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Sample records for physician-controlled wire-guided cannulation

  1. Perforation of the Papilla of Vater in Wire-Guided Cannulation

    PubMed Central

    Maruoka, Naotaka

    2016-01-01

    Background. WGC in ERCP is considered a safe technique, although rare complications can occur. One unique complication of WGC is the perforation of the papilla of Vater by the guidewire. Subjects and Methods. Of 2032 patients who underwent ERCP at our department between January 2010 and December 2014, we selected 208 patients who underwent WGC for naïve papilla as subjects. A detailed examination of patients in whom a perforation occurred was conducted, and risk factors for perforations were investigated. Results. The perforation was observed in 7 of 208 patients (3.4%). All patients recovered with conservative treatment without the need for surgery. The perforation rate was significantly higher in the patients with juxtapapillary duodenal diverticula than those without diverticula (12.5% versus 0.6%, p < 0.001). Cannulation of the bile duct was ultimately achieved in 5 of 7 patients; PSP was performed for 4 of these patients. Conclusion. Caution must be exercised when dealing with patients who have a juxtapapillary duodenal diverticula because they are at higher risk of perforations. Because these are small perforations made by a wire, most of them heal with conservative treatment. However, perforations can make cannulation difficult, and PSP may be useful for deep cannulation. PMID:27446851

  2. 0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangiopancreatography: A randomized study

    PubMed Central

    Kitamura, Katsuya; Yamamiya, Akira; Ishii, Yu; Sato, Yoshiki; Iwata, Tomoyuki; Nomoto, Tomohiro; Ikegami, Akitoshi; Yoshida, Hitoshi

    2015-01-01

    AIM: To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires (GWs) when used in wire-guided cannulation (WGC). METHODS: A single center, randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed, written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a naïve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria, and 269 patients were randomly allocated to two groups by a computer and analyzed: the 0.025-inch GW group (n = 109) and the 0.035-inch GW group (n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting, selective bile duct cannulation time, ERCP procedure time, the rate of pancreatic duct stent placement, the final success rate of selective bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP). RESULTS: The primary success rates of selective bile duct cannulation with WGC were 80.7% (88/109) and 86.3% (138/160) for the 0.025-inch and the 0.035-inch groups, respectively (P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique (46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups, respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting (66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups, respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7% (101/109) and 97.5% (156/160) for the 0.025-inch and 0.035-inch groups, respectively (P = 0

  3. Internal wire guide for GTAW welding

    NASA Technical Reports Server (NTRS)

    Morgan, Gene E. (Inventor); Dyer, Gerald E. (Inventor)

    1989-01-01

    A welding torch for gas tungsten arc welding apparatus has a filler metal wire guide positioned within the torch, and within the shielding gas nozzle. The wire guide is adjacent to the tungsten electrode and has a ceramic liner through which the wire is fed. This reduces the size of the torch and eliminates the outside clearance problems that exit with external wire guides. Additionally, since the wire is always within the shielding gas, oxidizing of the wire is eliminated.

  4. Long-Wearing Wire Guide For Welding Torch

    NASA Technical Reports Server (NTRS)

    Gutow, David A.; Burley, Richard K.; Gilbert, Jeffrey L.; Fogel, Irving

    1992-01-01

    Insert for wire-guide tube on tungsten/inert-gas welding apparatus extends life of guide tube and increases accuracy of weld. Hardened insert resists wear by sliding tungsten wire. Chamfer guides wire into insert.

  5. Selective biliary cannulation techniques for endoscopic retrograde cholangiopancreatography procedures and prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis.

    PubMed

    Mukai, Shuntaro; Itoi, Takao

    2016-06-01

    Numerous endoscopic retrograde cholangiopancreatography (ERCP) techniques have been reported to achieve selective biliary cannulation success. For standard biliary cannulation procedures, the wire-guided cannulation technique has been reported to reduce the rate of post-ERCP pancreatitis (PEP) and increase the biliary cannulation success rate, although conflicting reports exist. The pancreatic or double-guidewire technique and several precut techniques have been reported as useful techniques in difficult biliary cannulation cases. Although ERCP is a useful endoscopic procedure, the risk of adverse events, particularly post-ERCP pancreatitis, is inevitable. Previous studies and analyses have revealed the risk factors for PEP. The efficacy of prophylactic pancreatic duct stent placement and the administration of rectal nonsteroidal anti-inflammatory drugs for preventing PEP has also been reported. Herein, we reviewed reports in the literature regarding the current status of selective biliary cannulation techniques and PEP prevention. PMID:26782710

  6. Internal Wire Guide For Gas/Tungsten-Arc Welding

    NASA Technical Reports Server (NTRS)

    Morgan, Gene E.; Dyer, Gerald E.

    1990-01-01

    Wire kept in shielding gas, preventing oxidation. Guide inside gas cup of gas/tungsten-arc welding torch feeds filler wire to weld pool along line parallel to axis of torch. Eliminates problem of how to place and orient torch to provide clearance for external wire guide.

  7. Improving arteriovenous fistula cannulation skills.

    PubMed

    Ball, Lynda K

    2005-01-01

    Cannulation of arteriovenous fistulae is technically more challenging than cannulation of arteriovenous grafts. With the advent of the National Vascular Improvement Initiative, Fistula First, the United States has seen an increase in the number of arteriovenous fistulae. The problem we now face is how to refocus and reeducate nurses to the intricacies of arteriovenous fistula cannulation. Through evidenced-based practice and current best-demonstrated practices, this article will provide the tools needed to improve arteriovenous fistulae cannulation skills. PMID:16425809

  8. Comparison between loop-tip guidewire-assisted and conventional endoscopic cannulation in high risk patients

    PubMed Central

    Masci, Enzo; Mangiavillano, Benedetto; Luigiano, Carmelo; Bizzotto, Alessandra; Limido, Eugenio; Cantù, Paolo; Manes, Gianpiero; Viaggi, Paolo; Spinzi, Giancarlo; Radaelli, Franco; Mariani, Alberto; Virgilio, Clara; Alibrandi, Angela; Testoni, Pier Alberto

    2015-01-01

    Background: The guidewire biliary cannulation (GWC) technique may increase the cannulation rate and decrease the risk for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. The aim of our multicenter prospective randomized controlled trial was to determine if the use of an atraumatic loop-tip guidewire reduces the rate of post-ERCP pancreatitis (PEP) compared with the standard contrast-assisted cannulation (CC) technique. Methods: From June 2012 to December 2013, a total of 320 patients who had a naïve papilla and were referred for ERCP were randomly assigned to the GWC group (n = 160) or the CC group (n = 160). GWC or CC was randomly used. In cases of failed cannulation in both arms after crossover, biliary access was attempted with alternative techniques (e. g., dual-wire technique, pancreatic duct stenting, precut). Results: The biliary cannulation rates were 81 % in the GWC group and 73 % in the CC group (P = n. s.). Following crossover, cannulation was successful in 8 % and 11 % of patients in the GWC and CC groups, respectively. With use of an alternative technique, the cannulation rates were 98 % in the GWC group and 96 % in the CC group, respectively. The rates of PEP were 5 % in the GWC group and 12 % in the CC group (P = 0.027). The post-interventional complication rates did not differ between the two groups. Conclusion: GWC with the new wire guide is associated with a lower rate of PEP in comparison with the CC technique. Clinical trial reference number: NCT01771419 PMID:26528503

  9. Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004.

    PubMed

    Kawakami, Hiroshi; Kubota, Yoshimasa; Kawahata, Shuhei; Kubo, Kimitoshi; Kawakubo, Kazumichi; Kuwatani, Masaki; Sakamoto, Naoya

    2016-04-01

    In 1970, a Japanese group reported the first use of endoscopic retrograde cholangiopancreatography (ERCP), which is now carried out worldwide. Selective bile duct cannulation is a mandatory technique for diagnostic and therapeutic ERCP. Development of the endoscope and other devices has contributed to the extended use of ERCP, which has become a basic procedure to diagnose and treat pancreaticobiliary diseases. Various techniques related to selective bile duct cannulation have been widely applied. Although the classical contrast medium injection cannulation technique remains valuable, use of wire-guided cannulation has expanded since the early 2000s, and the technique is now widely carried out in the USA and Europe. Endoscopists must pay particular attention to a patient's condition and make an attendant choice about the most effective technique for selective bile duct cannulation. Some techniques have the potential to shorten procedure time and reduce the incidence of adverse events, particularly post-ERCP pancreatitis. However, a great deal of experience is required and endoscopists must be skilled in a variety of techniques. Although the development of the transpapillary biliary cannulation approach is remarkable, it is important to note that, to date, there have been no reports of transpapillary cannulation preventing post-ERCP pancreatitis. In the present article, selective bile duct cannulation techniques in the context of recent Japanese randomized controlled trials and cases of precut sphincterotomy are reviewed and discussed. PMID:26825609

  10. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    PubMed

    Testoni, Pier Alberto; Mariani, Alberto; Aabakken, Lars; Arvanitakis, Marianna; Bories, Erwan; Costamagna, Guido; Devière, Jacques; Dinis-Ribeiro, Mario; Dumonceau, Jean-Marc; Giovannini, Marc; Gyokeres, Tibor; Hafner, Michael; Halttunen, Jorma; Hassan, Cesare; Lopes, Luis; Papanikolaou, Ioannis S; Tham, Tony C; Tringali, Andrea; van Hooft, Jeanin; Williams, Earl J

    2016-07-01

    that is difficult to cannulate, transpancreatic biliary sphincterotomy should be considered if unintentional insertion of a guidewire into the pancreatic duct occurs (moderate quality evidence, strong recommendation).In patients who have had transpancreatic sphincterotomy, ESGE suggests prophylactic pancreatic stenting (moderate quality evidence, strong recommendation). 6 ESGE recommends that mixed current is used for sphincterotomy rather than pure cut current alone, as there is a decreased risk of mild bleeding with the former (moderate quality evidence, strong recommendation). 7 ESGE suggests endoscopic papillary balloon dilation (EPBD) as an alternative to endoscopic sphincterotomy (EST) for extracting CBD stones < 8 mm in patients without anatomical or clinical contraindications, especially in the presence of coagulopathy or altered anatomy (moderate quality evidence, strong recommendation). 8 ESGE does not recommend routine biliary sphincterotomy for patients undergoing pancreatic sphincterotomy, and suggests that it is reserved for patients in whom there is evidence of coexisting bile duct obstruction or biliary sphincter of Oddi dysfunction (moderate quality evidence, weak recommendation). 9 In patients with periampullary diverticulum (PAD) and difficult cannulation, ESGE suggests that pancreatic duct stent placement followed by precut sphincterotomy or needle-knife fistulotomy are suitable options to achieve cannulation (low quality evidence, weak recommendation).ESGE suggests that EST is safe in patients with PAD. In cases where EST is technically difficult to complete as a result of a PAD, large stone removal can be facilitated by a small EST combined with EPBD or use of EPBD alone (low quality evidence, weak recommendation). 10 For cannulation of the minor papilla, ESGE suggests using wire-guided cannulation, with or without contrast, and sphincterotomy with a pull-type sphincterotome or a needle-knife over a plastic stent (low quality evidence, weak

  11. Cannulation in the Diseased Aorta

    PubMed Central

    Khoynezhad, Ali; Plestis, Konstadinos A.

    2006-01-01

    The Seldinger technique is a method of femoral cannulation that has been used to establish cardiopulmonary bypass. Reports of cannulation of the ascending aorta for antegrade perfusion using the Seldinger method are anecdotal. To the best of our knowledge, the approach described herein for direct cannulation of the ascending aorta with use of the Seldinger technique for antegrade perfusion has not been previously described in the English-language medical literature. This method is helpful when the surgeon is treating a patient who has a calcified ascending aorta, complicated aortic dissection, calcified femoral vessels, or a diseased thoracoabdominal aorta. In such cases, retrograde perfusion has been associated with severe complications as a result of atheromatous embolization from the descending thoracic aorta. Herein, we describe our approach to cannulation for cardiopulmonary bypass, which entails insertion of an aortic cannula into the ascending aorta by means of the Seldinger technique. A soft-tip guidewire is inserted through an arterial entry catheter that has been used to puncture a hole in the wall of the vessel. Then the aortic cannula is introduced into the vessel, sliding along the guidewire. Guided by transesophageal echocardiography, the tip of the cannula is positioned carefully and is then advanced into the descending aorta. This positioning of the cannula decreases the chance of arterial embolization, thereby improving cerebral protection. If cannulation of the ascending aorta is not feasible, the transverse aortic arch or proximal descending aorta can be used. PMID:17041694

  12. Transcervical tubal cannulation: a review.

    PubMed

    Flood, J T; Grow, D R

    1993-11-01

    Rapid progress has been made in the last 10 years regarding minimally invasive access to the human fallopian tube. Coaxial catheter systems are being used with hysteroscopy, fluoroscopy, ultrasonography, and tactile sensation to cannulate the fallopian tube transcervically with consistent success. Uterotubal obstruction viewed at the time of hysterosalpingogram can often be successfully cannulated with intrauterine pregnancies resulting. This review surveys all available published series of transcervical tubal cannulation with discussion of methodology, success in establishing patency, and the resultant pregnancy rates. It also describes how this technology has been applied to the intratubal deposition of gametes and embryos, direct visualization of the tubal epithelium, (falloposcopy), and contraception. Collectively, these techniques are defining tubal pathology more precisely, allowing us to prescribe the proper therapy. PMID:8278140

  13. Buttonhole cannulation--an unexpected outcome.

    PubMed

    Doss, Sheila; Schiller, Brigitte; Moran, John

    2008-01-01

    The buttonhole method of needle insertion has been reported to be a safe and effective means of cannulation. In general, infections in patients with arteriovenous fistula access are considered to be infrequent compared to other types of accesses. Although minimal data exist regarding infection rates with buttonhole cannulation, these authors' data indicate that the infection rate with buttonhole cannulation may be underestimated. PMID:18783005

  14. Improved cannulation method for extracorporeal membrane oxygenation.

    PubMed

    Read, R; St Cyr, J; Tornabene, S; Whitman, G

    1990-10-01

    Extracorporeal membrane oxygenation has been shown to be useful for patients in reversible cardiogenic shock. Effective arterial cannulation techniques for infants have been developed that are simple to use and require minimal subsequent vascular repair or reconstruction after removal. Groin cannulation in adults frequently requires bidirectional arterial cannulation to ensure adequate distal perfusion as well as frequent complex arterial repairs after discontinuation. We describe a simple arterial cannulation technique using a single right-angle, high-flow arterial cannula. With this technique adequate bidirectional arterial perfusion is maintained with a single arterial cannula while the need for vascular repairs or reconstruction is minimized. PMID:2222065

  15. Limitations of the modulation method to smooth wire-guide roughness

    SciTech Connect

    Bouchoule, I.; Trebbia, J.-B.; Garrido Alzar, C. L.

    2008-02-15

    It was recently demonstrated that wire-guide roughness can be suppressed by modulating the wire currents so that the atoms experience a time-averaged potential without roughness [Trebbia et al., Phys. Rev. Lett. 98, 263201 (2007)]. In this paper, we theoretically study the limitations of this technique. At low modulation frequency, we show that the longitudinal potential modulation produces heating of the cloud, and we compute the heating rate. We also give a quantum derivation of the rough conservative potential associated with the micromotion of the atoms. At large modulation frequency, we compute the loss rate due to nonadiabatic spin flip and show that it presents resonances at multiple modulation frequencies. These studies show that the modulation technique works for a wide range of experimental parameters. We also give conditions to realize radio-frequency evaporative cooling in such a modulated trap.

  16. Anatomic considerations for central venous cannulation

    PubMed Central

    Bannon, Michael P; Heller, Stephanie F; Rivera, Mariela

    2011-01-01

    Central venous cannulation is a commonly performed procedure which facilitates resuscitation, nutritional support, and long-term vascular access. Mechanical complications most often occur during insertion and are intimately related to the anatomic relationship of the central veins. Working knowledge of surface and deep anatomy minimizes complications. Use of surface anatomic landmarks to orient the deep course of cannulating needle tracts appropriately comprises the crux of complication avoidance. The authors describe use of surface landmarks to facilitate safe placement of internal jugular, subclavian, and femoral venous catheters. The role of real-time sonography as a safety-enhancing adjunct is reviewed. PMID:22312225

  17. Enhanced nucleic acid amplification with blood in situ by wire-guided droplet manipulation (WDM)

    PubMed Central

    Harshman, Dustin K.; Reyes, Roberto; Park, Tu San; You, David J.; Song, Jae-Young; Yoon, Jeong-Yeol

    2013-01-01

    There are many challenges facing the use of molecular biology to provide pertinent information in a timely, cost effective manner. Wire-guided droplet manipulation (WDM) is an emerging format for conducting molecular biology with unique characteristics to address these challenges. To demonstrate the use of WDM, an apparatus was designed and assembled to automate polymerase chain reaction (PCR) on a reprogrammable platform. WDM minimizes thermal resistance by convective heat transfer to a constantly moving droplet in direct contact with heated silicone oil. PCR amplification of the GAPDH gene was demonstrated at a speed of 8.67 sec/cycle. Conventional PCR was shown to be inhibited by the presence of blood. WDM PCR utilizes molecular partitioning of nucleic acids and other PCR reagents from blood components, within the water-in-oil droplet, to increase PCR reaction efficiency with blood in situ. The ability to amplify nucleic acids in the presence of blood simplifies pre-treatment protocols towards true point-of-care diagnostic use. The 16s rRNA hypervariable regions V3 and V6 were amplified from Klebsiella pneumoniae genomic DNA with blood in situ. The detection limit of WDM PCR was 1 ng/µL or 105 genomes/µL with blood in situ. The application of WDM for rapid, automated detection of bacterial DNA from whole blood may have an enormous impact on the clinical diagnosis of infections in bloodstream or chronic wound/ulcer, and patient safety and morbidity. PMID:24140832

  18. Ileal cannulation and associated complications in dogs.

    PubMed

    Hill, R C; Ellison, G W; Burrows, C F; Bauer, J E; Carbia, B

    1996-02-01

    Accurate measurement of small intestinal digestibility is important in dogs because it allows the formulation of pet foods that provide optimal nutrition at minimal cost. Digestibility measured by comparing nutrient intake to fecal excretion in intact animals does not distinguish small intestinal digestion from large intestinal bacterial fermentation. Ileal cannulation allows small intestinal digestion to be measured alone by comparing nutrient intake with ileal excretion of chyme. Nevertheless, ileal cannulation and its associated complications are not well documented in dogs. We describe the implantation of a simple T-cannula in the ileum of nine dogs for an average duration of 26 weeks. Established cannulas were well tolerated, and one dog retained the cannula for 14 months. Nevertheless, ileal effluent proved extremely caustic, and the incidence of complications in the immediate postoperative period was high. Only one dog had an unremarkable postoperative course. Complications included abscessation and cannula extrusion, followed by severe excoriation and ulceration of the skin. This excoriation could be prevented only by immediate surgical closure of the fistula. Chronic ileal cannulation is therefore a viable technique in dogs, but careful monitoring of the cannula site is essential. Dogs should be subjected to this procedure only if adequate veterinary and nursing care is available. It is preferable to maintain a colony of long-term cannulated dogs rather than to implant cannulas as needed. PMID:8699825

  19. Different techniques of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders

    PubMed Central

    Ghoraba, Hammouda H; Elgouhary, Sameh M; Ellakwa, Amin F

    2013-01-01

    Purpose To evaluate the safety and efficacy of different methods of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders. Methods A prospective randomized study was done from August 2009 to February 2011. The study included 129 eyes of 122 patients, randomly divided into four groups. Group 1 comprised 34 eyes operated on using transconjunctival 20-gauge cannula Claes system. Group 2 comprised 32 eyes operated on using transconjunctival cannulated 23 gauge system. Group 3 comprised 27 eyes operated on using combined 20-gauge non-cannulated and 23-gauge transconjunctival cannulated system. Group 4 comprised 36 eyes operated on using conventional non-cannulated 20-gauge system. Results The four groups were demographically similar. Anatomical outcome was achieved in all cases. Vision was improved in 29 eyes (85.3%) in group 1, 23 eyes (71.9%) in group 2, 19 eyes (70.4%) in group 3, and 26 eyes (72.2%) in group 4. There was no statistical difference between the four groups 1-day postoperative (P=0.405) and 1-week postoperative intraocular pressure (P=0.254). The number of sutureless sclerotomies was 68 (66.6%) in group 1, 78 (81.3%) in group 2, 50 (61.8%) in group 3, and 0 in group 4. Hypotony occurred in one eye (2.9%) in group 1, three eyes (9.4%) in group 2, two eyes (7.4%) in group 3, and no eyes in group 4. Operative endophthalmitis did not occur in any one of the four groups. Conclusion Final anatomical and functional outcomes were not related to the type of sclerotomy used (cannulated or non-cannulated), the gauge used (20 or 23), the route (transconjunctival or transscleral), or type of suture used. The advantages of small-gauge transconjunctival vitrectomy were patient comfort, early ambulation, and preservation of the conjunctiva. This should be weighed against the cost of this cannula system. PMID:24109167

  20. Thrombosis following percutaneous radial artery cannulation.

    PubMed

    Cederholm, I; Sørensen, J; Carlsson, C

    1986-04-01

    A prospective study of the arterial supply of the hand was carried out in 100 ICU patients after cannulation of the radial artery. Patency of the radial artery was checked using a reversed Allen's test and Doppler ultrasonic technique. Furthermore, radial artery angiography was carried out in 15 patients with suspect thrombosis, and the artery was examined by microscopy in four patients at autopsy. Signs of thrombosis, Allen's test and Doppler technique, were found in 33/100 patients. In 10/15 angiograms a thrombosis was visualized, and in 3/4 patients at autopsy a thrombosis was found. The incidence of thrombosis was not correlated to sex, age, size of artery (judged by wrist circumference), cannulation technique or the presence of hypotension. It did, however, correlate to the presence of haematoma at the puncture site. After removal of the cannula recanalisation occurred soon in the majority of cases. PMID:3739580

  1. Chronic cannulation for intermittent intravenous fluid administration.

    PubMed

    Mostardi, R A; Worsencroft, D; Stern, J; Vanessen, F

    1975-04-01

    A system is described for rapid and effective venous cannulation for long-term administration of fluids in rabbits. This method is completely free of any harness or sling-type apparatus and in no way interferes with the normal mobility of the animal. The animals maintained in this way have participated in programs of tri-weekly administration (2-3 ml/dose) of fluid for as long as 5 mo. PMID:1141108

  2. Isolation and Cannulation of Cerebral Parenchymal Arterioles.

    PubMed

    Pires, Paulo W; Dabertrand, Fabrice; Earley, Scott

    2016-01-01

    Intracerebral parenchymal arterioles (PAs), which include parenchymal arterioles, penetrating arterioles and pre-capillary arterioles, are high resistance blood vessels branching out from pial arteries and arterioles and diving into the brain parenchyma. Individual PA perfuse a discrete cylindrical territory of the parenchyma and the neurons contained within. These arterioles are a central player in the regulation of cerebral blood flow both globally (cerebrovascular autoregulation) and locally (functional hyperemia). PAs are part of the neurovascular unit, a structure that matches regional blood flow to metabolic activity within the brain and also includes neurons, interneurons, and astrocytes. Perfusion through PAs is directly linked to the activity of neurons in that particular territory and increases in neuronal metabolism lead to an augmentation in local perfusion caused by dilation of the feed PA. Regulation of PAs differs from that of better-characterized pial arteries. Pressure-induced vasoconstriction is greater in PAs and vasodilatory mechanisms vary. In addition, PAs do not receive extrinsic innervation from perivascular nerves - innervation is intrinsic and indirect in nature through contact with astrocytic endfeet. Thus, data regarding contractile regulation accumulated by studies using pial arteries does not directly translate to understanding PA function. Further, it remains undetermined how pathological states, such as hypertension and diabetes, affect PA structure and reactivity. This knowledge gap is in part a consequence of the technical difficulties pertaining to PA isolation and cannulation. In this manuscript we present a protocol for isolation and cannulation of rodent PAs. Further, we show examples of experiments that can be performed with these arterioles, including agonist-induced constriction and myogenic reactivity. Although the focus of this manuscript is on PA cannulation and pressure myography, isolated PAs can also be used for

  3. Self-Cannulation for Haemodialysis: Patient Attributes, Clinical Correlates and Self-Cannulation Predilection Models

    PubMed Central

    Jayanti, Anuradha; Foden, Philip; Wearden, Alison; Morris, Julie; Brenchley, Paul; Mitra, Sandip

    2015-01-01

    Background and Objectives With emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care ‘in-centre’ and at home and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD). Design In this multicentre study, 508 of 535 patients from predialysis (Group A: n = 222), in-centre (Group B: n = 213), and home HD (Group C: n = 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was ‘perceived ability to self-cannulate AV access’. Predictive models were developed using logistic regression analysis. Results 36.6% of predialysis patients (A) and 29.1% of the ‘in-centre’ haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively. Conclusions There is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The

  4. Direct distal aortic arch graft cannulation after the elephant trunk procedure: technique for central cannulation during second-stage repair.

    PubMed

    Quintana, Eduard; Pochettino, Alberto

    2015-07-01

    Arterial cannulation after the elephant trunk (ET) procedure at the time of second-stage distal repair can be achieved through multiple routes. Common strategies for arterial perfusion at the time of second-stage aortic repair include retrograde perfusion (femoral/iliac vessels), transapical or left subclavian artery cannulation. In the event these cannulation options are not practical or advisable, we offer an alternative approach through cannulation of the distal aortic arch Dacron graft through the left thorax. Advantages include forward distal perfusion, minimal proximal ischaemic time, prevention of thromboembolic events from thrombus attached to the ET and avoidance of malperfusion syndromes. PMID:25281849

  5. A closed-loop pump-driven wire-guided flow jet for ultrafast spectroscopy of liquid samples

    NASA Astrophysics Data System (ADS)

    Picchiotti, Alessandra; Prokhorenko, Valentyn I.; Miller, R. J. Dwayne

    2015-09-01

    We describe the design and provide the results of the full characterization of a closed-loop pump-driven wire-guided flow jet system. The jet has excellent optical quality with a wide range of liquids spanning from alcohol to water based solutions, including phosphate buffers used for biological samples. The thickness of the jet film varies depending on the flow rate between 90 μm and 370 μm. The liquid film is very stable, and its thickness varies only by 0.76% under optimal conditions. Measured transmitted signal reveals a long term optical stability (hours) with a RMS of 0.8%, less than the overall noise of the spectroscopy setup used in our experiments. The closed loop nature of the overall jet design has been optimized for the study of precious biological samples, in limited volumes, to remove window contributions from spectroscopic observables. This feature is particularly important for femtosecond studies in the UV range.

  6. Droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling for simpler and faster PCR assay using wire-guided manipulations.

