and analyzed for 28 patients ranging from ages 6 to 68 years old that were diagnosed with a subcutaneous contracture in one or more areas of their body. The data recorded included demographics, procedure specifics and outcomes, patients’ assessments, and areas of which the procedure was most frequently done on. Results Of the data available, range of motion per site improved by 19.1 degrees. Average pain scores reported directly after the procedure were relatively low at 1.5 on a 10-point scale. Vancouver Scar Scale scores decreased by 0.6 from pre-operatively (10.7) to post-operatively (10.1). The most frequently occurring areas that subcutaneous scar release was done on was the neck (15), axilla (7), and shoulder (7). Overall, 83% of patients reported being very satisfied or satisfied with the outcome of their procedure. Conclusions Subcutaneous scar release improves burn patients’ range of mobility with less residual scarring and less recovery time than standard of care treatments for scar contractures.
8
Nguyen, Dinh H., Anh T. Vo, Khoi M. Le, Thanh T. Vu, Trang T. Nguyen, Thien T. Vu, Chuong V. T. Pham, and Binh Q. Truong. "Minimally Invasive Ozaki Procedure in Aortic Valve Disease." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 13, no. 5 (September 2018): 332–37. http://dx.doi.org/10.1097/imi.0000000000000556.
Повний текст джерелаАнотація:
Objective The Ozaki procedure for aortic valve reconstruction was reported in 2014 with low mortality, a highly reproducible rate and a good midterm result. However, the procedure still requires conventional sternotomy to be accomplished. The aim of the study was to start an initial evaluation for the feasibility of the minimally invasive approach in combination with the Ozaki technique. Methods From January 06, 2017, to January 12, 2017, nine patients with severe aortic valve diseases underwent minimally invasive Ozaki procedure through an upper ministernotomy. The pericardium was harvested endoscopically using three trocars in different intercostal spaces. Then, a ministernotomy was performed and the Ozaki procedure was accomplished in a similar manner to the conventional technique. We analyzed the in-hospital mortality and complications of this group. Results The mean age was 47.4 years and 55.6% patients were female. The predominant pathology was chronic rheumatic valve disease (66.7%) and other patients were diagnosed with a bicuspid aortic valve. The mean aortic cross-clamp time was 106.8 minutes, the mean cardiopulmonary bypass time was 153.6 minutes, the mean ventilation time was 8.4 hours, and the mean intensive care unit time was 1.6 days. No mortality was recorded in our series, no conversion to full sternotomy was required, one patient experienced right hemothorax requiring drainage, and one patient required valve replacement. Intraoperative transesophageal echocardiography and predischarge transthoracic echocardiography showed five competent valves and three valves with trivial regurgitation, and no stenosis was detected. Conclusions Ministernotomy combined with Ozaki procedure might be feasible, as well as an alternative to conventional sternotomy. This approach is associated with low mortality and morbidity and may be beneficial in younger populations.
9
Cammarata, Edoardo, Roberto Giorgione, Elia Esposto, Vanessa Mazzoletti, Paolo Boggio, and Paola Savoia. "Minced Skin Grafting: A Minimally Invasive and Low-Cost Procedure to Treat Pyoderma Gangrenosum." Advances in Skin & Wound Care 34, no. 2 (February 2021): 1–3. http://dx.doi.org/10.1097/01.asw.0000725172.24316.fd.
Повний текст джерела
10
Kouvelos, George, Miltiadis Matsagkas, Nikolaos Rousas, Petroula Nana, Konstantinos Mpatzalexis, Konstantinos Stamoulis, Athanasios Giannoukas, and Eleni Arnaoutoglou. "Perioperative Management of DOACs in Vascular Surgery: A Practical Approach." Current Pharmaceutical Design 24, no. 38 (February 27, 2019): 4518–24. http://dx.doi.org/10.2174/1381612825666181226154746.
Повний текст джерелаАнотація:
Background: Approximately 10–15% of patients on DOACs have to interrupt their anticoagulant before an invasive procedure every year. The perioperative management and monitoring of DOACs have proved to be challenging, as differences in patients’ status and in the invasiveness of each procedure develop different situations that need a tailored therapeutic approach to each patient’s needs. Methods: This review aims to summarize current evidence on the perioperative management of DOACs in patients undergoing a vascular surgical procedure focusing with a practical approach on three key clinical questions: (i) can we stop DOAC therapy before the vascular procedure? (ii) is bridging therapy necessary? and (iii) which is the best perioperative strategy for interruption and resumption of the anticoagulant therapy? Results: No specific data exist for the perioperative management of vascular surgery patients on DOACs, as most studies include low number of such patients. Therapeutic strategy on how to handle DOACs perioperatively must be based on their half-life, the bleeding risk of the invasive procedures, and on the thromboembolic risk of the patient. Renal function plays a crucial role in such situations, increasing thromboembolic and bleeding risk. In general, DOACs should be stopped 2 days for high bleed risk, 1 day for low risk and should be resumed 48-72 hrs after high risk, 24 hrs after low-risk procedure. Bridging is almost never needed. Conclusion: Further perioperative research studies on patients undergoing vascular surgery are needed to confirm whether currently accepted therapeutic perioperative strategy is appropriate for these patients.
11
Benetti, Federico, Jessica Gonzalez, and Natalia Scialacomo. "Left Internal Mammary Artery to Left Anterior Descending Artery. An Alternative for old, High-Risk, Multivessel, Coronary Artery Disease Patients and an Approach for Hybrid Revascularization." Clinical Cardiology and Cardiovascular Interventions 5, no. 1 (January 7, 2022): 01–03. http://dx.doi.org/10.31579/2641-0419/230.
Повний текст джерелаАнотація:
In 1997, the first ambulatory off-pump left internal mammary artery (LIMA) to left anterior descending artery (LAD) anastomosis was performed via xiphoid approach, an intervention known today as the MINI-OPCAB operation. This operation has been performed in more than 150 patients around the world for the management of single and multiple vessel coronary artery disease, and 70 of those cases underwent the procedure in our Foundation from 1997 to 2021, showing no operative mortality or reintervention rates, low conversion rates, early hospital discharge, and 100% graft patency at the follow-ups. The minimally invasive direct coronary artery bypass (MIDCAB) procedure was introduced in 1994 by Benetti from Argentina, and was developed based on our previous experience performing off-pump coronary surgery by manipulating the ascending aorta through a left-sided small thoracotomy. Although it represents one of the most common minimally invasive procedures done worldwide, the original technique is not easy to reproduce, and in most cases the pleura is opened, which increases patients pain, morbidity, hospital length of stay, and hinders the realization of immediate hybrid revascularization after the procedure. The latest minimally invasive approaches for CABG include robotic-assisted procedures, in which the IMAs are harvested using robotic technology or the whole procedure is done using robotic technology. This approach has shown adequate short-term clinical results, however, there are no studies available reporting the procedure’s long-term results. Conclusion: The MINI-OPCAB operation is a friendly approach to perform Minimally Invasive Coronary Bypass Surgery in old, high-risk, multivessel coronary artery disease patients, and it represents a good intervention alternative for the majority of cardiac surgeons and cardiac specialized centers. We also consider this approach as ideal for patients who further require Hybrid Revascularization; however, more experience is needed to validate this initials results.
12
Taguchi, Mitsuto, and Shu Nakamura. "Full Percutaneous Lumbar Interbody Fusion: Technical Note." Journal of Neurological Surgery Part A: Central European Neurosurgery 78, no. 06 (August 11, 2017): 601–6. http://dx.doi.org/10.1055/s-0037-1604360.
Повний текст джерелаАнотація:
Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.
13
Holly, Langston T., James D. Schwender, David P. Rouben, and Kevin T. Foley. "Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications." Neurosurgical Focus 20, no. 3 (March 2006): 1–5. http://dx.doi.org/10.3171/foc.2006.20.3.7.
Повний текст джерелаАнотація:
✓The authors provide an overview of the minimally invasive transforaminal lumbar interbody fusion (TLIF) procedure including indications, technique, and complications. This novel technique is a method of achieving circumferential lumbar fusion using a unilateral dorsal approach. Minimally invasive TLIF uses a tubular retractor that is inserted via a muscle-dilating exposure, thereby minimizing the approach-related morbidity. This procedure is ideal for refractory mechanical low-back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The authors' clinical experience and review of the medical literature indicate that TLIF can be effectively and safely performed in a minimally invasive fashion.