    PubMed

    You, David J; Yoon, Jeong-Yeol

    2012-01-01

    A computer numerical control (CNC) apparatus was used to perform droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling on a single superhydrophobic surface and a multi-chambered PCB heater. Droplets were manipulated using "wire-guided" method (a pipette tip was used in this study). This methodology can be easily adapted to existing commercial robotic pipetting system, while demonstrated added capabilities such as vibrational mixing, high-speed centrifuging of droplets, simple DNA extraction utilizing the hydrophobicity difference between the tip and the superhydrophobic surface, and rapid thermocycling with a moving droplet, all with wire-guided droplet manipulations on a superhydrophobic surface and a multi-chambered PCB heater (i.e., not on a 96-well plate). Serial dilutions were demonstrated for diluting sample matrix. Centrifuging was demonstrated by rotating a 10 μL droplet at 2300 round per minute, concentrating E. coli by more than 3-fold within 3 min. DNA extraction was demonstrated from E. coli sample utilizing the disposable pipette tip to cleverly attract the extracted DNA from the droplet residing on a superhydrophobic surface, which took less than 10 min. Following extraction, the 1500 bp sequence of Peptidase D from E. coli was amplified using rapid droplet thermocycling, which took 10 min for 30 cycles. The total assay time was 23 min, including droplet centrifugation, droplet DNA extraction and rapid droplet thermocycling. Evaporation from of 10 μL droplets was not significant during these procedures, since the longest time exposure to air and the vibrations was less than 5 min (during DNA extraction). The results of these sequentially executed processes were analyzed using gel electrophoresis. Thus, this work demonstrates the adaptability of the system to replace many common laboratory tasks on a single platform (through re-programmability), in rapid succession (using droplets), and with a high level of

  7. Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

    PubMed Central

    Harwood, Lori E.; Wilson, Barbara M.; Oudshoorn, Abe

    2016-01-01

    Background Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation. Method This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis. Results Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes. Conclusions Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use. PMID:26985384

  8. A closed-loop pump-driven wire-guided flow jet for ultrafast spectroscopy of liquid samples.

    PubMed

    Picchiotti, Alessandra; Prokhorenko, Valentyn I; Miller, R J Dwayne

    2015-09-01

    We describe the design and provide the results of the full characterization of a closed-loop pump-driven wire-guided flow jet system. The jet has excellent optical quality with a wide range of liquids spanning from alcohol to water based solutions, including phosphate buffers used for biological samples. The thickness of the jet film varies depending on the flow rate between 90 μm and 370 μm. The liquid film is very stable, and its thickness varies only by 0.76% under optimal conditions. Measured transmitted signal reveals a long term optical stability (hours) with a RMS of 0.8%, less than the overall noise of the spectroscopy setup used in our experiments. The closed loop nature of the overall jet design has been optimized for the study of precious biological samples, in limited volumes, to remove window contributions from spectroscopic observables. This feature is particularly important for femtosecond studies in the UV range. PMID:26429427

  9. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation.

    PubMed

    Altonbary, Ahmed Youssef; Bahgat, Monir Hussein

    2016-03-25

    Periampullary diverticulum (PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD is usually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography (ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD, suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation. PMID:27014423

  10. Endoscopic retrograde cholangiopancreatography in periampullary diverticulum: The challenge of cannulation

    PubMed Central

    Altonbary, Ahmed Youssef; Bahgat, Monir Hussein

    2016-01-01

    Periampullary diverticulum (PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD is usually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography (ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD, suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation. PMID:27014423

  11. Manikin model with breathing tube for wire-guided percutaneous cricothyrotomy in patients applying an intermaxillary fixation.

    PubMed

    Hwang, Kun; Kim, Han Joon; Kim, Yoo Chan; Choi, Yong Soon; Hwang, Se Won

    2014-09-01

    Jaw fracture surgery or orthognathic surgery usually involves the application of an intermaxillary fixation (IMF). Obstructions that cannot be relieved by suction require an immediate release of IMF wires, but releasing the IMF may damage the surgical alignment of the facial bones. The mean time taken to release the jaws was an average of 2 minutes 9 seconds by hospital staff involved in caring for these patients. The aims of this study were to introduce a training model for wire-guided percutaneous cricothyrotomy in the patients applying an IMF and to perform the procedure for medical students. Our model consisted of a facial mannequin, a plastic breathing tube, 2 rolls of tapes, and a reservoir bag. The inner parts of the 2 used rolls of tape represent tracheal/cricoid rings (1-inch width for thyroid and half-inch width for cricoid), and the space between them represents the cricothyroid membrane, which is wrapped with Peha-Haft. A surgeon demonstrated the technique on the model, and then, 60 medical students who had never attended airway-training courses applied the Melker cricothyrotomy kit on the model. All 60 students completed the procedure successfully. The mean (SD) time needed to insert a cricothyrotomy catheter of the medical students was 175 (50) seconds (range, 76-297 s). Most of the students (54; 90%) performed it within 4 minutes; more than half (33; 55%), within 3 minutes. With our manikin model and Melker cricothyrotomy kit, 60 medical students completed the procedure successfully. This model can be useful to cricothyrotomy training for medical personnel. PMID:25203581

  12. Droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling for simpler and faster PCR assay using wire-guided manipulations

    PubMed Central

    2012-01-01

    A computer numerical control (CNC) apparatus was used to perform droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling on a single superhydrophobic surface and a multi-chambered PCB heater. Droplets were manipulated using “wire-guided” method (a pipette tip was used in this study). This methodology can be easily adapted to existing commercial robotic pipetting system, while demonstrated added capabilities such as vibrational mixing, high-speed centrifuging of droplets, simple DNA extraction utilizing the hydrophobicity difference between the tip and the superhydrophobic surface, and rapid thermocycling with a moving droplet, all with wire-guided droplet manipulations on a superhydrophobic surface and a multi-chambered PCB heater (i.e., not on a 96-well plate). Serial dilutions were demonstrated for diluting sample matrix. Centrifuging was demonstrated by rotating a 10 μL droplet at 2300 round per minute, concentrating E. coli by more than 3-fold within 3 min. DNA extraction was demonstrated from E. coli sample utilizing the disposable pipette tip to cleverly attract the extracted DNA from the droplet residing on a superhydrophobic surface, which took less than 10 min. Following extraction, the 1500 bp sequence of Peptidase D from E. coli was amplified using rapid droplet thermocycling, which took 10 min for 30 cycles. The total assay time was 23 min, including droplet centrifugation, droplet DNA extraction and rapid droplet thermocycling. Evaporation from of 10 μL droplets was not significant during these procedures, since the longest time exposure to air and the vibrations was less than 5 min (during DNA extraction). The results of these sequentially executed processes were analyzed using gel electrophoresis. Thus, this work demonstrates the adaptability of the system to replace many common laboratory tasks on a single platform (through re-programmability), in rapid succession (using droplets), and with a high level of

  13. [Ultrasound guided radial artery cannulation: procedure description and literature review].

    PubMed

    Carmona Monge, F J; Martínez Lareo, M; Núñez Reiz, A

    2011-01-01

    Arterial catheterization is the second most common invasive procedure performed in critical care units. These devices are essential in certain types of patients (the hemodinamically unstable or those who require regular evaluation of the gasometric values). Complications related to arterial cannulation are relatively scarce. However, there are no reliable indicators to predict the occurrence of radial artery occlusions or ischemic lesions in the hand after a radial cannulation procedure has been performed. Ultrasound-guided catheter insertion has been used for years to guide central venous cannulation in critical care, but its use has been more limited for arterial catheterization. This paper aims to describe the technique of ultrasound-guided radial artery catheterization and reviews the most important research papers that have evaluated the safety and efficacy of this procedure in the adult population. PMID:21256787

  14. How I do it – sole innominate cannulation for acute type A aortic dissection

    PubMed Central

    2012-01-01

    We describe sole direct innominate cannulation for arterial return for establishing both cardiopulmonary bypass and selective antegrade cerebral perfusion in the repair of acute type A dissection and compare it with femoral, axillary, direct aortic and apical cannulations. We believe innominate cannulation has all the advantages of right axillary cannulation and none of its disadvantages. It can be used in all patients in whom innominate artery is not dissected, obstructed, calcified or otherwise diseased. PMID:23167966

  15. A pilot intravenous cannulation team: an Irish perspective.

    PubMed

    Carr, Peter J; Glynn, Ronan W; Dineen, Brendan; Kropmans, Thomas Jb

    Peripheral intravenous cannulation (PIVC) is a potentially painful and distressing procedure for patients, and is traditionally carried out by medical personnel. A university hospital in Ireland was chosen to initiate a pilot intravenous (IV) cannulation team, to ascertain whether this procedure could be performed effectively by a team of nurses. The team was introduced to support the implementation of the European working time directive (EWTD). A team of four registered general nurses, led by a senior phlebotomist, provided PIVC. Request books were placed on each ward and data was recorded before and after each insertion. A constantly increasing percentage of first-time cannulation success is displayed from the first five months of the study. In-depth analysis on an orthopaedic ward reveal a preference for distal site insertion and routine change at 72 hours. IV teams performing IV cannulation can effectively reduce insertion rate attempts, and potentially offer a solution to the manpower issues arising as a result of implementation of the EWTD. PMID:20622770

  16. Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery

    PubMed Central

    Ramchandani, Mahesh; Al Jabbari, Odeaa; Abu Saleh, Walid K.; Ramlawi, Basel

    2016-01-01

    For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs—the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation. PMID:27127556

  17. Use of small cannulated screws for fixation in foot surgery.

    PubMed

    Burns, A E

    2000-05-01

    Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California). The screw sizes available in the Mini Lag Screw System are 2.7, 3.5, and 4.0 mm. A long-term clinical and radiographic prospective evaluation of 70 procedures performed on 49 patients was conducted. The follow-up time for all patients was 2 years. None of the 70 implants fractured, and seven procedures (in seven patients) resulted in some type of implant-fixation failure. All of the fixation failures, however, appeared to be related to an untoward event or patient noncompliance. These smaller cannulated screws proved to be a reliable and effective means of fixation in foot surgery. PMID:10833872

  18. Electromagnetic needle tracking during simulated right internal jugular cannulation.

    PubMed

    Faulke, D J; Hall, T H; Nixon, C

    2015-07-01

    This study used three-dimensional information from Stealth navigation technology during simulated right internal jugular vein cannulation to define the initial needle trajectory taken when using three approaches: landmark (LM), short-axis (SAX) ultrasound and long-axis (LAX) ultrasound. Nineteen volunteers indicated the entry site and needle direction (track) they would use in performing right internal jugular vein cannulation by the three approaches. The likelihood of cannulation success, arterial puncture and needle direction were recorded. Volunteers were asked to assess the suitability of the simulation system for validity and educational benefit. The SAX track crossed the jugular vein more frequently than the LAX and LM tracks (SAX: 94%; LAX: 80%; LM: 47% [SAX versus LM, P <0.01]). The mean indicated needle direction in the coronal plane for LM, SAX and LAX were -4, 13 and 11 degrees, respectively. The track associated with the LAX technique would have entered the carotid artery by 16% of volunteers. At needle depths of over 40 mm, the track crossed the vertebral artery at the following rates (LM: 11%; SAX: 16%; LAX: 16%). The use of Stealth technology to provide three-dimensional feedback of the needle path taken during simulated right internal jugular cannulation was considered realistic (16/19) and of benefit for 18 of 19 (95%) respondents. The SAX track was associated with the highest likelihood of successful jugular cannulation and the lowest cross rate of the carotid artery. The simulation model using Stealth was considered to be valuable and realistic by participants despite some limitations. PMID:26099763

  19. Arterial cannulation can hasten the onset of symmetrical peripheral gangrene

    PubMed Central

    Srinivasan, Nataraj M.; Chaudhuri, Souvik

    2011-01-01

    Symmetrical peripheral gangrene (SPG) is a devastating complication seen in critical care settings due to several contributory factors like low perfusion, high dose of vasopressors, disseminated intravascular coagulation, etc. Arterial cannulation is commonly done in critical patients for monitoring. We report a case of patient who developed early features of SPG which recovered in one hand, although it progressed in the hand which had the arterial cannula. PMID:25885311

  20. Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla

    PubMed Central

    Wang, Wei; Gong, Biao; Jiang, Wei-Song; Liu, Lei; Bielike, Kouken; Xv, Bin; Wu, Yun-Lin

    2015-01-01

    AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife. METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed. RESULTS: Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301). CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed. PMID:26019460

  1. Force-Based Puncture Detection and Active Position Holding for Assisted Retinal Vein Cannulation*

    PubMed Central

    Gonenc, Berk; Tran, Nhat; Riviere, Cameron N.; Gehlbach, Peter; Taylor, Russell H.; Iordachita, Iulian

    2016-01-01

    Retinal vein cannulation is a demanding procedure proposed to treat retinal vein occlusion by direct therapeutic agent delivery methods. Challenges in identifying the moment of venous puncture, achieving cannulation and maintaining cannulation during drug delivery currently limit the feasibility of the procedure. In this study, we respond to these problems with an assistive system combining a handheld micromanipulator, Micron, with a force-sensing microneedle. The integrated system senses the instant of vein puncture based on measured forces and the position of the needle tip. The system actively holds the cannulation device securely in the vein following cannulation and during drug delivery. Preliminary testing of the system in a dry phantom, stretched vinyl membranes, demonstrates a significant improvement in the total time the needle could be maintained stably inside of the vein. This was especially evident in smaller veins and is attributed to decreased movement of the positioned cannula following venous cannulation. PMID:27127804

  2. Multiple cannulated screw fixation of young femoral neck fractures

    PubMed Central

    Kim, Joo Yong; Kong, Gyu Min; Park, Dae Hyun; Kim, Dae Yoo

    2015-01-01

    Objective: We wanted to analyze the factors affecting the results of multiple cannulated screws fixation in patients less than 60 years old with femoral neck fracture (FNF). Methods: We reviewed 52 patients (30 males, 22 females) who were treated with multiple cannulated screws fixation for FNFs. They were followed up for more than one year during January 2002 to December 2012. They were classified by Garden’s classification. The anatomic reduction was evaluated by Garden’s alignment index on hip both anteroposterior and lateral images. Postoperative complications were analyzed during follow up periods. Results: By Garden’s classification, 6 cases were in stage I, 13 cases in stage II, 30 cases in stage III and 3 cases in stage IV. During follow up periods, avascular necrosis of the femoral head was observed in 12 cases (23%) and nonunion was observed in 5 cases (9%). The 16 patients who had complications underwent total hip arthroplasty (31%). In non-displaced fracture groups (Garde I, II) did not have AVN nor nonunion. The incidence of complications in displaced fracture group was 51.5%. The complicated cases showed tendency for increased apex anterior angulation of femoral neck on hip lateral images and the result was statistically significant. (p=0.0260). Conclusion: The patients less than 60 years old who were treated with multiple cannulated screws fixation for displaced FNFs showed the incidence of complications was more than 50%. It needs a cautious approach for anatomical reduction, especially related to anterior angulation on hip lateral image. PMID:26870127

  3. Right internal jugular venous cannulation complicated by tension hydrothorax.

    PubMed

    Maroun, Rabih; Chalhoub, Michel; Harris, Kassem

    2013-01-01

    Central Venous Catheter (CVC) is a common procedure performed in patients' management, especially the critically ill ones. CVC has been used as main access in patients requiring large amount of fluid resuscitation, total parenteral nutrition or measuring the central venous pressure. Although most complications associated with central venous cannulation are minimal, local and easy to control, others may be critical and rapidly fatal if not recognized and treated immediately. One of the most serious incidents that can occur post CVC placement is delayed hydrothorax. It usually results from migration and perforation of the catheter through the SVC wall. In this report, we describe a case of tension hydrothorax that occurred a few hours after placement of CVC in the right internal jugular vein. In acutely ill patients that are already unstable, making the diagnosis of tension hydrothorax secondary to CVC placement requires high level of suspicion. Prompt pleural effusion drainage like in our case is crucial for favorable outcome. PMID:23871236

  4. Comparison between needle-knife fistulotomy and standard cannulation in ERCP

    PubMed Central

    Ayoubi, Mohammad; Sansoè, Giovanni; Leone, Nicola; Castellino, Francesca

    2012-01-01

    AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi’s syndrome. RESULTS: Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION: Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation. PMID:23125897

  5. Radial artery cannulation--the influence of method on blood flow after decannulation.

    PubMed

    Cronin, K D; Davies, M J; Domaingue, C M; Worner, M J; Koumoundouros, E

    1986-11-01

    A prospective randomised study of two hundred patients undergoing open-heart surgery was carried out to determine if the method of radial artery cannulation (direct threading or transfixion) had any influence on the incidence of abnormal flow after decannulation. A standard 20-gauge non-tapered teflon-coated cannula was used and the groups were well matched for age, sex, wrist circumference, duration of cannulation and haematoma formation, all of which have been postulated to influence thrombosis rate. We were unable to demonstrate a statistically significant difference between the two methods of cannulation. The overall abnormal flow rate at five days assessed by Doppler ultrasound was low at 5%. PMID:2952029

  6. Postmortem angiography using femoral cannulation and postmortem microbiology.

    PubMed

    Palmiere, Cristian; Egger, Coraline; Grabherr, Silke; Jaton-Ogay, Katia; Greub, Gilbert

    2015-07-01

    Despite the undeniable advantages of postmortem angiography, numerous questions have arisen concerning the influence that the injected contrast media may exercise on biological fluids and tissues collected for toxicological and biochemical investigations. Moreover, cardiac blood for microbiological investigations cannot be obtained post-angiography. In this study, we examined whether the peripheral blood collected prior to postmortem angiography, using percutaneous access to femoral vessels after skin surface disinfection, could be suitable for microbiological investigations when postmortem angiography with femoral vessel cannulation is also performed. A total of 66 cases were included in the study and were divided into two subgroups (angiography and bacteriology group, 33 cases and control group, 33 cases). Autopsies, histology, toxicology, bacteriology, and biochemical investigations (procalcitonin, C-reactive protein, interleukin-6, and soluble triggering receptors expressed on myeloid cells type 1) were performed in all cases. No statistically significant differences between the two groups were noted, and identified category distribution (death unrelated to infection, true infection, false positive, and undetermined) was rather similar in both studied populations. These preliminary results suggest that postmortem angiography using a femoral approach does not constitute an impediment to the collection of peripheral blood for microbiology and vice versa. Moreover, the use of femoral blood for microbiology does not lead to an increased risk of doubtful results. PMID:25381195

  7. Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

    PubMed Central

    Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

  8. Left Brachiocephalic Vein Cannulation in Bicaval Venous Drainage Is Safe, Effective, and Technically Advantageous

    PubMed Central

    Gholoobi, Arash; Amini, Shahram; Abdollahi-Moghadam, Alireza; Soltani, Ghassem

    2016-01-01

    Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) is cannulated instead of the superior vena cava. From 2012 through 2014, we performed routine LBCV cannulation in 150 consecutive patients as part of bicaval venous drainage before right atrial isolation. We prospectively collected demographic information, operative data, total pump and LBCV cannula flows with their respective calculated and indexed rates, central venous pressures, and perioperative complications. All patients survived surgery. There were no adverse technical outcomes or functional deficits associated with the technique. The mean indexed LBCV cannula flow was 1,520 ± 216 mL/min/m2, representing an LBCV cannula-to-calculated pump-flow ratio of 64%. The mean central venous pressure during right atrial isolation was 3.7 ± 1.9 mmHg. Cannulation of the LBCV is intrinsically a safe and reproducible procedure with proven hemodynamic adequacy. Its versatility can be an asset to surgical techniques and perfusion methods. Furthermore, the hemodynamic results in our series promise alternative intrathoracic and extracardiac cannulation sites for mini-extracorporeal circulation, on-pump beating-heart procedures, and short-term circulatory assist device implementation. PMID:27127430

  9. Cholesterol esterification by ACAT2 is essential for efficient intestinal cholesterol absorption: evidence from thoracic lymph duct cannulation[S

    PubMed Central

    Nguyen, Tam M.; Sawyer, Janet K.; Kelley, Kathryn L.; Davis, Matthew A.; Rudel, Lawrence L.

    2012-01-01

    The hypothesis tested in this study was that cholesterol esterification by ACAT2 would increase cholesterol absorption efficiency by providing cholesteryl ester (CE) for incorporation into chylomicrons. The assumption was that absorption would be proportional to Acat2 gene dosage. Male ACAT2+/+, ACAT2+/−, and ACAT2−/− mice were fed a diet containing 20% of energy as palm oil with 0.2% (w/w) cholesterol. Cholesterol absorption efficiency was measured by fecal dual-isotope and thoracic lymph duct cannulation (TLDC) methods using [3H]sitosterol and [14C]cholesterol tracers. Excellent agreement among individual mice was found for cholesterol absorption measured by both techniques. Cholesterol absorption efficiency in ACAT2−/− mice was 16% compared with 46–47% in ACAT2+/+ and ACAT2+/− mice. Chylomicrons from ACAT2+/+ and ACAT2+/− mice carried ∼80% of total sterol mass as CE, whereas ACAT2−/− chylomicrons carried >90% of sterol mass in the unesterified form. The total percentage of chylomicron mass as CE was reduced from 12% in the presence of ACAT2 to ∼1% in ACAT2−/− mice. Altogether, the data demonstrate that ACAT2 increases cholesterol absorption efficiency by providing CE for chylomicron transport, but one copy of the Acat2 gene, providing ∼50% of ACAT2 mRNA and enzyme activity, was as effective as two copies in promoting cholesterol absorption. PMID:22045928

  10. Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients.

    PubMed

    Li, Xiuyan; Fang, Guizhen; Yang, Danhua; Wang, Lanfang; Zheng, Chunmei; Ruan, Longjuan; Wang, Lingcong

    2016-01-01

    BACKGROUND This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. MATERIAL AND METHODS A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. RESULTS (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (P<0.05). (2) The cannulation duration in the ultrasound group and the palpation group was 8.77±6.33 s and 28.7±26.33 s, respectively (P<0.01). (3) Incidence of hematoma and staxis around stoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). CONCLUSIONS Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics. PMID:27397118

  11. Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients

    PubMed Central

    Li, Xiuyan; Fang, Guizhen; Yang, Danhua; Wang, Lanfang; Zheng, Chunmei; Ruan, Longjuan; Wang, Lingcong

    2016-01-01

    Background This study observed the efficacy of ultrasonic technique with out-of-plane orientation and in-plane guidance in radial artery puncture and cannulation in intensive care unit (ICU) shock patients to elucidate the effect of this technique on the security of cannulation. Material/Methods A total of 88 ICU shock patients, randomized into a palpation (control) group and an ultrasound (experimental) group, received continuous intravenous sedation and analgesia. The palpation group patients underwent radial artery cannulation using the traditional palpation pulsation approach, and the ultrasound group patients underwent radial artery cannulation under out-of-plane orientation and in-plane guidance using an ultrasonic apparatus. Data were recorded and compared between the 2 groups. Results (1) The success rate of the first puncture in the ultrasound group and the palpation group was 80% and 42%, respectively (P<0.05). (2) The cannulation duration in the ultrasound group and the palpation group was 8.77±6.33 s and 28.7±26.33 s, respectively (P<0.01). (3) Incidence of hematoma and staxis around stoma in the ultrasound group was 2.5% and 5%, respectively, which was significantly lower than that in the palpation group, which was 20% and 32.5%, respectively (P<0.05). (4) Time to achieve the early goal-directed therapy in the ultrasound group and the palpation group was 306.73±39.98 min and 356.75±40.97 min, respectively (P<0.01). Conclusions Compared with the traditional method, radial artery cannulation with out-of-plane orientation and in-plane guidance is a quick and secure cannulation method and is appropriate for use in clinics. PMID:27397118

  12. Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

    PubMed Central

    Bucsky, Bence S.; Richardt, Doreen; Petersen, Michael; Sievers, Hans H.

    2016-01-01

    Background The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Methods Between January 2003 and December 2015, 235 patients underwent repair of AADA. All patients were evaluated for the type of arterial cannulation (femoral vs. central) for initial bypass. Demographic data and outcome parameters were accessed. Results One hundred and twenty seven (54.0%) were initially cannulated in the central aortic vessels (ascending aorta or subclavian/axillary artery) and 108 (46.0%) in the femoral artery. Patients were comparable between age (62.4±14.4 vs. 62.9±14.4 years, P=0.805), gender (male, 62.2 vs. 69.4%, P=0.152) and previous sternotomy (15.7 vs. 16.7%, P=0.861) between both cannulation groups; while EuroSCORE I (11.5±4.0 vs. 12.7±4.2, P=0.031) and ASA Score (3.5±0.81 vs. 3.8±0.57, P=0.011) were significantly higher in the femoral artery cannulation group. Bypass (249±102 vs. 240±81 min, P=0.474), X-clamp (166±85 vs. 157±67 min, P=0.418) and circulatory arrest time (51.6±28.7 vs. 48.3±21.7 min, P=0.365) were similar between the groups as were lowest temperature (18.1±2.0 vs. 18.1±2.2, P=0.775). Postoperative neurologic deficit and 30-day mortality were comparable between both cannulation groups (11.7 vs. 7.2%, P=0.449 and 20.2 vs. 16.9%, P=0.699, central vs. peripheral cannulation). Multivariate analysis revealed only EuroScore I above 13 as single preoperative predictor for mortality. Conclusions AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. PMID:27563543

  13. Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery.

    PubMed

    Bhaskar, Pradeep; John, Jiju; Lone, Reyaz Ahmad; Sallehuddin, Ahmed

    2015-01-01

    Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery. PMID:26440256

  14. Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery

    PubMed Central

    Bhaskar, Pradeep; John, Jiju; Lone, Reyaz Ahmad; Sallehuddin, Ahmed

    2015-01-01

    Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery. PMID:26440256

  15. Our experience with EMLA Cream (for painless venous cannulation in children).

    PubMed

    Wig, J; Johl, K S

    1990-04-01

    The local analgesic efficacy of EMLA Cream (a eutectic mixture of lidocaine and prilocaine; Astra Pharmaceuticals, Sweden) in reducing the pain at Venous cannulation was investigated in a randommized blind study in 75 children scheduled for elective surgery. In 25 children placebo cream and in 50 children, EMLA cream was applied at the site of venous cannulation 1 hour prior. EMLA Cream was found to be highly effective (84% patients in contrast to 16% patients in placebo group; P less than 0.005). Local side effects of EMLA Cream were negligible. PMID:2253982

  16. Direct Cannulation of the Infrahepatic Vena Cava for Emergent Cardiopulmonary Bypass Support

    PubMed Central

    Gopaldas, Raja R.; Patel, Kirti P.; Livesay, James J.; Cooley, Denton A.

    2009-01-01

    Cannulation for cardiopulmonary bypass, although seemingly routine, can pose technical challenges. In patients undergoing repeat sternotomy, for example, peripherally established cardiopulmonary bypass may be necessary to ensure safe entry into the chest; however, establishing bypass in this way can sometimes be complicated by patients' body habitus. We describe a technique for direct cannulation of the infrahepatic abdominal vena cava that was required for emergent cardiopulmonary bypass. The patient was a 62-year-old woman who had presented with severely symptomatic left main coronary stenosis 3 months after elective aortic valve replacement. She had gone into cardiogenic shock as general anesthesia was being induced for repeat sternotomy and myocardial revascularization. Emergent establishment of femorofemoral cardiopulmonary bypass was precluded by difficulties in advancing the femoral venous cannula beyond the pelvic brim. Hence, an emergent celiotomy was performed, and the abdominal vena cava was directly cannulated to establish venous drainage for cardiopulmonary bypass. The rest of the operation was uneventful. Our technique for direct cannulation of the infrahepatic abdominal vena cava may be used in exceptional circumstances. Necessary precautions and potential pitfalls are also presented. PMID:19693306

  17. Repeat endoscopic retrograde cholangiopancreaticography after failed initial precut sphincterotomy for biliary cannulation

    PubMed Central

    Pavlides, Michael; Barnabas, Ashley; Fernandopulle, Nilesh; Bailey, Adam A; Collier, Jane; Phillips-Hughes, Jane; Ellis, Anthony; Chapman, Roger; Braden, Barbara

    2014-01-01

    AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation. METHODS: In this retrospective study, consecutive ERCPs performed between January 2009 and September 2012 were included. Data from our endoscopy and radiology reporting databases were analysed for use of precut sphincterotomy, biliary access rate, repeat ERCP rate and complications. Patients with initially failed precut sphincterotomy were identified. RESULTS: From 1839 consecutive ERCPs, 187 (10%) patients underwent a precut sphincterotomy during the initial ERCP in attempts to cannulate a native papilla. The initial precut was successful in 79/187 (42%). ERCP was repeated in 89/108 (82%) of patients with failed initial precut sphincterotomy after a median interval of 4 d, leading to successful biliary cannulation in 69/89 (78%). In 5 patients a third ERCP was attempted (successful in 4 cases). Overall, repeat ERCP after failed precut at the index ERCP was successful in 73/89 patients (82%). Complications after precut-sphincterotomy were observed in 32/187 (17%) patients including pancreatitis (13%), retroperitoneal perforations (1%), biliary sepsis (0.5%) and haemorrhage (3%). CONCLUSION: The high success rate of biliary cannulation in a second attempt ERCP justifies repeating ERCP within 2-7 d after unsuccessful precut sphincterotomy before more invasive approaches should be considered. PMID:25278710

  18. Use of Cannulated Instruments to Localize the Portals in Anterior Ankle Arthroscopy: A Technique Tip.

    PubMed

    Needleman, Richard L

    2016-01-01

    The use of cannulated instruments under fluoroscopy can improve the localization of the anteromedial and posterolateral portals for use in ankle arthroscopy. This technique is valuable for the less-experienced ankle arthroscopist, in resident education, and for the experienced arthroscopist when surface anatomy palpation and visualization is less than ideal due to soft tissue edema and obesity. PMID:26947000

  19. Theoretical Estimation of Cannulation Methods for Left Ventricular Assist Device Support as a Bridge to Recovery

    PubMed Central

    Lim, Ki Moo; Lee, Jeong Sang; Song, Jin-Ho; Youn, Chan-Hyun; Choi, Jae-Sung

    2011-01-01

    Left ventricular assist device (LVAD) support under cannulation connected from the left atrium to the aorta (LA-AA) is used as a bridge to recovery in heart failure patients because it is non-invasive to ventricular muscle. However, it has serious problems, such as valve stenosis and blood thrombosis due to the low ejection fraction of the ventricle. We theoretically estimated the effect of the in-series cannulation, connected from ascending aorta to descending aorta (AA-DA), on ventricular unloading as an alternative to the LA-AA method. We developed a theoretical model of a LVAD-implanted cardiovascular system that included coronary circulation. Using this model, we compared hemodynamic responses according to various cannulation methods such as LA-AA, AA-DA, and a cannulation connected from the left ventricle to ascending aorta (LV-AA), under continuous and pulsatile LVAD supports. The AA-DA method provided 14% and 18% less left ventricular peak pressure than the LA-AA method under continuous and pulsatile LVAD conditions, respectively. The LA-AA method demonstrated higher coronary flow than AA-DA method. Therefore, the LA-AA method is more advantageous in increasing ventricular unloading whereas the AA-DA method is a better choice to increase coronary perfusion. PMID:22147996

  20. Ultrasound-Guided Small Vessel Cannulation: Long-Axis Approach Is Equivalent to Short-Axis in Novice Sonographers Experienced with Landmark-Based Cannulation

    PubMed Central

    Erickson, Catherine S.; Liao, Michael M.; Haukoos, Jason S.; Douglass, Erica; DiGeronimo, Margaret; Christensen, Eric; Hopkins, Emily; Bender, Brooke; Kendall, John L.