14
Kastengren, Mikael, Peter Svenarud, Göran Källner, Anders Franco-Cereceda, Jan Liska, Isak Gran, and Magnus Dalén. "Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme." European Journal of Cardio-Thoracic Surgery 58, no. 6 (September 12, 2020): 1168–74. http://dx.doi.org/10.1093/ejcts/ezaa232.
Повний текст джерелаАнотація:
Abstract OBJECTIVES An increasing number of mitral valve operations are performed using minimally invasive procedures. The initiation of a minimally invasive mitral valve surgery programme constitutes a unique opportunity to study outcome differences in patients with similar characteristics operated on through a sternotomy versus a minimally invasive procedure. The goal of this study was to compare short-term outcomes of patients undergoing mitral valve surgery before versus those having surgery after the introduction of a minimally invasive programme. METHODS The single-centre study included mitral valve procedures performed through a sternotomy or with a minimally invasive approach between January 2012 and May 2019. Propensity score matching was performed to reduce selection bias. RESULTS A total of 605 patients (294 sternotomy, 311 minimally invasive) who underwent mitral valve surgery were included in the analysis. Propensity score matching resulted in 251 matched pairs. In the propensity score-matched analysis, minimally invasive procedures had longer extracorporeal circulation duration (149 ± 52 vs 133 ± 57 min; P = 0.001) but shorter aortic occlusion duration (97 ± 36 vs 105 ± 40 min, P = 0.03). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs 7.2%; P = 0.012), lower need for transfusion (19.1% vs 30.7%; P = 0.003) and shorter in-hospital stay (5.0 ± 2.7 vs 7.2 ± 4.6 days; P < 0.001). The 30-day mortality was low in both groups (0.4% vs 0.8%; P = 0.56). CONCLUSIONS Minimally invasive mitral valve surgery was associated with short-term outcomes comparable to those with procedures performed through a sternotomy. Initiating a minimally invasive mitral valve programme with a limited number of surgeons and a well-executed institutional selection strategy did not confer an increased risk for adverse events.
15
Jin, Mengran, Guokang Xu, Tong Shen, Jun Zhang, Haiyu Shao, Jianwen Liu, Tingxiao Zhao, and Yazeng Huang. "Minimally invasive surgery for low-grade spondylolisthesis: percutaneous endoscopic or oblique lumbar interbody fusion." Journal of Comparative Effectiveness Research 9, no. 9 (June 2020): 639–50. http://dx.doi.org/10.2217/cer-2020-0022.
Повний текст джерелаАнотація:
Aim: To compare the clinical and radiographic outcomes of percutaneous endoscopic-assisted lumbar interbody fusion (PELIF) versus oblique lumbar interbody fusion (OLIF) for the treatment of symptomatic low-grade lumbar spondylolisthesis. Material & methods: The clinical and radiographic records of 48 patients underwent single-level minimally invasive lumbar fusion with a PELIF (n = 16) or OLIF (n = 32) were reviewed. Results: The clinical and radiographic outcomes were similar in both groups. PELIF procedure exhibited superior capability of the enlargement of foraminal width, but inferior capability of the restoration of foraminal height than OLIF procedure. Conclusion: PELIF minimizes the iatrogenic damages and perioperative risks to a great extent, and seems to be a promising option for the treatment of symptomatic low-grade lumbar spondylolisthesis.
16
Deer, Timothy R. "New Image-Guided Ultra-Minimally Invasive Lumbar Decompression Method: The mild® Procedure." Pain Physician 1;13, no. 1;1 (January 14, 2010): 35–41. http://dx.doi.org/10.36076/ppj.2010/13/35.
Повний текст джерелаАнотація:
Background and Objectives: Lumbar canal stenosis is a common source of chronic low back and leg pain. Minimally Invasive Lumbar Decompression (mild®) is a new minimally invasive treatment for pain relief from symptomatic central lumbar canal stenosis. The procedure involves limited percutaneous laminotomy and thinning of the ligamentum flavum in order to increase the critical diameter of the stenosed spinal canal. The objective of this technical report is to evaluate the acute safety of the mild procedure. Methods: Manual and electronic chart survey was conducted by 14 treating physicians located in 9 U.S. states on 90 consecutive patients who underwent the mild procedure. Patients within local geographical practice areas were selected in keeping with product Instructions For Use. Those patients requiring lumbar decompression via tissue resection at the perilaminar space, within the interlaminar space and at the ventral aspect of the lamina were treated. Data collected included any complications and/or adverse events occurring during or immediately following the procedure prior to discharge. Results: Of 90 procedures reviewed, there were no major adverse events or complications related to the devices or procedure. No incidents of dural puncture or tear, blood transfusion, nerve injury, epidural bleeding, or hematoma were observed. Limitations: Data were not specifically collected; however, regardless of difficulty, in this series none of the procedures were aborted and none resulted in adverse events. Efficacy parameters were not collected in this safety survey. Conclusions: This review demonstrates the acute safety of the mild procedure with no report of significant or unusual patient complications. To establish complication frequency and longer-term safety profile associated with the treatment, additional studies are currently being conducted. Survey data on file at Vertos Medical, Inc. Key words: Spine, decompression, fluoroscopy, mild, stenosis, ligamentum
17
Lauder, Lucas, Bruno R. da Costa, Sebastian Ewen, Sean S. Scholz, William Wijns, Thomas F. Lüscher, Patrick W. Serruys, et al. "Randomized trials of invasive cardiovascular interventions that include a placebo control: a systematic review and meta-analysis." European Heart Journal 41, no. 27 (July 14, 2020): 2556–69. http://dx.doi.org/10.1093/eurheartj/ehaa495.
Повний текст джерелаАнотація:
Abstract Aims The difference in the benefit of invasive cardiovascular interventions compared with placebo controls has not been analysed systematically. Methods and results MEDLINE and Web of Science were searched through 29 March 2020. Randomized, placebo-controlled trials of invasive cardiovascular interventions (including catheter-based interventions and pacemaker-like devices) investigating predefined primary outcomes were included. Standardized mean differences (SMD) and odds ratios were calculated for continuous and dichotomous outcomes, respectively. Meta-regression analyses were performed to assess whether estimates of treatment effects were associated with methodological characteristics of trials. Thirty trials, including 4102 patients, were analysed. The overall risk of bias was judged to be low in only 43% of the trials. Ten trials (33%) demonstrated statistically significant superiority of invasive interventions over placebo controls for the respective predefined primary outcomes. In almost half of the 16 trials investigating continuous predefined primary outcomes, the SMD between the active and placebo procedure indicated a small (n = 4) to moderate (n = 3) treatment effect of active treatment over placebo. In contrast, one trial indicated a small treatment effect in favour of the placebo procedure. In the remaining trials, there was no relevant treatment effect of active treatment over placebo. In trials with a protocol-mandated stable and symmetrical use of co-interventions, the superiority of active procedures vs. invasive placebo procedures was significantly larger as compared with trials with frequent or unbalanced changes in co-interventions (P for interaction 0.027). Conclusions The additional treatment effect of invasive cardiovascular interventions compared with placebo controls was small in most trials.
18
Lessire, Sarah, Jonathan Douxfils, Lionel Pochet, Anne-Sophie Dincq, Anne-Sophie Larock, Maximilien Gourdin, Jean-Michel Dogné, Bernard Chatelain, and François Mullier. "Estimation of Rivaroxaban Plasma Concentrations in the Perioperative Setting in Patients With or Without Heparin Bridging." Clinical and Applied Thrombosis/Hemostasis 24, no. 1 (November 3, 2016): 129–38. http://dx.doi.org/10.1177/1076029616675968.
Повний текст джерелаАнотація:
Introduction: Estimation of residual rivaroxaban plasma concentrations may be requested before invasive procedures and some patients at high thromboembolic risk will have a bridging therapy with heparins when rivaroxaban is interrupted. Objective: The objective of this study was to assess the performance of the STA-Liquid Anti-Xa assay (STA LAX) and the low and normal procedures of the Biophen Direct Factor Xa Inhibitors (DiXaI) assay, in patients with and without bridging with low-molecular-weight heparins (LMWHs). Materials and Methods: Seventy-nine blood samples were collected from 77 patients on rivaroxaban at CTROUGH or before an invasive procedure. Rivaroxaban plasma concentrations were estimated using Biophen DiXaI, Biophen DiXaI LOW, and STA LAX and compared to liquid chromatography coupled with mass spectrometry (LC-MS/MS) measurements. Stratifications were performed according to heparin bridging. Results: The Biophen DiXaI LOW and STA LAX showed better correlation with LC-MS/MS measurements than Biophen DiXaI in patients not bridged with LMWH (R: 0.97, 0.96, and 0.91, respectively). However, the performance of Biophen DiXaI LOW and STA LAX decreased when residual LMWH activity was present (R: 0.18 and 0.19 respectively) demonstrating that these tests are not specific to rivaroxaban. Conclusion: In patients not bridged with LMWH, we suggest to use the Biophen DiXaI LOW and STA LAX for the estimation of rivaroxaban concentrations <50 ng/mL. These results should be confirmed on a larger cohort of patients. Patients bridged with LMWH have inaccurate estimates of low levels of rivaroxaban and the 3 assays studied should not be used to estimate if it is safe to perform a procedure.
19
Del Chiaro, Marco, and Ralf Segersvärd. "The State of the Art of Robotic Pancreatectomy." BioMed Research International 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/920492.
Повний текст джерелаАнотація:
During the last decades an increasing number of minimally invasive pancreatic resections have been reported in the literature. With the development of robotic surgery a new enthusiasm has not only increased the number of centers approaching minimally invasive pancreatic surgery in general but also enabled the use of this technique for major pancreatic procedures, in particular in minimally invasive pancreatoduodenectomy. The aim of this review was to define the state of the art of pancreatic robotic surgery. No prospective randomized trials have been performed comparing robotic, laparoscopic, and open pancreatic procedures. From the literature one may conclude that robotic pancreatectomies seem to be as feasible and safe as open procedures. The general idea that the overall perioperative costs of robotic surgery would be higher than traditional procedures is not supported. With the current lack of evidence of any oncologic advantages, the cosmetic benefits offered by robotic surgery are not enough to justify extensive use in cancer patients. In contrast, the safety of these procedure can justify the use of the robotic technique in patient with benign/low grade malignant tumors of the pancreas.
20
Biedermann, Joseph S., Willem M. H. Rademacher, Hendrika C. A. M. Hazendonk, Denise E. van Diermen, Frank W. G. Leebeek, Frederik R. Rozema, and Marieke J. H. A. Kruip. "Predictors of oral cavity bleeding and clinical outcome after dental procedures in patients on vitamin K antagonists." Thrombosis and Haemostasis 117, no. 07 (2017): 1432–39. http://dx.doi.org/10.1160/th17-01-0040.
Повний текст джерелаАнотація:
SummaryPatients on vitamin K antagonists (VKA) often undergo invasive dental procedures. International guidelines consider all dental procedures as low-risk procedures, while bleeding risk may differ between standard low-risk (e. g. extraction 1–3 elements) and extensive high-risk (e.g. extraction of >3 elements) procedures. Therefore current guidelines may need refinement. In this cohort study, we identified predictors of oral cavity bleeding (OCB) and evaluated clinical outcome after low-risk and highrisk dental procedures in patients on VKA. Perioperative management strategy, procedure risk, and 30-day outcomes were assessed for each procedure. We identified 1845 patients undergoing 2004 low-risk and 325 high-risk procedures between 2013 and 2015. OCB occurred after 67/2004 (3.3 %) low-risk and 21/325 (6.5 %) high-risk procedures (p=0.006). In low-risk procedures, VKA continuation with tranexamic acid mouthwash was associated with a lower OCB risk compared to continuation without mouthwash [OR=0.41, 95 %CI 0.23–0.73] or interruption with bridging [OR=0.49, 95 %CI 0.24–1.00], and a similar risk as interruption without bridging [OR=1.44, 95 %CI 0.62–3.64]. In high-risk procedures, VKA continuation was associated with an increased OCB risk compared to interruption [OR=3.08, 95 %CI 1.05–9.04]. Multivariate analyses revealed bridging, antiplatelet therapy, and a supratherapeutic or unobjectified INR before the procedure as strongest predictors of OCB. Non-oral cavity bleeding (NOCB) and thromboembolic event (TE) rates were 2.1 % and 0.2 %. Bridging therapy was associated with a two-fold increased risk of NOCB [OR=1.93, 95 %CI 1.03–3.60], but not with lower TE rates. In conclusion, predictors of OCB were mostly related to perioperative management and differed between low-risk and high-risk procedures. Perioperative management should be differentiated accordingly.
21
Manzur Villalobos, Isabella, Eilien Gisek Tovío Martínez, Eliana Marcela Guzmán Menco, and Adel Martínez Martínez. "LipStaT® Surgery, A Novel Technique for the Treatment of Gummy Smile: Case Report." Acta Odontológica Colombiana 10, no. 2 (July 31, 2020): 137–46. http://dx.doi.org/10.15446/aoc.v10n2.84452.
Повний текст джерелаАнотація:
Introduction: The lip stabilization technique (LipStaT®) is a novel surgical approach for the management of gummy smile. It is an outpatient technique, minimally invasive, with low risk of morbidity and low incidence of complications. The goal of the technique is to reduce the excessive gingival display during smile. Objective: to describe the LipStaT® technique including its indications, preoperative evaluation, surgical approach and patient post procedure care instructions. Clinical Cases: the authors present two female patients, aged 20 and 31 years, with excessive gingival display (over 3mm) and with experiences of failures with other procedures. The LipStaT® technique allowed to achieve aesthetic, harmonic and functional results. Conclusion: The LipStaT® technique is a safe outpatient procedure that allows to obtain predictable results, which are well accepted by patients.
22
De Sancho, Maria Teresa, and Svetoslava Bardarova. "Hematology Experience with Perioperative Anticoagulation at a Tertiary Hospital." Blood 116, no. 21 (November 19, 2010): 4399. http://dx.doi.org/10.1182/blood.v116.21.4399.4399.
Повний текст джерелаАнотація:
Abstract Abstract 4399 Introduction: The purpose of our study was to evaluate the peri-procedure management of patients on chronic vitamin K antagonists (VKA) and to assess adherence to the 2008 American College of Chest Physicians (ACCP) guidelines. Methods: We retrospectively reviewed the electronic medical records of patients on chronic VKA who required temporary discontinuation of anticoagulation due to an invasive or surgical procedure at New York Presbyterian Hospital from January 2006 to June 2010. Dermatological or oral procedures were excluded. Demographics, indications of VKA, underlying thrombophilia, cancer or inflammatory bowel disease, type of invasive or surgical procedure, method of bridge therapy and complications were recorded. When the ACCP guidelines were published, we compared our previous practice and modified our management accordingly. Results: A total of 48 procedures where performed in 34 patients. The demographic and clinical characteristics of these patients are shown in Table 1. The type of procedure, anticoagulant bridge therapy and complications are shown in Table 2. The majority of the procedures were managed using bridge therapy with low molecular heparin (LMWH) treatment dose. There were no thrombotic episodes, however there were 3 bleeding complications. All occurred prior to the publication of the 2008 ACCP guidelines. The patients who had bleeding complications were on therapeutic dose LMWH/Fondaparinux bridge therapy. One patient with the antiphospholipid syndrome developed severe thrombocytopenia after surgery that responded to intravenous gamma globulin. Conclusion: Adherence to the ACCP guidelines for the perioperative management of anticoagulation minimizes bleeding complications and improves patient outcomes. Disclosures: No relevant conflicts of interest to declare.
23
Souweidane, Mark M. "Endoscopic management of pediatric brain tumors." Neurosurgical Focus 18, no. 6 (June 2005): 1–6. http://dx.doi.org/10.3171/foc.2005.18.6.2.
Повний текст джерелаАнотація:
Object Primary endoscopic procedures for children with intraventricular brain tumors include endoscopic tumor biopsy and endoscopic tumor removal. The simultaneous treatment of hydrocephalus with endoscopic third ventricu-lostomy (ETV) or endoscopic septostomy increases the appeal of a minimally invasive endoscopic approach. Methods Eighty-five patients who underwent endoscopic management of an intraventricular brain tumor were identified from a prospective database. Of these patients, 26 were younger than 21 years of age at the time of diagnosis. The surgical technique, its success rate, and patient outcome were assessed. Illustrative cases are used in this study to detail the procedure of endoscopic tumor biopsy and resection. Endoscopic tumor procedures were successful in 96% of cases (23 of 24 endoscopic tumor biopsy samples and both endoscopic tumor removals). Fourteen simultaneous procedures were performed to treat hydrocephalus successfully. There was no recognized morbidity from the surgical procedures. Conclusions Endoscopic surgery in children with intraventricular brain tumors is an effective and safe method for sampling of the lesion and, in select cases, its resection. This minimally invasive technique should be considered in situations in which the patient might thereby avoid a more conventional procedure, given the high rate of success and low morbidity associated with endoscopic management.