    2014-01-01

    Introduction Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration. Methods This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber. Results Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7–12) and 10 (95% CI 6–13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1–5.5) and 5.6 (95% CI 5.1–6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%–48%; p=0.009) faster than short-axis attempts. Conclusion Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models. PMID:25493126

  1. Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

    PubMed

    Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

    2009-03-01

    An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds. PMID:19368267

  2. Afferent lymphatic cannulation as a model system to study innate immune responses to infection and vaccination.

    PubMed

    Neeland, Melanie R; Meeusen, Els N T; de Veer, Michael J

    2014-03-15

    The afferent lymphatics consist of the cells and immunomodulatory signals that are involved in the early response to peripheral stimuli. Examination of this compartment in both homeostatic and stimulatory conditions permits the analysis of the innate biological pathways responsible for the generation of an adaptive immune response in the lymph node. Afferent lymphatic cannulation is therefore an ideal model system to study cellular migration and antigen dispersal kinetics during infection and vaccination. Utilisation of these lymphatic cannulation models has demonstrated the ability to both increase current understanding of infectious diseases, vaccine delivery systems and has the potential to target effector cells and molecules that may be used as novel therapeutic or vaccine targets. PMID:23369582

  3. Modified Valsalva Maneuver for Venous Cannulation in Cardiopulmonary Bypass for Minimal Incision Mitral Valve Surgery.

    PubMed

    Rajaratnam, Kawryshanker; Tak, Chaitanya; Alexander, Sweeka; Passage, Jurgen

    2016-01-01

    A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulations such as withdrawing and reinserting, twisting, and to-and-fro movements did not result in success. Eventually, we attempted a novel maneuver, the modified "Valsalva maneuver," that worked incredibly well. PMID:27532301

  4. Percutaneous retrieval of malpositioned, kinked and unraveled guide wire under fluoroscopic guidance during central venous cannulation

    PubMed Central

    Jalwal, Gopal Krishan; Rajagopalan, Vanitha; Bindra, Ashish; Rath, Girija Prasad; Goyal, Keshav; Kumar, Atin; Gamanagatti, Shivanand

    2014-01-01

    The placement of central venous catheter using Seldinger's technique, remains a commonly performed procedure with its own risks and benefits. Various complications have been reported with the use of guide wire as well as catheter. We report a unique problem during subclavian vein cannulation due to guidewire malposition which led to its kinking and difficult retrieval requiring removal in fluoroscopy suit. The probable mechanism of guide wire entrapment and possible bedside management of similar problems is described. PMID:24803771

  5. Evaluation of inflow cannulation site for implantation of right-sided rotary ventricular assist device.

    PubMed

    Gregory, Shaun D; Pearcy, Mark J; Fraser, John; Timms, Daniel

    2013-08-01

    Right heart dysfunction is one of the most serious complications following implantation of a left ventricular assist device, often leading to the requirement for short- or long-term right ventricular assist device (RVAD) support. The inflow cannulation site induces major hemodynamic changes and so there is a need to optimize the site used depending on the patient's condition. Therefore, this study evaluated and compared the hemodynamic influence of right atrial cannulation (RAC) and right ventricular cannulation (RVC) inflow sites. An in vitro variable heart failure mock circulation loop was used to compare RAC and RVC in mild and severe biventricular heart failure (BHF) conditions. In the severe BHF condition, higher ventricular ejection fraction (RAC: 13.6%, RVC: 32.7%) and thus improved heart chamber and RVAD washout were observed with RVC, which suggested this strategy might be preferable for long-term support (i.e., bridge-to-transplant or destination therapy) to reduce the risk of thrombus formation. In the mild BHF condition, higher pulmonary valve flow (RAC: 3.33 L/min, RVC: 1.97 L/min) and lower right ventricular stroke work (RAC: 0.10 W, RVC: 0.13 W) and volumes were recorded with RAC. These results indicate an improved potential for myocardial recovery, thus RAC should be chosen in this condition. This in vitro study suggests that RVAD inflow cannulation site should be chosen on a patient-specific basis with a view to the support strategy to promote myocardial recovery or reduce the risk of long-term complications. PMID:23621773

  6. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25507120

  7. Inadvertent subclavian artery cannulation with a central venous catheter; successful retrieval using a minimally invasive technique.

    PubMed

    Redmond, C E; O'Donohoe, R; Breslin, D; Brophy, D P

    2014-10-01

    A 48-year-old lady was referred to our department as an emergency following an unsuccessful attempt at central venous catheter insertion, resulting in cannulation of the subclavian artery. She underwent angiography with removal of the catheter and closure of the arteriotomy using an Angio-Seal device. While the optimal management of this scenario has yet to be defined, the use of this minimally invasive technique warrants consideration. PMID:25417392

  8. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

    PubMed Central

    Farion, Ken J.; Splinter, Karen L.; Newhook, Kym; Gaboury, Isabelle; Splinter, William M.

    2008-01-01

    Background Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming, and thus impractical for routine use in the emergency department. Vapocoolant sprays provide transient skin anesthesia within seconds of application. We compared the effect of a new vapocoolant spray to placebo on pain due to intravenous cannulation in children. Methods In this double-blind randomized controlled trial, which we conducted between June 1 and Sept. 12, 2006, 80 children aged 6–12 years received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Secondary outcomes included success rate on first attempt at cannulation and pain ratings by the children's parents, nurses and child life specialists. Results We found a modest but significant reduction in pain with the use of vapocoolant spray (mean difference 19 mm, 95% confidence interval [CI] 6–32 mm; p < 0.01). Cannulation on first attempt was more often successful with the use of vapocoolant spray (85.0%) than with placebo (62.5%) (mean difference 22.5%, 95% CI 3.2%–39.9%; p = 0.03). The number needed to treat to prevent 1 cannulation failure was 5 (95% CI 3–32). Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p < 0.01) considered the children's pain to be reduced with the use of vapocoolant spray. Interpretation The vapocoolant spray in our study quickly and effectively reduced pain due to intravenous cannulation in children and improved the success rate of cannulation. It is an important option to reduce childhood procedural pain in emergency situations, especially when time precludes traditional interventions. (http://ClinicalTrials.gov trial register no. NCT00130650.) PMID:18591524

  9. In Vivo Cannulation Methods for Cardiomyocytes Isolation from Heart Disease Models

    PubMed Central

    Shimkunas, Rafael; Jian, Yuwen; Jaradeh, Mark; Chavez, Karen; Chiamvimonvat, Nipavan; Tardiff, Jil C.; Izu, Leighton T.; Ross, Robert S.; Chen-Izu, Ye

    2016-01-01

    Isolation of high quality cardiomyocytes is critically important for achieving successful experiments in many cellular and molecular cardiology studies. Methods for isolating cardiomyocytes from the murine heart generally are time-sensitive and experience-dependent, and often fail to produce high quality cells. Major technical difficulties can be related to the surgical procedures needed to explant the heart and to cannulate the vessel to mount onto the Langendorff system before in vitro reperfusion can begin. During this period, transient hypoxia and ischemia may damage the heart, resulting in low yield and poor quality of cells, especially for heart disease models that have fragile cells. We have developed novel in vivo cannulation methods to minimize hypoxia and ischemia, and fine-tuned the entire protocol to produce high quality ventricular myocytes. The high cell quality has been confirmed using important structural and functional criteria such as morphology, t-tubule structure, action potential morphology, Ca2+ signaling, responsiveness to beta-adrenergic agonist, and ability to have robust contraction under mechanically loaded condition. Together these assessments show the preservation of the cardiac excitation–contraction machinery in cells isolated using this technique. The in vivo cannulation method enables consistent isolation of high-quality cardiomyocytes, even from heart disease models that were notoriously difficult for cell isolation using traditional methods. PMID:27500929

  10. Serum albumin and fixation failure with cannulated hip screws in undisplaced intracapsular femoral neck fracture.

    PubMed

    Riaz, O; Arshad, R; Nisar, S; Vanker, R

    2016-07-01

    Introduction Internal fixation of undisplaced intracapsular femoral neck fractures with cannulated hip screws is a widely accepted surgical technique, despite reported failure rates of 12%-19%. This study determined whether preoperative serum albumin levels are linked to fixation failure. Methods We retrospectively reviewed 251 consecutive undisplaced intracapsular femoral neck fracture patients treated with cannulated hip screws in a district general hospital. Preoperative albumin levels were measured, and the fixation technique, classification and posterior tilt on radiography assessed. Fixation failure was defined as a screw cut, avascular necrosis (AVN) or non-union. Results Of the patients, 185 were female and 66 male. The mean age was 77 years (range 60-101 years). Thirty seven (15%) patients had fixation failure: 10 (4%) due to AVN; 12 (5%) due to non-union; and 15 (6%) due to fixation collapse. Low serum albumin levels were significantly associated with failure (p=0.01), whereas gender (p=0.56), operated side (p=0.62), age (p=0.34) and screw configuration (p=0.42) were not. A posterior tilt angle greater than 20° on lateral radiography significantly predicted failure (p=0.002). Conclusions Preoperative serum albumin is an independent predictor of cannulated hip screw fixation failure in undisplaced femoral neck fractures. Nutritional status should therefore be considered when deciding between surgical fixation and arthroplasty to avoid the possibility of revision surgery, along with an increased risk of morbidity and mortality. PMID:27055409

  11. Arterio-venous fistula buttonhole cannulation technique: a retrospective analysis of infectious complications

    PubMed Central

    O'Brien, Frank J.; Kok, Hong Kuan T.; O'Kane, Claire; McWilliams, Johanna; O'Kelly, Patrick; Collins, Paula; Walshe, Joseph; Magee, Colm C.; Denton, Mark D.; Conlon, Peter J.

    2012-01-01

    Background There are two main methods of accessing arterio-venous fistulas (AVFs); the ‘buttonhole’ and the ‘rope-ladder’ cannulation technique. Several small studies have hypothesized that the buttonhole technique is associated with increased rates of fistula-associated infection. This study addresses this hypothesis. Methods A retrospective review of all patients attending a large outpatient haemodialysis clinic was performed. Data were collected on the method of cannulation, infection rates, implicated microorganisms, complications of infection and time on haemodialysis. Results A total of 127 patients had received haemodialysis via an AVF: 53 via the rope-ladder technique and 74 via the buttonhole technique. Nine episodes of clinically significant bacteraemia were recorded in the buttonhole group. This equated to a rate of 0.073 bacteraemia events per 1000 AVF days. There were no episodes of bacteraemia in the rope-ladder group. Eight infections were due to methicillin-sensitive Staphylococcus aureus (MSSA); one was due to Staphylococcus epidermidis. Three patients with MSSA bacteraemia subsequently developed infective endocarditis. Five patients who developed bacteraemia events had been undergoing home haemodialysis. Conclusions This study highlights the infectious complications associated with buttonhole cannulation techniques. All organisms isolated in our cohort were known skin colonizers. The reason for the increased rates of infection is unclear. Given this high rate of often life-threatening infection, we recommend regular audit of infection rates. We currently do not recommend this technique to our patients receiving haemodialysis. PMID:26069795

  12. Effect of different radial hole designs on pullout and structural strength of cannulated pedicle screws.

    PubMed

    Chen, Hsin-Chang; Lai, Yu-Shu; Chen, Wen-Chuan; Chen, Jou-Wen; Chang, Chia-Ming; Chen, Yi-Long; Wang, Shih-Tien; Cheng, Cheng-Kung

    2015-08-01

    Cannulated pedicle screws are designed for bone cement injection to enhance fixation strength in severely osteoporotic spines. However, the screws commonly fracture during insertion. This study aims to evaluate how different positions/designs of radial holes may affect the pullout and structural strength of cannulated pedicle screws using finite element analysis. Three different screw hole designs were evaluated under torsion and bending conditions. The pullout strength for each screw was determined by axial pullout failure testing. The results showed that when the Von Mises stress reached the yield stress of titanium alloy the screw with four radial holes required a greater torque or bending moment than the nine and twelve hole screws. In the pullout test, the strength and stiffness of each screw with cement augmentation showed no significant differences, but the screw with four radial holes had a greater average pullout strength, which probably resulted from the significantly greater mean maximum lengths of cement augmentation. Superior biomechanical responses, with lower stress around the radial holes and greater pullout strength, represented by cannulated pedicle screw with four radial holes may worth recommending for clinical application. PMID:26054806

  13. A technique for cannulating the Cisterna magna and sampling cerebrospinal fluid from socially housed birds.

    PubMed

    Moore, M S; Kuenzel, W J; Mench, J A

    1994-04-01

    The measurement of central levels of neurochemicals is an important approach to the understanding of the neurophysiological basis of behavior patterns in animals. Previous studies have utilized central sampling techniques developed for individually housed animals. The purpose of this study was to develop a cannulation technique and a method for sampling cerebrospinal fluid (CSF) from socially housed birds to facilitate the study of the neurophysiological basis of social behaviors. The cannulation technique involved the surgical implantation of a 22-gauge concentric guide cannula into the cisterna magna of 16-wk-old, feed-restricted male broiler breeders (n = 6). Individual-specific coordinates and optimum angle and depth of implantation of the cannula were determined in order to place the cannula correctly in the designated site. Once implanted, the guide cannula proved to be unobtrusive and secure and did not attract aggressive pecking from other birds in the pen. Two methods of CSF sampling were then examined. The first method required the use of a push-pull perfusion pump to withdraw CSF at a rate of 1 to 2 microL/min. The second method (passive), which did not use a pump, involved simply removing a "dummy" cannula from the guide cannula to release the CSF, which was then collected with a glass Hamilton syringe. Samples ranging from 100 to 500 microL were collected using the passive method. The combination of the cannulation technique described and the passive sampling method proved to be the most simple, efficient, and reliable method for measuring central levels of neurochemicals in socially housed broiler breeder males. PMID:8202435

  14. Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin.

    PubMed

    Shirai, Toshiharu; Tsuchiya, Hiroyuki; Terauchi, Ryu; Tsuchida, Shinji; Mizoshiri, Naoki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Miwa, Shinji; Kimura, Hiroaki; Takeuchi, Akihiko; Hayashi, Katsuhiro; Yamamoto, Norio; Kubo, Toshikazu

    2015-06-01

    Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin.A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5-22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated.Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05).In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence. PMID:26107670

  15. Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin

    PubMed Central

    Shirai, Toshiharu; Tsuchiya, Hiroyuki; Terauchi, Ryu; Tsuchida, Shinji; Mizoshiri, Naoki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Miwa, Shinji; Kimura, Hiroaki; Takeuchi, Akihiko; Hayashi, Katsuhiro; Yamamoto, Norio; Kubo, Toshikazu

    2015-01-01

    Abstract Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin. A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5–22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated. Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05). In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence. PMID:26107670

  16. Skirted Cannula Technique for Apical Cannulation in Implantation of Centrimag Left Ventricular Assist Device.

    PubMed

    Shen, Ta-Chung; Tsai, Kuei-Ton; Hu, Chin-Yuan; Chen, Robert Jeen-Chen

    2016-06-01

    The CentriMag, an extracorporeal short-term ventricular assist device designed for treatment of patients with acute cardiogenic shock, is Conformité Européenne-marked in Europe for use up to 30 days. Extended use beyond the licensed period is not uncommon, however. We have developed a skirted cannula technique for apical cannulation in implantation of the Centrimag. This technique allows easy positioning of the cannula and excellent hemostasis. It also offers secure fixation of the cannula so that patients can ambulate and attend rehabilitation programs should extended use be anticipated. PMID:27211964

  17. Comparison of the bending performance of solid and cannulated spinal pedicle screws using finite element analyses and biomechanical tests.

    PubMed

    Shih, Kao-Shang; Hsu, Ching-Chi; Hou, Sheng-Mou; Yu, Shan-Chuen; Liaw, Chen-Kun

    2015-09-01

    Spinal pedicle screw fixations have been used extensively to treat fracture, tumor, infection, or degeneration of the spine. Cannulated spinal pedicle screws with bone cement augmentation might be a useful method to ameliorate screw loosening. However, cannulated spinal pedicle screws might also increase the risk of screw breakage. Thus, the purpose of this study was to investigate the bending performance of different spinal pedicle screws with either solid design or cannulated design. Three-dimensional finite element models, which consisted of the spinal pedicle screw and the screw's hosting material, were first constructed. Next, monotonic and cyclic cantilever bending tests were both applied to validate the results of the finite element analyses. Finally, both the numerical and experimental approaches were evaluated and compared. The results indicated that the cylindrical spinal pedicle screws with a cannulated design had significantly poorer bending performance. In addition, conical spinal pedicle screws maintained the original bending performance, whether they were solid or of cannulated design. This study may provide useful recommendations to orthopedic surgeons before surgery, and it may also provide design rationales to biomechanical engineers during the development of spinal pedicle screws. PMID:26208430

  18. The efficacy of 'Radio guided Occult Lesion Localization' (ROLL) versus 'Wire-guided Localization' (WGL) in breast conserving surgery for non-palpable breast cancer: A randomized clinical trial – ROLL study

    PubMed Central

    van Esser, Stijn; Hobbelink, Monique GG; Peeters, Petra HM; Buskens, Erik; van der Ploeg, Iris M; Mali, Willem PTHM; Rinkes, Inne H M Borel; van Hillegersberg, Richard

    2008-01-01

    Background With the increasing number of non palpable breast carcinomas, the need of a good and reliable localization method increases. Currently the wire guided localization (WGL) is the standard of care in most countries. Radio guided occult lesion localization (ROLL) is a new technique that may improve the oncological outcome, cost effectiveness, patient comfort and cosmetic outcome. However, the studies published hitherto are of poor quality providing less than convincing evidence to change the current standard of care. The aim of this study is to compare the ROLL technique with the standard of care (WGL) regarding the percentage of tumour free margins, cost effectiveness, patient comfort and cosmetic outcome. Methods/design The ROLL trial is a multi center randomized clinical trial. Over a period of 2–3 years 316 patients will be randomized between the ROLL and the WGL technique. With this number, the expected 15% difference in tumour free margins can be detected with a power of 80%. Other endpoints include cosmetic outcome, cost effectiveness, patient (dis)comfort, degree of difficulty of the procedures and the success rate of the sentinel node procedure. The rationale, study design and planned analyses are described. Trial Registration (, study protocol number NCT00539474) PMID:18495027

  19. Open and closed chest extrathoracic cannulation for cardiopulmonary bypass and extracorporeal life support: methods, indications, and outcomes

    PubMed Central

    Field, M L; Al‐Alao, B; Mediratta, N; Sosnowski, A

    2006-01-01

    Extrathoracic cannulation to establish cardiopulmonary bypass has been widely applied in recent years and includes: (a) repeat surgery, (b) minimally invasive surgery, and (c) cases with diseased vessels such as porcelain, aneurysmal, and dissecting aorta. In addition, the success and relative ease of peripheral cannulation, among other technological advances, has permitted the development of closed chest extracorporeal life support, in the form of cardiopulmonary support and extracorporeal membrane oxygenation. With this development have come applications for cardiopulmonary bypass based support outside the traditional cardiac theatre setting, including emergency circulatory support for patients in cardiogenic shock and respiratory support for patients with severely impaired gas exchange. This review summarises the approach to extrathoracic cannulation for the generalist. PMID:16679471

  20. A Novel Surgical Technique for Removing Buried Cannulated Screws Using a Guidewire and Countersink: A Report of Two Cases

    PubMed Central

    Chen, Yongsheng; Giri, Krishna Prasad; Pearce, Christopher Jon

    2015-01-01

    Removal of metal implants is a common procedure that is performed for a variety of indications. However, problems such as a buried screw head may occasionally arise and render hardware removal difficult or even impossible. The problem is further compounded when the initial screw was inserted percutaneously or via a minimally-invasive (MIS) technique. In the present paper, we introduce a novel, minimally invasive technique to remove buried cannulated screws which obviates the need for excessive extension of the skin incision, surgical exploration, soft tissue dissection or excess bone removal, which surgeons may otherwise have to undertake to uncover the buried screw head. This technique is especially useful in removing cannulated screws which have been inserted using small stab incisions and MIS techniques initially. This technique can be applied to the removal of buried cannulated screws which are placed into any bone in the body. PMID:26161159

  1. Successful Use of Endoscopy for Transcervical Cannulation Procedures in the Goat

    PubMed Central

    Colagross-Schouten, A; Allison, D; Brent, L; Lissner, E

    2014-01-01

    Contents Two methods for transcervical cannulation of the goat were evaluated during a contraception study in 15 adult female Nigerian dwarf and African pygmy goats. Twenty-four transcervical cannulation procedures were conducted in which seven females underwent the procedure 2–3 times. Initially, a rigid 4-mm stainless steel cannula and external light source were used in 19 procedures to introduce the contraceptive compound into the uterus. Placement of the cannula was directed by feel or depth assessment. Of seven females that were euthanized following this procedure, four evidenced complications including penetration of the cervix with the cannula and cervical damage. A 2-mm custom-made endoscope with a specially designed cannula was then used for the remaining five procedures. No complications were found. A single animal, that underwent the endoscopic procedure twice, was euthanized for study purposes and no abnormal findings of the reproductive tract were reported. The use of an endoscope resulted in better outcomes because the uterus could be visualized after traversing the cervix. PMID:25220916

  2. Anatomical barriers in the right atrium to the coronary sinus cannulation

    PubMed Central

    Klimek-Piotrowska, Wiesława; Koziej, Mateusz; Strona, Marcin

    2015-01-01

    Background. The coronary venous system is an increasingly frequent target of minimally invasive cardiac procedures. The purpose of this paper is to assess the anatomical barriers in the right atrium to coronary sinus cannulation. Methods. We examined the anatomy of the right atrium, coronary sinus ostium, inferior and superior vena cava ostia in 110 randomly selected autopsied human hearts of both sexes (27% females; mean age 49.2 ± 17.5 years). Results. The Eustachian valve was present in 79 cases (71.8%) with mean height =4.9 ± 2.6 mm. The valve was perforated in 11 cases (13.9%). It is typically too small to hinder the coronary sinus catheterization, but in some cases (about 2%) a significantly protruding valve may be an obstacle. Chiari’s network (4.6%) is not a barrier to catheter entry into the right atrium but may significantly impede further catheter manipulations inside the heart venous system. A typical Thebesian valve leaves enough space for the passage of the standard catheter to the coronary sinus. Discussion. Detailed anatomy of various anatomical structures within the right atrium that could play a potential role in coronary sinus cannulation is discussed. PMID:26823994

  3. Right Internal Jugular Vein Cannulation: Carotid Artery-directed versus Sternocleidomastoid-directed Methods.

    PubMed

    Yu, Zhao-Yan; Yuan, Ping; Pan, Yang; Zhang, Zhong-Min

    2016-02-01

    The aim of the present study was to explore a simple and safe method for central venous catheterization (CVC) from the right internal jugular vein (RIJV) by comparing carotid artery (CA) positioning with sternocleidomastoid (SCM) positioning. The medical records of patients who underwent CVC between January 2011 and January 2015 were retrospectively reviewed. Central venous catheters were inserted into the RIJV either above the level of the cricoid cartilage using the CA-directed method (419 patients, Group 1) or below the level of the cricoid cartilage using the SCM-directed method (436 patients, Group 2). Success rate and related complications of catheterization were evaluated in the two groups. The total success rate of RIJV cannulation in Group 1 (97.2%) was higher than that in Group 2 (94.5%). Moreover, the success rate at first attempt was significantly higher in Group 1 than in Group 2 (92.4% vs 86.9%). The incidence of hematoma was 1.6 per cent in Group 1 and 3.8 per cent in Group 2. The rate of other complications such as pneumothorax, catheter-related infections, and catheter occlusion did not significantly differ between the groups. In conclusions, CA-directed RIJV cannulation is more effective and simple to perform than the SCM-directed method, and should become the preferred CVC technique in the absence of ultrasound guidance. PMID:26874140

  4. Characterization of post-surgical alterations in the bile duct-cannulated rat.

    PubMed

    Bachir-Cherif, Dalila; Blum, Denise; Braendli-Baiocco, Annamaria; Chaput, Evelyne; Pacheco, Gonzalo Christiano Duran; Flint, Nicholas; Haiker, Monika; Hoflack, Jean-Christophe; Justies, Nicole; Neff, Rachel; Starke, Volkmar; Steiner, Guido; Tournillac, Charles Alexandre; Singer, Thomas; Ubeaud-Séquier, Geneviève; Schuler, Franz

    2011-08-01

    The bile duct-cannulated (BDC) rat is a standard animal model used in ADME experiments. The aim of this study was to investigate post-surgical alterations that are relevant to ADME investigations in BDC rats compared with sham- and non-operated animals. Water and food intake was reduced in the animals' post-surgery. This led to a lower body weight in operated animals. In BDC animals, aspartate aminotransferase (AST) levels in plasma were transiently elevated and total bile acid levels were reduced. Alpha(1)-acid glycoprotein (AGP) in plasma and the concentration of bile components in bile were elevated. Histopathology showed inflammation in the area of the cannulation between the liver and the small intestine. A microarray-based gene expression and RTq-PCR analysis identified altered expression for several genes involved in drug disposition including the down-regulation of cytochrome P450 enzymes. This led to reduced cytochrome P450 content in the liver and lower metabolic activity in microsomes from BDC and sham-operated rats compared with naïve animals. The results of the study suggest that the post-surgical inflammation leads to physiological changes relevant for drug absorption and disposition. These alterations should be accounted for in the interpretation of ADME studies in BDC animals. PMID:21521079

  5. Development of competencies for the use of bedside ultrasound for assessment and cannulation of hemodialysis vascular access.