24
Küppers, Julia, Viviane van Eckert, Nadine R. Muensterer, Anne-Sophie Holler, Stephan Rohleder, Takafumi Kawano, Jan Gödeke, and Oliver J. Muensterer. "Percutaneous Anorectoplasty (PARP)—An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair." Children 9, no. 5 (April 21, 2022): 587. http://dx.doi.org/10.3390/children9050587.
Повний текст джерелаАнотація:
Background: Anorectal malformations comprise a broad spectrum of disease. We developed a percutaneous anorectoplasty (PARP) technique as a minimal-invasive option for repair of amenable types of lesions. Methods: Patients who underwent PARP at five institutions from 2008 through 2021 were retrospectively analyzed. Demographic information, details of the operative procedure, and perioperative complications and outcomes were collected. Results: A total of 10 patients underwent the PARP procedure during the study interval. Patients either had low perineal malformations or no appreciable fistula. Most procedures were guided by ultrasound, fluoroscopy, or endoscopy. Median age at PARP was 3 days (range 1 to 311) days; eight patients were male. Only one intraoperative complication occurred, prompting conversion to posterior sagittal anorectoplasty. Functional outcomes in most children were highly satisfactory in terms of continence and functionality. Conclusions: The PARP technique is an excellent minimal-invasive alternative for boys born with perineal fistulae, as well as patients of both sexes without fistulae. The optimal type of guidance (ultrasound, fluoroscopy, or endoscopy) depends on the anatomy of the lesion and the presence of a colostomy at the time of repair.
25
Pinsky, Paul F., Christina R. Bellinger, and David P. Miller. "False-positive screens and lung cancer risk in the National Lung Screening Trial: Implications for shared decision-making." Journal of Medical Screening 25, no. 2 (September 20, 2017): 110–12. http://dx.doi.org/10.1177/0969141317727771.
Повний текст джерелаАнотація:
Objectives Low-dose computed tomography lung cancer screening has been shown to reduce lung cancer mortality but has a high false-positive rate. The precision medicine approach to low-dose computed tomography screening assesses subjects’ benefits versus harms based on their personal lung cancer risk, where harms include false-positive screens and resultant invasive procedures. We assess the relationship between lung cancer risk and the rate of false-positive LDCT screens. Methods The National Lung Screening Trial randomized high-risk subjects to three annual screens with low-dose computed tomography or chest radiographs. Following the completion of National Lung Screening Trial, the Lung CT Screening Reporting and Data System (Lung-RADS) classification system was developed and retrospectively applied to National Lung Screening Trial low-dose computed tomography findings. The rate of false-positive screens (by Lung-RADS) and the resultant invasive procedures were examined as a function of lung cancer risk estimated by a model. Results Of 26,722 subjects randomized to the low-dose computed tomography arm, 26,309 received a baseline screen and were included in the analysis. The proportion with any false positive over three screening rounds increased from 12.9% to 25.9% from lowest to highest risk decile, and the proportion with an invasive procedure following a false positive also significantly increased from 0.7% to 2.0% from lowest to highest risk decile. Conclusion These findings indicate a need for personalized low-dose computed tomography lung cancer screening decision aids to accurately convey the benefits to harm trade-off.
26
Shin, Jae Ho, Yunsun Song, Jae Jon Sheen, Dongwhane Lee, Jaewoo Chung, Ga Young Lee, Hyunhee Jeong, et al. "Safety and Effectiveness of Percutaneous Low-Dose Thrombin Injection for Femoral Puncture Site Pseudoaneurysms in Neurointervention: Single-Center Experience." Neurointervention 15, no. 1 (March 31, 2020): 25–30. http://dx.doi.org/10.5469/neuroint.2019.00206.
Повний текст джерелаАнотація:
Purpose: We present ultrasound-guided percutaneous low-dose thrombin (200–250 IU) injection for the treatment of iatrogenic femoral pseudoaneurysms. Second, we compared patient and procedure factors between subcutaneous hematoma and pseudoaneurysm groups.Materials and Methods: From April 2012 to May 2018, 8425 patients underwent neurointervention. Among these patients, 18 had small subcutaneous hematomas and 6 had pseudoaneurysms. Pseudoaneurysms in the neck and entire sac were visualized, and low-dose thrombins were injected while visualizing a “whirlpool” hyperechoic core in the pseudoaneurysm sac. Subcutaneous hematomas were treated with simple compression. We compared the following parameters between the subcutaneous hematoma group and pseudoaneurysm group: sex, age, body mass index (BMI), type of procedure, heparin usage, sheath size, procedure time, and number of previous neurointervention procedures with the Mann-Whitney U test.Results: Most of the pseudoaneurysms were successfully occluded with 200 IU of thrombin (n=5). Only 1 pseudoaneurysm required a slightly higher thrombin concentration (250 IU, n=1). During the short-term follow-up, no residual sac was observed and no surgical repair was necessary. Pain in the groin region was alleviated. During the 1-month follow-up, no evidence of pseudoaneurysm recurrence nor subcutaneous hematoma was noted. Patient factors (sex, age, and BMI) and procedure factors (heparin usage, sheath size, procedure time, number of previous procedures) were not statistically different between the subcutaneous hematoma and pseudoaneurysm groups.Conclusion: Ultrasound-guided percutaneous low-dose thrombin injection (200–250 IU) is safe, effective, and less invasive for treating iatrogenic femoral pseudoaneurysm in neurointervention.
27
Tarantino, Michael D., Patrick F. Fogarty, Bhabita Mayer, Sandra Y. Vasey, and Andres Brainsky. "Hemostatic Challenges In Patients Treated with Eltrombopag." Blood 116, no. 21 (November 19, 2010): 2511. http://dx.doi.org/10.1182/blood.v116.21.2511.2511.
Повний текст джерелаАнотація:
Abstract Abstract 2511 Introduction: Chronic immune thrombocytopenia (ITP) is an autoimmune disease in which antiplatelet-antibodies induce platelet destruction and impair platelet production, resulting in chronically low platelet counts. Patients with chronic ITP may require invasive procedures associated with bleeding (hemostatic challenges) that cannot be undertaken if the platelet count is unacceptably low. Eltrombopag is an oral, nonpeptide, thrombopoietin receptor (TPO-R) agonist developed to increase platelet counts in various conditions associated with thrombocytopenia; its use may facilitate undertaking invasive procedures in patients with chronic ITP, reducing the need for additional supportive requirements including cellular blood products. Methods: Across the eltrombopag ITP clinical trials, information about hemostatic challenges was collected retrospectively (TRA100773A and B) and prospectively (REPEAT, RAISE, EXTEND). Basic demographic information, platelet counts before and after the procedures, type of procedure, need for additional treatment to increase platelet counts (one week before and after the intervention), use of blood products, and where possible, assessment of bleeding and bleeding complications were recorded. For the purpose of this analysis, minor invasive procedures (eg, dental cleaning, endoscopy, bone marrow biopsy) were distinguished from major invasive procedures (splenectomy, laparotomy, hip replacement, aortic aneurysm repair, arthroplasty). Results: Seventy-seven patients underwent 120 invasive procedures while enrolled in clinical trials with eltrombopag. The median age of patients undergoing invasive procedures was 54 years; the median duration of treatment at the time of all procedures was 131 days. 112 invasive procedures were performed in patients while receiving eltrombopag, compared to 8 procedures among patients while receiving placebo. 65 (54%) were considered to be major and 55 (46%) were considered to be minor. The median platelet count closest to minor or major invasive procedures in patients receiving eltrombopag was higher than in those receiving placebo (Table). For minor procedures, rescue ITP medication was required in 9/52 (17%) procedures in patients treated with eltrombopag and in 1/3 (33%) procedures in patients receiving placebo. For major procedures, rescue ITP medication was required in 14/60 (23%) procedures in patients treated with eltrombopag and 3/5 (60%) procedures in patients receiving placebo. One bleeding complication was reported in an eltrombopag-treated patient with colon cancer who, on the first post-operative day after a colectomy, experienced a pulmonary embolism requiring anticoagulation and had an intra-abdominal hemorrhage on post-operative day 2. Conclusions: No difference in use of periprocedural blood products between groups was discernable, possibly due to the low frequency of bleeding events reported. Although the number of patients who did not undergo procedures due to thrombocytopenia was not captured, data from 77 patients undergoing 120 invasive procedures suggest that by achieving a sustained platelet increase in patients with chronic ITP, eltrombopag facilitates the undertaking of medical and surgical procedures associated with bleeding. Disclosures: Tarantino: GlaxoSmithKline, Novo Nordisk, Talecris, Baxter, Cangene: Honoraria, Research Funding, Speakers Bureau. Fogarty: GlaxoSmithKline: Honoraria, Research Funding. Mayer: GlaxoSmithKline: Employment, Equity Ownership. Vasey: GlaxoSmithKline: Employment. Brainsky: GlaxoSmithKline: Employment.