    PubMed

    Marticorena, Rosa M; Mills, Linda; Sutherland, Kelly; McBride, Norma; Kumar, Latha; Bachynski, Jovina Concepcion; Rivers, Carol; Petershofer, Elizabeth J; Hunter, Joyce; Luscombe, Rick; Donnelly, Sandra

    2015-01-01

    Use of ultrasound for hemodialysis vascular access assessment and real-time cannulation requires specialized training. In order to obtain basic hand-eye coordination, theoretical sessions on ultrasound use, as well as practical sessions using phantom models are recommended prior to its use in the clinical setting with patients. New users of this technology need to consider that all competencies can be achieved with daily use of ultrasound at the bedside. It takes approximately 500 guided cannulations to achieve the highest level of competency described above. PMID:26964424

  6. Evaluation of Previously Cannulated Radial Arteries as Patent Coronary Artery Bypass Conduits

    PubMed Central

    Pope, Adele; van Pelt, Niels; Ruygrok, Peter N.

    2015-01-01

    In coronary artery bypass grafting, good-quality conduits are needed to maximize the potential for long-term patency. Revascularization has traditionally been achieved with use of the saphenous vein and the internal thoracic arteries. In recent years, total arterial revascularization with use of the radial arteries has been promoted. Meanwhile, use of the transradial approach for coronary angiography has also increased. The long-term effects of previous cannulation in radial artery bypass grafts are not known. Therefore, we used multidetector computed tomographic angiography to investigate radial-artery graft patency in a small series of patients who had undergone transradial angiography. We found a high patency rate, and we discuss those findings here. PMID:26504438

  7. Improving room layouts for venepuncture, cannulation and ABG equipment on surgical wards.

    PubMed

    Pedley, Ryan; Whitehouse, Anna; Hammond, Sarah

    2014-01-01

    The Productive Ward series has effectively helped to standardise the storage of equipment in hospital ward treatment rooms; however, in our organisation equipment for venepunture and cannulation had been excluded. This resulted in clinicians having to navigate several unfamiliar environments while on-call and hence waste valuable time searching for basic equipment. We aimed to make it easier to locate and identify the basic equipment used for cannulation, venepuncture, and arterial blood gas sampling and more efficient to collect. We examined the initial layout of equipment on four surgical wards in a large teaching hospital. The time taken for junior doctors, nurses, health care assistants, and physician assistants to gather equipment on these wards was recorded along with a process map of steps involved. Our intervention was to relocate the equipment into adjacent storage and make it easily identifiable by the use of a 'red dot'. Following these changes we repeated the measurements. There was an overall reduction in the mean time taken to gather the equipment required to insert a venous cannula on an unfamiliar ward from 2 min 41 s pre-intervention (range 52 s to 6 mins 58 s, n = 23) to 26 s post-intervention (range 8 s to 1 min 20 s, n = 51). Additionally, the number of steps involved in the process was reduced from 16 to five. All of the 32 junior doctors surveyed felt that faster identification improved patient safety. A significant reduction in the time wasted by clinicians searching for venepuncture equipment on surgical wards has been achieved by simplifying the storage, layout, and identification of this kit. The accumulated benefit includes increased productivity, familiarity, and safety, which is paramount when attending unwell patients on unfamiliar wards. PMID:26734247

  8. The effect of right internal jugular vein cannulation on intracranial pressure.

    PubMed

    Woda, R P; Miner, M E; McCandless, C; McSweeney, T D

    1996-10-01

    Access to the central venous circulation is often necessary in patients who have elevated intracranial pressure. It has been suggested that a disadvantage of the internal jugular vein approach to the central circulation may be an elevated intracranial pressure. The purpose of this prospective study was to evaluate the effect of right internal jugular vein cannulation on intracranial pressure in patients who are at risk of intracerebral hypertension. Eleven adult patients studied in the intensive care unit were evaluated. The population included those patients who were admitted to the neurosurgical intensive care unit requiring intracranial pressure monitoring and central venous access. With the intracranial pressure monitor in place, patients were put in supine and 30 degrees head-up positions while intracranial pressure was recorded. The Queckenstedt maneuver was performed on all patients. A central venous line was then placed in the right internal jugular vein, and intracranial pressure was recorded. The Queckenstedt maneuver was again performed in the study population, and intracranial pressure measurements were recorded for the right, left, and bilateral compression of the internal jugular vein. The results of the intracranial pressure measurements before and after placement of the central venous line were statistically analyzed using single-factor analysis of variance over time. The mean Glasgow coma and Apache II scores for the study groups were 8 +/- 4 and 15 +/- 6, respectively. There were no significant differences in heart rate; cerebral perfusion pressure; or systolic, mean, or diastolic pressures throughout the study period. There was no statistical difference found between the intracranial pressures at any time point throughout the study. Furthermore, no difference was found in percentage change from baseline intracranial pressure data throughout the study period. Our results suggest that cannulation of the right internal jugular vein is a safe

  9. Wire-Guide Manipulator For Automated Welding

    NASA Technical Reports Server (NTRS)

    Morris, Tim; White, Kevin; Gordon, Steve; Emerich, Dave; Richardson, Dave; Faulkner, Mike; Stafford, Dave; Mccutcheon, Kim; Neal, Ken; Milly, Pete

    1994-01-01

    Compact motor drive positions guide for welding filler wire. Drive part of automated wire feeder in partly or fully automated welding system. Drive unit contains three parallel subunits. Rotations of lead screws in three subunits coordinated to obtain desired motions in three degrees of freedom. Suitable for both variable-polarity plasma arc welding and gas/tungsten arc welding.

  10. ACAT2 and ABCG5/G8 are both required for efficient cholesterol absorption in mice: evidence from thoracic lymph duct cannulation[S

    PubMed Central

    Nguyen, Tam M.; Sawyer, Janet K.; Kelley, Kathryn L.; Davis, Matthew A.; Kent, Carol R.; Rudel, Lawrence L.

    2012-01-01

    The metabolic fate of newly absorbed cholesterol and phytosterol is orchestrated through adenosine triphosphate-binding cassette transporter G5 and G8 heterodimer (G5G8), and acyl CoA:cholesterol acyltransferase 2 (ACAT2). We hypothesized that intestinal G5G8 limits sterol absorption by reducing substrate availability for ACAT2 esterification and have attempted to define the roles of these two factors using gene deletion studies in mice. Male ACAT2−/−, G5G8−/−, ACAT2−/−G5G8−/− (DKO), and wild-type (WT) control mice were fed a diet with 20% of energy as palm oil and 0.2% (w/w) cholesterol. Sterol absorption efficiency was directly measured by monitoring the appearance of [3H]sitosterol and [14C]cholesterol tracers in lymph after thoracic lymph duct cannulation. The average percentage (± SEM) absorption of [14C]cholesterol after 8 h of lymph collection was 40.55 ± 0.76%, 19.41 ± 1.52%, 32.13 ± 1.60%, and 21.27 ± 1.35% for WT, ACAT2−/−, G5G8−/−, and DKO mice, respectively. [3H]sitosterol absorption was <2% in WT and ACAT2−/− mice, whereas it was up to 6.8% in G5G8−/− and DKO mice. G5G8−/− mice also produced chylomicrons with ∼70% less cholesterol ester mass than WT mice. In contrast to expectations, the data demonstrated that the absence of G5G8 led to decreased intestinal cholesterol esterification and reduced cholesterol transport efficiency. Intestinal G5G8 appeared to limit the absorption of phytosterols; ACAT2 more efficiently esterified cholesterol than phytosterols. The data indicate that handling of sterols by the intestine involves both G5G8 and ACAT2 but that an additional factor (possibly Niemann-Pick C1-like 1) may be key in determining absorption efficiency. PMID:22669916

  11. Comparison of an ultrasound-guided technique versus a landmark-guided technique for internal jugular vein cannulation.

    PubMed

    Dolu, Hasan; Goksu, Sıtkı; Sahin, Levent; Ozen, Onder; Eken, Levent

    2015-02-01

    Central venous cannulation is a commonly preformed procedure in many branches of medicine, particularly in anaesthesia and intensive care medicine. The purpose of this study was to compare the landmark-guided technique to the ultrasound-guided technique for internal jugular vein cannulation in cardiovascular surgery patients. One hundred cardiovascular surgery patients, of whom 65 were male and 35 were female with ages ranging from 22 to 65, who had internal jugular cannulation between December 2010-March 2011 in our clinic were investigated prospectively. Patients were randomized into two groups; ultrasound guided internal jugular cannulation cases in group U (n=50), and anatomic landmark guided cases in group A (n=50). The number of attempts until successful catheterization, the time required for successful catheterization, arising complications, the demographics and the duration of catheterization were recorded for each patient. There were no significant differences found in the demographic features between the two groups. The number of attempts for successful catheterization was statistically lower in group U (1.1±0.5) than in group A (2.2±1.6). The time required for successful catheterization was statistically lower in group U (109.4±30.4) than in group A (165.9±91.5). There were no significant differences found in the total complications of the two groups (p=0.092). Four patients had an arterial punction [group U (n=0) and group A (n=4)] and two patients had a hematoma [group U (n=1) and group A (n=1)]. Arterial punction complication was increased significantly in landmark group (p=0.041). The findings of this study indicate that internal jugular vein catheterization guided by real-time ultrasound results in a lower access time and a lower rate of attempts. PMID:24838550

  12. Polymeric Curcumin Nanoparticle Pharmacokinetics and Metabolism in Bile Duct Cannulated Rats

    PubMed Central

    Zou, Peng; Helson, Lawrence; Maitra, Anirban; Stern, Stephan T.; McNeil, Scott E.

    2013-01-01

    The objective of this study was to compare the pharmacokinetics and metabolism of polymeric nanoparticle encapsulated (nanocurcumin), and solvent solubilized curcumin formulations in Sprague Dawley (SD) rats. Nanocurcumin is currently under development for cancer therapy. Since free, unencapsulated curcumin is rapidly metabolized and excreted in rats, upon i.v. administration of nanocurcumin only nanoparticle encapsulated curcumin can be detected in plasma samples. Hence, the second objective of this study was to utilize the metabolic instability of curcumin to assess in vivo drug release from nanocurcumin. Nanocurcumin and solvent solubilized curcumin were administered at 10 mg curcumin/kg by jugular vein to bile duct-cannulated male SD rats (n = 5). Nanocurcumin increased the plasma Cmax of curcumin 1749 fold relative to the solvent solubilized curcumin. Nanocurcumin also increased the relative abundance of curcumin and glucuronides in bile, but did not dramatically alter urine and tissue metabolite profiles. The observed increase in biliary and urinary excretion of both curcumin and metabolites for the nanocurcumin formulation suggested rapid, “burst” release of curcumin. Although the burst release observed in this study is a limitation for targeted tumor delivery, nanocurcumin still exhibits major advantages over solvent solubilized curcumin, as the nanoformulation does not result in the lung accumulation observed for the solvent solubilized curcumin and increases overall systemic curcumin exposure. Additionally, the remaining encapsulated curcumin fraction following burst release is available for tumor delivery via the enhanced permeation and retention effect commonly observed for nanoparticle formulations. PMID:23534919

  13. Pain during venous cannulation: Double-blind, randomized clinical trial of analgesic effect between topical amethocaine and eutectic mixture of local anesthetic

    PubMed Central

    Yeoh, CN; Lee, CY

    2012-01-01

    Background: Venous cannulation is often a painful procedure for the patient. Eutectic mixture of local anesthetic (EMLA) is the commonest topical analgesic used but suffers from disadvantages such as slow onset and skin blanching, which may interfere with venous cannulation. Amethocaine is a newer topical analgesic which seems to be devoid of such problems. Materials and Methods: This prospective randomized double-blind study compared the analgesic efficacy of EMLA with amethocaine during venous cannulation in adults. Eighty ASA I-II patients, aged 18–65 years, were recruited. The test drug was applied on the designated site of venous cannulation and covered with an occlusive dressing for at least 60 min prior to the procedure. Data collected included visual analogue score (VAS) during first attempt at venous cannulation, the ease and success rate at cannulation, and cutaneous changes at the application site. Results: Mean and median VAS for the EMLA group were 27.9 ± 9.8 and 30 mm, respectively; while for the Amethocaine group were 19.1 ± 14.1 and 20 mm, respectively. Differences in VAS did not reach statistical significance. No statistically significant differences were observed in the ease and success rate at cannulation. Cutaneous changes in the form of local induration and erythema (three patients in the Amethocaine group) and blanching (eight patients in the EMLA group) were mild, localized, and required no further treatment. No patient developed severe allergic reactions. Conclusion: Topical EMLA and amethocaine were comparable in terms of analgesic efficacy and ease of venous cannulation in adult patients. PMID:22557744

  14. Endoscopic bile duct and/or pancreatic duct cannulation technique for patients with surgically altered gastrointestinal anatomy.

    PubMed

    Okabe, Yoshinobu; Ishida, Yusuke; Kuraoka, Kei; Ushijima, Tomoyuki; Tsuruta, Osamu

    2014-04-01

    There are two major hurdles to carrying out endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered gastrointestinal anatomy (Billroth II gastrectomy [B-II], Roux-en-Y anastomosis [R-Y] etc.), post-pancreatoduodenectomy or post-choledochojejunostomy. These are: (i) the endoscopic approach to the afferent loop, blind end, and the site of bilio-pancreatic anastomosis; and (ii) bile duct and/or pancreatic duct cannulation. Balloon-assisted enteroscopy (BAE) became available in recent years and is now being actively used to overcome the first hurdle and, at least, the success rate has improved. However, room for improvement still remains in regards to the second hurdle (i.e. the success rate of cannulation of the bile duct and/or pancreatic duct), and there has been a desire for the development of dedicated devices (ERCP catheters, hoods etc.) and for improvement in the functionality of the enteroscopes etc. In the present review, we explain the basic procedure for bile duct and/or pancreatic duct cannulation with conventional endoscopes and BAE, and modifications of the basic procedure. PMID:24750161

  15. Iatrogenic ascending aortic dissection following cannulation for arterial return and for infusion of cardioplegic solution: Prevention and repair

    PubMed Central

    Ugorji, Clement C.; Cooley, Denton A.; Norman, John C.

    1980-01-01

    Two patients are presented in whom dissection of the ascending aorta resulted from cannulation for arterial return and from the infusion of cardioplegic solution. The dissections were recognized promptly. Following dissection in the first patient, the femoral artery was used to reestablish systemic perfusion. The aortic valve and dissected ascending aorta were replaced, and three vessels were grafted. In the second patient, the dissected anterior wall of the ascending aorta was excised and replaced with a low-porosity Dacron patch into which the proximal aortocoronary anastomoses were inserted. Predisposing factors are discussed, along with preventive measures and methods of repair. PMID:15216287

  16. Excessive Access Cannulation Site Bleeding Predicts Long-Term All-Cause Mortality in Chronic Hemodialysis Patients.

    PubMed

    Tsai, Wan-Chuan; Chen, Hung-Yuan; Lin, Chi-Lin; Huang, Shu-Chen; Hsu, Shih-Ping; Pai, Mei-Fen; Peng, Yu-Sen; Chiu, Yen-Ling

    2015-10-01

    Our group has previously reported that excessive vascular access bleeding during dialysis treatment in stable hemodialysis (HD) patients was associated with anemia and may indicate poorer health. The association between excessive blood loss from access cannulation site and clinical outcomes was unknown. We hypothesized that excessive access bleeding may have an impact on all-cause and cardiovascular (CV) mortality in this population. We prospectively conducted an observational, longitudinal study of 360 HD patients. Excessive access bleeding was defined as at least an occurrence of blood loss greater than 4 mL per HD session during a study period of one month. During a median follow-up of 83 months, all-cause mortality and CV mortality were registered. Outcomes were analyzed by Kaplan-Meier and Cox proportional hazards regression analyses. A total of 118 (32.8%) participants died and 54 of these were from CV death. Using a multivariate Cox proportional hazards regression, access bleeding was found to be an independent predictor of all-cause mortality (HR 1.67, 95% CI 0.96-2.91, P = 0.070) but not for CV death (HR 1.53, 95% CI 0.88-2.68, P = 0.135). Our study identified that excessive access cannulation site bleeding could be a novel marker for increased risk of death in HD patients. PMID:25944488

  17. Cannulation Selection of Portal Venous and Splenic Venous Catheterization in Venovenous Bypass of Swine Orthotopic Liver Transplantation.

    PubMed

    Wang, Meng-Yuan; Wang, Meng-Hao; Peng, Yong; You, Hai-Bo; Chen, Xian-Feng; Zhao, Lei; Gan, Lin; Li, Min; Li, Jin-Zheng; Gong, Jian-Ping; Li, Xu-Hong

    2016-01-01

    BACKGROUND The aim of this study was to compare the hemodynamic changes in 2 different cannulations in portal system (portal venous catheterization and splenic venous catheterization) during venovenous bypass (VVB) of swine orthotopic liver transplantation (OLT) MATERIAL AND METHODS Thirty pairs (a total of 60) of healthy Duroc pigs were selected for OLT. According to the difference of cannulation in portal venous system during VVB, these pigs were divided into 2 groups: the PVC group (pigs with portal venous catheterization, n=15) and the SVC group (pigs with splenic venous catheterization, n=15). Intraoperative hemodynamic parameters were monitored continuously. RESULTS Two recipients in the PVC group died: 1 died of unsmooth bypass during the operation and 1 died of disseminated intravascular coagulation (DIC). There was only 1 death in the SVC group, due to hemorrhagic shock. The duration of anhepatic phase (AP) in the SVC group was significantly shorter than in the PVC group (P<0.05). Moreover, hemodynamic parameters in phase III (5 min after start of portal vein suturing) and phase IV (5 min after graft reperfusion) were remarkably different between the SVC group and the PVC group (P<0.05). CONCLUSIONS Our results show that VVB via splenic venous catheterization in swine OLT: 1) shortens the AP time; 2) keeps the hemodynamics stable; and 3) reduces the occurrence of postoperative complications. Thus, SVC appears to be superior to PVC. PMID:27251849

  18. [Central cannulation of the aorta by Seldinger technique in DeBakey type I acute aortic dissection with malperfusion of internal organs].

    PubMed

    Barbukhatti, K O; Belash, S A; Kaleda, V I

    2016-01-01

    Described herein is a case report concerning the use of central cannulation of the aorta by Seldinger technique for DeBakey type I aortic dissection with the involvement of both femoral arteries and the brachiocephalic trunk, as well as with thrombosis of the false lumen from the level of the ascending aorta. This is followed by a brief review discussing the methods of instrumental control of the cannula position in the true lumen of the aorta, as well as peculiarities of using this technique of cannulation in various clinical situations. PMID:27626260

  19. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  20. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation.

    PubMed

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    BACKGROUND The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. MATERIAL AND METHODS A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. RESULTS There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). CONCLUSIONS The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  1. Real time three-dimensional transesophageal echocardiography guided coronary sinus cannulation during CARILLON mitral annuloplasty device therapy for a patient with chronic severe mitral regurgitation.

    PubMed

    Mahmoud, Hani M; Al-Ghamdi, Mohammed A; Ghabashi, Abdullah E

    2015-01-01

    The coronary sinus (CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time. PMID:25231878

  2. A single burr hole approach for direct transverse sinus cannulation for the treatment of a dural arteriovenous fistula

    PubMed Central

    Caplan, Justin M; Kaminsky, Ian; Gailloud, Philippe; Huang, Judy

    2014-01-01

    A 55-year-old woman with a symptomatic Borden II/Cognard IIa+b transverse sinus dural arteriovenous fistula underwent an attempted percutaneous transvenous embolization which was ultimately not possible given the fistula anatomy. She then underwent a partial percutaneous transarterial embolization but the fistula recurred. Given the failed percutaneous interventions, the patient underwent a combined open surgical/transvenous embolization using neuronavigation and a single burr hole craniectomy. She has remained symptom free for 3 months. This case report illustrates the feasibility of combining minimally invasive open surgical access to allow for direct venous cannulation for endovascular embolization of a dural arteriovenous fistula when traditional percutaneous methods are not an option. PMID:24398868

  3. Recommendation to Exclude Bile-Duct-Cannulated Rats with Hyperbilirubinemia for Proper Conduct of Biliary Drug Excretion Studies.

    PubMed

    Kato, Koji; Hasegawa, Yoshitaka; Iwata, Katsuya; Ichikawa, Takuya; Yahara, Tohru; Tsuji, Satoshi; Sugiura, Masayuki; Yamaguchi, Jun-Ichi

    2016-08-01

    Hyperbilirubinemia (HB) is sometimes encountered following bile-duct cannulation in rats. It possibly originates from the reduced functioning of multidrug resistance-associated protein 2 (Mrp2) and subsequent adaptive alterations in the expression of Mrp3 and the organic anion transporting polypeptides (Oatps). Our aim was to clarify the importance of excluding bile-duct-cannulated (BDC) rats with HB for proper conduct of drug excretion studies. We detected HB [serum total bilirubin concentration (TBIL) ≥0.20 mg/dl] in 16% of all BDC rats prepared. The serum activities of aspartate aminotransferase, alanine aminotransferase, leucine aminopeptidase, and alkaline phosphatase were within the respective normal ranges in the BDC rats with mild HB (TBIL, 0.20-0.79 mg/dl), indicating the absence of hepatic failure. In the pharmacokinetics of pravastatin, an Oatps/Mrp2 probe drug in the BDC rats, the apparent volume of distribution and the clearance were smaller in the mild HB group as compared with the normal group, suggesting the reduction of apparent hepatic uptake and hepatobiliary elimination. The biliary excretion (percentage of dose) was significantly reduced by 54%, suggesting that the biliary efflux activity via Mrp2 was reduced to a greater extent relative to metabolic activity in hepatocytes. The serum γ-glutamyltransferase (GGT) activity correlated with TBIL and inversely correlated with biliary excretion of pravastatin, a finding which could serve as a clue to uncover the regulatory system involving cooperation between GGT and Mrp2. In conclusion, BDC rats with HB, however mild, should be excluded from drug excretion studies to avoid the risk of underestimation of the biliary excretion of drugs. PMID:27208382

  4. Biomechanical and finite element analyses of bone cement-Injectable cannulated pedicle screw fixation in osteoporotic bone.

    PubMed

    Liu, Yaoyao; Xu, Jianzhong; Sun, Dong; Luo, Fei; Zhang, Zehua; Dai, Fei

    2016-07-01

    The objectives of this study were to investigate the safety and biomechanical stability of a polymethylmethacrylate (PMMA)-augmented bone cement-injectable cannulated pedicle screw (CICPS) in cancellous bone model, and to analyze the stress distribution at the screw-cement-bone interface. The OMEGA cannulated pedicle screw (OPS) and conventional pedicle screw (CPS) were used as control groups. Safety of the CICPS was evaluated by the static bending and bending fatigue tests. Biomechanical stability was analyzed by the maximum axial pullout strength and maximum torque tests. Stress distribution at the screw-cement-bone interface was analyzed by the finite element (FE) method. The CICPS and CPS produced statistically similar values for bending stiffness, bending structural stiffness, and bending yield moment. The maximum pullout force was 53.47 ± 8.65 N in CPS group, compared to 130.82 ± 7.32 N and 175.45 ± 43.01 N in the PMMA-augmented OPS and CICPS groups, respectively (p < 0.05). The CICPS had a significantly greater torque than the OPS and CPS. The FE model did not reveal excessive stress at the screw-cement-bone interface in the CICPS group. In conclusion, PMMA-augmentation with CICPS may be a potentially useful method to increase the stability of pedicle screws in patients with osteoporosis. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 960-967, 2016. PMID:25976272

  5. Anatomical features of the vertebral artery for transbrachial direct cannulation of a guiding catheter to perform coil embolization of cerebral aneurysms in the posterior cerebral circulation

    PubMed Central

    Iwata, Tomonori; Miyazaki, Yuichi; Tanno, Yuhei; Kasakura, Shigen; Aoyagi, Yoshinori

    2015-01-01

    Background Transbrachial approach is an alternative technique for coil embolization of posterior circulation aneurysms. The purpose of our study was to investigate the anatomical features of the vertebral artery (VA) for transbrachial direct VA cannulation of a guiding catheter (GC) to perform coil embolization of posterior circulation aneurysms. Methods Included in retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation by direct VA cannulation of a GC from 2007 to 2013. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the target VA and the subclavian artery (AVS), and the VA diameter at the level of the fourth cervical vertebral body (VAD) in the side of the transbrachial access route. Results Thirty-one patients with 32 aneurysms met our criteria. The locations of aneurysms were the VA (n = 16), basilar artery (BA) tip (n = 10), BA trunk (n = 3), BA superior cerebellar artery (n = 1), BA anterior inferior cerebellar artery (n = 1), and VA posterior inferior cerebellar artery (n = 1). The right brachial artery was punctured in 27 cases with 28 aneurysms as transbrachial direct cannulation of a GC, and left was in 4 cases with 4 aneurysms. The average AVS, ranging from 45° to 95°, was 77°, and the average VAD, ranging from 3.18 to 4.45 mm, was 3.97 mm. Conclusion For transbrachial direct cannulation of a GC, it seems required that the AVS is about 45° or more and the VAD is about 3.18 mm or more. PMID:25964434

  6. A novel mechanical simulator for cannulation and sphincterotomy after Billroth II or Roux-en-Y reconstruction

    PubMed Central

    Frimberger, Eckart; Abdelhafez, Mohamed; Schmid, Roland M.; von Delius, Stefan

    2016-01-01

    Introduction: In patients with Billroth II (B II) or Roux-en-Y anatomy, endoscopic retrograde cholangiopancreatography (ERCP) is demanding. Here, we describe a novel simulator with simulated fluoroscopy for cannulation and sphincterotomy training in such situations. Methods: A custom-made simulation system was built based upon a common chassis of a series of previously described ERCP simulators. The papilla is made out of organic material and can be cut by high frequency current. The advancement of guidewires and other instruments within transparent mock bile ducts can be viewed in the window of the simulator without the need for fluoroscopy. The ERCP B II/Roux-en-Y simulation system was first evaluated during an ERCP course. Results: There were no technical problems related to the novel simulator during the course. After sphincterotomy, the organic papillae could easily be exchanged within a few seconds. Overall, the novel B II/Roux-en-Y simulator achieved favorable results by trainees and expert endoscopists in all categories assessed. Conclusions: The new B II/Roux-en-Y mechanical simulator is simple and practicable. A first evaluation during an ERCP course showed promising results. PMID:27540584

  7. Differences in sensitivity of rat mesenteric small arteries to agonists when studied as ring preparations or as cannulated preparations.

    PubMed Central

    Buus, N. H.; VanBavel, E.; Mulvany, M. J.

    1994-01-01

    1. Pharmacological experiments on vascular tissue are normally performed on isometric ring or strip preparations. The aim of this study was to compare the isometric characteristics with the characteristics obtained if vessels were examined under the more physiologically appropriate isobaric condition. 2. Rat mesenteric small arteries were mounted either on two steel wires for isometric force measurement (wire-myograph) or cannulated for measurement of the internal diameter under isobaric conditions (pressure-myograph). 3. The passive pressure-diameter characteristics of the small arteries were similar on the wire- and pressure-myograph (using the Laplace relation to convert wall tension-internal circumference data from the wire-myograph to effective pressure-diameter characteristics). 4. In cumulative concentration-response experiments with noradrenaline and phenylephrine, the threshold concentration was 8-10 times lower, and the EC50-concentration was 4-5 times lower, in the pressure myograph compared to the wire-myograph. Thus vessels were not only more sensitive on the pressure myograph, but the slopes of the concentration-response curves were less steep. Similar experiments with vasopressin also showed this difference in the threshold-concentration and slope, but EC50 concentrations were similar. 5. Cumulative concentration-response experiments with K+ showed no difference either in EC50 or in slope on the wire- and pressure-myographs. 6. On the wire-myograph, some vessels were stretched longitudinally (to mimic the longitudinal stretch which had to be used in the pressure-myograph to avoid buckling). Such stretch did not affect the passive characteristics.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7915613

  8. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: A comparative study between cannulated screws with cement injection and solid screws with cement pre-filling

    PubMed Central

    2011-01-01

    Background Pedicle screws with PMMA cement augmentation have been shown to significantly improve the fixation strength in a severely osteoporotic spine. However, the efficacy of screw fixation for different cement augmentation techniques, namely solid screws with retrograde cement pre-filling versus cannulated screws with cement injection through perforation, remains unknown. This study aimed to determine the difference in pullout strength between conical and cylindrical screws based on the aforementioned cement augmentation techniques. The potential loss of fixation upon partial screw removal after screw insertion was also examined. Method The Taguchi method with an L8 array was employed to determine the significance of design factors. Conical and cylindrical pedicle screws with solid or cannulated designs were installed using two different screw augmentation techniques: solid screws with retrograde cement pre-filling and cannulated screws with cement injection through perforation. Uniform synthetic bones (test block) simulating severe osteoporosis were used to provide a platform for each screw design and cement augmentation technique. Pedicle screws at full insertion and after a 360-degree back-out from full insertion were then tested for axial pullout failure using a mechanical testing machine. Results The results revealed the following 1) Regardless of the screw outer geometry (conical or cylindrical), solid screws with retrograde cement pre-filling exhibited significantly higher pullout strength than did cannulated screws with cement injection through perforation (p = 0.0129 for conical screws; p = 0.005 for cylindrical screws). 2) For a given cement augmentation technique (screws without cement augmentation, cannulated screws with cement injection or solid screws with cement pre-filling), no significant difference in pullout strength was found between conical and cylindrical screws (p >0.05). 3) Cement infiltration into the open cell of the test block led to

  9. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor.

    PubMed

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the 'MAU style' trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust

  10. A standardised storage solution for venepuncture/cannulation equipment could save an NHS hospital the equivalent of a whole junior doctor

    PubMed Central

    Lindley, Steven; Robertson, Ian

    2014-01-01

    Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the ‘MAU style’ trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust

  11. An inexpensive drivable cannulated microelectrode array for simultaneous unit recording and drug infusion in the same brain nucleus of behaving rats.

    PubMed

    du Hoffmann, Johann; Kim, James J; Nicola, Saleem M

    2011-08-01

    Neurons are functionally segregated into discrete populations that perform specific computations. These computations, mediated by neuron-neuron electrochemical signaling, form the neural basis of behavior. Thus fundamental to a brain-based understanding of behavior is the precise determination of the contribution made by specific neurotransmitters to behaviorally relevant neural activity. To facilitate this understanding, we have developed a cannulated microelectrode array for use in behaving rats that enables simultaneous neural ensemble recordings and local infusion of drugs in the same brain nucleus. The system is inexpensive, easy to use, and produces robust and quantitatively reproducible drug effects on recorded neurons. PMID:21613588

  12. Complex regional pain syndrome and acute carpal tunnel syndrome following radial artery cannulation: a neurological perspective and review of the literature.

    PubMed

    Lazaro, Reynaldo P

    2015-01-01

    Complex regional pain syndrome (CRPS) associated with acute carpal tunnel syndrome (aCTS) developed in a 38-year-old right-handed man following radial artery cannulation (RAC) during the course of lumbar spine surgery. Inciting events and risk factors that might have led to these complications included: multiple arterial punctures and subsequent hematoma formation, radial artery spasm compounded by aggressive hemostasis, anatomical changes in the wrists related to repetitive manual activities in the workplace, and possible protracted hyperextension of the wrists during perioperative and operative procedure. Although CRPS is considered a rare complication of RAC, the condition is disabling and debilitating, especially when associated with aCTS. PMID:25621693

  13. Technical note: Can the sulfur hexafluoride tracer gas technique be used to accurately measure enteric methane production from ruminally cannulated cattle?

    PubMed

    Beauchemin, K A; Coates, T; Farr, B; McGinn, S M

    2012-08-01

    An experiment was conducted to determine whether using ruminally cannulated cattle affects the estimate of enteric methane (CH(4)) emissions when using the sulfur hexafluoride (SF(6)) tracer technique with samples taken from a head canister. Eleven beef cattle were surgically fitted with several types of ruminal cannula (2C, 3C, 3C+washer, 9C; Bar Diamond, Parma, ID). The 2C and 3C models (outer and inner flanges with opposite curvature) had medium to high leakage, whereas the 9C models (outer and inner flanges with the same curvature) provided minimum to moderate leakage of gas. A total of 48 cow-day measurements were conducted. For each animal, a permeation tube containing sulfur hexafluoride (SF(6)) was placed in the rumen, and a sample of air from around the nose and mouth was drawn through tubing into an evacuated canister (head canister). A second sample of air was collected from outside the rumen near the cannula into another canister (cannula canister). Background concentrations were also monitored. The methane (CH(4)) emission was estimated from the daily CH(4) and SF(6) concentrations in the head canister (uncorrected). The permeation SF(6) release rate was then partitioned based on the proportion of the SF(6) concentration measured in the head vs. the cannula canister. The CH(4) emissions at each site were calculated using the two release rates and the two CH(4):SF(6) concentration ratios. The head and cannula emissions were summed to obtain the total emission (corrected). The difference (corrected - uncorrected) in CH4 emission was attributed to the differences in CH(4):SF(6) ratio at the 2 exit locations. The proportions of CH(4) and SF(6) recovered at the head were greater (P < 0.001) for the 9C cannulas (64% and 66%) compared with the other cannulas, which were similar (P > 0.05; 2C, 6% and 4%; 3C, 17% and 15%; 3C+washer, 19% and 14%). Uncorrected CH(4) emissions were ± 10% of corrected emissions for 53% of the cow-day measurements. Only when more

  14. Revision characteristics of cement-augmented, cannulated-fenestrated pedicle screws in the osteoporotic vertebral body: a biomechanical in vitro investigation. Technical note.

    PubMed

    Blattert, Thomas R; Glasmacher, Stefan; Riesner, Hans-Joachim; Josten, Christoph

    2009-07-01

    In generalized osteoporosis, instrumentation with cement-augmented pedicle screws is an amplification of the therapeutic spectrum. Early clinical results are promising for both solid and cannulated screws; however, there are concerns regarding the revision characteristics of these screws, especially for the cannulated-fenestrated type with its continuous cement interconnection from the core of the screw to surrounding bone tissue. In a human cadaver model, bone mineral density (BMD) was assessed radiographically. Spinal levels T9-L4 were instrumented left unilaterally, transpedicularly by using cannulated-fenestrated pedicle screws with the dimensions 6.5 x 45 mm. Polymethylmethacrylate cement (1.5 ml) was injected through the screws into each vertebra. After polymerization of the cement, the extraction torque was recorded. For both implantation and explantation of the screws, a fluoroscope was used to guarantee correct screw and cement positioning and to observe possible co-movements-that is, any movement of the cement mass within the vertebral body upon removal of the screw. For comparison, the extraction torque of same-dimension pedicle screws was recorded in a nonosteoporotic, non-cement-augmented instrumentation. The BMD was 0.60 g/cm2, a level that corresponds to a severe grade of osteoporosis. For removal of the screws, the median and mean extraction torques were 34 and 49 +/- 44 Ncm, respectively. No co-movements of the cement mass occurred within the vertebral body. In the nonosteoporotic control, BMD was 1.38 g/cm2. The median and mean extraction torques were 123 and 124 +/- 12 Ncm, respectively. Thus, the revision characteristics of cement-augmented, cannulated-fenestrated pedicle screws are not problematic, even in cases of severe osteoporosis. The winglike cement interconnection between the screw core and surrounding bone tissue is fragile enough to break off in the event of an extraction torque and to release the screw. There is no proof to support

  15. Backscattering particle immunoassays in wire-guide droplet manipulations.

    PubMed

    Yoon, Jeong-Yeol; You, David J

    2008-01-01

    A simpler way for manipulating droplets on a flat surface was demonstrated, eliminating the complications in the existing methods of open-surface digital microfluidics. Programmed and motorized movements of 10 muL droplets were demonstrated using stepper motors and microcontrollers, including merging, complicated movement along the programmed path, and rapid mixing. Latex immunoagglutination assays for mouse immunoglobulin G, bovine viral diarrhea virus and Escherichia coli were demonstrated by merging two droplets on a superhydrophobic surface (contact angle = 155 +/- 2 degrees ) and using subsequent back light scattering detection, with detection limits of 50 pg mL-1, 2.5 TCID50 mL-1 and 85 CFU mL-1, respectively, all significantly lower than the other immunoassay demonstrations in conventional microfluidics (~1 ng mL-1 for proteins, ~100 TCID50 mL-1 for viruses and ~100 CFU mL-1 for bacteria). Advantages of this system over conventional microfluidics or microwell plate assays include: (1) minimized biofouling and repeated use (>100 times) of a platform; (2) possibility of nanoliter droplet manipulation; (3) reprogrammability with a computer or a game pad interface. PMID:19014703

  16. Successful rescue from cardiac arrest in a patient with postinfarction left ventricular blow-out rupture: "extra-pericardial aortic cannulation" for establishment total cardiopulmonary bypass.

    PubMed

    Ohira, Suguru; Yaku, Hitoshi; Nakajima, Shunsuke; Takahashi, Akihiko

    2014-08-01

    We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture. PMID:25179976

  17. Service and collaboration keys to physician control.

    PubMed

    Bujak, Joseph S

    2002-01-01

    Discover what physicians must do to regain power and half health care's slide from a profession toward a trade. The solutions lie in better customer service and improved physician collaboration. PMID:12055949

  18. Coronary sinus blood flow and coronary haemodynamic function in children: measurement by the continuous thermodilution method with coronary sinus cannulation via the femoral vein.

    PubMed Central

    Hamaoka, K; Onouchi, Z; Kamiya, Y

    1991-01-01

    In 19 children with Kawasaki disease without any cardiac sequelae the coronary sinus was cannulated via the femoral vein with a specially designed flow catheter and coronary sinus blood flow was measured by the continuous thermodilution method. There was a statistically significant positive correlation between coronary sinus blood flow and age, body surface area, and left ventricular mass, but coronary sinus blood flow per left ventricular mass (100 g) was negatively correlated with age, body surface area, and left ventricular mass. Coronary vascular resistance was negatively correlated with age, body surface area, and left ventricular mass. Younger children require a much greater coronary blood flow per left ventricular mass and have a higher coronary vascular resistance than older children and adolescents. These results may indicate that coronary blood flow is less efficient in childhood than in adolescence or adulthood. Images PMID:2015130

  19. Safe and easy method with little modification in technique is useful for successful internal jugular vein cannulation on same side even after intra-arterial puncture without using ultrasound guidance in adult cardiac patients

    PubMed Central

    Thosani, Rajesh; Patel, Jigar; Gandhi, Hemang; Doshi, Chirag; Kothari, Jignesh

    2016-01-01

    Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate. PMID:27052069

  20. Pharmacokinetics of TDP223206 following intravenous and oral administration to intact rats and intravenous administration to bile duct-cannulated rats.

    PubMed

    Chen, Yanmin; Cheng, Deping; Marugan, Juan Jose; Manthey, Carl; Tomczuk, Bruce; Huebert, Norman

    2008-05-01

    The pharmacokinetics of TDP223206 was studied following single intravenous and oral administrations in rats. A mixture of TDP223206 and (14)C-TDP223206 were administered to intact and bile duct-cannulated rats. Following intravenous administration, plasma concentrations declined biphasically. The AUC(inf) increased linearly with dose but was not dose proportional. The PK parameters of TDP223206 indicated low clearance (254-386 ml/h/kg) and a moderate volume of distribution (968-1883 ml/kg). The bioavailability was 32.95% and 24.46% for 10 and 50 mg/kg oral doses, respectively. (14)C-TDP223206 was distributed widely into different tissues with small intestine, liver, kidneys and large intestine having large tissue to plasma ratios. (14)C-TDP223206 was the major circulating component in the plasma. A total of 91.2% of administered radioactivity of (14)C-TDP223206 was recovered in bile indicating that biliary excretion was the major pathway for drug elimination. (14)C-TDP223206-acyl glucuronides were the major metabolites in bile. The oxo-(14)C-TDP223206 was the major metabolite in plasma and an important metabolite in bile. Two forms of diastereomeric acyl glucuronides of (14)C-TDP223206 were detected in bile with similar LC/MS intensities suggesting a similar biotransformation capacity. Only one form of these (14)C-TDP223206-acyl glucuronides was detected in plasma suggesting that enterohepatic recirculation was related to the nature of the stereo-isomers. PMID:18260095

  1. Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study—80 Case Studies and 6 Years of Follow-Up

    PubMed Central

    Poggetti, Andrea; Rosati, Marco; Castellini, Iacopo; Evangelisti, Gisberto; Battistini, Pietro; Parchi, Paolo; Lisanti, Michele

    2015-01-01

    Background Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA). Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10). Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head–trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV. PMID:26261746

  2. The metabolism of 4-bromoaniline in the bile-cannulated rat: application of ICPMS (79/81Br), HPLC-ICPMS & HPLC-oaTOFMS

    PubMed Central

    Duckett, Catherine; McCullagh, Michael; Smith, Christopher; Wilson, Ian D

    2015-01-01

    Abstract 1. An excretion balance study was performed following i.p. administration of 4-bromoaniline (50 mg kg−1) to bile-cannulated rats, using bromine-detected (79/81Br) ICPMS for quantification. Approximately 90% of the dose was recovered in urine (68.9 ± 3.6%) and bile (21.4 ± 1.4%) by 48 h post-administration. 2. HPLC-ICPMS (79/81Br) was used to selectively detect and profile the major urinary and biliary-excreted metabolites and determined that the 0–12 h urine contained at least 21 brominated metabolites with 19 bromine-containing peaks observed in the 6–12 h bile samples. 3. The urinary and biliary metabolites were subsequently profiled using HPLC-oaTOFMS. By exploiting the distinctive bromine isotope pattern ca. 60 brominated metabolites were detected in the urine in negative electrospray ionisation (ESI) mode while bile contained ca. 21. 4. While a large number of bromine-containing metabolites were detected, the profiles were dominated by a few major components with the bulk of the 4-bromoaniline-related material in urine accounted for by 4-bromoanaline O-sulfate (∼75% of the total by ICPMS, 84% by TOFMS). In bile a hydroxylated N-acetyl compound was the major metabolite detected, forming some ∼65% of the 4-bromoaniline-related material by ICPMS (37% by TOFMS). PMID:25837688

  3. The Effect of Polymethyl Methacrylate Augmentation on the Primary Stability of Cannulated Bone Screws in an Anterolateral Plate in Osteoporotic Vertebrae: A Human Cadaver Study

    PubMed Central

    Rüger, Matthias; Sellei, Richard M.; Stoffel, Marcus; von Rüden, Christian

    2015-01-01

    Study Design Cohort study. Objective Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this in vitro study, the craniocaudal yield load of the osseous fixation of an anterior angular stable plate fixation system and the effect of polymethyl methacrylate (PMMA) screw augmentation on the primary stability of the screw–bone interface during kyphosis reduction was evaluated in 12 osteoporotic human thoracolumbar vertebrae. Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to 12 thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement-controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean 393 ± 66 N, whereas the cemented screws showed significantly higher yield load of 966 ± 166 N (p < 0.02). We detected no significant correlation between bone mineral density and yield load in this setting. Conclusion Our results indicate that PMMA augmentation is an effective method to increase two- to threefold the primary stability of the screw–bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend it in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability. PMID:26835201

  4. Digestibility energy and amino acids of canola meal from two species (Brassica juncea and Brassica napus) fed to distal ileum cannulated grower pigs.

    PubMed

    Le, M H A; Buchet, A D G; Beltranena, E; Gerrits, W J J; Zijlstra, R T

    2012-12-01

    Yellow-seeded Brassica juncea is a novel canola species targeted to grow in the southern Canadian prairies where thermotolerance, disease resistance, and adaptation to dry agronomic conditions are required. The support of its cultivation needs nutritional evaluation of its coproduct. The B. juncea canola meal (CM) contains less fiber than conventional, dark-seeded Brassica napus CM but also slightly less Lys. In a 6 × 6 Latin square, 6 distal ileum cannulated pigs (47 kg BW) were fed 6 diets to determine the apparent ileal digestibility (AID) and standardized ileal digestibility (SID) of CP and AA, AID and apparent total tract digestibility (ATTD) of energy, and VFA content in digesta and feces. Pigs were fed 6 diets: basal [46% wheat (Triticum aestivum) and corn (Zea mays) starch], 4 diets with 46% wheat and either B. juncea or B. napus CM at 25 or 50%, and a N-free diet based on corn starch. The B. juncea CM had higher (P < 0.05) ATTD of energy than B. napus CM (68.6 vs. 60.3%) likely due to its lower fiber content. Ileal total VFA was lower (P < 0.001) in pigs fed B. juncea than B. napus CM diets. In pigs fed B. juncea CM, the molar ratio in digesta was lower (P < 0.001) for acetate and butyrate whereas the propionate ratio was lower (P < 0.001) in feces than in pigs fed B. napus CM diets. The CM species did not affect the AID of energy, SID of AA, and feces VFA content. The DE value was higher (P < 0.05) and content of SID Lys was lower (P < 0.05) for B. juncea than B. napus CM. In conclusion, availability of B. juncea CM, a coproduct of a canola species grown in Canadian prairie land, will increase flexibility in swine feed formulation. PMID:23365335

  5. The Effect of Polymethyl Methacrylate Augmentation on the Primary Stability of Cannulated Bone Screws in an Anterolateral Plate in Osteoporotic Vertebrae: A Human Cadaver Study.

    PubMed

    Rüger, Matthias; Sellei, Richard M; Stoffel, Marcus; von Rüden, Christian

    2016-02-01

    Study Design Cohort study. Objective Expandable anterolateral plates facilitate the reduction of posttraumatic deformities of thoracolumbar spine injuries and are commonly used in cases of unstable injuries or compromised bone quality. In this in vitro study, the craniocaudal yield load of the osseous fixation of an anterior angular stable plate fixation system and the effect of polymethyl methacrylate (PMMA) screw augmentation on the primary stability of the screw-bone interface during kyphosis reduction was evaluated in 12 osteoporotic human thoracolumbar vertebrae. Methods The anterolateral stabilization device used for this study is comprised of two swiveling flanges and an expandable midsection. It facilitates the controlled reduction of kyphotic deformities in situ with a geared distractor. Single flanges were attached to 12 thoracolumbar vertebrae. Six specimens were augmented with PMMA by means of cannulated bone screws. The constructs were subjected to static, displacement-controlled craniocaudal loading to failure in a servohydraulic testing machine. Results The uncemented screws cut out at a mean 393 ± 66 N, whereas the cemented screws showed significantly higher yield load of 966 ± 166 N (p < 0.02). We detected no significant correlation between bone mineral density and yield load in this setting. Conclusion Our results indicate that PMMA augmentation is an effective method to increase two- to threefold the primary stability of the screw-bone interface of an anterolateral spine stabilization system in osteoporotic bone. We recommend it in cases of severely compromised bone quality to reduce the risk of screw loosening during initial kyphosis correction and to increase long-term construct stability. PMID:26835201

  6. IRS views on physician control of integrated networks.

    PubMed

    Griffith, G M

    1995-11-01

    Integrated delivery systems and their components are evolving rapidly, as are Internal Revenue Service (IRS) tax-exemption rulings and standards affecting these entities. A common concern addressed by two recent IRS tax-exemption rulings centered on the impact of physician involvement on a hospital's tax-exempt status. PMID:10151865

  7. UPLC-MS, HPLC-radiometric, and NMR-spectroscopic studies on the metabolic fate of 3-fluoro-[U-14C]-aniline in the bile-cannulated rat.

    PubMed

    Athersuch, T J; Castro-Perez, J; Rodgers, C; Nicholson, J K; Wilson, Ian D

    2010-07-01

    1. A study of the rates and routes of excretion of 3-fluoro-[U-(14)C]aniline following intraperitoneal administration to male bile-cannulated rats by liquid scintillation counting (LSC) gave a total recovery of approximately 90% in the 48 h following dosing, with the majority of the dose being excreted in the urine during the first 24 h (approximately 49%). 2. The total recovery as determined by (19)F-nuclear magnetic resonance ((19)F-NMR) was approximately 49%, with the majority of the dose excreted in the first 24 h (approximately 41%). The comparatively low recovery in comparison to that obtained from LSC was due to matrix effects in bile and a contribution from metabolic defluorination. 3. High-performance liquid chromatography with radiometric profiling of urine and bile revealed a complex pattern of metabolites with the bulk of the dose excreted as a single peak. 4. Ultra-performance liquid chromatography-orthogonal acceleration time of flight mass spectrometry profiling also showed a complex pattern of metabolites, detecting approximately 21 metabolites of 3-fluoroaniline (3-FA) with six of these detected only in urine and four solely in bile. 5. (19)F-NMR revealed the presence of the parent compound and 15 metabolites in urine collected during the first 24 h after -dosing. The matrix effects of bile on (19)F-NMR spectroscopy made metabolite profiling impractical for this biofluid. The major metabolite of 3-FA was identified as 2-fluoro-4-acetamidophenol-sulfate. PMID:20443683

  8. Cannulation in situ of equine umbilicus. Identification by gas chromatography-mass spectrometry (GC-MS) of differences in steroid content between arterial and venous supplies to and from the placental surface.

    PubMed

    Marshall, D E; Gower, D B; Silver, M; Fowden, A; Houghton, E

    1999-03-01

    Equine umbilicus was cannulated in utero and a series of cord plasma samples removed for analysis. After steroid extraction and derivatisation, gas chromatographic-mass spectrometric (GC-MS) analysis demonstrated large differences in steroid content between the plasma samples obtained from the umbilical artery and vein, the blood supplies leading to and from the placental surface, respectively. 3Beta-hydroxy-5,7-androstadien-17-one, dehydroepiandrosterone, pregnenolone, 3beta-hydroxy-5alpha-pregnan-20-one, 5-pregnene-3beta,20beta-diol and 5beta-pregnane-3beta,20beta-diol were identified as major constituents in extracts from umbilical arterial plasma samples, mostly as unconjugated steroids. Together with 5alpha-pregnane-3,20-dione, these steroids were identified in extracts from umbilical venous plasma samples but at significantly reduced levels to those determined in arterial plasma samples. Oestradiol-17alpha, dihydroequilin-17alpha and dihydroequilenin-17alpha were identified in extracts (mostly sulphate-conjugated) from both umbilical arterial and venous plasma samples, much larger amounts being detected in the plasma sampled from, rather than to, the placental surface. Equilin, equilenin, oestrone, oestradiol-17beta, dihydroequilin-17beta and dihydroequilenin-17beta were not detected in the present studies. Isomers of 5(10)-oestrene-3,17beta-diol together with 5(10),7-oestradiene-3,17beta-diol and its possible oxidative artifact, 5(10),7,9-oestratriene-3,17beta-diol, were tentatively identified only in sulphate-conjugated extracts from umbilical venous plasma samples. No glucuronic acid-conjugated steroids could be detected. The implications of this work in the elucidation of the biosynthetic pathways leading to both the formation of oestrogens and C18 neutral steroids at the placental surface are discussed. PMID:10416837

  9. Long-term closed chest partial and total cardiopulmonary bypass by peripheral cannulation for severe right and/or left ventricular failure, including ventricular fibrillation. The use of a percutaneous spring in the pulmonary artery position to decompress the left heart.

    PubMed

    Kolobow, T; Rossi, F; Borelli, M; Foti, G

    1988-01-01

    The authors report that total cardiopulmonary bypass (CPBP) for severe heart failure can be safely maintained for several days through peripheral cannulation alone. In two healthy sheep under general anesthesia, the authors cannulated the right external jugular vein and the right subclavian artery. A special spring was attached to a 7F Swan-Ganz catheter and positioned at the level of the pulmonary artery (PA) valve, rendering it partially incompetent. The extracorporeal circuit included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator set at 25 beats/min. Ventricular fibrillation was induced with 110 VAC. Extracorporeal blood flow was raised to 100-120 ml/kg min. Mechanical pulmonary ventilation was changed to 5% CO2 in room air. During bypass, the wedge pressure (WP) averaged 9-13 mmHg, PA pressure 7-13 mmHg, and central venous pressure 1-9 mmHg. After 38 and 48 hr respectively the hearts were defibrillated with DC shock. There was total heart failure with no ejection from right or left. We continued with TCPBP. The right heart recovered after 1 and 3 hr respectively. After 7 and 5 hr, respectively, there was some aortic ejection. By 11 and 4 hr, respectively, the sheep were off bypass and on room air, with return to baseline cardiac function. Throughout the recovery the WP averaged 4-8 mmHg. At autopsy, all hearts were soft and normal in appearance. Histologic examination of the lungs and the heart was unremarkable. The authors conclude that the PA spring readily decompressed the LV. Ventilating lungs with 5% CO2 in air during CPBP sustained excellent lung function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3196550

  10. Evaluation of venous distension device: potential aid for intravenous cannulation.

    PubMed

    Hedges, J R; Weinshenker, E; Dirksing, R

    1986-05-01

    A device designed to augment venous filling by applying a vacuum to the upper extremity during tourniquet application was evaluated. Ten healthy adult male volunteers with clinical normovolemia were studied for changes in forearm volume and dorsal hand vein turgor during use of an elastic tubing tourniquet, a blood pressure cuff tourniquet, and a vacuum-assisted cuff tourniquet. Use of the device for 30 seconds was not associated with petechia formation and resulted in a significant increase in venous turgor, as measured by an ophthalmologic tonometer, in comparison to the other tourniquet techniques (P less than .005). Use for 60 seconds was associated with mild to moderate subjective discomfort in all volunteers and petechiae in all nine white volunteers. All petechiae resolved in three days. Venous engorgement as reflected by volume displacement was significantly greater for the vacuum device and blood pressure cuff tourniquet combination than other techniques at 30 and 60 seconds of tourniquet application (P less than .005). Brief application of a vacuum to the arm during tourniquet use increases venous turgor and engorgement in normovolemic volunteers. PMID:3963533

  11. Therapeutic opportunities when using vapocoolants for cannulation in children.

    PubMed

    Richardson, Cliff; Ovens, Elizabeth

    2016-07-28

    How nurses make a difference and influence outcome has been the subject of much debate over many years and is perhaps more relevant now owing to healthcare funding being a scarce commodity. Nurses need justification and validation of what they do. Nursing therapeutics is a relatively new term that can help nurses and others to appreciate the multifariousness, complexity and value of what they do. It encapsulates the means by which a nurse delivers care that is both evidence based and beneficial to his or her patients. This article highlights how nurses can make use of common nursing interventions to ensure that the full impact of their skills is embedded in their care-using the administration of vapocoolants as the focus of the discussion. It will be illustrated that through each patient contact, a nurse can establish therapeutic principles that can positively influence health outcomes. PMID:27467652

  12. Proximal migration of a 5 French pancreatic stent during bile stone extraction: a successful retrieval using mini-snare.

    PubMed

    Liao, Yu-Sheng; Zhao, Qiu; Fan, Yan; Wu, Jie

    2014-01-01

    Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications. PMID:24714023

  13. Thoracic Duct Cannulation and Hemal Node Formation in Mice Infected with Cowpox Virus

    PubMed Central

    Wallnerova, Zlata; Mims, C. A.

    1970-01-01

    Mice experiencing generalized and fatal infection after i.v. injection of large doses of cowpox virus showed no significant changes in the recirculating pool of thoracic duct lymphocytes. There was little or no growth of virus in lymphoid tissues, but changes associated with the immune response and with stress (mediated by corticosteroid hormones) were substantial. A characteristic feature of fatal cowpox virus infection was the formation of hemal nodes accompanied by the appearance of large numbers of erythrocytes in the thoracic duct lymph from the 3rd day after inoculation. Erythrocytes entered lymphatics to form hemal nodes after extravasation from small blood vessels. Extravasation resulted from vascular damage caused by the growth of virus in vessel walls. ImagesFigs. 2, 6-7Figs. 8-9 PMID:5420988

  14. Protein digestibility evaluations of meat and fish substrates using laboratory, avian and ileally cannulated dog assays

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fish and meat protein serves as important protein sources in the human and companion animal diets: however, limited information is available on differences in protein quality. Pollock fillet, and salmon fillet, beef loin, pork loin and chicken breast, were evaluated for protein quality and amino aci...