28
Hasan, Md Nazmul, Md Abu Siddique, Sajal Krishna Banerjee, Syed Ali Ahsan, AKM Fazlur Rahman, Choudhury Meshkat Ahmed, Mohammad Faisal Ibn Kabir, and Md Harisul Hoque. "Antithrombotic Strategies in Perioperative Period." University Heart Journal 9, no. 1 (July 14, 2014): 47–51. http://dx.doi.org/10.3329/uhj.v9i1.19511.
Повний текст джерелаАнотація:
Antithrombotic therapy (Warfarin, Aspirin,Clopidogrel etc.) are routinely used in prevention and treatment of various cardiovascular diseases. In patients who are having a surgical or other invasive procedure, interruption of antithrombotic therapy is typically required to minimize the risk for perioperative bleeding. It involves balancing the risk of periprocedural bleeding with continued treatment against the thrombotic risk with suspension of treatment and use of bridging anticoagulation therapy. The need for bridging is driven by patients estimated risk for thromboembolism and the bleeding risk of invasive procedure. Treatment with subcutaneous low-molecular- weight heparin or intravenous unfractionated heparin at a therapeutic dose before and after the procedure recommended as bridging anticoagulation therapy. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19511 University Heart Journal Vol. 9, No. 1, January 2013; 47-51
29
Suematsu, Yoshihiro. "Is An Off-Pump Wrapping Procedure for Stanford Type A Acute Aortic Dissection Low Invasive Surgery?" Annals of Thoracic Surgery 110, no. 2 (August 2020): 750. http://dx.doi.org/10.1016/j.athoracsur.2020.01.055.
Повний текст джерела
30
Delate, Thomas, Stephanie M. Meisinger, Daniel M. Witt, Daniel Jenkins, James D. Douketis, and Nathan P. Clark. "Bridge Therapy Outcomes in Patients With Mechanical Heart Valves." Clinical and Applied Thrombosis/Hemostasis 23, no. 8 (September 21, 2016): 1036–41. http://dx.doi.org/10.1177/1076029616669786.
Повний текст джерелаАнотація:
Background: Bridge therapy is associated with an increased risk of major bleeding in patients with atrial fibrillation and venous thromboembolism (TE) without a corresponding reduction in TE. The benefits of bridge therapy in patients with mechanical heart valve (MHV) prostheses interrupting warfarin for invasive procedures are not well described. Methods and Results: A retrospective cohort study was conducted at an integrated health-care delivery system. Anticoagulated patients with MHV interrupting warfarin for invasive diagnostic or surgical procedures between January 1, 2006, and March 31, 2012, were identified. Patients were categorized according to exposure to bridge therapy during the periprocedural period and TE risk (low, medium, and high). Outcomes validated via manual chart review included clinically relevant bleeding, TE, and all-cause mortality in the 30 days following the procedure. There were 547 procedures in 355 patients meeting inclusion criteria. Mean cohort age was 65.2 years, and 38% were female. Bridge therapy was utilized in 466 (85.2%) procedures (95.2%, 77.3%, and 65.8% of high, medium, and low TE risk category procedures, respectively). The 30-day rate of clinically relevant bleeding was numerically higher in bridged (5.8%; 95% confidence interval [CI], 3.9%-8.3%) versus not bridged procedures (1.2%; 95% CI, <0.1%-6.7%; P = .102). No TEs or deaths were identified. Conclusion: The use of bridge therapy is common among patients with MHV and may be associated with increased bleeding risk. Further research is needed to determine whether bridge therapy reduces TE in patients with MHV interrupting warfarin for invasive procedures.
31
Jacques, Thibaut, Charlotte Brienne, Simon Henry, Hortense Baffet, Géraldine Giraudet, Xavier Demondion, and Anne Cotten. "Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe." European Radiology 32, no. 3 (October 14, 2021): 1718–25. http://dx.doi.org/10.1007/s00330-021-08263-4.
Повний текст джерелаАнотація:
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.
32
Jacques, Thibaut, Charlotte Brienne, Simon Henry, Hortense Baffet, Géraldine Giraudet, Xavier Demondion, and Anne Cotten. "Minimally invasive removal of deep contraceptive implants under continuous ultrasound guidance is effective, quick, and safe." European Radiology 32, no. 3 (October 14, 2021): 1718–25. http://dx.doi.org/10.1007/s00330-021-08263-4.
Повний текст джерелаАнотація:
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.
33
Eisen, Daniel B., Laurence Warshawski, David Zloty, and Rahman Azari. "Results of a Survey regarding Perioperative Antiseptic Practices." Journal of Cutaneous Medicine and Surgery 13, no. 3 (May 2009): 134–39. http://dx.doi.org/10.2310/7750.2008.08019.
Повний текст джерелаАнотація:
Background: Currently, there are many options available for perioperative antiseptic techniques for cutaneous surgery. However, there is a paucity of scientific evidence available to suggest which techniques are worthwhile and which are not. Objectives: To determine if there is any consensus among dermatologic surgeons as to which perioperative techniques are being used and which are not. Methods: A questionnaire regarding perioperative techniques was mailed to the 641 members of the American College of Mohs Surgery (ACMS). Results: Forty-one percent of those queried returned the questionnaire within the allotted time. Surgical caps and booties were the least used antiseptic techniques. Respondents tended to use antiseptic techniques less often for less invasive procedures and more often for more invasive procedures. Few people used surgical caps, surgical gowns, or booties for any procedure. Conclusions: Many traditional perioperative antiseptic techniques are not being performed by respondents. Calculated infection rates are very low for all queried procedures.
34
Bjelica, Artur, and Srna Subanovic. "Assessment of the embryo quality in the procedure of in vitro fertilization." Medical review 69, no. 7-8 (2016): 241–46. http://dx.doi.org/10.2298/mpns1608241b.
Повний текст джерелаАнотація:
Introduction. Since reproductive technologies are becoming increasingly popular among the couples with infertility problem, and having in mind that the success rate is still low, the clinicians tend to transfer more embryos in order to increase the probability of success. However, such a strategy increases the risk of multiple pregnancy, which brings about numerous risks to the health of both the mother and children. Therefore, an elective single-embryo transfer is set as imperative, which, on the other hand, would not be possible without selection and evaluation of the quality of embryos. Assessment of Embryo Quality. Embryos can be selected by various methods, from non-invasive to invasive methods. In non-invasive methods, the embryos are selected by their morphology or by the techniques based on the analysis of molecular components - analyses of the level of proteomes or metabolomes. A more detailed monitoring of the kinetics of the embryo development can be related to the introduction of time-lapse imaging and monitoring systems into laboratory practice. The invasive methods encompass the techniques such as preimplantation genetic diagnosis and preimplantation genetic screening. In preimplantation genetic diagnosis, the assisted reproduction technologies cycle is approached for the genetic reasons, whereas preimplantation genetic screening is used to enhance the success rate of the assisted reproduction cycles. Conclusion. In this paper we have shown that the application of elective single-embryo transfer requires the selection and assessment of the quality of embryos by the methods that have been developed in the last four decades, and still need further improvements.
35
Komlev, A. E., P. M. Lepilin, E. V. Kurilina, V. V. Romakina, and T. E. Imaev. "Delayed coronary obstruction of the left main artery after transcatheter aortic valve replacement." Terapevticheskii arkhiv 92, no. 4 (May 19, 2020): 70–75. http://dx.doi.org/10.26442/00403660.2020.04.000466.