  15. The Relationship of the Subclavius Muscle with Relevance to Venous Cannulation below the Clavicle

    PubMed Central

    Kawagishi, Kyutaro; Tokumine, Joho; Lefor, Alan Kawarai

    2016-01-01

    Introduction. The catheter “pinch-off syndrome” has been described to be secondary to crimping of the catheter between the clavicle and the first rib, as well as entrapment of the catheter at the site of penetration of the subclavius muscle. The lateral insertion technique has been recommended to prevent catheter pinch-off, but it is unknown if this technique can prevent entrapment by the subclavius muscle. We undertook this study to evaluate the anatomical relationship of the subclavius muscle and the subclavian vein. Methods. Twenty-eight adult cadavers were studied on both right and left sides. The adherence between the subclavian vein and subclavius muscle was subjectively assessed and the distance between the two structures was measured in mm. Results. The subclavius muscle and subclavian vein were tightly adherent in 72% of specimens, partly adherent in 14% with a mean distance of 4.5 mm and loosely connected in 14% with a mean distance of 6.1 mm. Conclusions. The anatomical relationship between the subclavius muscle and vein was very close in the majority of specimens, suggesting that the lateral insertion technique may not prevent penetration of the muscle, which may contribute to catheter pinch-off. The real-time ultrasound-guided technique may prevent penetration of the subclavius muscle. PMID:26966432

  16. Innovative technique: Distal venous cannulation for salvaging free flap venous thrombosis by heparinised saline irrigation

    PubMed Central

    Kalra, G. D. S.; Mohanty, Devidutta; Jain, Ritesh

    2015-01-01

    Introduction: Successful free tissue transfer depends on a multitude of factors, and adequate drainage of venous blood is one of the most critical part of successful free tissue transfers. Material and Methods: We report 6 cases of microvascular free flaps used for covering various defects, which developed venous congestion, that were salvaged with heparinised saline irrigation through the distal end of the congested vein by the help of an intravenous cannula. The irrigation was continued for 5 days. Results: All the flaps were successfully salvaged. Conclusion: This method has potential applications in situations for successful salvage of free tissue transfer particularly due to venous thrombosis. PMID:25991887

  17. The Relationship of the Subclavius Muscle with Relevance to Venous Cannulation below the Clavicle.

    PubMed

    Kawagishi, Kyutaro; Tokumine, Joho; Lefor, Alan Kawarai

    2016-01-01

    Introduction. The catheter "pinch-off syndrome" has been described to be secondary to crimping of the catheter between the clavicle and the first rib, as well as entrapment of the catheter at the site of penetration of the subclavius muscle. The lateral insertion technique has been recommended to prevent catheter pinch-off, but it is unknown if this technique can prevent entrapment by the subclavius muscle. We undertook this study to evaluate the anatomical relationship of the subclavius muscle and the subclavian vein. Methods. Twenty-eight adult cadavers were studied on both right and left sides. The adherence between the subclavian vein and subclavius muscle was subjectively assessed and the distance between the two structures was measured in mm. Results. The subclavius muscle and subclavian vein were tightly adherent in 72% of specimens, partly adherent in 14% with a mean distance of 4.5 mm and loosely connected in 14% with a mean distance of 6.1 mm. Conclusions. The anatomical relationship between the subclavius muscle and vein was very close in the majority of specimens, suggesting that the lateral insertion technique may not prevent penetration of the muscle, which may contribute to catheter pinch-off. The real-time ultrasound-guided technique may prevent penetration of the subclavius muscle. PMID:26966432

  18. Endoscopic prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

    PubMed Central

    Lee, Tae Hoon; Park, Do Hyun

    2014-01-01

    Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography (EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation, precut fistulotomy, and transpancreatic septostomy are reviewed. Prophylactic pancreatic stent placement, which is the best-known prophylactic method, is reviewed with reference to the ideal stent type, adequate duration of stent placement, and stent-related complications. Finally, we comment on other treatment alternatives, and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis. PMID:25469026

  19. Cannulation of the internal carotid artery in mice: a novel technique for intra-arterial delivery of therapeutics.

    PubMed

    Santillan, Alejandro; Rubin, David G; Foley, Conor P; Sondhi, Dolan; Crystal, Ronald G; Gobin, Y Pierre; Ballon, Douglas J

    2014-01-30

    We have developed a novel minimally invasive technique for the intra-arterial delivery of therapeutics to the mouse brain. CD-1 mice were anesthetized and placed in a lateral decubitus position. A 10mm midline longitudinal incision was made over the thyroid bone. The omohyoid and sternomastoid muscles were retracted to expose the common carotid artery and external carotid artery (ECA). To maximize delivery of administered agents, the superior thyroid artery was ligated or coagulated, and the occipital artery and the pterygopalatine artery (PPA) were temporarily occluded with 6-0 prolene suture. The ECA was carefully dissected and a permanent ligature was placed on its distal segment while a temporary 6-0 prolene ligature was placed on the proximal segment in order to obtain a flow-free segment of vessel. A sterilized 169 μm outer diameter polyimide microcatheter was introduced into the ECA and advanced in retrograde fashion toward the carotid bifurcation. The catheter was then secured and manually rotated so that the microcatheter tip was oriented cephalad in the internal carotid artery (ICA). We were able to achieve reproducible results for selective ipsilateral hemispheric carotid injections of mannitol mediated therapeutics and/or gadolinium-based MRI contrast agent. Survival rates were dependent on the administered agent and ranged from 78 to 90%. This technique allows for reproducible delivery of agents to the ipsilateral cerebral hemisphere by utilizing anterograde catheter placement and temporary ligation of the PPA. This method is cost-effective and associated with a low rate of morbimortality. PMID:24269174

  20. Rotational Stability of Scaphoid Osteosyntheses: An In Vitro Comparison of Small Fragment Cannulated Screws to Novel Bone Screw Sets

    PubMed Central

    Erhart, Jochen; Unger, Ewald; Schefzig, Philip; Varga, Peter; Trulson, Inga; Gormasz, Anna; Trulson, Alexander; Reschl, Martin; Hagmann, Michael; Vecsei, Vilmos; Mayr, Winfried

    2016-01-01

    Background The current standard of care for operative repair of scaphoid fractures involves reduction and internal fixation with a single headless compression screw. However, a compression screw in isolation does not necessarily control rotational stability at a fracture or nonunion site. The single screw provides rotational control through friction and bone interdigitation from compression at the fracture site. We hypothesize that osteosyntheses with novel bone screw sets (BSS) equipped with anti-rotational elements provide improved rotational stability. Methods Stability of osteosynthesis under increasing cyclic torsional loading was investigated on osteotomized cadaveric scaphoids. Two novel prototype BSS, oblique type (BSS-obl.) and longitudinal type (BSS-long.) were compared to three conventional screws: Acutrak2®mini, HCS®3.0 and Twinfix®. Biomechanical tests were performed on scaphoids from single donors in paired comparison and analyzed by balanced incomplete random block design. Loading was increased by 50 mNm increments with 1,000 cycles per torque level and repeated until a rotational clearance of 10°. Primary outcome measure was the number of cycles to 10° clearance, secondary outcome measure was the maximum rotational clearance for each torque level. Findings BSS-obl. performed significantly better than Acutrak2®mini and HCS® (p = 0.015, p<0.0001). BSS-long. performed significantly better than HCS® (p = 0.010). No significant difference in performance between BSS-obl. and BSS-long. (p = 0.361), between BSS obl. and Twinfix® (p = 0.50) and BSS long. and Twinfix® (p = 0.667) was detected. Within the torque range up to 200 mNm, four of 21 (19%) BSS-long. and four of 21 (19%) BSS-obl. preparations showed early failure. The same loading led to early failure in four (29%) Twinfix®, seven (50%) Acutrak2®mini and 10 (71%) HCS® of 14 screw samples, respectively. Conclusions For both BSS and to a lesser extent for Twinfix® (as dual-component screw), higher rotational stabilities were identified in comparison to single component headless compression screws. PMID:27258387

  1. Internal jugular vein cannulation complications and elimination of the muscular triangle of the neck due to aberrant infrahyoid muscles.

    PubMed

    Raikos, Athanasios; Agnihotri, Ashwin; Yousif, Saif; Kordali, Panagiota; Saberi, Minu; Brand-Saberi, Beate

    2014-01-01

    We report on a rare case of anatomical variations of the infrahyoid muscles with prominent clinical significance. The aberrant anatomy was on the right side of the neck and involved the omohyoid and sternohyoid muscles. The superior belly of the omohyoid was duplicated in width due to an aberrant belly anteriorly and merged with fibers of the inferior belly inferiorly and the sternohyoid muscle medially. An additional aberrant muscle slip extended between the inferior third of the sternohyoid muscle and united with the inferior belly of the omohyoid. The intermediate tendon between the two bellies of the omohyoid was absent, whereas the so-called muscular triangle of the neck was diminished. Due to the arrangement and fusion of myofibers the muscle could be termed as omo-sternohyoid muscle. A profound hematoma was noted in the aberrant muscle at the area overlying the internal jugular vein indicating difficulty in obtaining jugular venous access for catheter placement. Clinicians and surgeons should be aware of muscular anatomic variations when intervening in the lateral neck area as the classical anatomical landmarks might be misinterpreted and confuse. PMID:25329135

  2. Videothoracoscopic management of a perforated central vein and pleura after ultrasound-guided internal jugular vein cannulation: a case report

    PubMed Central

    Kim, Jeong-Eun; Jeon, Joon-Pyo; Kim, Yongsuk; Jeong, Su Ah

    2014-01-01

    A 23-year-old male underwent a left internal jugular vein catheterization during extended surgery for treatment of multiple fractures due to a traffic accident. Although the catheterization was performed under ultrasound (US) guidance, iatrogenic perforation of the central vein and pleura occurred. The catheter was removed, and the perforated site was addressed under thoracoscopy rather than an open thoracotomy. This case suggests that using US does not completely guarantee a complication-free outcome, and that catheter placement should be carefully confirmed. In addition, this case suggests that thoracoscopy may be an ideal method of resolving a perforation of the central vein and pleura. PMID:24851167

  3. Solute equilibrium over the extracellular fluid space in haemorrhagic hypotension: a study in a cannulated thoracic duct model.

    PubMed

    Ware, J; Norberg, K A; Nylander, G

    1983-01-01

    Haemorrhagic hypotension, 50 mm Hg, has been inflicted on non-starved rats. Osmolar and solute developments have been followed in lymph and arterial plasma to assess diffusion and equilibration characteristics of the initial stages of haemorrhage. Lymph flow changes have reflected an intracellular fluid mobilization to the interstitium, caused by an osmotic gradient due to the elevated levels of glucose. A fluid homeostatic effect of pseudodiabetes associated with stress and haemorrhage is postulated. PMID:6617708

  4. Influence of Ileo-Caecal Cannulation and Oxytetracycline on Ileo-Caecal and Rectal Coliform Populations in Pigs

    PubMed Central

    Högberg, A; Lindberg, JE; Wallgren, P

    2001-01-01

    The effect of surgery (insertion of an ileo-caecal cannula) and a subsequent parenteral treatment with oxytetracycline on the ileo-caecal and rectal coliform populations in 7 Swedish Yorkshire castrates were studied. Samples were collected during surgery as well as 3, 7, 14 and 20 days post surgery. The diversity of the enteric coliform flora was initially high both in the ileo-caecal ostium and in rectum. No alteration in the diversity of the enteric coliform flora was observed following surgery and treatment with oxytetracycline. As the insertion of ileo-caecal cannulas did not affect the intestinal coliform flora this study gives support to the use of this technique to mirror processes in the small intestine of pigs. Further, the diversity of the enteric coliform flora was unaffected by the parenteral treatment with oxytetracycline. PMID:11957371

  5. Cannulation of the biliary tree under endoscopic control with an echoendoscope, without fluoroscopy: report of a case series

    PubMed Central

    Mangiavillano, Benedetto; Carrara, Silvia; Petrone, Maria Chiara; Santoro, Tara; Testoni, Pier Alberto

    2015-01-01

    Introduction: Endoscopic ultrasonography (EUS) is a validated technique allowing precise diagnosis and staging of pancreatic, biliary and ampullary disease. Developments in instruments and accessories have led to a more extensive use of this technology to perform operations. The use of EUS as an operative technique, alone or in conjunction with other endoscopic procedures, has already been described in the literature in several reports. However, despite the use of EUS, fluoroscopy has always been required to perform these operations. There are no data in the literature describing the feasibility, safety and efficacy of operative EUS in the treatment of common bile duct (CBD) obstruction, following a malignant or benign disease, performed completely under EUS guidance without fluoroscopic assistance. Methods: In this series we describe three cases of EUS treatment of CBD diseases performed without fluoroscopic assistance. Results: All the cases were treated by EUS without fluoroscopic assistance and no complications were encountered. Conclusion: Operative EUS without fluoroscopy appears to be a feasible technique. Its major advantages could be to shorten the examination time and to enable biliary or pancreatic operative endoscopy in patients in whom fluoroscopy could be dangerous, such as pregnant women. The endoscopist should have a good training both in EUS and endoscopic retrograde cholangiopancreatography. Prospective, larger studies are needed to confirm our preliminary data. PMID:25949525

  6. Contrast-free endoscopic stent insertion in malignant biliary obstruction

    PubMed Central

    De Palma, Giovanni D; Lombardi, Giovanni; Rega, Maria; Simeoli, Immacolata; Masone, Stefania; Siciliano, Saverio; Maione, Francesco; Salvatori, Francesca; Balzano, Antonio; Persico, Giovanni

    2007-01-01

    AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/guiding catheter by a pusher tube system. RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study. PMID:17663512

  7. Long-term bioeffects of 435-MHz radiofrequency radiation on selected blood-borne endpoints in cannulated rats. Volume 6. Cardiovascular studies. Final report, October 1982-June 1985

    SciTech Connect

    Popovic, V.P.; Toler, J.C.; Bonasera, S.J.; Popovic, P.P.; Honeycutt, C.B.

    1988-01-01

    Two hundred adult male white rats with chronically implanted aortic cannulas were randomly divided into 2 groups. Animals in the first group were exposed to low-level pulsed-wave 435-MHz radiofrequency radiation for approximately 22 hours daily, 7 days a week, for 6 months. Animals in the second group were maintained under identical conditions but were not radiated. The cannulas were used to record heart rate and arterial blood pressure in unrestrained, unanesthetized rats. Statistical analysis of the results did not indicate any increase in heart rate or arterial blood pressure of RFR-exposed animals when compared to sham-exposed animals. Thus, chronic exposure to the low-level radiofrequency environment did not induce stress that was manifested as increases in heart rate or mean arterial blood pressure. This result correlated with the conclusion of a previous report demonstrating no RFR effects on plasma norepinephrine and epinephrine concentrations in the group of rats.

  8. Long-term bioeffects of 435-MHz radiofrequency radiation on selected blood-borne endpoints in cannulated rats. Volume 4. Plasma catecholamines. Final report, October 1982-June 1985

    SciTech Connect

    Popovic, V.P.; Toler, J.C.; Bonasera, S.J.; Popovic, P.P.; Honeycutt, C.B.

    1987-08-01

    Two hundred adult male white rates (Sprague-Dawley) with chronically implanted aortic cannulas were randomly divided into two groups. Animals in the first group were exposed to low-level (1.0mW/sq cm) pulsed-wave 435-MHz radiofrequency radiation (RFR) for about 22 h daily, 7 days each week for 6 months. Animals in the second group were maintained under identical conditions but were not irradiated. The aortic cannulas were used to draw microsamples (0.6 mL) of aortic blood from the unrestrained, unanesthetized rats on a cyclic schedule. Plasma catecholamine (nonrepinephrine, epinephrine, and dopamine) concentrations were determined by radioimmunoassays. Statistical analysis of the results did not indicate increased plasma catecholamine concentrations on radiation-exposed animals when compared to sham-exposed animals. Exposure to this nonionizing radiofrequency (RF) environment did not induce stresses that were manifested as an alteration in plasma hormones.

  9. [An accidental puncture of a small artery behind the internal jugular vein in real-time ultrasound-guided pediatric central venous cannulation].

    PubMed

    Kayashima, Kenji

    2013-02-01

    A baby girl, 15-month-old, 75.6 cm in height, and 7.5 kg in weight, was scheduled to undergo ventricular septal defect repair. The right IJV, 3.0 mm in thickness and 7.0 mm in depth, was punctured to place a central venous catheter with a 19-mm-long 24G puncture needle. Non-pulsatile bright red blood appeared during the 15.8-mm-long needle insertion and dark red blood appeared during the 14.7-mm-long needle insertion. The vertebral artery, 3.9 mm in width, lay 14.1 mm in depth. The 15.8-mm-long needle inserted at a 45-degree angle could reach about 11.3 mm deep perpendicularly from the skin surface. The 14.7-mm-long needle inserted at a 45-degree angle reached about 10.4 mm, which is near the posterior wall of the IJV It seemed that a small artery behind the IJV was punctured mistakenly. In withdrawing blood from a cyanotic patient, it may be difficult to judge if the blood was arterial because it was non-pulsatile when it appeared. We should be careful to know the existence of small arteries behind IJVs and to confirm which vessels the returned blood comes from. PMID:23479923

  10. Hemodynamic effects of left atrial or left ventricular cannulation for acute circulatory support in a bovine model of left heart injury.

    PubMed

    Kapur, Navin K; Paruchuri, Vikram; Pham, Duc Thinh; Reyelt, Lara; Murphy, Barbara; Beale, Corinna; Bogins, Courtney; Wiener, Daniel; Nilson, James; Esposito, Michele; Perkins, Scott; Perides, George; Karas, Richard H

    2015-01-01

    Our objective was to examine the hemodynamic effects of a trans-aortic axial flow catheter (Impella CP) in the left ventricle (LV) versus left atrial (LA) to femoral artery bypass using a centrifugal pump (TandemHeart: TH) in a bovine model of acute LV injury. In three male calves, we performed sequential activation of a CP then TH device in each animal. After 60 minutes of left anterior descending artery ligation, a CP was activated at maximal power. The CP was then removed and the TH activated at 5,500 then a maximum of 7,500 rotations per minute (RPM). The CP generated a maximum 3.1 ± 0.2 L/minute (LPM) of flow, whereas the TH at 5,500 and 7,500 RPM generated 3.1 ± 0.4 and 4.4 ± 0.3 LPM. At 3.1 LPM, the CP and TH reduced LV stroke work (LVSW) similarly. The TH reduced stroke volume, whereas the CP did not. The CP reduced end-systolic pressure, whereas the TH did not. At a maximum flow of 4.4 LPM, the TH provided a greater reduction in LVSW than maximal CP activation. This is the first report to compare the hemodynamic effects of trans-aortic LV unloading versus LA-to-femoral artery (FA) bypass. PMID:25485565

  11. Quantification of short-chain fatty acids and energy production from hindgut fermentation in cannulated pigs fed graded levels of wheat bran.

    PubMed

    Iyayi, E A; Adeola, O

    2015-10-01

    This study investigated the amount of energy available to growing pigs from fermentation of dietary fiber in the hindgut. Eighteen growing barrows, fitted with a simple T-shaped cannula at the terminal ileum, were allocated to 3 experimental diets in a completely randomized design. The 3 diets were a standard-fiber diet (SFD), which contained 75.1 g NDF/kg diet; a medium-fiber diet (MFD) of 105.7 g NDF/kg diet; and a high-fiber diet (HFD), which contained 146.9 g NDF/kg diet. Each diet had 6 replicate pigs. After a 5-d period of adjustment of the pigs to the cage environment, feces were collected on d 6 and 7 and ileal digesta on d 8 and 9 and subsequently freeze-dried. Fecal slurry from a pig was used to inoculate the ileal digesta from the same pig. The amount of energy available was calculated from the amount of short-chain fatty acids (SCFA) produced from a 48-h in vitro fermentation of the ileal digesta. Increasing NDF enhanced ( < 0.01) the ileal DM flow and DM in feces. The energy available in the foregut was reduced ( < 0.05) from 3,360 to 2,974 kcal/kg feed DM and increased ( < 0.01) from 619 to 1,009 kcal/kg feed DM produced in the hindgut with increasing dietary NDF. The amount of SCFA increased ( < 0.01) with higher dietary NDF. Acetic acid was highest ( < 0.01) in the HFD whereas propionic and valeric acids were highest ( < 0.05) in the SFD. The amount of butyric acid was not affected by diet. The amount of energy contributed from SCFA fermentation to total tract digestible energy increased ( < 0.01) from 10.7 to 24.2% as dietary NDF level increased from 75 to 147 g/kg feed. The results of the study showed that increasing level of dietary NDF resulted in reduced energy digestibility in the foregut of growing pigs with a corresponding increase in the amount of energy from microbial fermentation in the hindgut. PMID:26523571

  12. Dual wire welding torch and method

    DOEpatents

    Diez, Fernando Martinez; Stump, Kevin S.; Ludewig, Howard W.; Kilty, Alan L.; Robinson, Matthew M.; Egland, Keith M.

    2009-04-28

    A welding torch includes a nozzle with a first welding wire guide configured to orient a first welding wire in a first welding wire orientation, and a second welding wire guide configured to orient a second welding wire in a second welding wire orientation that is non-coplanar and divergent with respect to the first welding wire orientation. A method of welding includes moving a welding torch with respect to a workpiece joint to be welded. During moving the welding torch, a first welding wire is fed through a first welding wire guide defining a first welding wire orientation and a second welding wire is fed through a second welding wire guide defining a second welding wire orientation that is divergent and non-coplanar with respect to the first welding wire orientation.

  13. 50 CFR 218.20 - Specified activity and specified geographical area and effective dates.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (Hellfire missile); (B) Tube-launched Optically tracked Wire-guided (TOW) missile; (C) Mine Neutralization (20 lb NEW charges); and (D) 5″ Naval Gunfire. (ii) Training Exercises: (A) Mine Neutralization (20...

  14. 50 CFR 218.20 - Specified activity and specified geographical area and effective dates.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... (Hellfire missile); (B) Tube-launched Optically tracked Wire-guided (TOW) missile; (C) Mine Neutralization (20 lb NEW charges); and (D) 5″ Naval Gunfire. (ii) Training Exercises: (A) Mine Neutralization (20...

  15. Electrode carrying wire for GTAW welding

    NASA Technical Reports Server (NTRS)

    Morgan, Gene E. (Inventor); Dyer, Gerald E. (Inventor)

    1990-01-01

    A welding torch for gas tungsten arc welding apparatus has a hollow tungsten electrode including a ceramic liner and forms the filler metal wire guide. The wire is fed through the tungsten electrode thereby reducing the size of the torch to eliminate clearance problems which exist with external wire guides. Since the wire is preheated from the tungsten more wire may be fed into the weld puddle, and the wire will not oxidize because it is always within the shielding gas.

  16. Left-sided mouse intubation: description and evaluation.

    PubMed

    Singer, Thomas; Brand, Vanessa; Moehrlen, Ueli; Fehrenbach, Heinz; Purkabiri, Kurosch; Ott, Sebastian Robert; Stammberger, Uz; Ochs, Matthias; Hamacher, Jürg

    2010-02-01

    A method of left main bronchus intubation was developed based on a wire guide-based microscopic endotrachael mouse intubation technique. The authors used a 22 G x 1 inch catheter elongated by a 38-mm silicone tube, and a wire guide with a tag to assign the length of the wire completely covered by the silicon tube. The isoflurane-anesthetized mouse was hung perpendicularly with its incisors on a thread and transorally intubated under strict vision with the wire guide tip advanced 3 mm out of the catheter. Then the catheter was advanced about 6 to 8 mm into the trachea. Afterwards the wire guide was redrawn to the level of the catheter tip (blue tag on the wire guide appeared at the upper end of catheter) to prevent injury. Then the neck was pushed into a right lateral flexion with one finger against a foam block fixed on the vertical plate, causing a straight distance between mouth and left main bronchus. This positioning allows to gently advance the catheter into the left main bronchus by another about 20 mm, using the wire guide with its tip just within the tube, to achieve there a wedge position with gentle pressure.The technique had a success rate of more than 80% in 81 mice weighing 23 to 48 g. It may be of interest for unilateral lung intervention, e.g., with injurious substances or with drugs. PMID:20128679

  17. Long-term bioeffects of 435-MHz radiofrequency radiation on selected blood-borne endpoints in cannulated rats. Volume 2. Plasma ACTH (adrenocorticotropic hormone) and plasma corticosterone. Final report, 20 August 1984-16 February 1986

    SciTech Connect

    Popovic, V.P.; Toler, J.C.; Bonasera, S.J.; Popovic, P.P.; Honeycutt, C.B.

    1987-08-01

    Two hundred adult male white rats with chronically implanted aortic cannulas were randomly divided into two groups. Animals in the first group were exposed to low-level (1.0 mW/cm2) pulsed-wave 435-MHz radiofrequency radiation (RFR) for approximately 22 h daily, 7 days each week, for 6 months. Animals in the second group were maintained under identical conditions, but were not radiated. The cannulas were used to draw microsamples (0.3 mL) of aortic blood from the unrestrained, unanesthetized rats on a cyclic schedule. Plasma adrenocorticotropic hormone (ACTH) and plasma corticosterone concentrations were determined by radioimmunoassays hormone (ACTH) and plasma corticosterone concentrations were determined by radioimmunoassays. Statistical analysis of the results did not indicate increased plasma ACTH and plasma corticosterone concentrations in exposed animals when compared to sham-exposed animals. Exposure to this low-level radiofrequency environment did not induce stresses that were manifested as an alteration in plasma hormones.

  18. Intake and digestibility by sheep, and in-situ disappearance in cannulated cows, and chemical composition of crabgrass hayed at two moisture concentrations and treated with a non-viable lactobacillus-lactic acid additive

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Crabgrass [Digitaria ciliaris (Retz.) Koel.] is a high-quality warm-season annual that can be used as hay, but field curing time may be lengthy compared with other forages. A 1.6-ha field of common crabgrass was divided into 12 plots that were used in a randomized complete block design with a 2 × 2 ...

  19. Chemical composition, intake by sheep, and in situ disappearance in cannulated cows of bermudagrass hayed at two moisture concentrations and treated with a non-viable lactobacillus-lactic acid preservative

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Bermudagrass [Cynodon dactylon (L.) Pers.] is commonly used for grazing and haying in the southern USA, but hay curing can be challenging due to frequent rainfall events during spring and early summer. An existing stand of ‘Greenfield’ bermudagrass was divided into 12 plots using a randomized comple...

  20. Endoscopic removal of esophageal and ruminal foreign bodies in 5 Holstein calves

    PubMed Central

    Gomez, Diego E.; Cribb, Nicola C.; Arroyo, Luis G.; Desrochers, André; Fecteau, Gilles; Nichols, Sylvain

    2014-01-01

    Endoscopic removal of esophageal and ruminal foreign bodies was successfully performed in 5 Holstein-Friesian calves under sedation or general anesthesia by using an electrocautery snare or a wire-guided Dormi basket. This report describes the endoscopic manipulations, treatment, and outcomes of esophageal foreign body removal in these calves. PMID:25320385

  1. Welding torch and wire feed manipulator

    NASA Technical Reports Server (NTRS)

    Williams, R. T.

    1967-01-01

    Welding torch and wire feed manipulator increase capability for performing automatic welding operations. The manipulator rotates on its horizontal axis to avoid obstacles as they approach the torch. The initial individual attitudes of the torch and wire guide are set with respect to the general configuration of the part.

  2. Rocket center Peenemuende - Personal memories

    NASA Technical Reports Server (NTRS)

    Dannenberg, Konrad; Stuhlinger, Ernst

    1993-01-01

    A brief history of Peenemuende, the rocket center where Von Braun and his team developed the A-4 (V-2) rocket under German Army auspices, and the Air Force developed the V-1 (buzz bomb), wire-guided bombs, and rocket planes, is presented. Emphasis is placed on the expansion of operations beginning in 1942.

  3. Manual tube-to-tubesheet welding torch

    SciTech Connect

    Kiefer, Joseph H.; Smith, Danny J.

    1982-01-01

    A welding torch made of a high temperature plastic which fits over a tube intermediate the ends thereof for welding the juncture between the tube and the back side of a tube plate and has a ballooned end in which an electrode, filler wire guide, fiber optic bundle, and blanketing gas duct are disposed.

  4. Extracorporeal membrane oxygenation with right axillary artery perfusion.

    PubMed

    Navia, José L; Atik, Fernando A; Beyer, Erik A; Ruda Vega, Pablo

    2005-06-01

    Extracorporeal membrane oxygenation can be instituted through various cannulation sites. This paper describes a technique for axillary artery cannulation for inflow perfusion in extracorporeal membrane oxygenation and discusses both potential advantages and limitations. Exposure of the artery was achieved through the deltoid-pectoral approach. Both direct cannulation and interposition graft cannulation are possible, but the latter is preferred. Advantages of axillary artery cannulation are related mainly to the establishment of "central" support with antegrade flow and excellent upper body oxygenation. It also affords chest closure after postcardiotomy shock, and easy control of any mediastinal bleeding. These cannulation sites may be options for the institution of venoarterial extracorporeal membrane oxygenation, especially in postcardiotomy and respiratory failure patients and in patients with significant peripheral vascular disease. PMID:15919341

  5. Effect of site selection on pain of intravenous cannula insertion: A prospective randomised study

    PubMed Central

    Goudra, Basavana Gouda; Galvin, Eilish; Singh, Preet Mohinder; Lions, Jimme

    2014-01-01

    Background and Aim: Pain on intravenous (IV) cannulation continues to cause considerable anxiety among the patients visiting the hospital for elective surgery. Often, it is the only unpleasant experience, especially in ambulatory surgical settings. Although, anecdotal evidence suggests that antecubital fossa (ACF) might be less painful site for venous cannulation, no scientific study exists to validate the same. Methods: In this prospective randomised study, effect of site selection on pain of venous cannulation was studied. Fifty-five consecutive adults, scheduled to undergo elective surgery, were randomly allocated to get IV cannulation first on ACF (28 patients) or on dorsum of hand (DOH) (27 patients) followed by cannulation on the contralateral arm on the alternative site (DOH or ACF). Five patients were excluded due to multiple cannulation attempts. Pain scores on cannulation related to both sites were recorded and compared. Results: Non-parametric data and frequency data analysis, using the Wilcoxon signed rank test or the Chi-square test as appropriate, showed that ACF approach was significantly less painful in comparison to the DOH when using a 20-gauge cannula for venous cannulation (P < 0.05). Conclusion: We recommend that in the absence of any contraindications, ACF should be the cannulation site of choice. However, considerations like increased chance of kinking and obstruction might preclude such practice. PMID:25624538

  6. Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery (HAI)_2

    ClinicalTrials.gov

    2016-05-11

    Cardiovascular Disease; Healthcare Associated Infectious Disease; Sternal Superficial Wound Infection; Deep Sternal Infection; Mediastinitis; Thoracotomy; Conduit Harvest or Cannulation Site; Sepsis; Pneumonia

  7. Plasma arc torch with coaxial wire feed

    DOEpatents

    Hooper, Frederick M

    2002-01-01

    A plasma arc welding apparatus having a coaxial wire feed. The apparatus includes a plasma arc welding torch, a wire guide disposed coaxially inside of the plasma arc welding torch, and a hollow non-consumable electrode. The coaxial wire guide feeds non-electrified filler wire through the tip of the hollow non-consumable electrode during plasma arc welding. Non-electrified filler wires as small as 0.010 inches can be used. This invention allows precision control of the positioning and feeding of the filler wire during plasma arc welding. Since the non-electrified filler wire is fed coaxially through the center of the plasma arc torch's electrode and nozzle, the wire is automatically aimed at the optimum point in the weld zone. Therefore, there is no need for additional equipment to position and feed the filler wire from the side before or during welding.

  8. Phase-Sensing Guidance for Wire-Following Vehicles

    NASA Technical Reports Server (NTRS)

    Hansen, G. R.

    1983-01-01

    Guidance system for wire-following vehicles tested successfully at speeds exceeding 50 mi/h (80 km/h) on difficult 1 mile (1.6km) course. Unlike previous sensors that compare amplitudes of signals picked up from guide wire, new system compares signal phases. Array of coils is mounted in line along front bumper of vehicle and monitors electromagnetic signal radiating from wire. Guide wire on ground beneath vehicle carrier 6- to 7-kHz alternating current.

  9. History of the Buttonhole Technique.

    PubMed

    Misra, Madhukar

    2015-01-01

    The constant side method of access cannulation in hemodialysis, popularly known as the 'buttonhole' method, has an interesting history. Dr. Zbylut J. Twardowski, a Polish nephrologist, discovered this technique by pure serendipity in 1972. A patient with a complicated vascular access history and limited options for cannulation was repeatedly 'stuck' at the same sites by a nurse. Soon it was noticed that the cannulation at the same spot became easier with time. Since the needles were being reused, the sharpness of the needles decreased with time and the bluntness of the needle seemed to minimize the damage to the cannulation tract (another serendipity!). This method soon became popular among patients, and many patients started using this technique. This chapter traces the invention of this technique and its subsequent development following Dr. Twardowski's emigration to the USA. PMID:26283554

  10. Ultrasound guidance for central vascular access in the pediatric emergency department.

    PubMed

    Skippen, Peter; Kissoon, Niranjan

    2007-03-01

    Central vascular access is sometimes required for hemodynamic monitoring and infusion of fluids and medications in the pediatric emergency department. In many cases, it is attempted after failed peripheral venous and intraosseous access. Some evidence exists demonstrating benefits of ultrasound (US)-guided central vascular cannulation in adults in emergency departments. With appropriate education in its use, US-guided cannulation of central veins in children is likely to be associated with less complications and greater success. In the pediatric emergency department, the femoral vein is the most practical central venous cannulation site. A sound educational and quality assurance program is necessary for US-guided cannulation in the pediatric emergency department. PMID:17413442

  11. Effect of herbage depletion on cattle grazing dynamics in wheat pastures

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Two complementary experiments were conducted to assess grazing dynamics, intake rate, quality and ruminal degradation kinetics of herbage consumed under three herbage depletion levels. In the first experiment (behavioral), three rumen cannulated steers faced (15 min. grazing session) grazing scenari...

  12. SOME CHARACTERISTICS OF VENTILATION AND COUGHING IN THE BLUEGILL 'LEPOMIS MACROCHRIS' RAFINESQUE

    EPA Science Inventory

    Simultaneous measurement of buccal water-pressure changes verified the presence of coughing manoeuvres on strip-chart recordings of bioelectric potentials associated with respiratory movements and sensed with non-contact electrodes from cannulated bluegills. Additional recordings...

  13. Butorphanol premedication to facilitate invasive monitoring in cardiac surgery patients before induction of anaesthesia.

    PubMed

    Tripathi, Mukesh; Nath, Soumya Shanker; Banerjee, Sudipto; Tripathi, Mamta

    2009-01-01

    Cannulations (peripheral vein, radial artery and jugular vein) performed for invasive monitoring before induction of anaesthesia in cardiac surgery patients may be associated with stress and anxiety. The efficacy and safety of butorphanol premedication was assessed in setting up of invasive monitoring. The study was a prospective, randomized, double blind, placebo controlled one with 70 patients undergoing elective cardiac surgery. In group-1 patients (n = 35) (placebo) intramuscular saline was administered 1-2 hours before the surgery in equivalent volume to butorphanol. In group-2 (n = 35) butorphanol (1, 1.5 and 2 mg for three body weight groups < 40 kg, 41-60 kg and> 60 kg, respectively) was administered 1-2 hours before surgery. Observer blinded for medication recorded the sedation score, pupil size and pain after each cannulation using visual analogue score (VAS). Student's 't' test and Chi-square test for proportions, Mann-Whitney test for non-parametric data was carried out. The median pain score of cannulation in group-2 (butorphanol) in the hand (10 mm) and neck (20 mm) were significantly (P < 0.05) lower than group-1 (placebo) patients (hand = 30 mm and neck = 40 mm). Pain during neck cannulation was significantly (P < 0.05) reduced (VAS < 30 mm) in patients with the pupil size of < 2.5 mm. Since the pain during neck cannulation was more than pain during hand cannulations in both the groups, we conclude that the intensity of pain depends also upon the site of cannulation. Besides the analgesic effect of butorphanol, its sedative effect helped to effectively decrease the pain during neck cannulation in conscious patients. PMID:19136753

  14. Biomechanical testing of a novel osteosynthesis plate for the ulnar coronoid process

    PubMed Central

    Bogun, Jorn; Brockhaus, Nina; Waizner, Klaus; Schulz, Arndt-Peter; Wendlandt, Robert

    2014-01-01

    Background The present study aimed to biomechanically evaluate a novel locking plate intended for osteosynthesis of coronoid fracture compared to mini L-plates and cannulated screws. Methods Biomechanical tests were performed on a fracture model in synthetic bones. Three groups, each with eight implant-bone-constructs, were analyzed in quasi-static and dynamic tests. Finally, samples were tested destructively for maximum strength. Results The mean (SD) highest stiffness was measured for the novel plate [693 (18) N/mm], followed by the mini L-plate [646 (37) N/mm] and the cannulated screws [249 (113) N/mm]. During the cycling testing of the novel plate and the mini L-plate, no failures occurred, although three of the eight samples of cannulated screws failed during the test. The mean (SD) maximum strength during the destructive testing was 1333 (234) N for the novel plate, 1338 (227) N for the mini-L-plate and 459 (56) N for the cannulated screws. No statistical differences were found during the destructive testing between the two plates (p = 0.999), although statistical differences were found between both plates and the cannulated screws (p = 0.000 each). Conclusions Osteosynthesis of the coronoid process using the novel plate is mechanically similar to the mini L-plate. Both plates were superior to osteosynthesis with cannulated screws.

  15. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  16. Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures

    PubMed Central

    Shieh, Frederick K; Luong-Player, Adelina; Khara, Harshit S; Liu, Haiyan; Lin, Fan; Shellenberger, Matthew J; Johal, Amitpal S; Diehl, David L

    2014-01-01

    AIM: To determine if a new brush design could improve the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to protocol implementation in July 2011, after which, a new 9 French wire-guided cytology brush (Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pathologists who determined whether the sample was positive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular findings consistent with malignancy as compared to 17 of 46 (37%) in the historical control group (P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes (21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to historical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased diagnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clusters obtained. PMID:25031790

  17. Cast polycrystalline silicon photovoltaic module manufacturing technology improvements. Annual subcontract report, 1 January 1996--31 December 1996

    SciTech Connect

    Wohlgemuth, J.

    1997-10-01

    This report describes Solarex`s accomplishments during this phase of the Photovoltaic Manufacturing Technology (PVMaT) program. During this reporting period, Solarex researchers converted 79% of production casting stations to increase ingot size and operated them at equivalent yields and cell efficiencies; doubled the casting capacity at 20% the cost of buying new equipment to achieve the same capacity increase; operated the wire saws in a production mode with higher yields and lower costs than achieved on the ID saws; purchased additional wire saws; developed and qualified a new wire-guide coating material that doubles the wire-guide lifetime and produces significantly less scatter in wafer thickness; ran an Al paste back-surface-field process on 25% of all cells in manufacturing; completed environmental qualification of modules using cells produced by an all-print metallization process; qualified a vendor-supplied Tedlar/ethylene vinyl acetate (EVA) laminate to replace the combination of separate sheets of EVA and Tedlar backsheet; substituted RTV adhesive for the 3M Very High Bond tape after several field problems with the tape; demonstrated the operation of a prototype unit to trim/lead attach/test modules; demonstrated the use of light soldering for solar cells; demonstrated the operation of a wafer pull-down system for cassetting wet wafers; and presented three PVMaT-related papers at the 25th IEEE Photovoltaic Specialists Conference.

  18. The care and keeping of vascular access for home hemodialysis patients.

    PubMed

    Faratro, Rose; Jeffries, Janine; Nesrallah, Gihad E; MacRae, Jennifer M

    2015-04-01

    Creating and maintaining a healthy vascular access is a critical factor in successful home hemodialysis (HD). This article aims to serve as a "how-to manual" regarding vascular access issues for both patients and health-care providers in a home HD program. This document outlines cannulation options for patients with arteriovenous access and describes troubleshooting techniques for potential complications; strategies are suggested to help patients overcome fear of cannulation and address problems associated with difficult cannulation. Technical aspects of central venous catheter care, as well as a guide to troubleshooting catheter complications, are covered in detail. Monitoring for access-related complications of stenosis, infection, and thrombosis is a key part of every home HD program. Key performance and quality indicators are important mechanisms to ensure patient safety in home HD and should be used during routine clinic visits. PMID:25925828

  19. Venovenous extracorporeal life support in neonates using a double lumen catheter.

    PubMed

    Anderson, H L; Otsu, T; Chapman, R A; Barlett, R H

    1989-01-01

    After satisfactory development and testing of a polyurethane 14 Fr double lumen catheter, we used this device for venovenous extracorporeal life support in neonates who had respiratory failure. This catheter was designed for single site cannulation of the internal jugular vein, thereby sparing the carotid artery from ligation. Cannulation was successful in 17 of 21 neonates, with 15 successful venovenous runs, whereas 2 of the 17 patients were converted to venoarterial bypass because of inadequate support. Oxygenation and CO2 removal were adequate in the remaining patients. Average time on bypass was 111 hours. All 15 patients survived, and exploration of the cannulation site for bleeding was required in three patients. Preoxygenator pressure, recirculation of oxygenated blood, and hemolysis were all within acceptable levels during each run. Venovenous extracorporeal life support with the double lumen catheter can replace venoarterial access in most cases of neonatal respiratory failure. PMID:2574593

  20. Clinical review: Vascular access for fluid infusion in children

    PubMed Central

    Haas, Nikolaus A

    2004-01-01

    The current literature on venous access in infants and children for acute intravascular access in the routine situation and in emergency or intensive care settings is reviewed. The various techniques for facilitating venous cannulation, such as application of local warmth, transillumination techniques and epidermal nitroglycerine, are described. Preferred sites for central venous access in infants and children are the external and internal jugular veins, the subclavian and axillary veins, and the femoral vein. The femoral venous cannulation appears to be the most safe and reliable technique in children of all ages, with a high success and low complication rates. Evidence from the reviewed literature strongly supports the use of real-time ultrasound techniques for venous cannulation in infants and children. Additionally, in emergency situations the intraosseous access has almost completly replaced saphenous cutdown procedures in children and has decreased the need for immediate central venous access. PMID:15566619

  1. Iatrogenic Transient Complete Heart Block in a Preexisting LBBB

    PubMed Central

    Kalamkar, Prachi; Bonnet, Christopher A.; Bajwa, Omer A.

    2016-01-01

    Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure. PMID:27478653

  2. Comparison of Conventional versus Steerable-Catheter Guided Coronary Sinus Lead Positioning in Patients Undergoing Cardiac Resynchronization Device Implantation

    PubMed Central

    Er, Fikret; Yüksel, Dilek; Hellmich, Martin; Gassanov, Natig

    2015-01-01

    Objectives The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS) cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT). Background Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation. Methods 176 consecutive patients with ischemic and non-ischemic heart failure undergoing CRT implantation from January 2008 to December 2012 at the University Hospital of Cologne were identified. During the study period two concurrent CS cannulation techniques were used: standard CS cannulation technique (standard-group, n = 113) and CS cannulation using a steerable electrophysiology (EP) catheter (EPCath-group, n = 63). Propensity-score matched pairs of conventional and EP-catheter guided CS cannulation made up the study population (n = 59 pairs). Primary endpoints were total fluoroscopy time and contrast medium amount used during procedure. Results The total fluoroscopy time was 30.9 min (interquartile range (IQR), 19.9–44.0 min) in the standard-group and 23.4 min (IQR, 14.2-34-2 min) in the EPCath-group (p = 0.011). More contrast medium was used in the standard-group (60.0 ml, IQR, 30.0–100 ml) compared to 25.0 ml (IQR, 20.0–50.0 ml) in the EPCath-group (P<0.001). Conclusions Use of steerable EP catheter was associated with significant reduction of fluoroscopy time and contrast medium use in patients undergoing CRT implantation. PMID:26599637

  3. Endoscopic sphincterotomy of the major duodenal papilla in acute relapsing pancreatitis associated with pancreas divisum: a case report.

    PubMed

    Spaziani, E; Trentino, P; Picchio, M; Di Filippo, A; Briganti, M; Pietricola, G; Elisei, W; Ceci, F; Coda, S; Pattaro, G; Parisella, F; De Angelis, F; Pecchia, M; Stagnitti, F

    2010-05-01

    We report a case of acute relapsing pancreatitis associated with pancreas divisum, who underwent major papilla sphincterotomy after failed minor papilla cannulation. Long-term results were satisfactory. The possible explanations of the efficacy of major papilla endoscopic resection in this particular case are discussed. PMID:20615366

  4. Education in vascular access.

    PubMed

    Moist, Louise M; Lee, Timmy C; Lok, Charmaine E; Al-Jaishi, Ahmed; Xi, Wang; Campbell, Vern; Graham, Janet; Wilson, Barb; Vachharajani, Tushar J

    2013-01-01

    The successful creation and use of an arteriovenous vascular access (VA) requires a coordinated, educated multidisciplinary team to ensure an optimal VA for each patient. Patient education programs on VA are associated with increased arteriovenous VA use at dialysis initiation. Education should be tailored to patient goals and preferences with the understanding that experiential education from patient to patient is far more influential than that provided by the healthcare professional. VA education for the nephrologist should focus on addressing the systematic and patient-level barriers in achieving a functional VA, with specific components relating to VA creation, maturation, and cannulation that consider patient goals and preferences. A deficit in nursing skills in the area of assessment and cannulation can have devastating consequences for hemodialysis patients. Delivery of an integrated education program increases nurses' knowledge of VA and development of simulation programs or constructs to assist in cannulation of the VA will greatly facilitate the much needed skill transfer. Adequate VA surgical training and experience are critical to the creation and outcomes of VA. Simulations can benefit nephrologists, dialysis nurses surgeons, and interventionalists though aiding in surgical creation, understanding of the physiology and anatomy of a dysfunctional VA, and practicing cannulation techniques. All future educational initiatives must emphasize the importance of multidisciplinary care to attain successful VA outcomes. PMID:23432319

  5. Forage Physically Effective Fiber Source Alters Ruminal pH and Site of Digestion

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The study objective was to evaluate the effects of physically effective fiber source (peNDF) and starch sources with different rates of fermentation (ST). Thirty-two lactating Holstein cows (8 cannulated) were used in an incomplete Latin square design with 3 21-d periods. Dietary treatments were inc...

  6. Shifts in Bacterial Community Composition in the Rumen of Lactating Dairy Cows Under Conditions of Milk Fat Depression

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eighteen ruminally cannulated dairy cattle were fed a series of diets (in 28-d periods) designed to elicit different degrees of milk fat depression (MFD) for the purpose of relating MFD to ruminal bacterial populations. Cows were fed a TMR containing 25% starch (DM basis), supplied as corn silage, ...

  7. Coronary intervention in anomalous origin of the right coronary artery (ARCA) from the left sinus of valsalva (LSOV): A single center experience

    PubMed Central

    Uthayakumaran, Kalaichelvan; Subban, Vijayakumar; Lakshmanan, Anitha; Pakshirajan, Balaji; Solirajaram, Ramkumar; Krishnamoorthy, Jaishankar; Janakiraman, Ezhilan; Pandurangi, Ulhas M.; Kalidoss, Latchumanadhas; Ajit Sankaradas, Mullasari

    2014-01-01

    Objective To assess the technical challenges in percutaneous coronary intervention of Anomalous right coronary artery arising from the left sinus of valsalva. Methods Between year 2008 and 2012, a total of 17 patients underwent PCI for an angiographically significant lesion in the right coronary artery of an anomalous origin in the LSOV. Their procedure details such as usage of catheters, radiation time, amount of contrast used were assessed. Results A total of 17 patients with anomalous right coronary artery underwent PCI during the above mentioned period. 8 patients had type A origin, 3 had type B origin and the remaining 6 had type C origin. Type A origin RCA were successfully cannulated in 6 patients with Judkins left 5.0 and in 2 patients using Judkins left 4.0. Extra back up (EBU) 3.5 were doing well in 2 patients of Type B origin and the remaining one patient was successfully cannulated using Judkins left 4.0. In type C origin 4 patients had successful cannulation with Amplatz Left 1.0, 1 patient with Amplatz Left 2.0 and 1 patient with Judkins left 4.0. The mean fluoroscopic time was 20.7 min and amount of contrast used was 210 ml. Conclusion PCI of anomalous RCA origin from LSOV requires appropriate guide catheter selection according to the anatomy of origin for successful cannulation and to reduce the contrast usage and radiation exposure. PMID:25173202

  8. EFFECT OF FEEDING PROTEIN SUPPLEMENT OF DIFFERING DEGRADABILITY ON OMASAL FLOW OF MICROBIAL AND UNDEGRADED PROTEIN (CHANGE OF TITLE FROM ORIGINAL)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Ten ruminally cannulated lactating Holstein cows, that were part of a larger 5 x 5 Latin square trial studying the effects of feeding different proteins on milk production, were used to quantify flows of microbial and rumen-undegraded protein (RUP) in omasal digesta. Cows were fed total mixed ration...

  9. Cattle Differ in Ability to Adapt to Small Intestinal Digestion of Starch

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to evaluate the impact of post-ruminal starch digestion on inflammatory response in dairy cattle. Six cull, nonpregnant, nonlactating, multiparous cannulated Holstein dairy cows (BW 804±101 kg) were fed a high forage diet ad libitum starting 15 d before the infusion p...

  10. Arginine supplementation does not alter nitrogen metabolism of beef steers during a lipopolysaccharide challenge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Demand for Arg is reported to increase during immune challenge. This study evaluated the effects of lipopolysaccharide (LPS) and abomasal Arg infusion on N metabolism and immune response of 20 ruminally cannulated steers (369 ± 46 kg BW) in a randomized block design. Each block was 20 d and consiste...

  11. A COMPARISON OF SAMPLING SITES, DIGESTA AND MICROBIAL MARKERS, AND MICROBIAL REFERENCES FOR ASSESSING POST-RUMINAL SUPPLY OF NUTRIENTS IN DAIRY COWS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study evaluated the impact of some methodological factors on the flows of nutrients at the omasal canal and duodenum of dairy cows fed corn-based diets. Three ruminally and duodenally cannulated cows were assigned to an incomplete 4 x 4 Latin square with four 14-day periods and fed diets formul...

  12. Malposition of central venous catheter in the jugular venous arch via external jugular vein -a case report-

    PubMed Central

    Ahn, SoWoon; Lee, Ju Ho; Park, Chunghyun; Hong, Yong-woo

    2015-01-01

    The central venous cannulation is commonly performed in the operating rooms and intensive care units for various purposes. Although the central venous catheter (CVC) is used in many ways, the malpositioning of the CVC is often associated with serious complications. We report a case of an unexpected malposition of a CVC in the jugular venous arch via external jugular vein. PMID:25844137

  13. Recognizing misplacement of a dialysis catheter in the azygos vein.

    PubMed

    Calviño, Jesús; Bravo, Juan; Martínez, Lucía; Millán, Beatriz; Pulpeiro, José R

    2013-07-01

    Uneventful central venous catheterization for hemodialysis patients may not always result in a correct tip position. A case of inadvertent cannulation of the azygos vein is described. Radiographic features for its early recognition are emphasized and mechanisms related with azygos unintended catheterization are discussed. PMID:23113923

  14. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note.

    PubMed

    Park, Jin Young; Chung, Woo Chull; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-06-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  15. Effects of corn processing method and wet distiller's grains plus solubles (WDGS) inclusion and source on in situ digestibility and ruminal Ph of crossbred steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Six ruminally and duodenally cannulated crossbred steers (472kg) were used in a 6 x 6 Latin square design to determine effects of corn processing method and wet distiller's grains plus soluble (WDGS) inclusion and source on in situ digestibly and ruminal pH. The 6 finishing diets were dry-rolled co...

  16. Effects of rumen fill on short-term ingestive behavior and circulating concentrations of ghrelin, insulin, and glucose of dairy cows foraging vegetative micro-swards

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The impact of ruminal fill (RF) on foraging behaviour, intake rate and the levels of circulating ghrelin, insulin and glucose was measured with four rumen-cannulated lactating dairy cows foraging micro-swards of vegetative orchardgrass. The treatments compared were removal of 1.00 (RF0), 0.66 (RF33)...

  17. Communicative Intentions of Three Prelinguistic Children with a History of Long-Term Tracheostomy.

    ERIC Educational Resources Information Center

    Kertoy, Marilyn K.; Waters, Robert J.

    1995-01-01

    Early communication was examined for 3 children (ages 20 to 27 months) who had been tracheostomized during their first year and were still cannulated. Communication means and intentions and rate of communication were examined. Potential contributions of social, cognitive, and language skills to the onset of early words were assessed. (Author/SW)

  18. Tracheostomy in Young Children: Implications for Assessment and Treatment of Communication and Feeding Disorders.

    ERIC Educational Resources Information Center

    Simon, Bonnie M.; McGowan, Joy Silverman

    1989-01-01

    The article reviews studies showing that speech and language intervention during the period of cannulation can benefit tracheostomized and ventilator-dependent children by improving their communicative functioning while decreasing their frustration with the tracheostomy placement. Therapeutic interventions with feeding skills are also recommended.…

  19. Effects of Different Protein Supplements on Milk Production and Nutrient Utilization in Lactating Dairy Cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sixteen (8 ruminally cannulated) multiparous and 8 primiparous lactating Holstein cows were used in 6 replicated 4 x 4 Latin squares to test the effects of feeding supplemental protein as urea, solvent soybean meal (SSBM), cottonseed meal (CSM), or canola meal (CM) on milk production, nutrient utili...

  20. Bilateral antegrade perfusion of the superficial femoral artery to prevent limb ischaemia during combined use of Impella CP left ventricular assist device and extracorporeal life support.

    PubMed

    Kizner, Lukasz; Flottmann, Christian; Horstkotte, Dieter; Gummert, Jan

    2016-08-01

    The combined use of extracorporeal cardiac life support and the Impella left ventricular assist device is feasible in severe cardiogenic shock. Ischaemic complications due to the arterial cannulation may occur. The following cases show how the use of a perfusion adapter for bilateral antegrade leg perfusion prevents malperfusion of the lower extremities. PMID:27130716

  1. Effects of Different Protein Supplements on Omasal Nutrient Flow and Microbial Protein Synthesis in Lactating Dairy Cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eight ruminally cannulated Holstein cows that were part of a larger lactation trial were used in 2 replicated 4 x 4 Latin squares to quantify effects of supplementing protein as urea, solvent soybean meal (SSBM), cottonseed meal (CSM), or canola meal (CM) on omasal nutrient flows and microbial prote...

  2. OMASAL FLOW OF SOLUBLE PROTEINS, PEPTIDES, AND FREE AMINO ACIDS IN DAIRY COWS FED DIETS SUPPLEMENTED WITH PROTEINS OF VARYING RUMINAL DEGRADABILITIES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Three ruminally and duodenally cannulated cows were assigned to an incomplete 4 x 4 Latin square with four 14-day periods and fed diets supplemented with urea, solvent soybean meal (SSBM), xylose-treated soybean meal (XSBM), or corn gluten meal (CGM) to study the effects of crude protein source on o...

  3. SUPPLEMENTAL METHIONINE AND UREA FOR GESTATING BEEF COWS CONSUMING LOW QUALITY FORAGE DIETS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Studies conducted to evaluate Met requirements for late gestating beef cows consuming low quality forages. Inadequate supply of metabolizable AA may limit protein accretion during pregnancy in beef cows. In Exp. 1, two ruminally cannulated non-gestating non- lactating cows were utilized in a flow s...

  4. EFFECTS OF FEEDING DAIRY COWS PROTEIN SUPPLEMENTS OF VARYING RUMINAL DEGRADABILITY

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Twenty-five (10 ruminally cannulated) Holstein cows averaging 82 ± 34 days in milk were assigned to 5x5 Latin squares (21-d periods) and fed diets supplemented with one of four different proteins to assess effects on production, ruminal metabolism, omasal flow of N fractions, and degradation rates o...