Повний текст джерелаАнотація:
Coronary arteries obstruction associated with transcatheter aortic valve implantation (TAVI) may occur either during the procedure or after it. In the latter coronary obstruction can be further divided into early (7 days after procedure) or delayed one (7 days). Delayed coronary obstruction (DCO) is referred as a rare but devastating complication after TAVI and is associated with the extremely high mortality. This case demonstrates the objective difficulties of timely diagnostics of DCO. Since the results of non-invasive methods are indetermined in most cases, the authors conclude that even low-specific clinical symptoms must be interpreted as the definite rationale for the implementation of invasive diagnostic and treatment strategy.
36
Herdiman, Hafis, Oea Khairsyaf, and Russilawati Russilawati. "Pleuroskopi Sebagai Tindakan Diagnostik pada Paru." Jurnal Sehat Mandiri 16, no. 2 (December 31, 2021): 147–57. http://dx.doi.org/10.33761/jsm.v16i2.486.
Повний текст джерелаАнотація:
Pleuroscopy, also known as medical thoracoscopy, is a minimally invasive procedure that is used to examine and biopsy the pleural cavity as well as to perform therapeutic interventions. This procedure has a near-perfect diagnostic accuracy in malignant pleural effusions and tuberculosis. With a mortality rate of 0.1%, the complication rate is low (2% - 5%) and usually mild (subcutaneous emphysema, bleeding, infection). Objective : Increase knowledge of pleuroscopy as a diagnostic and therapeutic tool in lung disease. Method : This paper is based on a review of the literature on pleuroscopy. Conclusion : Pleuroscopy is a minimally invasive procedure that can be used to examine and biopsy the pleural cavity, as well as for therapeutic intervention. Complications are uncommon and usually minor. Sugestion : Other articles are required to increase knowledge about pleuroscopy in order to obtain more knowledge.
37
Nahas, Sergio C., Caio S. R. Nahas, Carlos Frederico S. Marques, Andre Roncon Dias, Wilson M. Pollara, and Ivan Cecconello. "Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 23, no. 1 (March 2010): 35–39. http://dx.doi.org/10.1590/s0102-67202010000100009.
Повний текст джерелаАнотація:
Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Based on review of the literature and in the authors experience, this review present the method and indications for TEM.
38
Avery, John, Keshav Kumar, Vijaya Thakur, and Anjani Thakur. "Radiofrequency Ablation as First-line Treatment of Varicose Veins." American Surgeon 80, no. 3 (March 2014): 231–35. http://dx.doi.org/10.1177/000313481408000316.
Повний текст джерелаАнотація:
Endovascular radiofrequency ablation is a minimally invasive method to safely treat symptomatic refluxing varicose veins. A retrospective chart review was used to determine patient demographics, disease severity, treatment algorithm, and outcome in patients who underwent radiofrequency ablation of symptomatic refluxing veins that had failed conservative management. Statistical analysis was done using GraphPad Demo Version (San Diego, CA). Two hundred forty-one limbs in 179 patients (average age, 53 years; 73% females, 27% males) were treated. Preprocedure Clinical Etiological Anatomic and Pathologic (CEAP) scores were C2s: 236, C3s: 4, and C5s:1. Procedures were performed in the office using tumescent anesthetic; all patients could ambulate immediately after the procedure. Postprocedure total occlusion (TO) rate was seen in 93 per cent of limbs (223 limbs) at 3 months and 91 per cent of limbs (220 limbs) at 12 months posttreatment. No relationship was found between patients who did not have total occlusion and age, sex, diameter of veins, CEAP scores, preoperative reflux time, and volume of tumescent anesthetic ( P > 0.05). The VNUS procedure is an in-office, minimally invasive procedure with a low complication rate and quick recovery. Total occlusion rates are high and there is improvement in disease severity after treatment.
39
Camino Willhuber, Gaston Oscar, Mariana Bendersky, Carolina Vilte, Gonzalo Kido, Matias Pereira Duarte, Martin Estefan, Julio Bassani, Matias Petracchi, Marcelo Gruenberg, and Carlos Sola. "Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty." Revista de la Facultad de Ciencias Médicas de Córdoba 78, no. 3 (August 23, 2021): 257–63. http://dx.doi.org/10.31053/1853.0605.v78.n3.32619.
Повний текст джерелаАнотація:
Introduction: Percutaneous cement discoplasty is a minimally invasive procedure to treat low back pain due to advanced degenerative disc disease in elderly patients. Complications of this procedure has been described such as infection, vertebral fracture, cement leakage and nerve injury. Intraoperative neuromonitoring is used to detect the latter. The objective of this study was to assess the usefulness of neuromonitoring during discoplasty to detect new neurological compromise. Methods: 100 consecutive patients were included in this retrospective study, (30 males and 70 females, mean age of 76.3 ± 5.71 years) with mechanical low back pain who underwent percutaneous cement discoplasty. Results: Sensitivity to detect neurological injury was 82% (CI 95% 66-98), specificity was of 99% (CI 95%98-100) with a positive predictive value of 0.95 (CI 95% 85-100) and a negative predictive value of 0.97 (CI 95% 95-99). In 5 patients neurological compromise was not detected by neuromonitoring. Discussion: Our study showed high sensitivity and specificity of neuromonitoring to detect neurological irritation during percutaneous discoplasty. Intraoperative neuromonitoring resulted an effective assistance during this minimally invasive procedure.
40
Bazzocchi, Frida, Sara Ticci, Vincenzo Di Naso, and Andrea Rocchetti. "LOW-COST AND NON-INVASIVE ENERGY RECOVERY TECHNIQUES FOR PUBLIC RESIDENTIAL BUILDINGS MADE WITH GREAT PANEL STRUCTURES IN ITALY." Journal of Green Building 14, no. 3 (June 2019): 23–46. http://dx.doi.org/10.3992/1943-4618.14.3.23.
Повний текст джерелаАнотація:
In Italy, a large stock of public housing was built during the 1970s and 1980s with industrialized/prefabricated techniques. These buildings have envelopes characterized by the presence of many thermal bridges and low transmittance values. In addition, they feature inefficient single heating systems in residential units and no cooling/ventilation systems. As a result, these buildings require urgent energy retrofitting actions, and it is therefore necessary to define procedures that will guarantee effective results. The possible interventions must be compatible with building construction techniques as well as be minimally invasive and inexpensive. There are only a limited number of technical solutions, considering that residents should not have to move out during the renovations. In most Italian climatic zones, current interventions are usually linked to external insulation and window replacement, leading to an improvement in energy performance and comfort only during winter. Internal comfort conditions tend to worsen in summer months because seasonal temperatures tend to increase by a few degrees. Therefore, solutions should be proposed that will improve both summer and winter conditions. This work proposes an energy recovery procedure applied to a representative building from the abovementioned period located in the Florence area and constructed with an industrialized system named the “tunnel system” (great panels structure). The procedure used in this study provides for the redevelopment of the envelope and the application of a simple mechanical ventilation system to achieve substantial energy savings and improved indoor comfort conditions.
41
Feng, Yan, Desiree Carcioppolo, and Alan E. Lichtin. "Low Incidence of Thrombosis in Hemophilic Patients Undergoing Surgeries or Invasive Procedures,." Blood 118, no. 21 (November 18, 2011): 4221. http://dx.doi.org/10.1182/blood.v118.21.4221.4221.
Повний текст джерелаАнотація:
Abstract Abstract 4221 BACKGROUND AND OBJECTIVE: The major concern for hemophilic patients who undergo surgery is bleeding, and they usually receive factor replacement. Since surgery is a well known risk factor for venous thrombosis, non-hemophilic patients frequently receive DVT prophylaxis in post-op period. However the risk of venous thrombosis in hemophilic patients who undergo surgery is rarely studied or reported. We observed a patient with severe hemophilia B who developed extensive DVT after open heart surgery when he was receiving factor IX replacement. This prompted a retrospective chart review study to evaluate the risk of DVT in hemophilia patients who undergo surgery or invasive procedure. SUBJECTS AND METHOD: A total of 154 patients who received factor VIII or IX replacement from Feb. 1997 to June 2011 at Cleveland Clinic were identified by searching the pharmacy database. A total of 38 patients who underwent 58 elective surgeries were finally included in the analysis. Patients who had surgery for bleeding were excluded RESULTS: All patients are male, except one female hemophilic carrier. Patients' age at surgery varied from 9 months to 85 years with median age 48 years. Twenty seven patients (71%) had factor VIII deficiency with baseline level 1%-31% (median 5%, 25th to 75th 2%-12%). Eleven patients (29%) had factor IX deficiency with baseline level 2%-36% (median 5%, 25th to 75th 3%-8%). Thirteen patients had more than one surgery at Cleveland Clinic. Out of these 58 surgeries/procedures in these 38 patients, 15 were orthopedic, 10 open heart, 10 abdominal (including liver and kidney transplant), 5 neurosurgery, 2 head and neck and 16 other surgery (including 3 vascular procedures). The factor replacement duration was 1–19 days (median 8 days, 25th to 75th5 to 9 days). The median trough level was 97% (25th to 75th77% to 130%). Eighteen (31%) patients had post-op bleeding defined as requiring surgical intervention or more than 1 unit blood transfusion. One patient received subcutaneous heparin for DVT prophylaxis from day 2 after his head/neck surgery and did not experience any episodes of bleeding or DVT. Six patients (5 with open heart surgery and one with carotid endarterectomy) received aspirin post-operatively (one with clopidogrel and one with warfarin on discharge) and two of them experienced bleeding (both had mild thrombocytopenia and one had trough factor IX level 55%). One patient had one episode of TIA on the next day after total knee replacement (his trough level was 98%). Only one patient had DVT after surgery. He was a 72 year old male with hemophilia B (factor IX baseline level 5%) who underwent an open heart surgery (1 vessel CABG, mitral valve repair and pulmonary vein isolation). He did have history of renal thrombosis when he was on factor IX concentrate replacement twenty years ago. He was started with recombinant factor IX twice daily before his open heart surgery, and dose adjusted based on trough level, which was maintained near 100%. On post-op day 5, he developed an occlusive DVT extending from the right internal jugular vein to median cubital vein, where he had a temporary central line placed post-op. He was ambulatory but not on aspirin or DVT prophylaxis. He was anticoagulated with heparin which was subsequently converted to warfarin, along with factor IX infusion. He did well and was discharged home on post-op day 14. CONCLUSION: We found two thrombotic events (DVT and TIA) in this retrospective study (3.4%). Had routine prophylactic anticoagulation been given to all patients, a higher incidence of bleeding could be anticipated. This study therefore supports the position of not giving routine prophylactic anticoagulation to hemophilic patients undergoing surgery, unless there is previous history of excessive thrombosis with factor replacement. Disclosures: No relevant conflicts of interest to declare.
42
LEE, TRACY YH, and YM DENNIS LO. "FETAL NUCLEIC ACIDS IN MATERNAL PLASMA." Fetal and Maternal Medicine Review 17, no. 2 (May 2006): 125–37. http://dx.doi.org/10.1017/s0965539506001720.
Повний текст джерелаАнотація:
Prenatal diagnosis is now an established part of modern obstetrical practice around the world. While the current definitive methods for prenatal diagnosis rely mainly on invasive procedures such as chorionic villus sampling and amniocentesis, such procedures carry a low but definite risk of fetal loss. As a consequence of the procedure-associated risk of miscarriage, prenatal diagnosis is currently limited to pregnant women with an increased likelihood of bearing an abnormal fetus. To extend the application of prenatal diagnosis to all pregnant women, it has been a long-sought goal of researchers worldwide to introduce safer methods for prenatal diagnosis, towards noninvasive prenatal diagnosis.
43
Aghaie Meybodi, Mohamad, Bashar Qumseya, Delaram Shakoor, Katie Lobner, Kia Vosoughi, Yervant Ichkhanian, and Mouen Khashab. "Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and meta-analysis." Endoscopy International Open 07, no. 03 (February 28, 2019): E322—E329. http://dx.doi.org/10.1055/a-0812-1458.
Повний текст джерелаАнотація:
Abstract Background and aim Clinical management of patients with gastroparesis is challenging. Prior pyloric targeted procedures are either invasive or have questionable long-term efficacy. Gastric per-oral endoscopic myotomy (G-POEM) has been recently introduced as a minimally invasive approach. In this review, we performed a meta-analysis to evaluate the feasibility and efficacy of this technique in the management of patients with refractory gastroparesis. Methods PubMed, Embase, and Scopus databases were searched to identify relevant studies published through May 2018. Weighted pool rates (WPR) of the clinical resolution were calculated. Pooled values of Gastroparesis Cardinal Symptom Index (GCSI) before and after the procedure were compared. Pooled difference in means comparing gastric emptying before and after the procedure was calculated. Fixed or random effect model was used according to the level of heterogeneity. Results Seven studies with 196 patients were included in the meta-analysis. The mean value of procedure duration was 69.7 (95 % confidence interval [95 % CI]: 39 – 99 minutes) and average estimate of hospital stay was 1.96 (95 % CI: 1.22 – 2.95) days. The WPR for clinical success was 82 % (95 % CI: 74 % – 87 %, I2 = 0). Compared with pre-procedure GCSI values, mean values of GCSI were reduced significantly at 5 days (–1.57 (95 % CI:–2.2,-0.9), I2 = 80 %) (P < 0.001). Mean values of gastric emptying were significantly decreased 2 – 3 months after the procedure (–22.3 (95 %CI: –32.9, – 11.6), I2 = 67 %) (P < 0.05). Conclusion Due to the high rate of clinical success and low rate of adverse events, G-POEM should be considered in management of refractory gastroparesis.
44
Garcia, David, and Elaine Hylek. "Risk of Thromboembolism after Short-Term Interruption of Warfarin." Blood 108, no. 11 (November 16, 2006): 625. http://dx.doi.org/10.1182/blood.v108.11.625.625.
Повний текст джерелаАнотація:
Abstract Background: Significant uncertainty exists for patients who must discontinue warfarin prior to an invasive procedure. In part, the controversy results from the lack of published information about the risk of thromboembolism associated with short-term warfarin interruption. The aim of this observational study was to assess the frequency of thromboembolism and bleeding among a large cohort of patients whose warfarin was temporarily withheld before and after an outpatient invasive procedure. Methods: A prospective cohort of patients taking warfarin was assembled from 101 sites with personnel designated as warfarin managers across the United States during the period August 2000 to December 2001; 98 sites were community-based physician office practices. All episodes of warfarin interruption among the 6,761 patients in the cohort were identified by investigator review of provider-generated progress notes. Surgical procedures (including cardiovascular interventions) that required hospitalization and cases in which follow-up INR values were not available for at least 30 days post-procedure were excluded. The primary outcomes (30 day follow-up) were thromboembolism and clinically significant hemorrhage. For each patient, the following data were also recorded: type of procedure, number of days warfarin was withheld, presence or absence of bridging therapy (e.g. low molecular weight heparin [LMWH]). Results: 1,024 unique patients (1,293 episodes of warfarin interruption) were included in our analysis. The mean age was 71.9 years; 43% were female. The most common procedures were colonoscopy (n=324), oral surgery (n=323), and ophthalmic surgery (116). Other common reasons for withholding warfarin were: epidural injection, prostate biopsy, breast biopsy, and dermatologic procedures. Perioperative heparin or LMWH was used in only 8.3% of cases. The duration of warfarin interruption was variable; however, more than 80% of patients had warfarin withheld for 5 days or fewer. Seven patients (0.7%) suffered post-procedure thromboembolism within 30 days (4 arterial, 3 venous). None of the 7 patients who experienced thromboembolism received peri-procedural bridging therapy; 3 of these thromboembolic events were associated with warfarin interruption ≥ 7 days. Twenty-three patients (2.3%) suffered clinically significant hemorrhage - of these, 14 had received peri-procedural heparin or LMWH. Conclusion: For many chronically anticoagulated patients who need to undergo a minor, outpatient intervention, a brief (5 or fewer days) peri-procedural interruption of warfarin is associated with a low risk of thromboembolism. The risk for clinically significant bleeding, even among outpatients undergoing minor procedures, should be considered prior to the administration of bridging therapy.
45
Alvarez-Breckenridge, Christopher, Matthew Muir, Laurence D. Rhines, and Claudio E. Tatsui. "The Use of Skin Staples as Fiducial Markers to Confirm Intraoperative Spinal Navigation Registration and Accuracy." Operative Neurosurgery 21, no. 3 (May 26, 2021): E193—E198. http://dx.doi.org/10.1093/ons/opab132.