  5. EFFECTS OF FEEDING FORMATE-TREATED ALFALFA SILAGE OR RED CLOVER SILAGE ON OMASAL FLOW OF NUTRIENTS AND MICROBIAL PROTEIN SYNTHESIS IN LACTATING DAIRY COWS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eight ruminally cannulated Holstein cows that were part of a larger lactation trial were blocked by days in milk and randomly assigned to replicated 4 x 4 Latin squares to quantify effects of nonprotein N (NPN) content of alfalfa silage (AS) and red clover silage (RCS) on omasal nutrient flows. Diet...

  6. Comparison of Bloat Potential Between Soft-red and Hard-red Winter Wheat Forages

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Some aspects of wheat pasture bloat have been researched extensively, but little research has evaluated the effect of wheat type on bloat. Forty-eight Angus heifers (238 ± 12 kg BW) and 8 Gelbvieh by Angus ruminally cannulated heifers (515 ± 49 kg BW) grazed 1-ha pastures of either hard-red or soft...

  7. Comparison of Bloat Potential Between Hard Red and Soft Red Winter Wheat

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Some aspects of wheat pasture bloat have been researched extensively, but little research has evaluated the effects of wheat type on bloat. Forty-eight Angus stocker calves (238 ± 12 kg BW) and 8 Angus ruminally cannulated heifers (515 ± 49 kg BW) grazed 1-ha pastures of either hard red (HR) or sof...

  8. Cannula implantation into the lateral ventricle does not adversely affect recognition or spatial working memory.

    PubMed

    Seyer, Benjamin; Pham, Vi; Albiston, Anthony L; Chai, Siew Yeen

    2016-08-15

    Indwelling cannulas are often used to deliver pharmacological agents into the lateral ventricles of the brain to study their effects on memory and learning, yet little is known about the possible adverse effects of the cannulation itself. In this study, the effect of implanting an indwelling cannula into the right lateral ventricle was examined with respect to cognitive function and tissue damage in rats. Specifically, the cannula passed through sections of the primary motor (M1) and somatosensory hind limb (S1HL) cortices. One week following implantation, rats were impaired on the rotarod task, implying a deficit in fine motor control, likely caused by the passage of the cannula through the aforementioned cortical regions. Importantly, neither spatial working nor recognition memory was adversely affected. Histological examination showed immune cell activation only in the area immediately surrounding the cannulation site and not spreading to other brain regions. Both GFAP and CD-11b mRNA expression was elevated in the area immediately surrounding the cannulation site, but not in the contralateral hemisphere or the hippocampus. Neither of the inflammatory cytokines, TNF-α or IL-6, were upregulated in any region. These results show that cannulation into the lateral ventricle does not impair cognition and indicates that nootropic agents delivered via this method are enhancing normal memory rather than rescuing deficits caused by the surgery procedure. PMID:27345383

  9. Effects of glycerin on receiving performance and health status of beef steers and nutrient digestibility and rumen fermentation characteristics of growing steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    One experiment was conducted to evaluate the influence of crude glycerin (GLY) on animal performance and health when used as a partial replacement for roughage in receiving diets. The second experiment was conducted using ruminally and duodenally cannulated steers in a 4 x 4 Latin square to determin...

  10. Pullout performance comparison of pedicle screws based on cement application and design parameters.

    PubMed

    Tolunay, Tolga; Başgül, Cemile; Demir, Teyfik; Yaman, Mesut E; Arslan, Arslan K

    2015-11-01

    Pedicle screws are the main fixation devices for certain surgeries. Pedicle screw loosening is a common problem especially for osteoporotic incidents. Cannulated screws with cement augmentation are widely used for that kind of cases. Dual lead dual cored pedicle screw has already given promising pullout values without augmentation. This study concentrates on the usage of dual lead dual core with cement augmentation as an alternative to cannulated and standard pedicle screws with cement augmentation. Five groups (dual lead dual core, normal pedicle screw and cannulated pedicle screw with augmentation, normal pedicle screw, dual lead dual cored pedicle screw) were designed for this study. Healthy bovine vertebrae and synthetic polyurethane foams (grade 20) were used as embedding test medium. Test samples were prepared in accordance with surgical guidelines and ASTM F543 standard testing protocols. Pullout tests were conducted with Instron 3300 testing frame. Load versus displacement values were recorded and maximum pullout loads were stated. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation exhibited the highest pullout values, while dual lead dual cored pedicle screw demonstrated similar pullout strength as cannulated pedicle screw and normal pedicle screw with poly-methyl methacrylate augmentation. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation can be used for osteoporotic and/or severe osteoporotic patients according to its promising results on animal cadaver and synthetic foams. PMID:26503840

  11. USE OF ARISA TO MONITOR SHIFTS IN RUMEN MICROBIAL POPULATIONS CAUSED BY CHANGES IN DIET

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective was to determine whether automated ribosomal intergenic spacer analysis (ARISA) is sensitive enough to detect shifts in rumen microbial populations caused by dietary changes. Six ruminally cannulated, non-lactating, non-pregnant Holstein cows were sampled for rumen contents in a random...

  12. Chylous Ascites: A Rare Complication of Thoracic Duct Embolization for Chylothorax

    SciTech Connect

    Gaba, Ron C. Owens, Charles A.; Bui, James T.; Carrillo, Tami C.; Knuttinen, M. Grace

    2011-02-15

    Thoracic duct embolization represents a safe and effective method to treat postsurgical chylothorax. Complications of this procedure are rare despite transabdominal puncture of lymphatic channels for thoracic duct access, and chylous ascites is unreported. Herein, we describe a case of chylous ascites formation after lymphatic puncture and attempted cannulation. Our management approach is also discussed.

  13. Pharmacometrics of Pterostilbene: Pre-Clinical Pharmacokinetics and Metabolism, Anti-Cancer, Anti-Inflammatory, Anti-Oxidant, and Analgesic Activity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Purpose: To evaluate the pre-clinical pharmacokinetics and pharmacodynamics of pterostilbene. Methods: Rat liver microsomes were used to evaluate in vitro phase I and II metabolism. Right jugular vein cannulated male Sprague-Dawley rats were dosed intravenously with 20 mg/kg of pterostilbene and sam...

  14. OXIDATION OF CARDIAC MYOGLOBIN IN-VIVO BY SODIUM NITRATE OR HYDROXYLAMINE

    EPA Science Inventory

    A non-vascularized fish heart model was used to assess the oxidation of cardiac myoglobin in vivo by compounds known to cause methemoglobinemia. Buffalo sculpin (Enophrys bison) were cannulated from the afferent branchial artery to permit repeated blood sampling and injected intr...

  15. Protein and Carbohydrate Interactions Alter Ruminal Fermentation, Digesta Characteristics, and Behavior in Lactating Dairy Cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effect of altering dietary nonfiber carbohydrate complement and ruminally degradable protein was evaluated in an incomplete partially balanced Latin square design with a 2 x 2 factorial arrangement of treatments (trt) and two 21-d periods. Eight ruminally cannulated Holstein dairy cows were rand...

  16. Effect of herbage depletion on short-term foraging dynamics and diet quality of steers grazing wheat pastures

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Two complementary experiments were completed to assess short-term foraging dynamics, diet quality, and ruminal degradation kinetics of herbage consumed by steers with 3 level of herbage depletion. Experiment (Exp.) 1 was a behavioral study in which 3 ruminally cannulated steers were allocated to gra...

  17. Comparison of Bloat Potential Between Soft-Red and Hard-Red Winter Wheat Forages

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Some aspects of wheat pasture bloat have been researched extensively, but few studies have evaluated the effect of wheat type on bloat. Eight Gelbvieh ' Angus ruminally cannulated heifers (1,135 ± 108 lb BW) and 48 Angus heifers (525 ± 26 lb BW) grazed 2.5-acre pastures of either hard-red or soft-re...

  18. Alteration of fasting heat production during fescue toxicosis in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of fasting heat production (FHP) during fescue toxicosis. Six ruminally cannulated Holstein steers (BW=348 ±13 kg) were weight-matched into pairs and utilized in a two period crossover design experiment. Each period consisted of two temperature segments,...

  19. Alteration of fasting heat production during fescue toxicosis in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of fasting heat production (FHP) during fescue toxicosis. Six ruminally cannulated Holstein steers (BW = 348±26kg) were weight matched into pairs and utilized in a two period crossover design experiment. Each period consisted of two segments, one each at...

  20. Effect of fescue toxicosis on ruminal kinetics, nitrogen and energy balance in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of ruminal kinetics, as well as N and energy balance during fescue toxicosis. Six ruminally cannulated Holstein steers (BW=217 ±7 kg) were weight-matched into pairs and pair-fed throughout a cross-over design experiment with a 2x2 factorial treatment str...

  1. Effect of fescue toxicosis on whole body energy and nitrogen balance, in situ degradation and ruminal passage rates in Holstein steers

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was designed to examine alteration of ruminal kinetics, as well as N and energy balance during fescue toxicosis. Six ruminally cannulated Holstein steers (BW=217 ±7 kg) were weight-matched into pairs and pair-fed throughout a cross-over design experiment with a 2x2 factorial treatment str...

  2. Alteration of basal metabolic rate in Holstein steers during fescue toxicosis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The results of this study indicate that consumption of E+ tall fescue by cattle results in a reduction in basal metabolic rate. Six ruminally cannulated steers were weight-matched and pair-fed during a two period crossover experiment. Each period consisted of two temperatures (22°C and 30°C). During...

  3. Efficiency and rumen responses in younger and older Holstein heifers limit-fed diets of differing energy density

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to evaluate the effects of limit-feeding diets of different predicted energy density on the efficiency of utilization of feed and nitrogen and rumen responses in younger and older Holstein heifers. Eight rumen-cannulated Holstein heifers (4 heifers beginning at 257 ± ...

  4. pH Dynamics and Bacterial Community Composition in the Rumen of Lactating Dairy Cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The influence of pH dynamics on ruminal bacterial community composition was studied in 8 ruminally cannulated Holstein cows fitted with indwelling electrodes that recorded pH at 10-min intervals over a 3-d period. Cows were fed a silage-based TMR supplemented with monensin. Ruminal samples were col...

  5. Analysis of rumen motility patterns using a wireless telemetry system to characterize bovine reticuloruminal contractions

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objective of this study was to characterize rumen motility patterns of cattle fed once daily. Eight ruminally-cannulated Holstein steers (BW = 321 ± 11 kg) were fed alfalfa cubes once daily at 1.5 × NEm top-dressed with a TM-salt pre-mix. Three 24-h collection periods were conducted and each com...

  6. pH Dynamics and Bacterial Community Composition in the Rumen of Lactating Dairy Cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effect of pH dynamics on ruminal bacterial community composition (BCC) was studied in 8 ruminally cannulated Holstein cows fitted with indwelling electrodes that recorded pH at 10-min intervals over a 2.4-d period. Cows were fed a silage-based TMR supplemented with monensin. Ruminal samples wer...

  7. Arginine supplementation does not alter nitrogen metabolism of beef steers during a lipopolysaccharide challenge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Demand for arginine (Arg) is reported to increase during immune challenges. This study evaluated effects of lipopolysaccharide (LPS) and abomasal Arg infusion on nitrogen (N) metabolism and immune response of 20 ruminally cannulated steers (369 ± 46 kg BW) in a randomized block design. Each block co...

  8. Short Communication: Effectiveness of sample duplication to control error in ruminant digestion studies

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Eight ruminally-cannulated lactating dairy cows from a study on the effect of dietary rumen-degraded protein on production and digestion of nutrients were used to assess using sample duplication to control day-to-day variation within animals and errors associated with sampling and laboratory analyse...

  9. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  10. Effects of feeding different amounts of supplemental glycerol on ruminal environment and digestibility of lactating dairy cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A study was conducted to evaluate the effects of increasing amounts of dietary glycerol on rumen environment, blood metabolites, and nutrient digestibility. Six rumen cannulated Holstein cows averaging 56 ± 18 DIM and 38.0 ± 8.2 kg/d of milk were used in the study. Experimental design was a replicat...

  11. Effects of ruminal dosing of Holstein cows with Megasphaera elsdenii on milk fat production, ruminal chemistry, and bacterial strain persistence

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Megasphaera elsdenii (Me) is a lactate-utilizing bacterium whose ruminal abundance has been shown to be greatly elevated during milk fat depression (MFD). To further examine this association, a total of 25 cannulated multiparous Holstein cows were examined in three studies in which strains of Me wer...

  12. In Situ Digestibility of Grass Hay after Heifer Diets were Abruptly Switched from 35 to 70% Concentrate to 100% Forage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Twelve ruminally-cannulated Hereford-cross heifers (non-pregnant, 2-yr-old, 508 ± 2 kg) were randomly assigned to 3 individually-fed, pre-experiment diets (4 heifers/diet). Diets were: 1) all forage, (CONTROL); 2) 35% concentrate, (35%), and 3) 70% concentrate (70%). Heifers were fed the diets for...

  13. In Situ Digestibility of Grass Hay after Heifer Diets were Abruptly Switched from 35 or 70% Concentrate to 100% Forage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Twelve ruminally-cannulated Hereford cross heifers (non-pregnant, 2-yr-old, 508 ± 2 kg) were randomly assigned to 3 individually-fed, pre-experiment diets (4 heifers/diet). Diets were: 1) all forage,(CONTROL); 2) 35% concentrate, (35%), and 3) 70%concentrate (70%). Heifers were fed the diets for ~10...

  14. The effect of brown midrib corn silage and dried distillers' grains with solubles on milk production, nitrogen utilization and microbial community structure in dairy cows

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Thirty-six Holstein cows, four of which were ruminally cannulated, (mean ± SD, 111 ± 35 DIM; 664 ± 76.5 kg BW) were used in replicated 4×4 Latin squares to investigate the effects of brown midrib (bm3) and conventional (DP) corn silages and the inclusion of dried distillers grains with solubles (DDG...

  15. Effects of including saponins (Micro-aid®) on intake, rumen fermentation, and digestibility in steers fed low-quality prairie hay

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sixteen ruminally-cannulated crossbred steers (529 ± 45 kg initial body weight, BW) were used to evaluate in situ dry matter (DM), neutral detergent fiber (aNDF), and N degradation characteristics of low quality prairie hay, blood urea nitrogen (BUN) and rumen fermentation parameters in steers provi...

  16. Post-extraction algal residue in steam-flaked corn-based diets for beef cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effects of post-extraction algal residue (PEAR) as N source 23 in steam-flaked corn-based (SFC) beef cattle finishing diets on intake, duodenal flow, digestion, ruminal microbial efficiency, ruminal parameters, and blood constituents were evaluated. Ruminally and duodenally cannulated steers (BW...

  17. Brief History of the Lightcraft Technology Demonstrator (LTD) Project

    NASA Astrophysics Data System (ADS)

    Myrabo, Leik N.

    2003-05-01

    This paper presents a brief history of the laser lightcraft research and development project that lead to the first outdoor free-flight demonstrations for the U.S. government on November 1997 - using the 10 kW PLVTS CO2 laser at the High Energy Laser Systems Test Facility (HELSTF), White Sands Missile Range (WSMR), NM. Summarized herein are some of the technological milestones that brought the Lightcraft Technology Demonstrator (LTD) concept vehicle to its present state of development: 1) from the initial LTD conceptual design, systems integration, and performance analysis for the Strategic Defense Initiative Organization (SDIO) 2) through laboratory engine bench testing, indoor wire-guided and vertical free-flight testing phases under contract to NASA and the USAF; and 3) finally resulting in outdoor flights to the current record altitude of 71 meters (233 ft) on 2 October 2000, sponsored by the Foundation for International Non-governmental Development of Space (FINDS).

  18. Mesoscopic mechanical resonators as quantum noninertial reference frames

    NASA Astrophysics Data System (ADS)

    Katz, B. N.; Blencowe, M. P.; Schwab, K. C.

    2015-10-01

    An atom attached to a micrometer-scale wire that is vibrating at a frequency ˜100 MHz and with displacement amplitude ˜1 nm experiences an acceleration magnitude ˜109ms -2 , approaching the surface gravity of a neutron star. As one application of such extreme noninertial forces in a mesoscopic setting, we consider a model two-path atom interferometer with one path consisting of the 100 MHz vibrating wire atom guide. The vibrating wire guide serves as a noninertial reference frame and induces an in principle measurable phase shift in the wave function of an atom traversing the wire frame. We furthermore consider the effect on the two-path atom wave interference when the vibrating wire is modeled as a quantum object, hence functioning as a quantum noninertial reference frame. We outline a possible realization of the vibrating wire, atom interferometer using a superfluid helium quantum interference setup.

  19. Preoperative Localization and Surgical Margins in Conservative Breast Surgery

    PubMed Central

    Corsi, F.; Sorrentino, L.; Bossi, D.; Sartani, A.; Foschi, D.

    2013-01-01

    Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies. PMID:23986868

  20. Ultrasonography-guided endoscopic stent placement for malignant biliary obstruction: a preliminary report of four cases.

    PubMed

    De Palma, G D; Puzziello, A; Rega, M; Mastantuono, L; Persico, F; Patrone, F; Persico, G

    2004-04-01

    We present a new combination of transabdominal ultrasound (US) and biliary endoscopy, with endoscopic stent placement carried out under US guidance. Four patients (two men, two women; average age 66.2 years) underwent US-guided stent placement for palliation of ampullary carcinoma (n = 3) or pancreatic cancer (n = 1). A guide wire and a guiding catheter were endoscopically introduced and identified, by US in the common bile duct across the stricture. Hydromer-coated polyurethane angled stents (10 Fr) were finally inserted over the guide wire/guiding catheter by a pusher tube system. Successful drainage, with substantial reduction in bilirubin level, was achieved in all patients (14.2 +/- 9.5 vs. 4.2 +/- 2.9 mg/dl at 1 week). The present case series shows that endoscopic stent placement performed under US guidance is safe and effective. Further studies of larger series, including more proximal strictures, are warranted. PMID:15057684

  1. Cast polycrystalline silicon photovoltaic module manufacturing technology improvements. Semiannual technical report, 1 January 1996--30 June 1996

    SciTech Connect

    Wohlgemuth, J

    1997-01-01

    Two specific objectives of Solarex`s program are to reduce the manufacturing cost for polycrystalline silicon photovoltaic modules to less than $1.20/watt and to increase the manufacturing capacity by a factor of three. This report highlights accomplishments during the period of January 1 through June 30, 1996. Accomplishments include: began the conversion of production casting stations to increase ingot size; operated the wire saw in a production mode with higher yields and lower costs than achieved on the ID saws; developed and qualified a new wire guide coating material that doubles the wire guide lifetime and produces significantly less scatter in wafer thickness; completed a third pilot run of the cost-effective Al paste back-surface-field (BSF) process, verifying a 5% increase in cell efficiency and demonstrating the ability to process and handle the BSF paste cells; completed environmental qualification of modules using cells produced by an all-print metallization process; optimized the design of the 15.2-cm by 15.2-cm polycrystalline silicon solar cells; demonstrated the application of a high-efficiency process in making 15.2-cm by 15.2-cm solar cells; demonstrated that cell efficiency increases with decreasing wafer thickness for the Al paste BSF cells; qualified a vendor-supplied Tedlar/ethylene vinyl acetate (EVA) laminate to replace the combination of separate sheets of EVA and Tedlar backsheet; demonstrated the operation of a prototype unit to trim/lead attach/test modules; and demonstrated the operation of a wafer pull-down system for cassetting wet wafers.

  2. Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations.

    PubMed

    van Loon, Fredericus H J; Puijn, Lisette A P M; Houterman, Saskia; Bouwman, Arthur R A

    2016-04-01

    Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85-8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09-6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39-6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92-8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12-5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A-DIVA score 4 plus

  3. Development of the A-DIVA Scale:

    PubMed Central

    van Loon, Fredericus H. J.; Puijn, Lisette A. P. M.; Houterman, Saskia; Bouwman, Arthur R. A.

    2016-01-01

    Abstract Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85–8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09–6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39–6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92–8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12–5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A

  4. Can we increase hepatic oxygen availability? The role of intentional hypercarbia.

    PubMed

    Atallah, M M; Demian, A D; el-Diasty, T A; Ma Saied, M

    2000-06-01

    Our hypothesis is that hypercarbia produces sympathetic stimulant effect and local vasodilatation. We studied the effect of intentional hypercarbia (IHC) on hepatic venous oxygen saturation. The hepatic vein (HV) was cannulated in 15 patients through either the right internal jugular vein or the femoral vein to measure HV oxygen saturation and calculate oxygen content. The inferior vena cava (IVC) was cannulated in 6 patients above and below drainage of the hepatic veins for oxygen saturation and content difference along the IVC. IHC was achieved in awake patients by breathing oxygen enriched air at a flow rate of 2L/min for 10 min, and during anesthesia by increasing anesthetic dead space and reducing tidal volume. IHC increased HV blood oxygen saturation, decreased the arterio-hepatic vein oxygen content difference and decreased oxygen saturation difference and oxygen content difference along IVC. PMID:11126503

  5. Is Long Axis View Superior to Short Axis View in Ultrasound-Guided Central Venous Catheterization?

    PubMed Central

    Vogel, Jody A.; Haukoos, Jason S.; Erickson, Catherine L.; Liao, Michael M.; Theoret, Jonathan; Sanz, Geoffrey E.; Kendall, John

    2014-01-01

    Objective To evaluate whether using long axis (LA) or short axis (SA) view during ultrasound-guided internal jugular (IJ) and subclavian (SC) central venous catheterization (CVC) results in fewer skin breaks, decreased time to cannulation, and fewer posterior wall penetrations (PWP). Design Prospective, randomized crossover study. Setting Urban emergency department with approximate annual census of 60,000. Subjects Emergency medicine resident physicians at the Denver Health Residency in Emergency Medicine, a PGY 1-4 training program. Interventions Resident physicians blinded to the study hypothesis used ultrasound guidance to cannulate the IJ and SC of a human torso mannequin using the LA and SA views at each site. Measurements An ultrasound fellow recorded skin breaks, redirections, and time to cannulation. An experienced ultrasound fellow or attending used a convex 8–4 MHz transducer during cannulation to monitor the needle path and determine PWP. Generalized linear mixed models with a random subject effect were used to compare time to cannulation, number of skin breaks and redirections, and PWP of the LA and SA at each cannulation site. Results 28 resident physicians participated: 8 PGY-1, 8 PGY-2, 5 PGY-3, and 7 PGY-4. The median [interquartile range (IQR)] number of total IJ central venous catheters placed was 27 (IQR 9-42) and SC was 6 (IQR 2-20) catheters. The median number of previous ultrasound-guided IJ catheters was 25 (IQR 9-40), and ultrasound-guided SC catheters was 3 (IQR 0-5). The LA view was associated with a significant decrease in the number of redirections at the IJ and SC sites, relative risk (RR) 0.4 (95% confidence interval [CI] 0.2-0.9), and RR 0.5 (95% CI 0.3-0.7), respectively. There was no significant difference in the number of skin breaks between the LA and SA at the SC and IJ sites. The LA view for SC was associated with decreased time to cannulation; there was no significant difference in time between the SA and LA views at the IJ

  6. Development of a Mock Extracorporeal Membrane Oxygenation Circuit to Assess Recirculation.

    PubMed

    Jayewardene, Ishanth Devinda; Xie, Ashleigh; Iyer, Arjun; Pye, Roger; Dhital, Kumud

    2016-01-01

    A limitation of veno-venous extracorporeal membrane oxygenation (VV-ECMO) is the recirculating of newly oxygenated blood back to the VV-ECMO circuit. We compared cannulation strategies for combating recirculation utilizing a mock circulation loop (MCL) with ultrasonic flow probes and pressure transducers ensuring that the MCL was run at physiological hemodynamic parameters. Mean recirculation percentages were lower (ANOVA, F = 14.25; p = 0.0001) with the Wang-Zwische dual lumen cannula (4.00 ± 1.77, n = 7) than both the femoro-jugular (15.23 ± 7.00, n = 8) and the femoro-femoral cannulation configurations (13.49 ± 1.44, n = 8). PMID:26809084

  7. Systemic fibrinolysis through intraosseous vascular access in ST-segment elevation myocardial infarction.

    PubMed

    Ruiz-Hornillos, Pedro José; Martínez-Cámara, Fernando; Elizondo, Mercedes; Jiménez-Fraile, José Antonio; Del Mar Alonso-Sánchez, Maria; Galán, Dolores; García-Rubira, Juan Carlos; Macaya, Carlos; Ibanez, Borja

    2011-06-01

    In emergency situations, intraosseous cannulation represents an alternative route of vascular access when peripheral vein insertion is difficult. We present the first documented case of intraosseous systemic fibrinolysis in a patient with ST-segment elevation myocardial infarction. In this case, repetitive episodes of ventricular fibrillation occurred soon after first contact with emergency care providers. Given that the patient had difficult peripheral venous access, an intraosseous catheter was inserted. Fibrinolytics and antiarrhythmic drugs were administered though this line, resulting in resolution of coronary ischemia and electrical instability, without complications. Intraosseous cannulation represents a novel route for administration of systemic fibrinolysis in cases of difficult peripheral venous access in the out-of-hospital setting. PMID:20947209

  8. A useful surgical technique for retrieval of a broken guide pin in the midfoot.

    PubMed

    Roy, Shuvendu Prosad; Lim, Chin Tat; Tan, Ken Jin

    2014-01-01

    Perioperative instrument breakage is not an infrequent occurrence, even for experienced surgeons. The most commonly reported instrument breaks in orthopedic procedures are drill bits, followed by Kirschner wires and cannulated guide pins. The reasons for failure include improper technique and repetitive use. The retrieval of broken hardware can be technically challenging, particularly if the fragment has become embedded in bone. Retrieval methods have been described for cannulated guide pin fragments in the hip; however, no specific techniques have been described for the retrieval of guide pin fragments embedded in the bones of the foot. In the present report, we describe a technique we have found useful for retrieval of a guide pin fragment that had broken off during a Lisfranc fracture repair 6 weeks earlier. The technique was used in a delayed situation; however, we believe it would be even easier to use during an intraoperative breakage. PMID:23871172

  9. Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions

    PubMed Central

    Davierwala, Piroze; Seeburger, Joerg; Pfannmueller, Bettina; Misfeld, Martin; Borger, Michael A.; Mohr, Friedrich-Wilhelm

    2013-01-01

    Effective myocardial protection and perfusion strategies during minimally invasive mitral valve surgery (Mini-MV) have evolved over the last decade. Our institutional approach for right-sided Mini-MV has been standardized over the last 15 years in more than 4,500 cases. Cardiopulmonary bypass (CPB) is usually instituted by right-sided femoral arterial and venous cannulation with additional cannulation of the right jugular vein in patients with a body weight greater than 75 kg or when a concomitant tricuspid valve (TV) procedure and/or atrial septal defect closure is performed. A single dosage of crystalloid-based cardioplegia [Custodial- histidine-trypthophan-ketoglutarate (Custodial-HTK)] administered via the aortic root in combination with moderate hypothermia (34-35 °C) has become the standard of care for induction and maintenance of myocardial protection at our institution. The present article highlights and discusses the principal techniques of myocardial protection for Mini-MV. PMID:24349985

  10. Transfemoral Transvenous Embolization of Dural Arteriovenous Fistulas Involving the Isolated Transverse-Sigmoid Sinus

    PubMed Central

    Kiura, Y.; Ohba, S.; Shibukawa, M.; Sakamoto, S.; Okazaki, T.; Kurisu, K.

    2007-01-01

    Summary Dural arteriovenous fistulas involving the transverse-sigmoid sinus (T-S dAVFs) are sometimes isolated because this affected sinus is often thrombosed. It is difficult to perform to microcatheter cannulation to the isolated sinus through the thrombosed portion. We are now treating these T-S dAVFs by transfemoral transvenous embolization via the ipsilateral side even if the affected sinus is thrombosed and isolated or not. We use a triaxial system (6Fr. guiding catheter / 4Fr. diagnostic catheter / microcatheter) to emphasize the pushability and handling of the microcatheter. And we insert 4 Fr. Catheter into the affected sinus. So we can perform microcatheter cannulation into the isolated and affected sinus for treatment by coil embolization with various detachable coils. PMID:20566087