Повний текст джерелаАнотація:
Abstract BACKGROUND With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.
46
Clark, Justin C., Gary Jasmer, Frederick F. Marciano, and Luis M. Tumialán. "Minimally invasive transforaminal lumbar interbody fusions and fluoroscopy: a low-dose protocol to minimize ionizing radiation." Neurosurgical Focus 35, no. 2 (August 2013): E8. http://dx.doi.org/10.3171/2013.5.focus13144.
Повний текст джерелаАнотація:
Object There is an increasing awareness of radiation exposure to surgeons and the lifelong implications of such exposure. One of the main criticisms of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) is the amount of ionizing radiation required to perform the procedure. The goal in this study was to develop a protocol that would minimize the fluoroscopy time and radiation exposure needed to perform an MIS TLIF without compromising visualization of the anatomy or efficiency of the procedure. Methods A retrospective review of a prospectively collected database was performed to review the development of a low-dose protocol for MIS TLIFs in which a combination of low-dose pulsed fluoroscopy and digital spot images was used. Total fluoroscopy time and radiation dose were reviewed for 50 patients who underwent single-level MIS TLIFs. Results Fifty patients underwent single-level MIS TLIFs, resulting in the placement of 200 pedicle screws and 57 interbody spacers. There were 28 women and 22 men with an average age of 58.3 years (range 32–78 years). The mean body mass index was 26.2 kg/m2 (range 17.1–37.6 kg/m2). Indications for surgery included spondylolisthesis (32 patients), degenerative disc disease with radiculopathy (12 patients), and recurrent disc herniation (6 patients). Operative levels included 7 at L3–4, 40 at L4–5, and 3 at L5–S1. The mean operative time was 177 minutes (range 139–241 minutes). The mean fluoroscopic time was 18.72 seconds (range 7–29 seconds). The mean radiation dose was 0.247 mGy*m2 (range 0.06046–0.84054 mGy*m2). No revision surgery was required for any of the patients in this series. Conclusions Altering the fluoroscopic technique to low-dose pulse images or digital spot images can dramatically decrease fluoroscopy times and radiation doses in patients undergoing MIS TLIFs, without compromising image quality, accuracy of pedicle screw placement, or efficiency of the procedure.
47
Pengo, V., U. Cucchini, G. Denas, N. Erba, G. Guazzaloca, L. La Rosa, V. De Micheli, et al. "Standardized Low–Molecular-Weight Heparin Bridging Regimen in Outpatients on Oral Anticoagulants Undergoing Invasive Procedure or Surgery." Circulation 119, no. 22 (June 9, 2009): 2920–27. http://dx.doi.org/10.1161/circulationaha.108.823211.
Повний текст джерела
48
Dhaese, Thomas Markus, Leonardo C. Welling, Alice Magro Koscianski, Gustavo Frigeri, Judy Auada, Nícollas Nunes Rabelo, and Eberval Gadelha Figueiredo. "Non-invasive intracranial pressure monitoring in idiopathic intracranial hypertension and lumbar puncture in pediatric patient: Case report." Surgical Neurology International 12 (September 30, 2021): 493. http://dx.doi.org/10.25259/sni_124_2021.
Повний текст джерелаАнотація:
Background: Intracranial pressure (ICP) monitoring has been variously explored as a diagnostic and therapeutic modality in many pathological conditions leading neurological injury. This monitoring standardly depends on an invasive procedure such as cranial or lumbar catheterization. The gold standard for ICP monitoring is through an intraventricular catheter, but this invasive technique is associated with certain risks such as haemorrhage and infection. (1) Also, it is a high-cost procedure and consequently not available in a variety of underprivileged places and clinical situations in which intracranial hypertension is prevalent (3). An accurate non-invasive and low-priced method to measure elevated ICP would therefore be desirable. Under these circumstances, Brazilian scientists developed a non-invasive method for intracranial pressure monitoring (ICP-NI), which uses an electric resistance extensometer that measures micro deformations of the skull and transforms it into an electrical signal. In this case report, the authors describe a pediatrician patient with the diagnosis of idiopathic intracranial hypertension who was successfully submitted to a lumbar puncture under monitorization with this device. Case description: 7 year old girl with progressive symptoms that lead to the diagnosis of idiopathic intracranial hypertension. The patient was submitted to a lumbar punction with continuous non-invasive ICP monitoring. Conclusion: Estimating ICP (non-invasive) from LP monitoring (invasive) often reflect inaccurate ICP results, and affects negatively on IIH diagnosis and a non-invasive diagnostic method could reduce the requirement for invasive approaches, improving patient health outcomes.
49
Pfau, Oskar, André Kemmling, and Philipp Rostalski. "Low-cost physiological simulation system for endovascular treatment of aneurysms." Current Directions in Biomedical Engineering 4, no. 1 (September 1, 2018): 37–40. http://dx.doi.org/10.1515/cdbme-2018-0010.
Повний текст джерелаАнотація:
AbstractMinimally invasive procedures are more and more becoming the standard treatment for many surgical procedures such as the treatment of cerebral aneurysms. In an endovascular procedure the aneurysm is filled with flexible platinum coils leading to embolization and blocking the blood flow in the aneurysm. This established treatment needs high skills and experience on the surgeon. In order to practice and plan a specific procedure or test a new device, a realistic simulation environment is needed. Modern 3D printing technology allows the fabrication of patient specific models incorporating the exact geometry of the pathological anatomy. This article describes the development of a low-cost physiological simulation system for the training of the endovascular treatment of aneurysms. In order to practice the procedure in a realistic scenario, a 3D printed model of the aneurysm is embedded in a fluidic simulation s ystem. In addition to the patient-specific anatomy of the aneurysm a pulsatile water flow is generated, which emulates the influence of blood flow on the behaviour of catheters and coils during deployment. The system consist of a controllable pump circuit generating a pulsatile flow which can be regulated automatically and additionally controlled externally by the user. For a suitable representation, a display which graphically represents the sensor data and settings is employed. The components were compactly integrated in a small case allowing for easy deployment in training workshops. The simulation setup was successfully tested in prospective patient specific treatment planning and workshops for students.
50
Poordad, Fred, Norah A. Terrault, Naim Alkhouri, Wei Tian, Lee F. Allen, and Mordechai Rabinovitz. "Avatrombopag, an Alternate Treatment Option to Reduce Platelet Transfusions in Patients with Thrombocytopenia and Chronic Liver Disease-Integrated Analyses of 2 Phase 3 Studies." International Journal of Hepatology 2020 (January 25, 2020): 1–11. http://dx.doi.org/10.1155/2020/5421632.
Повний текст джерелаАнотація:
Aims. Thrombocytopenia complicates the management of patients with chronic liver disease (CLD) undergoing invasive procedures with a bleeding risk. Until recently, prophylactic platelet transfusion was the only treatment option, but has significant safety and efficacy limitations. Phase 3 data demonstrated the superiority of avatrombopag to placebo in reducing platelet transfusions for bleeding, supporting its recent approval. Methods. Integrated analyses of pooled data (N=435) from two randomized, double-blind, placebo-controlled, phase 3 studies assessed the original efficacy endpoints. Additional analyses included subgroup analyses, alternate Baseline platelet count definitions, and another efficacy endpoint. Results. Avatrombopag was superior to placebo in increasing patients not requiring a platelet transfusion or rescue procedure, those achieving a platelet count ≥50 × 109/L on Procedure Day, and the change in platelet counts from Baseline. The avatrombopag treatment effect was consistently positive across clinically important disease and Baseline clinical characteristic subgroups, and using alternate Baseline platelet count cohort definitions. Similarly, more avatrombopag-treated patients achieved ≥50 × 109/L platelets with an increase of ≥20 × 109/L from Baseline. The incidence and severity of adverse events were similar between avatrombopag and placebo. Further, safety data demonstrated a low risk for thromboembolic events and hepatotoxicity. Conclusion. These integrated analyses confirmed the superiority of avatrombopag to placebo in reducing platelet transfusions or rescue procedures for bleeding in patients with thrombocytopenia and CLD scheduled to undergo an invasive procedure, and its tolerable safety profile. Importantly, these data warrant reconsideration of clinical decision making regarding the need to treat thrombocytopenia in patients with CLD. This trial was registered with NCT01972529 and NCT01976104.